bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of penehyclidine hydrochloride combined with dexmedetomidine on pulmonary function in patients undergoing heart valve surgery: a double-blind, randomized trial
Authors: He Fang , Lu Yizhi , Mao Qi , Zhou Lifang , Chen Yanhua , Xie Yubo
Published: July 2023

Aim

To investigate the effects of penehyclidine hydrochloride combined with dexmedetomidine on pulmonary function in patients undergoing heart valve surgery with cardiopulmonary bypass (CPB).

Methods

A total of 180 patients undergoing elective heart valve surgery with CPB were randomly divided into four groups: 45 in group P (intravenous penehyclidine hydrochloride 0.02 mg/kg 10 min before anesthesia induction and at the beginning of CPB, total 0.04 mg/kg); 43 in group D (dexmedetomidine 0.5 μg/kg/h after induction of anesthesia until the end of anesthesia); 44 in group PD ( penehyclidine hydrochloride 0.04 mg/kg combined with dexmedetomidine 0.5 μg/kg/h intravenously during anesthesia); and 43 in group C (same amount of normal saline 10 min before and after anesthesia induction, to the end of anesthesia, and at the beginning of CPB). The main outcomes were the incidence and severity of postoperative pulmonary complications (PPCs). The secondary outcomes were: (1) extubation time, length of stay in intensive care, and postoperative hospital stay, and adverse events; and (2) pulmonary function evaluation indices (oxygenation index and respiratory index) and plasma inflammatory factor concentrations (tumor necrosis factor-α, interleukin-6, C-reactive protein and procalcitonin) during the perioperative period.

Results

The incidence of PPCs in groups P, D and PD after CPB was lower than that in group C (P < 0.05), and the incidence in group PD was significantly lower than that in groups P and D (P < 0.05). The scores for PPCs in groups P, D and PD were lower than those in group C (P < 0.05).

Conclusion

Combined use of penehyclidine hydrochloride and dexmedetomidine during anesthesia reduced the occurrence of postoperative pulmonary dysfunction, and improved the prognosis of patients undergoing heart valve surgery with CPB.

Trial registration

The trial was registered in the Chinese Clinical Trial Registry on 3/11/2020 (Registration No.: ChiCTR2000039610).
Outpatient sexually transmitted infection testing and treatment patterns in the United States: a real-world database study
Authors: Lillis Rebecca , Kuritzky Louis , Huynh Zune , Arcenas Rodney , Hansra Avneet , Shah Roma , Yang Baiyu , Taylor Stephanie N.
Published: July 2023

Background

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most common notifiable sexually transmitted infections (STIs) in the United States. Because symptoms of these infections often overlap with other urogenital infections, misdiagnosis and incorrect treatment can occur unless appropriate STI diagnostic testing is performed in clinical settings. The objective of this study was to describe STI diagnostic testing and antimicrobial treatment patterns and trends among adolescent and adult men and women with lower genitourinary tract symptoms (LGUTS).

Methods

We analyzed insurance claims data from the IBM® MarketScan® Research Databases. Patients included were between 14 and 64 years old with LGUTS as determined by selected International Classification of Diseases codes between January 2010 and December 2019. Testing of STIs and relevant drug claims were captured, and distribution of testing patterns and drug claims were described.

Results

In total, 23,537,812 episodes with LGUTS (87.4% from women; 12.6% from men) were analyzed from 12,341,154 patients. CT/NG testing occurred in only 17.6% of all episodes. For episodes where patients received treatment within 2 weeks of the visit date, 89.3% received treatment within the first 3 days (likely indicating presumptive treatment), and 77.7% received it on the first day. For women with pelvic inflammatory disease and men with orchitis/epididymitis and acute prostatitis, ≤ 15% received CT/NG testing, and around one-half received antibiotic treatment within 3 days.

Conclusions

Our study revealed low CT/NG testing rates, even in patients diagnosed with complications commonly associated with these STIs, along with high levels of potentially inappropriate presumptive treatment. This highlights the need for timely and accurate STI diagnosis in patients with LGUTS to inform appropriate treatment recommendations.
Weight progression and adherence to weight gain target in women with vs. without gestational diabetes: a retrospective cohort study
Authors: Miao Hong , Liang Feng , Zheng Zheng , Chen Huimin , Li Xiaojun , Guo Yi , Li Kuanrong , Liu Xihong , Xia Huimin
Published: July 2023

Background

Weight management has been an important component of the service in obstetric care offered to pregnant women. Current gestational weight gain recommendations were primarily for the general obstetric population, raising concern about the applicability to women with gestational diabetes mellitus (GDM). We aimed to assess the difference in weight progression and adherence to the recommended gestational weight gain targets between women with gestational diabetes mellitus (GDM) and women with normal glucose tolerance (NGT).

Methods

This was a hospital-based retrospective study of 56,616 pregnant women (9,430 GDM women and 47,186 NGT women) from Guangzhou between 2017 and 2021. The average change in weight progression was estimated based on serial weight measurements throughout pregnancy, using a mixed effects model with a random intercept to account for repeated measures of the same individual.

Results

Women with GDM gained less weight (12.07 [SD 5.20] kg) than women with NGT (14.04 [SD 5.04] kg) throughout pregnancy. Before OGTT, a small difference was observed in the average change in weight progression between the two groups (GDM, 0.44 kg/week vs. NGT, 0.45 kg/week, p < 0.001), however, this gap widened significantly after the test (0.34 vs. 0.50 kg/week, p < 0.001). GDM individuals were identified with an approximately 4-fold increased proportion of insufficient weight gain (41.1% vs. 10.4%) and a 2-fold decreased proportion of excessive weight gain (22.6% vs. 54.2%) compared to NGT individuals. These results were consistently observed across different BMI categories, including underweight (insufficient: 52.7% vs. 19.9%; excessive: 15.6% vs. 35.3%), normal weight (insufficient 38.2% vs. 7.4%; excessive: 22.2% vs. 57.3%), and overweight/obese (insufficient: 43.1% vs. 9.8%; excessive: 30.1% vs. 68.8%).

Conclusion

Weight progression varied significantly between GDM and NGT individuals, resulting in a substantial difference in identifying insufficient and excessive weight gain between the two groups under current gestational weight gain guidelines.
An extensive study of potential inhibitors of extracellular vesicles release in triple-negative breast cancer
Authors: McNamee Niamh , Catalano Mariadelva , Mukhopadhya Anindya , O’Driscoll Lorraine
Published: July 2023

Background

Cancer cells release heterogeneous populations of extracellular vesicles (EVs) that transmit aggressive phenotypic traits to recipient cells. We aimed to establish if the heterogenous EVs population or a sub-population is responsible, if we could block undesirable cell-to-cell communication by EVs, and, if some EVs continued to be released, would their undesirable influences on recipient cells continue.

Methods

Three triple-negative breast cancer (TNBC) cell lines were used. Non-toxic concentrations of calpeptin, Y27632, manumycin A, GW4869 and combinations thereof were tested to block EVs. Ultracentrifugation-based methods collected EVs, which were then characterised by nanoparticle tracking analysis, immunoblotting, and transmission electron microscopy. A quick screening flow cytometry method evaluated EVs in solution. The influences of EVs on recipient cells’ migration was investigated.

Results

All EV sub-populations were apparently involved in transmitting undesirable phenotypic characteristics. All compounds/combinations significantly (64–98%) reduced EVs’ release. Our quick screening broadly reflected our more comprehensive EVs analysis. The 2–36% of EVs that continued to be released caused less transmission to recipient cells, but not on a comparable scale to the reduction of EVs release achieved.

Conclusion

Up to 98% inhibition of EVs’ release was achieved. To prevent the transmission of undesirable phenotypic traits by EVs, their total inhibition may be necessary.
Evaluation of the better operative outcome software tool to predict cataract surgical outcome in the early postoperative follow-up
Authors: Lecumberri M. , Moser C L. , Loscos-Arenas J.
Published: July 2023

Background

Cataracts are the world’s leading cause of avoidable blindness. In low-income countries, there are high rates of poor follow-up, which makes it very difficult to monitor surgical outcomes. To address this issue, the Better Operative Outcome Software Tool (BOOST Cataract app) predicts outcome on the first postoperative day and provides specific advice to improve outcomes. The aim of the study is to evaluate the ability of the BOOST Cataract app to categorise surgical outcomes and to analyse the possible factors that contribute to its performance. This was a prospective observational study performed at the General Hospital of Hospitalet of Llobregat.

Results

A total of 126 cataracts were included. Patients had a mean [SD] age of 75.8 [12.19] years, and 52% were females. Manual small-incision cataract surgery was involved in 57% and phacoemulsification in 43%. Thirty-eight percent of eyes presented significant corneal oedema on day 1. The BOOST Cataract app succeeded in categorising the final outcome in 65.6% of the eyes and in 93,4% of the eyes with good outcome.The agreement between the BOOST and UDVA outcomes was 0.353 (p< .000). The level of agreement improved to 0.619 (p< .000) in eyes with clear corneas. Success obtained by BOOST for both types of surgery was not statistically different. Eyes that obtained a good outcome on day one after surgery and eyes with clear cornea had 37 times higher odds (95% CI 6.66, 212.83) and 12 times higher odds (95% CI 3.13, 47.66) of being correctly categorised by the BOOST Cataract app than eyes that obtained a suboptimal (moderate and poor) outcome and eyes with corneal oedema on day 1.

Conclusions

The BOOST Cataract app is an e-Health tool designed to address issues of measuring quality in low- and middle-income settings. Although its reliability is limited to eyes that obtain a good outcome and with clear corneas on day 1, the use of the tool on a regular basis facilitates monitoring and reporting outcomes when clinical data collection is challenging due to low postoperative follow-up rates.
Patent ductus arterious and increased conjugated bilirubin in the second week after birth are independent risk factors for necrotizing enterocolitis in preterm infants: an observational study
Authors: Han Xiaoya , Cui Shudong
Published: July 2023

Background

Neonatal necrotizing enterocolitis (NEC) is a common critical illness of the gastrointestinal system in neonatal intensive care units with complex causes. We want to explore effects of serum-conjugated bilirubin on the occurrence of NEC in preterm infants.

Methods

A retrospective study of clinical case data of premature infants from 2017 to 2020 in the Department of pediatrics of the First Affiliated Hospital of Nanjing Medical University was conducted. Among these, 41 were diagnosed with NEC. After screening, 2 cases were excluded because of incomplete data. Propensity-matching score (PSM) was performed according to the ratio of 1:2(2 preterm infants in the NEC group were not matched), and finally, 37 cases were in the NEC group (average time to diagnosis was 18.9 days), and 74 cases in the non-NEC group. We compared the difference between the NEC and non-NEC groups in early serum-conjugated bilirubin and total bilirubin levels (time points: the first day of birth, 1 week after birth, 2 weeks after birth).

Results

(1) The changing trend of conjugated bilirubin was different between the two groups(F = 4.085, P = 0.019). The NEC group’s serum-conjugated bilirubin levels gradually increased ($$\bar x$$ ± s:12.64±2.68; 17.11±4.48; 19.25±11.63), while the non-NEC group did not show a continuous upward trend ($$\bar x$$ ± s:13.39±2.87; 15.63±3.75; 15.47±4.12). (2) Multiple analyses showed that patent ductus arteriosus(PDA) (odds ratio[OR] = 5.958, 95%confidence interval[CI] = 2.102 ~ 16.882) and increased conjugated bilirubin in the 2nd week (OR = 1.105, 95%CI = 1.013 ~ 1.206) after birth were independent risk factors for NEC.

Conclusions

The body had already experienced an elevation of conjugated bilirubin before the occurrence of NEC. The change of early conjugated bilirubin may be an important factor in the occurrence of NEC.
Evaluation of enamel roughness after orthodontic debonding and clean-up procedures using zirconia, tungsten carbide, and white stone burs: an in vitro study
Authors: Thawaba Ahmed A. , Albelasy Nehal F. , Elsherbini Amira M. , Hafez Ahmad M.
Published: July 2023

Background

The main goal of orthodontic debonding is to restore the enamel surface as closely as possible to its pretreatment condition without iatrogenic damage. This study aimed to compare the effects of different adhesive removal burs; zirconia burs, tungsten carbide burs, and white stone burs on enamel surface roughness.

Materials and methods

Total sample of 72 extracted premolars was randomly divided into three equal groups (n = 24) depending on the method of adhesive removal: zirconia burs (ZB); tungsten carbide burs (TC); and white stones (WS). The metal brackets were bonded using Transbond XT orthodontic adhesive (3 M Unitek, Monrovia, CA, USA) and debonded after 24 h using a debonding plier, then the ARI was assessed. The adhesive remnants were removed using the different burs and Final polishing was performed using Sof-lex discs and spirals. Thirteen samples from each group were evaluated using a Mitutoyo SJ-210 profilometer to determine average surface roughness (Ra) and three samples from each group were examined under Scanning Electron Microscopy (SEM) to determine EDI score. The evaluations were performed at three time points; before bonding (T0), after adhesive removal (T1) and after polishing (T2) and the time consumed for adhesive removal by burs was recorded in seconds. The data were analyzed statistically by ANOVA, Tukey’s test and Kruskal–Wallis H-test.

Results

Kruskal–Wallis H-test showed no statistically significant difference of ARI in all studied groups (p = 0.845) and two-way mixed ANOVA revealed that all burs significantly increased surface roughness at T1 compared to T0 (p < 0.001) in all groups with the lowest Ra values were observed in the ZB group, followed by the TC group, and WS group. The fastest procedure was performed with WS, followed by ZB, then TC bur (p < 0.001). After polishing (T2), Ra values showed no significant difference in ZB group (P = 0.428) and TC group (P = 1.000) as compared to T0, while it was significant in WS group (p < 0.001).

Conclusion

zirconia bur was comparable to tungsten carbide bur and can be considered as alternative to white stone which caused severe enamel damage. The polishing step created smoother surface regardless of the bur used for resin removal.
Analysis of the relapse of imported Plasmodium vivax and Plasmodium ovale in five provinces of China
Authors: Yan Hui , Wei Shujiao , Sui Yuan , Lu Shenning , Zhang Weiwei , Feng Xiangyang , Liu Ying , Zhang Tao , Ruan Wei , Xia Jing , Lin Wen , Ley Benedikt , Auburn Sarah , Li Shizhu , Li Jun , Wang Duoquan
Published: July 2023

Background

The global battle against malaria is facing formidable challenges, particularly in controlling Plasmodium vivax and Plasmodium ovale, whose cases have not been reduced as effectively as Plasmodium falciparum because of their relapse. This study investigates the current situation and underlying factors contributing to relapse or recrudescence of imported cases of P. vivax and P. ovale, and seeks to provide a reference for reducing relapse or recrudescence in malaria-free areas and offers a scientific basis for designing strategies to prevent imported re-transmission.

Methods

This study analysed imported P. vivax and P. ovale in Anhui, Zhejiang, Henan, Hubei, and Guangxi provinces during 2014–2021 by retrospective analysis. A case–control study was conducted on patients who experienced relapse or recrudescence.

Results

From 2014 to 2021, 306 cases of P.vivax and 896 cases of P.ovale were included in the study, while 75 cases had relapse or recrudescence, including 49 cases of P. ovale (65.33%) and 26 cases of P. vivax (34.67%). Within less than 5 weeks after returning to the country, 122 cases of P. vivax (39.87%, 122/306) and 265 cases of P. ovale (29.58%, 265/896) occurred. Within less than 53 weeks, the ratio of P. vivax was 94.77% (290/306), and that of P. ovale was 89.96% (806/896). Among the cases experiencing relapse or recrudescence, only 1 case of P. vivax (1/26 3.85%) and 3 cases of P. ovale (3/49 6.12%) occurred within less than 5 weeks after the first onset, whereas 21 cases of P. vivax (21/26 80.77%) and 42 cases of P. ovale (42/49 85.71%) occurred within less than 53 weeks after the first onset. The difference in relapse or recrudescence due to different drugs and medication regimens and medical activities at various levels of medical institutions was statistically significant.

Conclusion

In areas where malaria has been eliminated, routine health screening in a scientific time frame for people returning from at-risk areas can effectively improve the efficiency of preventing re-transmission, thereby reducing prevention costs and disease burden. Preventing patients from self-treating and strengthening medication regulations in health facilities are key measures to reduce relapse or recrudescence.
Nanosilicate-functionalized nanofibrous membrane facilitated periodontal regeneration potential by harnessing periodontal ligament cell-mediated osteogenesis and immunomodulation
Authors: Xu Xiongcheng , Chen Ziqin , Xiao Long , Xu Yanmei , Xiao Nianqi , Jin Weiqiu , Chen Yuling , Li Yanfen , Luo Kai
Published: July 2023

Although various new biomaterials have enriched the methods for periodontal regeneration, their efficacy is still controversial, and the regeneration of damaged support tissue in the periodontium remains challenging. Laponite (LAP) nanosilicate is a layered two-dimensional nanoscale, ultrathin nanomaterial with a unique structure and brilliant biocompatibility and bioactivity. This study aimed to investigate the effects of nanosilicate-incorporated PCL (PCL/LAP) nanofibrous membranes on periodontal ligament cells (PDLCs) in vitro and periodontal regeneration in vivo. A PCL/LAP nanofibrous membrane was fabricated by an electrospinning method. The characterization of PCL/LAP nanofibrous membrane were determined by scanning electron microscopy (SEM), energy dispersive spectrum of X-ray (EDS), inductively coupled plasma mass spectrometry (ICP-MS) and tensile test. The proliferation and osteogenic differentiation of PDLCs on the PCL/LAP nanofibrous membrane were evaluated. A PDLCs and macrophage coculture system was used to explore the immunomodulatory effects of the PCL/LAP nanofibrous membrane. PCL/LAP nanofibrous membrane was implanted into rat calvarial and periodontal defects, and the regenerative potential was evaluated by microcomputed topography (micro-CT) and histological analysis. The PCL/LAP nanofibrous membrane showed good biocompatibility and bioactivity. It enhanced the proliferation and osteogenic differentiation of PDLCs. The PCL/LAP nanofibrous membrane also stimulated anti-inflammatory and pro-remodeling N2 neutrophil formation, regulated inflammatory responses and induced M2 macrophage polarization by orchestrating the immunomodulatory effects of PDLCs. The PCL/LAP nanofibrous membrane promoted rat calvarial defect repair and periodontal regeneration in vivo. LAP nanosilicate-incorporated PCL membrane is capable of mediating osteogenesis and immunomodulation of PDLCs in vitro and accelerating periodontal regeneration in vivo. It could be a promising biomaterial for periodontal regeneration therapy.
Incidence and outcomes of critical illness in Indigenous peoples: a systematic review and meta-analysis
Authors: Bowker Samantha L. , Williams Kienan , Volk Auriele , Auger Leonard , Lafontaine Alika , Dumont Paige , Wingert Aireen , Davis Amanda , Bialy Liza , Wright Erica , Oster Richard T. , Bagshaw Sean M.
Published: July 2023

Background

Indigenous Peoples experience health inequities and racism across the continuum of health services. We performed a systematic review and meta-analysis of the incidence and outcomes of critical illness among Indigenous Peoples.

Methods

We searched Ovid MEDLINE/PubMed, Ovid EMBASE, Google Scholar, and Cochrane Central Register of Controlled Trials (inception to October 2022). Observational studies, case series of > 100 patients, clinical trial arms, and grey literature reports of Indigenous adults were eligible. We assessed risk of bias using the Newcastle–Ottawa Scale and appraised research quality from an Indigenous perspective using the Aboriginal and Torres Strait Islander Quality Assessment Tool. ICU mortality, ICU length of stay, and invasive mechanical ventilation (IMV) were compared using risk ratios and mean difference (MD) for dichotomous and continuous outcomes, respectively. ICU admission was synthesized descriptively.

Results

Fifteen studies (Australia and/or New Zealand [n = 12] and Canada [n = 3]) were included. Risk of bias was low in 10 studies and moderate in 5, and included studies had minimal incorporation of Indigenous perspectives or consultation. There was no difference in ICU mortality between Indigenous and non-Indigenous (RR 1.14, 95%CI 0.98 to 1.34, I2 = 87%). We observed a shorter ICU length of stay among Indigenous (MD − 0.25; 95%CI, − 0.49 to − 0.00; I2 = 95%) and a higher use for IMV among non-Indigenous (RR 1.10; 95%CI, 1.06 to 1.15; I2 = 81%).

Conclusion

Research on Indigenous Peoples experience with critical care is poorly characterized and has rarely included Indigenous perspectives. ICU mortality between Indigenous and non-Indigenous populations was similar, while there was a shorter ICU length of stay and less mechanical ventilation use among Indigenous patients.

Systematic Review RegistrationPROSPERO CRD42021254661; Registered: 12 June, 2021.
Stable maternal proteins underlie distinct transcriptome, translatome, and proteome reprogramming during mouse oocyte-to-embryo transition
Authors: Zhang Hongmei , Ji Shuyan , Zhang Ke , Chen Yuling , Ming Jia , Kong Feng , Wang Lijuan , Wang Shun , Zou Zhuoning , Xiong Zhuqing , Xu Kai , Lin Zili , Huang Bo , Liu Ling , Fan Qiang , Jin Suoqin , Deng Haiteng , Xie Wei
Published: July 2023

Background

The oocyte-to-embryo transition (OET) converts terminally differentiated gametes into a totipotent embryo and is critically controlled by maternal mRNAs and proteins, while the genome is silent until zygotic genome activation. How the transcriptome, translatome, and proteome are coordinated during this critical developmental window remains poorly understood.

Results

Utilizing a highly sensitive and quantitative mass spectrometry approach, we obtain high-quality proteome data spanning seven mouse stages, from full-grown oocyte (FGO) to blastocyst, using 100 oocytes/embryos at each stage. Integrative analyses reveal distinct proteome reprogramming compared to that of the transcriptome or translatome. FGO to 8-cell proteomes are dominated by FGO-stockpiled proteins, while the transcriptome and translatome are more dynamic. FGO-originated proteins frequently persist to blastocyst while corresponding transcripts are already downregulated or decayed. Improved concordance between protein and translation or transcription is observed for genes starting translation upon meiotic resumption, as well as those transcribed and translated only in embryos. Concordance between protein and transcription/translation is also observed for proteins with short half-lives. We built a kinetic model that predicts protein dynamics by incorporating both initial protein abundance in FGOs and translation kinetics across developmental stages.

Conclusions

Through integrative analyses of datasets generated by ultrasensitive methods, our study reveals that the proteome shows distinct dynamics compared to the translatome and transcriptome during mouse OET. We propose that the remarkably stable oocyte-originated proteome may help save resources to accommodate the demanding needs of growing embryos. This study will advance our understanding of mammalian OET and the fundamental principles governing gene expression.
“A breach in the protocol for no good reason”: a surgical antimicrobial prophylaxis experience in an Ethiopian academic medical center
Authors: Afework Veronica , Kejela Segni , Abebe Nebyou Seyoum
Published: July 2023

Background

An appropriately administered surgical antimicrobial prophylaxis decreases the rate of surgical site infections. Although evidence-based clinical practice guidelines have been published on surgical antimicrobial prophylaxis, the rate of adherence to the protocol and the impact of extending antimicrobial prophylaxis postoperatively is yet to be well elucidated.

Method

A total of general surgery and vascular surgery patients with clean and clean contaminated wound undergoing elective surgical procedures were included in the study. The rate of surgical antimicrobial prophylaxis utilization, the proportion of patients whom had their antimicrobial prophylaxis extended beyond 24 h and the rate of surgical site infections across groups were evaluated.

Results

The surgical antimicrobial prophylaxis utilization rate was 90.5%. Of these patients, 12.6% were unnecessarily administered with antibiotics. An “extended” antibiotics administration beyond 24 h after the surgery was found in 40.2%. Gastrointestinal and hepato-pancreatico-biliary surgery patients had 7.9-fold rate of “extended” surgical antimicrobial prophylaxis beyond 24 h, AOR 7.89 (95% CI 3.88–20.715.62, p value < 0.0001). The overall rate of surgical site infection was 15(6.8%). The “extended” regimen of prophylactic antibiotics had no effect on the rate of surgical site infections.

Conclusion

Less than half of the patients included here had surgical antimicrobial prophylaxis regimen in accordance with the existing guidelines. The most common protocol violation was noted as extension of antimicrobial prophylaxis for more than 24 h after surgery. The extension of antimicrobial prophylaxis did not decrease the rate of surgical site infections, reaffirming the evidence that prophylactic extension of surgical antimicrobial prophylaxis is unnecessary.
Using adenosine triphosphate bioluminescence level monitoring to identify bacterial reservoirs during two consecutive Enterococcus faecium and Staphylococcus capitis nosocomial infection outbreaks at a neonatal intensive care unit
Authors: Kim Ye Ji , Hong Min Yeong , Kang Hyun Mi , Yum Sook Kyung , Youn Young Ah , Lee Dong-Gun , Kang Jin Han
Published: July 2023

Introduction

This study aimed to assess the role of adenosine triphosphate (ATP) bioluminescence level monitoring for identifying reservoirs of the outbreak pathogen during two consecutive outbreaks caused by Enterococcus faecium and Staphylococcus capitis at a neonatal intensive care unit (NICU). The secondary aim was to evaluate the long-term sustainability of the infection control measures employed one year after the final intervention measures.

Methods

Two outbreaks occurred during a 53-day period in two disconnected subunits, A and B, that share the same attending physicians. ATP bioluminescence level monitoring, environmental cultures, and hand cultures from healthcare workers (HCW) in the NICU were performed. Pulsed-field gel electrophoresis (PFGE) typing was carried out to investigate the phylogenetic relatedness of the isolated strains.

Results

Four cases of E. faecium sepsis (patients A-8, A-7, A-9, B-8) and three cases of S. capitis sepsis (patients A-16, A-2, B-8) were diagnosed in six preterm infants over a span of 53 days. ATP levels remained high on keyboard 1 of the main station (2076 relative light unit [RLU]/100 cm2) and the keyboard of bed A-9 (4886 RLU/100 cm2). By guidance with the ATP results, environmental cultures showed that E. faecium isolated from the patients and from the main station’s keyboard 1 were genotypically indistinguishable. Two different S. capitis strains caused sepsis in three patients. A total 77.8% (n = 7/9) of S. capitis cultured from HCW's hands were genotypically indistinguishable to the strains isolated from A-2 and A-16. The remaining 22.2% (n = 2/9) were genotypically indistinguishable to patient B-8. Three interventions to decrease the risk of bacterial transmission were applied, with the final intervention including a switch of all keyboards and mice in NICU-A and B to disinfectable ones. Post-intervention prospective monitoring up to one year showed a decrease in blood culture positivity (P = 0.0019) and catheter-related blood stream infection rate (P = 0.016) before and after intervention.

Conclusion

ATP monitoring is an effective tool in identifying difficult to disinfect areas in NICUs. Non-medical devices may serve as reservoirs of pathogens causing nosocomial outbreaks, and HCWs' hands contribute to bacterial transmission in NICUs.
Occurrence and health risk assessment of antimony, arsenic, barium, cadmium, chromium, nickel, and lead in fresh fruits consumed in South Korea
Authors: Lee Jian , Hwang Insun , Park Ye-Seul , Lee Do Yup
Published: July 2023

Although various fruits are consumed as fresh produce in South Korea, information on the concentrations of heavy metals in such fruits remains lacking despite the known toxic effects of the metals. Moreover, the health risks posed by seven potentially toxic metals (As, Ba, Cd, Cr, Ni, Pb, and Sb) ingested through fruit consumption have not been assessed using recent dietary data and occurrence data. Inductively coupled plasma-mass spectrometry was used to quantify these metals in 207 samples of fresh fruits mainly consumed in South Korea. The mean concentrations (mg kg−1 fresh weight) of the metals in all fruit samples were as follows: As < 0.0021, Ba 0.3675, Cd < 0.0022, Cr 0.0307, Ni 0.0815, Pb 0.0236, and Sb < 0.0021. Only Ba showed a significant negative correlation with Pb (ρ =  −0.5385) in the studied fruits at the 95% confidence level. The non-carcinogenic risk of the seven metals in terms of hazard quotients was Pb (0.0149) > As (0.0086) > Ni (0.0081) > Sb (0.0080) > Ba (0.0031) > Cd (0.0027) > Cr (0.0001), and the hazard index, which is the sum of the hazard quotients, was 0.0275 (less than 1). The carcinogenic risks of As and Pb were 4.62E − 07 and 5.05E − 07, respectively (below 1E − 04). The hazard index of seven metals and carcinogenic risks of As and Pb indicated that no health risks were associated with fruit consumption in the Korean population. However, the hazard quotient and carcinogenic risk of Pb in apples were the highest for children aged 1–2 years, indicating that continuous targeted risk monitoring in this age group is required.
Exploring the Low Force-High Velocity Domain of the Force–Velocity Relationship in Acyclic Lower-Limb Extensions
Authors: Rivière Jean Romain , Morin Jean-Benoît , Bowen Maximilien , Cross Matt R. , Messonnier Laurent A. , Samozino Pierre
Published: July 2023

Purpose

To compare linear and curvilinear models describing the force–velocity relationship obtained in lower-limb acyclic extensions, considering experimental data on an unprecedented range of velocity conditions.

Methods

Nine athletes performed lower-limb extensions on a leg-press ergometer, designed to provide a very broad range of force and velocity conditions. Previously inaccessible low inertial and resistive conditions were achieved by performing extensions horizontally and with assistance. Force and velocity were continuously measured over the push-off in six resistive conditions to assess individual force–velocity relationships. Goodness of fit of linear and curvilinear models (second-order polynomial function, Fenn and Marsh’s, and Hill’s equations) on force and velocity data were compared via the Akaike Information Criterion.

Results

Expressed relative to the theoretical maximal force and velocity obtained from the linear model, force and velocity data ranged from 26.6 ± 6.6 to 96.0 ± 3.6% (16–99%) and from 8.3 ± 1.9 to 76.6 ± 7.0% (5–86%), respectively. Curvilinear and linear models showed very high fit (adjusted r2 = 0.951–0.999; SEE = 17-159N). Despite curvilinear models better fitting the data, there was a ~ 99–100% chance the linear model best described the data.

Conclusion

A combination between goodness of fit, degrees of freedom and common sense (e.g., rational physiologically values) indicated linear modelling is preferable for describing the force–velocity relationship during acyclic lower-limb extensions, compared to curvilinear models. Notably, linearity appears maintained in conditions approaching theoretical maximal velocity. Using horizontal and assisted lower-limb extension to more broadly explore resistive/assistive conditions could improve reliability and accuracy of the force–velocity relationship and associated parameters.
RETRACTED ARTICLE: Acute coronary syndrome due to left main coronary trunk compression 2 months after left atrial auricle clipping: a case report
Authors: Uchida Satoshi , Takekawa Daiki , Kato Koudai , Hirota Kazuyoshi
Published: July 2023

Background

Left atrial auricle (LAA) clipping is a common method of preventing cardiogenic thromboembolism. However, acute coronary syndrome (ACS) has been reported as a fatal complication of LAA clipping. We describe a case of ACS 2 months after LAA clipping.

Case presentation

A 33-year-old male with atrial fibrillation was scheduled LAA clipping during aortic valve replacement for congenital aortic bicuspid valve. The surgery went smoothly with no postoperative complications, but he suddenly went into cardiac arrest 2 months later. Emergency coronary angiography and intravascular ultrasonography revealed that compression by the clip of the left main coronary trunk had caused the ACS. Percutaneous coronary intervention with stents was performed, and the clip was removed under general anesthesia.

Conclusion

Even in the remote timepoint of LAA clipping, compression of the coronary artery by the clip should be differentiated as a cause of ACS.
Assessment of the role of telemedicine in the outcome of multiple sclerosis patients
Authors: Ahmed Mohamed Abd El-khalik , Zakaria Magd Fouad , Elaziz Azza Abd Elnasser Abd , Fouad Mohamed Mahmoud , Elbokl Ahmed Mohamed , Swelam Mahmoud Saad
Published: July 2023

Background

Multiple sclerosis (MS) is a chronic autoimmune disease, affecting about 2.5 million people worldwide. Telemedicine is a relatively recent telecommunication tool that has multiple formats such as store-and-forward, interactive video conferencing, remote medical record access, and remote patient monitoring. Telemedicine can be used to assess individuals with MS regarding their disease process, the development and impact of new symptoms as well as inquire about health behaviors that promote effective self-management. In this study, we aimed to evaluate the effect of telemedicine on patient satisfaction, clinical outcome and financial feasibility for MS patients.

Results

Sixty MS patients from the MS unit, at Kafr Elshikh General Hospital, were recruited and divided into 2 groups; 30 in the telemedicine group and 30 in the control group. Both groups were followed up for 12 months. We found a significant difference between the telemedicine group compared to controls as it showed less severe visual symptoms (p 0.006), a smaller number of dropouts (p 0.034) and higher patient satisfaction, with no significant difference between the two groups in the number of relapses, gait, bowel and bladder, lower limb weakness.

Conclusion

Telemedicine was found to be a promising practice that can be used to promote, coordinate and adjust ongoing clinical services of MS patients.
Inclisiran adjuvant therapy to statins for the use of hypercholesterolemia: a commentary
Authors: Vohra Laiba Imran , Rizwan Kashf , Saeed Emaan , Hamza Muhammad Syed Ali , Ochani Sidhant
Published: July 2023

Background

Hypercholesterolemia is a lipid disorder characterized by excessively high levels of low-density lipoproteins, which encourages fat accumulation in your arteries, hence escalating the chances of heart attack and stroke. Globally, 39% of individuals experience elevated total cholesterol levels with 98.6 million DALYs (disability-adjusted life years) caused by high non-HDL cholesterol in 2019, supposedly killing 4.4 million people.

Main body

LDL cholesterol is the primary target of treatment for lowering the risk of cardiovascular events in both primary and secondary prevention. The usual drug to achieve this goal is HMG-CoA reductase inhibitors (statins), which constitute the most potent and effective class to reduce LDL cholesterol. The current treatment of choice for hypercholesterolemia is statin therapy; however, a considerable proportion of patients are unable to reach their desired low-density lipoproteins levels (LDL), while some cannot take statins at all. The regular use and possible non-adherence to long-term therapy of statins have prompted the development of novel PCSK9-targeting drugs such as inclisiran—a synthesized small interfering RNA. Inclisiran binds to the proprotein convertase subtilisin/kexin type 9 (PCSK9) mRNA causing its disintegration and hence preventing its formation. This results in reduced amounts of PCSK9 both within and outside the cells, which significantly lowers LDL levels. Multiple double-blind, placebo-controlled Osaka Emergency Information Research Intelligence Operation Network System (ORION) trials were conducted; ORION-9 was conducted on patients with familial hypercholesterolemia and LDL cholesterol levels higher than 100 mg/dl despite taking the maximum dose of statin therapy, whereas ORION-10 and ORION-11 were conducted on patients with cardiovascular disease or having its risk factors. These patients were administered Inclisiran injections on days 1, 90 (month 3), 270 (month 9), and 450 (month 15) and were followed for 540 days. The results showed decreased LDL levels by 51% compared to the placebo and further established a strong link with reduced major adverse cardiac events rates with no effect on creatinine kinase and liver function test levels. The drug’s significant side effect was reported to be an injection site reaction.

Conclusion

Inclisiran may be utilized alone or in conjunction with other lipid-lowering treatments in individuals who are unable to take statins or for whom they are contraindicated. Furthermore, its exceptional stability throughout a broad range of heat conditions makes its use well-suited for developing countries.
Dimensions of psychopathology associated with psychotic-like experiences: Findings from the network analysis in a nonclinical sample
Authors: Rejek Maksymilian , Misiak Błażej
Published: July 2023

Background

Psychotic-like experiences (PLEs) are associated with a variety of psychopathological symptoms. However, it remains unknown which dimensions of psychopathology are most closely related to the occurrence of PLEs. In this study, we aimed to analyze the association of PLEs with various domains of psychopathology.

Methods

A total of 1100 nonclinical adults (aged 18–35 years, 51.4% females) with a negative history of psychiatric treatment were surveyed. Assessment of psychopathology was performed using self-reports. Symptoms associated with PLEs were explored as continuous variables and based on clinically relevant thresholds using two separate network analyses.

Results

In both network analyses, PLEs were directly connected to obsessive-compulsive disorder (OCD) symptoms, manic symptoms, depressive symptoms, and attention-deficit/hyperactivity disorder (ADHD) symptoms. Anxiety symptoms were associated with PLEs only in the network based on threshold scores. Importantly, edge weight for the connection of PLEs and OCD symptoms was significantly higher compared to edge weights of all other direct connections of PLEs with psychopathology in both networks. Edge weight for the connection between PLEs and manic symptoms was significantly higher compared to edge weights for direct connections of PLEs with depressive and ADHD symptoms in the network based on continuous scores of psychopathological symptoms. Edge weights of direct connections of PLEs with depressive, anxiety, and ADHD symptoms did not differ significantly in both networks.

Conclusions

Our findings indicate that PLEs are associated with multiple domains of psychopathology. However, these phenomena are most strongly associated with OCD symptoms regardless of their severity threshold.
A Positive Distress Screen…Now What? An Updated Call for Integrated Psychosocial Care
Authors: Tsao Phoebe A. , Fann Jesse R. , Nevedal Andrea L. , Bloor Lindsey E. , Krein Sarah L. , Caram Megan E.V.
Published: July 2023

How can we move collaborative care from evidence-based practice to everyday practice for those living with cancer and distress?
Preventing Future Harm: Identifying the Drivers of an Unsafe Discharge to Improve Safety on an Inpatient Oncology Service
Authors: Roberts Thomas J. , McGuire Jessica , Clark Jeffrey W. , Drutchas Alexis E. , Photopoulos Rhaea , Das Devika , Mulvey Therese M.
Published: July 2023

Cancer Morbidity, Mortality, and Improvement Rounds is a series of articles intended to explore the unique safety risks experienced by oncology patients through the lens of quality improvement, systems and human factors engineering, and cognitive psychology. For purposes of clarity, each case focuses on a single theme, although, as is true for all medical incidents, there are almost always multiple, overlapping, contributing factors. The quality improvement paradigm used here, which focuses on root cause analyses and opportunities to improve care delivery systems, was previously outlined in this journal.

This article describes the care of a young patient with aggressive breast cancer, declining performance status, and multiple hospital admissions who died shortly after being discharged home without essential medications or an adequate plan for follow-up. The patient's death due to her malignancy was unavoidable, but she had inadequate resources before her death, leading to avoidable suffering. This outcome resulted from a series of minor errors attributable to inadequate handoffs, challenges establishing realistic goals of care, and hierarchy within and between medical teams that resulted in major lapses at the time of discharge. We explore these issues and discuss how this case led to the establishment of programs designed to empower health care providers and increase engagement of outpatient oncologists at critical points of patients' disease courses.
Pigment Epithelium-Derived Factor, a Novel Adipokine, Contributes to Gestational Diabetes Mellitus
Authors: Qi Weiwei , Zhu Dan , Yin Ping , Gu Xiaoqiong , Zhao Zhen , Li Miaoxin , Dong Chang , Tang Qilong , Xie Wanting , Zhou Ti , Xia Huimin , Qiu Xiu , Yang Xia , Gao Guoquan
Published: July 2023

Context

Excessive insulin resistance, inadequate insulin compensation, or both could result in gestational diabetes mellitus (GDM). Levels of pigment epithelium-derived factor (PEDF), a novel adipokine that could induce insulin resistance, are high in patients with obesity and diabetes. However, the impact of PEDF in pregnancy remains unknown.

Objective

This study aimed to elucidate the role of PEDF on insulin resistance and compensatory elevation of insulin levels during normal pregnancy and in patients with GDM.

Methods

In this population-based and cohort study, logistic regression analysis was performed to determine the association of PEDF/adiponectin/leptin levels with the risk of developing GDM and to predict postpartum prediabetes. PEDF protein, PEDF transgenic mice, PEDF knockout mice, and PEDF-neutralized antibodies were used to observe changes in insulin resistance and insulin levels with pregnancy.

Results

Plasma PEDF levels were increased in normal pregnancy and higher in GDM women. Higher PEDF levels were associated with the increased risk of developing GDM and emerged as a significant independent determinant of postpartum prediabetes in GDM women. Mechanistically, in vivo and in vitro experiments revealed that PEDF induced insulin resistance by inhibiting the insulin signaling pathway.

Conclusion

In addition to insulin resistance and upregulated insulin levels in normal pregnancy and GDM, aberrant PEDF levels can serve as a “fingerprint” of metabolic abnormalities during pregnancy. Thus, PEDF is a valuable biomarker but could interfere with the time course for early diagnosis and prognosis of GDM.
Associations of Clinical Risk Factors and Novel Biomarkers With Age at Onset of Type 2 Diabetes
Authors: Chen Jun-Xiang , Geng Tingting , Zhang Yan-Bo , Wang Yi , Li Rui , Qiu Zixin , Wang Yuexuan , Yang Kun , Zhang Bing-Fei , Ruan Hua-Ling , Zhou Yan-Feng , Pan An , Liu Gang , Liao Yun-Fei
Published: July 2023

Context

Younger onset of type 2 diabetes (T2D) was associated with higher risks of vascular complications and mortality.

Objective

To prospectively assess risk profiles for incident T2D stratified by age at onset.

Methods

A total of 471 269 participants free of T2D at baseline were included from the UK Biobank. Approximately 70 clinical, lipid, lipoprotein, inflammatory, and metabolic markers, and genetic risk scores (GRSs) were analyzed. Stratified Cox proportional-hazards regression models were used to estimate hazard ratios (HRs) for T2D with age of diagnosis divided into 4 groups (≤50.0, 50.1-60.0, 60.1-70.0, and >70.0 years).

Results

During 11 years of follow-up, 15 805 incident T2D were identified. Among clinical risk factors, obesity had the highest HR at any age, ranging from 13.16 (95% CI, 9.67-17.91) for 50.0 years and younger to 4.13 (3.78-4.51) for older than 70.0 years. Other risks associated with T2D onset at age 50.0 years and younger included dyslipidemia (3.50, 2.91-4.20), hypertension (3.21, 2.71-3.80), cardiovascular disease (2.87, 2.13-3.87), parental history of diabetes (2.42, 2.04-2.86), education lower than college (1.89, 1.57-2.27), physical inactivity (1.73, 1.43-2.10), smoking (1.38, 1.13-1.68), several lipoprotein particles, inflammatory markers, liver enzymes, fatty acids, amino acids, as well as GRS. Associations of most risk factors and biomarkers were markedly attenuated with increasing age at onset (P interaction <.05), and some were not significant for onset at age older than 70.0 years, such as smoking, systolic blood pressure, and apolipoprotein B.

Conclusion

Most risk factors or biomarkers had stronger relative risks for T2D at younger ages, which emphasizes the necessity of promoting primary prevention among younger individuals. Moreover, obesity should be prioritized.
Promise and Perils of MicroRNA Discovery Research: Working Toward Quality Over Quantity
Authors: McIlwraith Emma K , He Wenyuan , Belsham Denise D
Published: July 2023

Since the first microRNA (miRNA) was described in 1993 in the humble worm Caenorhabditis elegans, the miRNA field has boomed, with more than 100 000 related patents filed and miRNAs now in ongoing clinical trials. Despite an advanced understanding of the biogenesis and action of miRNAs, applied miRNA research faces challenges and irreproducibility due to a lack of standardization. This review provides guidelines regarding miRNA investigation, while focusing on the pitfalls and considerations that are often overlooked in prevailing applied miRNA research. These include miRNA annotation and quantification, to modulation, target prediction, validation, and the study of circulating miRNAs.