bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of secukinumab in Takayasu arteritis with myocardial infarction complicated with generalized pustular psoriasis: A case report
Authors: Asano Tomoyuki , Yoshida Shuhei , Matsuoka Naoki , Ishikawa Masato , Sato Akihiko , Ogawa Shotaro , Saito Kenji , Sumichika Yuya , Matsumoto Haruki , Temmoku Jumpei , Fujita Yuya , Sato Shuzo , Takeishi Yasuchika , Yamamoto Toshiyuki , Migita Kiyoshi
Published: December 2024

Rationale:

Takayasu arteritis (TAK) is an autoimmune disease that causes chronic inflammation targeting the aortic wall. Since many patients are resistant to steroid treatment, multiple immunosuppressants or interleukin-6 (IL-6) suppression therapy have served as treatment alternatives. However, there are very few reports on the effectiveness of biologics against inflammatory cytokines upstream of IL-6.

Patient concerns:

We present a case of TAK in a 51-year-old female presenting with a myocardial infarction. She had persistent carotid wall thickening despite glucocorticoid (GC) therapy, and IL-6 suppression therapy was being proactively considered. While the GC was being tapered, widespread pustules appeared all over her body.

Diagnosis:

TAK complicated with generalized pustular psoriasis (GPP).

Interventions:

Aside from GC, the patient was treated with secukinumab (SEC), an anti-IL-17A monoclonal antibody.

Outcomes:

Immediately after treatment with SEC, the pustules disappeared, and the thickening of the common carotid artery wall improved on ultrasound.

Lessons:

Since IL-17 is an important cytokine in the pathogenesis of TAK, anti-cytokine therapy targeting IL-17 may be effective for TAK.
The adverse effect of mood swings on the risk of cardiovascular diseases: Evidence from Mendelian randomization analysis
Authors: Dai Yuanhui , Hao Yuqi
Published: December 2024

Recent studies have explored the impact of personality traits, including mood swings, on physical health. However, it remains unclear whether there is a direct cause-and-effect link between mood swings and cardiovascular diseases (CVDs). A STROBE-compliant cross-sectional observational study was conducted and analyzed using a two-sample Mendelian randomization (MR) approach to examine the potential causal relationship between mood swings and a range of CVDs, such as arrhythmia, artery aneurysm, coronary heart disease (CHD), heart failure, hypertension, stroke, ischemic stroke, and peripheral artery disease. We sourced genome-wide association studies (GWAS) summary data for mood swings from the UK Biobank, and for CVDs from the GWAS Catalog and FinnGen databases. We excluded single-nucleotide polymorphisms (SNPs) linked to potential confounders such as obesity, smoking, sex, diabetes, as well as SNPs suspected of horizontal pleiotropy, as identified by MR-PRESSO and the MR-pleiotropy method, prior to the final analysis. Sensitivity analyses were conducted using the MR-Egger, inverse variance weighted, and leave-one-out methods. After screening, 57 SNPs were identified as instrumental variables for mood swings, and 9 SNPs related to confounding factors were excluded. An increase in mood swing frequency is correlated with a significant increase in the likelihood of various conditions. Notably, arrhythmia in the FinnGen dataset showed an odds ratio (OR: 2.28, 95% confidence interval [CI]: 1.44–3.61, P < .001), and atrial fibrillation had an OR (OR: 2.25, 95% CI: 1.23–4.11, P = .01). CHD risk was elevated in both the IEU OpenGWAS project (OR: 2.05, 95% CI: 1.30–3.21, P < .001) and GWAS Catalog (OR: 4.45, 95% CI: 1.75–11.33, P < .001). Increased risks were also noted for heart failure (GWAS Catalog: OR: 1.75, 95% CI: 1.09–2.83, P = .02) and hypertension (FinnGen: OR, 2.17; 95% CI: 1.47–3.19, P < .001). However, no significant associations were found for conditions such as arterial aneurysms or ischemic stroke. In combined analyses, mood swings were associated with a higher risk of CHD (OR: 2.21, 95% CI: 1.64–2.97, P < .01), heart failure (OR: 1.74, 95% CI: 1.21–2.50, P < .01), and other CVDs. This study revealed a causal link between mood swings and various CVDs, highlighting intriguing findings. This suggests that implementing proper psychological interventions to stabilize mood may be beneficial for preventing negative cardiovascular events.
Development and validation of the renal dosing questionnaire (RDQ-13) for pharmacists
Authors: Zafar Roheena , Rehman Inayat Ur , Shah Yasar , Ming Long Chiau , Hadi Muhammad Abdul , Suleiman Amal K. , Goh Khang Wen
Published: December 2024

Pharmacists, as an integral part of the healthcare team, can play a crucial role in preventing drug-related problems in patients with chronic kidney disease that arise due to inappropriate doses. This study aimed to develop and validate a new tool, the renal dosing questionnaire (RDQ-13), for pharmacists working across hospital, community, and retail pharmacy settings. A cross-sectional study was conducted from January to March 2023 among pharmacists working in different settings. The RDQ-13 scale consists of 3-sections, encompassing demographic details, a knowledge section with 6 domains, each having 4 questions with the choice of “yes/no,” an attitude section featuring a Likert scale for 4 items, and a perception section featuring a Likert scale for 3 items. The assessment of construct and discriminative validity was performed along with testing for reliability. The average variance extracted value and the composite reliability value were used for convergent validity. A total of 65 pharmacists completed the RDQ-13, but at retest n = 2 participants were dropped (response rate at retest was 96.9%). Exploratory factor analysis revealed 3-factor loadings with 59.1% of the variance, whereas the Kaiser–Mayer–Olkin value was 0.60. The Cronbach alpha value of 0.700 indicates good internal consistency, whereas the intraclass correlation coefficient (ICC) for the test and retest showed that most domains/scores were statistically significant (P < .001), showing an excellent agreement between the test and retest. The RDQ-13 underwent extensive validation through a cross-sectional survey, demonstrating high content and face validity. The scale showed consistent responses over time (test–retest stability) and good internal consistency.
Early pulmonary rehabilitation in ARDS patients: Effects on respiratory function and long-term outcomes: A retrospective study
Authors: Da Li , Zhang Kai
Published: December 2024

This retrospective cohort study, conducted at People’s Hospital of Wenjiang Chengdu (January 2018 to January 2022), aimed to evaluate the effects of early pulmonary rehabilitation (PR) on respiratory function in acute respiratory distress syndrome patients after discontinuing invasive mechanical ventilation in the intensive care unit. Patients were divided into PR and control groups based on an offline training protocol. Outcome measures included short physical performance battery scores, respiratory muscle strength, and pulmonary function indicators at discharge and 3 months post-discharge, including peak expiratory flow, forced expiratory volume in 1 second/forced vital capacity, and vital capacity. Kaplan–Meier analysis assessed 6-month survival rates. Among the 240 patients, 120 received traditional training and 120 received early PR. Both groups had no significant differences in baseline characteristics. Short physical performance battery scores and respiratory muscle strength showed gradual improvements in both groups, with the PR group achieving significantly higher scores at 5 and 7 days (P < .05). At 3 months post-discharge, pulmonary function indicators such as peak expiratory flow, forced expiratory volume in 1 second/forced vital capacity, and vital capacity in the PR group were significantly improved compared to discharge and were higher than those in the control group (P < .05). The number of sputum aspirations in the PR group significantly decreased (P < .05), and intensive care unit stays after weaning were significantly shorter (P < .05). Kaplan–Meier survival analysis revealed that the cumulative survival rate at 6 months post-discharge was significantly higher in the PR group compared to the control group (hazard ratio = 0.660, 95% CI: 0.472–0.922, P = .014). These findings suggest that early PR significantly enhances respiratory function recovery, reduces complications, and improves survival outcomes in acute respiratory distress syndrome patients after invasive ventilation.
Osmotic demyelination syndrome: Case report and literature retrospect
Authors: Yu Zhenzhen , Wang Chen
Published: December 2024

Rationale:

Osmotic demyelination syndrome (ODS) is a noninflammatory demyelinating disorder involving the pontis and other regions of the central nervous system. This article tries to enhance the understanding of ODS. Combined with clinical features, we use laboratory/imaging examination and literature review.

Patient concerns:

We report on 4 ODS cases and review the different etiologies, clinical manifestations, and possible pathophysiology.

Diagnoses:

We provide an update on the diagnosis and treatment of ODS, with a special focus on the prevention of ODS.

Interventions:

We corrected the hyponatremia appropriately and treated complications.

Outcomes:

The development of ODS is by association with a variety of clinical conditions. Also, the prognosis of ODS is heterogeneous, ranging from complete recovery to vegetative state, even death. However, there is no specific effective treatment, thus, it is more important to recognize the path mechanism of ODS and to avoid its occurrence.

Lessons:

It is essential to reduce the risk of suffering this potentially devastating disease through an appropriate rate of hyponatremia correction and the treatment of comorbid clinical conditions.
Langerhans cell histiocytosis mimicking hematoma of the lower eyelid: A case report
Authors: Li Jing , Ren Mingyu , Wang Jianjie , Cheng Yanyan , Li Ruimiao , Lu Lu , Zhang Ruina
Published: December 2024

Rationale:

The orbital Langerhans cell histiocytosis (LCH) is rare clinically, due to its ability to mimic other conditions, distinguishing LCH from hematoma when these disorders coexist can be particularly challenging.

Patient concerns:

A 3-year-old boy presented with a 2-week history of unresolved bruising and swelling of the left eye. CT revealed a well-defined cystic lesion in the preseptal tissues of the left eyelid, with an incomplete bone structure at the lower margin of the orbit. MRI revealed a well-circumscribed circular mass in the lower margin of the orbit, and a second lesion under the hematoma.

Diagnosis:

Postoperative histological examination revealed a diagnosis of LCH with concurrent hematoma.

Interventions:

The lesions in the left eye were surgically removed through a lower eyelid skin incision under general anesthesia. The patient received 6 courses of systemic chemotherapy, consisting of a combination of vinblastine and prednisolone.

Outcomes:

No recurrence was observed after a follow-up period of 11 months.

Lessons:

LCH rarely occurs at the infraorbital margin. When external factors, lead to local bleeding and hematoma formation, the presence of lesions may be masked, resulting in a missed diagnosis. Radiographic features such as localized “worm-eaten” bone destruction should not be overlooked for timely LCH diagnosis and treatment.
Vitality index predicts walking independence in patients with hip fracture: A retrospective study
Authors: Fujita Takaaki , Kasahara Ryuichi , Kurita Megumi , Jinbo Ryohei , Yamamoto Yuichi , Ohira Yoko , Otsuki Koji , Iokawa Kazuaki
Published: December 2024

This study aimed to determine if the vitality index predicts walking independence in inpatients with hip fractures and calculate a cutoff value. This retrospective cohort study included inpatients with hip fracture (N = 133). Logistic regression analysis was performed with walking independence at discharge and vitality index as the dependent and independent variables, respectively, and age, Berg balance scale (BBS), knee extension muscle strength, and revised Hasegawa’s dementia scale at admission as covariates. A receiver operating characteristic curve was used to calculate the cutoff value. Logistic regression analysis showed that the vitality index at admission was significantly associated with walking independence at discharge, even after adjusting for covariates (P < .01). The area under the receiver operating characteristic curve was 0.82, and the cutoff value of the vitality index at admission was 6.5 points (sensitivity, 78%; specificity, 83%). Our results suggest that the vitality index at admission can be used to predict walking independence in inpatients with hip fractures. In particular, the vitality index score ≥ 7 points at admission is a convenient index for predicting walking independence.
Dual antiplatelet therapy in GI-bleed patients with extensive coronary artery disease history: a systematic review
Authors: Onimisi Abdulrahim Abdulrashid , Yahya Abd-Alhadi Mohannad Jawad , Hussein Mahmoud Hussein Attia , Sarwar Ayesha , Akram Anum , Alvarado Walter Jauregui , Sadik Olamide , Kesireddy Srija Reddy , Mumtaz Hassan
Published: December 2024

Introduction:

Extensive coronary artery disease whether at initial presentation or after percutaneous coronary intervention (PCI), involves the use of dual antiplatelet therapy (DAPT) as a very significant therapeutic option. There are many reasons why clinicians should weigh the risks of bleeding and cardiovascular thrombosis when deciding whether to maintain or discontinue DAPT in such patients.

Methods:

This comprehensive review systematically analysed via electronic databases, a total of 39 papers most of which were on countries in Southeast Asia. The focus was on randomized control designs (RCTs) & observational studies.

Results and discussion:

Percutaneous coronary intervention (PCI) with drug eluting stents (DES) was the most common method of treating acute coronary syndrome. The study found more independent predictors of gastrointestinal bleeding in young and elderly patients from Southeast Asia. The precise DAPT score was more readily used among various bleeding risk prediction models for patients on antiplatelet therapy.

Conclusion:

The use of DAPT in the setting of the gastrointestinal bleeding risk in patients with coronary artery disease has been studied extensively, but there are still no clearly defined strategies and very definite answers to the risk of bleeding versus cardiac event envisaged during the management of an extensive acute coronary disease mostly in southeast Asia. More studies using good study designs and statistics and establishing clinical prediction rules, are needed to fill this knowledge gap most especially in Southeast Asia and Middle East.
Cystic parathyroid lesion: case report of rare entity
Authors: Princi Pietro , Di Fede Ludovica , Tempera Serena Elisa , Salvi Giulia , De Ninno Maria , Veleno Miriam , Nigro Casimiro
Published: December 2024

Introduction and importance:

Parathyroid cysts are rarely encountered in neck surgery and often misdiagnosed. We review the case incidence and treatment of parathyroid cystic lesions among all neck procedure in two single institutions operated on by a single surgeon.

Case presentation:

We report two female patients presenting with neck swallowing, dysphagia, choking and occasional dysphonia. Ultrasound US (ultrasound) imaging revealed two neck masses of 66 × 44 mm and 44 × 25 × 23 mm; serum iPTH (intact Parathyroid Hormone) levels were 238 and 699 ng/mL respectively and sestamibi scintiscan results were negative for both masses. Intra-cystic fluid evaluation of PTH showed elevated value (>5000 ng/ml). Both patients underwent parathyroidectomy along with total thyroidectomy and thyroid lobectomy. Post-operatively I-PTH and serum calcium levels became normal. Final histology confirmed a benign parathyroid cystic adenoma with concomitant benign thyroid disease.

Clinical discussion:

Parathyroid cyst is of rare entity and a diagnostic challenge.

Conclusions:

This case report demonstrates that fine needle aspiration (FNA) fluid with intra-cystic parathyroid analysis shows to be fundamental and supports surgery for hyperparathyroidism resolution.
Successful management of an unusual case of pediatric inflammatory myofibroblastic tumor: a case report and literature review
Authors: Amro Alhareth M. , Almassri Tabarak , Albandak Maram , Elqadi Mohammad , Bannoura Sami , Asafrah Anas A. , Abu Asbeh Yousef
Published: December 2024

Introduction and importance:

Inflammatory myofibroblastic tumor (IMT) is a rare neoplastic condition that primarily affects children and young adults. This case report highlights the challenges in diagnosing and treating pediatric IMT, emphasizing the importance of tailored interventions.

Case presentation:

An 8-year-old boy presented with respiratory symptoms and was diagnosed with an IMT located in the left main bronchus. Imaging studies revealed a soft tissue mass and lymph node enlargement. Bronchoscopy and biopsy confirmed the diagnosis. The patient underwent bronchoscopic debulking procedures followed by lobectomy and bronchoplasty due to persistent disease.

Clinical discussion:

IMTs pose diagnostic challenges due to their varied clinical presentation and similarities with other neoplasms. A multidisciplinary approach involving pathologists, radiologists, and surgeons is crucial for accurate diagnosis and optimal treatment planning. The pathogenesis of IMTs is not fully understood, but theories suggest an inflammatory response or involvement of the ALK gene. IMTs can affect various organs, each with distinct symptoms. Imaging modalities lack specificity, emphasizing the importance of histopathological examination.

Conclusion:

IMTs require individualized treatment approaches based on the location and extent of the tumor. Long-term follow-up is essential for monitoring recurrence and metastasis. Further research is needed to enhance our understanding of IMT biology and develop targeted therapies to improve patient outcomes. This case report underscores the importance of tailored interventions in pediatric IMT cases and highlights the challenges in diagnosis and treatment.
The health effects of poor air quality
Authors: Bingham Karilee W.
Published: December 2024

Smoke, particularly from wildfires and other combustion sources, is a significant contributor to air pollution, comprising a complex mixture of particulate matter and gaseous pollutants. Prolonged exposure to smoke can exacerbate respiratory diseases, such as asthma and chronic obstructive pulmonary disease, leading to increased ED visits and hospitalizations. This article examines the significant health risks associated with air pollution, particularly chronic diseases and acute respiratory conditions, and discusses the emergency treatment of acute respiratory distress from exposure.
Enhancing primary healthcare in under-resourced communities with mobile health clinics
Authors: David Marjory , Charles Marie Lourdes
Published: December 2024

Mobile health clinics (MHCs) have the potential to enhance primary care in low-resource communities. This article describes an initiative spearheaded by public health nurses that utilized MHCs to provide affordable, equitable, and culturally appropriate primary healthcare services to a rural community in Haiti.
Nurse stress relief
Authors: Noel Stacy A. , Sarik Danielle Altares , Collins Michelle
Published: December 2024

Purpose:

To investigate and assess the effects of Healing Touch (HT) level-one education and training and the 21-day practice of the self-chakra connection technique on the perceived stress levels of nurses at a large healthcare system located in the Mid-Atlantic US region.

Methods:

This study used a mixed-methods design to collect quantitative and qualitative data via pre- and post-intervention surveys with Cohen's Perceived Stress Scale and post-open-ended questions. Data were analyzed using descriptive and correlational statistics.

Results:

In this pilot study of 58 nurses who participated in HT classes, 34 nurses completed the presurvey and 22 completed both pre- and post-surveys. Results revealed a 3.8-point mean decrease in perceived stress scores, with participants reporting improved stress management, increased confidence, and better work preparedness. However, statistical significance was not achieved due to low post-survey completion rates.

Conclusion:

Nurses who received HT training and practiced the self-chakra connection technique as part of their self-care reported decreased perceived stress levels, supporting the use of HT as a potentially effective approach to stress reduction among nurses.
Essential guide to epidural analgesia for nurses
Authors: Sawhney Monakshi , Martinez-Rivera Emily
Published: December 2024

Epidural analgesia is an effective way to manage pain for labor and delivery, surgery, trauma, cancer, and neuropathic pain. It involves the administration of local anesthetics and/or opioids into the epidural space. To ensure its efficacy and safety, nurses must understand the basic anatomy and pharmacology of epidural analgesia, considerations when monitoring patients, and identify its adverse reactions.
Embracing practice innovation
Authors: Makic Mary Beth Flynn , Dailey-Vail Jennifer , Armstrong Gail , Rosenthal Laura
Published: December 2024

This article explores the synergistic relationship between evidence-based practice (EBP) and quality improvement (QI) methods in nursing, highlighting their potential to enhance patient outcomes and foster practice change. By identifying clinical gaps and employing a structured approach to integrate EBP and QI, nurses can effectively implement best practices tailored to evolving healthcare needs. Ultimately, this article provides a comprehensive framework for nurses to leverage EBP and QI collaboratively, thereby advancing nursing practice and improving patient care.
Family Presence at the PICU Bedside and Pediatric Patient Delirium: Retrospective Analysis of a Single-Center Cohort, 2014–2017
Authors: Smith Mallory B. , Killien Elizabeth Y. , Watson R. Scott , Dervan Leslie A.
Published: December 2024

Objectives:

To examine the association between family presence at the PICU bedside and daily positive delirium screening scores.

Design:

Retrospective cohort study.

Setting:

Tertiary children’s hospital PICU.

Subjects:

Children younger than 18 years old with PICU length of stay greater than 36 hours enrolled in the Seattle Children’s Hospital Outcomes Assessment Program from 2014 to 2017.

Interventions:

None.

Measurements and Main Results:

In the dataset, delirium screening had been performed bid using the Cornell Assessment of Pediatric Delirium, with scores greater than or equal to 9 classified as positive. Family presence was documented every 2 hours. Among 224 patients, 55% (n = 124/224) had positive delirium screening on 44% (n = 408/930) of PICU days. Family presence at the bedside during PICU stay (< 90% compared with ≥ 90%) was associated with higher proportion of ever (as opposed to never) being screened positive for delirium (26/37 vs. 98/187; difference, 17.9% [95% CI, 0.4–32.1%]; p = 0.046). On univariate analysis, each additional decile of increasing family presence was associated with lower odds of positive delirium screening on the same day (odds ratio [OR], 0.87 [95% CI, 0.77–0.97]) and subsequent day (OR, 0.84 [95% CI, 0.75–0.94]). On multivariable analysis after adjustments, including baseline Pediatric Cerebral Performance Category (PCPC), higher family presence was associated with lower odds of subsequent-day positive delirium screening (OR, 0.89 [95% CI, 0.81–0.98]). Among patients with PCPC less than or equal to 2, each additional decile of increasing family presence was independently associated with lower odds of both same-day (OR, 0.90 [95% CI, 0.81–0.99]) and subsequent-day (OR, 0.85 [95% CI, 0.76–0.95]) positive delirium screening.

Conclusions:

In our 2014–2017 retrospective cohort, greater family presence was associated with lower odds of delirium in PICU patients. Family presence is a modifiable factor that may mitigate the burden of pediatric delirium, and future studies should explore barriers and facilitators of family presence in the PICU.
Challenges and Supports for Implementing Health Equity During National Accreditation Among Small Local Health Departments in the United States
Authors: Crenshaw Andrew N. , Allen Peg , Fifolt Matthew , Lang Britt , Belflower Thomas Amy , Erwin Paul C. , Brownson Ross C.
Published: December 2024

Objective:

This article focuses on supports and challenges to health equity that small local health departments (LHDs) experienced while working toward national reaccreditation or Pathways Recognition with the Public Health Accreditation Board’s Standards & Measures Version 2022 (PHAB S&M v2022).

Design:

The study team conducted 22 qualitative interview sessions with members of health department leadership teams.

Setting:

In the spring of 2024, participants from 4 small LHDs in the western and midwestern regions of the United States participated in individual remote interview sessions.

Participants:

Participants were members of leadership teams in LHDs with population jurisdictions less than 50 000.

Main Outcome Measure(s):

Common challenges relating to the health equity measures in the PHAB S&M v2022 included external influences on equity language; lack of small population data; and racially and ethnically homogeneous populations and staff. The main support was the national equity standards provided justification for pursuing equity work.

Results:

Strategies to overcome challenges associated with the equity measures included staff training, seeking alternative equity language, and examining socioeconomic inequities in addition to race and ethnicity. Internal workforce understanding of health equity was improved through department-wide training initiatives. When working under restrictive language requirements for state agencies, grants, and other funding sources, staff suggested using alternative phrases and keywords such as level playing field and equal access. When addressing racially and ethnically homogenous populations, staff pursued equity in terms of income and focused on those living with pre-existing conditions (ie, diabetes).

Conclusions:

Ensuring that LHDs can work toward health equity is crucial for reducing health inequities. While the equity focus of PHAB S&M v2022 proved challenging, for this selection of LHDs, participants affirmed that PHAB accreditation allowed them to solidify their equity work to better serve their communities.
Associations of Maternal Salivary Cortisol and Psychological Symptoms With Human Milk’s Microbiome Composition
Authors: Deflorin Nadia , Ehlert Ulrike , Amiel Castro Rita T.
Published: December 2024

Objective

Human milk (HM) is considered the best source of infant nutrition with many benefits for the infant. However, pregnancy changes can lead to increased stress in some women, which might affect HM composition. Although studies have demonstrated a link between maternal psychopathology and child development, it remains unclear how maternal psychobiological changes can be intergenerationally transmitted. We aimed to investigate the associations of maternal stress, depressive symptoms, and anxiety symptoms with the HM microbiome; to analyze these parameters in relation to HM glucocorticoid concentrations; and to explore the influence of HM glucocorticoids on HM bacterial composition.

Methods

One hundred women completed psychological questionnaires (e.g., EPDS, STAI, GAS) at 34–36 weeks’ gestation and in the early postpartum period and provided saliva at 34–36 and 38 weeks’ gestation. HM samples were collected in the early postpartum. Microbiota were analyzed using 16S rRNA amplicon sequencing.

Results

Birth anxiety was negatively correlated with Alphaproteobacteria (τ = −0.20, FDR = 0.01), whereas in the postpartum period, anxiety symptoms were negatively correlated with different taxa. The sum of postpartum-related symptoms was linked to lower Propionibacteriales. Salivary cortisol AUCg at 34–36 weeks was negatively correlated with Stenotrophomonas (τ = −0.24, FDR = 0.05), whereas HM cortisol was positively correlated with Streptococcus mitis (τ = 0.26, FDR = 0.03) and Gemella haemolysans (τ = 0.24, FDR = 0.02). No associations emerged between psychobiological parameters and HM glucocorticoids.

Conclusions

Higher perinatal psychological symptoms and prenatal salivary cortisol AUCg were associated with lower relative abundances of different bacteria, whereas higher HM cortisol was linked to higher Gemella and Streptococcus. These findings suggest a negative association between high maternal psychobiological symptoms and relative abundances of the milk microbiota.
Psychosocial Problems at Preschool Age and Cardiometabolic Health Profile at Preadolescence
Authors: Ivanova Hristiyanna I. , de Rooij Susanne R. , Hutten Barbara A. , Vrijkotte Tanja G.M.
Published: December 2024

Objective

Evidence suggests that children with psychosocial problems face a higher risk of cardiometabolic diseases in adulthood. However, this may already be evident prior to adulthood. In this study, the associations between psychosocial problems at preschool age and cardiometabolic outcomes 6 years later were investigated.

Methods

Data from 936 participants from the Amsterdam Born Children and their Development (ABCD) study was used. Psychosocial problems were assessed using the Strengths & Difficulties Questionnaire (SDQ) when the children were 5–6 years old, reported by both mothers and teachers. Cardiometabolic parameters, including body mass index, waist circumference, total cholesterol, triglycerides, high- and low-density lipoprotein cholesterol, fasting glucose, systolic and diastolic blood pressure, and carotid intima-media thickness were subsequently measured at ages 11–12 years. The associations between psychosocial problems and cardiometabolic outcomes were assessed using multivariable linear and logistic regression models.

Results

In model 1, adjusted for age, sex, and puberty status, and in model 2, for sociodemographic and biological predisposition factors, the combined mother-teacher score yielded a positive association with clustered cardiometabolic score (b = 0.05, 95% confidence interval = 0.03–0.10) 6 years later. Adjusting for lifestyle factors rendered this association nonsignificant. Significant associations between mother-reported SDQ scores and most cardiometabolic parameters, except for triglycerides, diminished after controlling for confounders. Children with higher total SDQ score (by mother) had 1.31 times higher odds of developing metabolic syndrome (95% confidence interval = 1.05–1.62).

Conclusion

This study established a small inverse association between mother-reported psychosocial problems at ages 5–6 years and cardiometabolic health profile at ages 11–12 years.
Health inequalities in respiratory tract infections – beyond COVID-19
Authors: Ulanova Marina
Published: December 2024

Purpose of review

To discuss recent findings on the global burden of respiratory tract infections in underprivileged populations, highlighting the critical role of socioeconomic factors in the incidence and severity of these diseases, with a particular focus on health disparities affecting Indigenous communities.

Recent findings

Pulmonary tuberculosis and lower respiratory tract infections, particularly those caused by Streptococcus pneumoniae and respiratory syncytial virus (RSV), continue to disproportionally impact populations in low-income countries and Indigenous communities worldwide. Indigenous children <5 years old bear the highest global burden of RSV infection, reflecting persistent social inequalities between Indigenous and non-Indigenous populations. Repeated episodes of acute pneumonia during childhood significantly contribute to the high prevalence of chronic respiratory diseases among Indigenous populations. The widespread occurrence of bronchiectasis in these communities is closely linked to adverse socioeconomic conditions.

Significant disparities in the incidence and severity of lower respiratory tract infections between affluent and impoverished populations are driven by socioeconomic inequalities. Vaccinating vulnerable population groups with newly developed vaccines has the potential to prevent infections caused by pathogens such as S. pneumoniae and RSV. However, global access to these vaccines and monoclonal antibodies remains limited due to their high costs.
Role of intrauterine instillation of autologous platelet-rich plasma in prevention of intrauterine adhesions following surgical abortion: An interventional randomized controlled trial
Authors: Singh Akanksha , Jha Sangam , Das Bankim
Published: December 2024

Objective:

The incidence of intrauterine adhesions (IUA) following surgical abortion is reportedly approximately 19%. It is associated with adverse reproductive outcomes. Therefore, there has been a search for preventive modalities that can facilitate endometrial regeneration and decrease the disease burden. This study aimed to estimate the incidence of IUAs after surgical abortion following intrauterine infusion of autologous platelet-rich plasma using the American fertility society (AFS) scoring system through hysteroscopy

Methods

A randomized controlled trial was conducted, and all women, aged 18-45 years, with a period of gestation (POG) <20 weeks who underwent surgical abortion were included in the study. The participants were randomized into two groups (33 in each); the intervention group received surgical abortion + PRP instillation and the control group underwent surgical abortion. All participants underwent follow-up hysteroscopy at 8 weeks to assess for the occurrence of IUA. The IUA was scored according to AFS scoring.

Results

The demographic and clinical characteristics of the study population were similar between the groups. The mean age was 28.09 ± 5.329 years and 26.94 ± 4.092 years in the intervention and control group, respectively. The mean adhesion score was significantly higher in the control group than in the intervention group (1.87 ± 2.71 vs. 0.43 ± 1.28; P=0.01). The overall incidence of IUAs was 29.3% and 10% (P=0.007) in the control and intervention group, respectively. Multivariate logistic regression analysis showed that POG >12 weeks (odds ratio [OR]=8.5), prior abortions >2 (OR=5.3), and prior suction-evacuation (OR=2.15) were significantly associated with the development of IUA. A predictive model was constructed using various risk factors with good sensitivity (79%) and specificity (88.2%) for identifying women at risk of developing IUA.

Conclusion

PRP instillation after surgical abortion reduced the primary incidence of IUA.
Diversity in crisis: The impact of race and ethnicity on failure to rescue among geriatric trauma patients over the years
Authors: Huang Raymond , Hejazi Omar , Khurshid Muhammad Haris , Nelson Adam , Stewart Collin , Anand Tanya , Matthews Marc R. , Okosun Stanley E. , Magnotti Louis J. , Joseph Bellal
Published: December 2024

BACKGROUND

Failure to rescue (FTR) is an indicator of the quality of care provided by trauma centers. The aim of this study was to examine the trends of FTR incidence in geriatric trauma patients over the years and to determine whether race, ethnicity, and sex impact the FTR incidence.

METHODS

This is a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database over 4 years (2017–2020). All geriatric (≥60 years) trauma patients were included. Patients who died within 24 hours of admission or whose length of stay was ≤1 day were excluded. Trend analysis was performed. Patients were stratified based on race, ethnicity, and sex, and multivariable regression analyses were performed.

RESULTS

Over the course of 4 years, 1,105,651 geriatric patients were identified, of whom 30,984 (2.8%) developed major complications and 10,684 (34.5% of those with complications) had FTR. The mean (SD) age was 75 (9) years, 46% were male, 86% were White, and 6% were Hispanic. The median (interquartile range) Injury Severity Score was 9 (4–10) with no change over the years (p = 0.364) and 96.8% sustained a blunt injury. Over the 4 years, the rate of FTR increased from 0.55% in 2017 to 1.04% in 2020 (p < 0.001). An analysis of trends in FTR patients revealed no significant difference in the proportion of males and females over the years (p = 0.482). However, there was a notable increase in the proportion of Black and Hispanic patients in comparison with White (p < 0.001) and non-Hispanic patients (p = 0.023), respectively. The odds of developing FTR have been increasing over the years, with Black race and Hispanic ethnicity identified as the independent risk factors for FTR.

CONCLUSION

The risk-adjusted odds of developing FTR have been increasing over the years, with one in every three patients who developed complications not surviving to discharge. Our findings demonstrate that racial and ethnic factors significantly impact the incidence of FTR.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III
The impact of taxonomic family and supplemental zinc on minimum inhibitory concentration against carbapenem antibiotics among bacteria expressing IMP metallo-beta-lactamase
Authors: Grooters Susan Vaughn , Mollenkopf Dixie F. , Ballash Gregory A , Wittum Thomas E
Published: December 2024

2. Abstract

Antibiotic-resistant infections cause an estimated 2.8 million illnesses and 35,900 deaths annually in the US. Carbapenems are a class of antibiotics that are generally reserved to treat life-threatening invasive infections including sepsis. Accurate diagnosis of carbapenem-resistant infections is critical for early and appropriate treatment. blaIMP encodes bacterial production of the IMP metallo-beta-lactamase (MBL) which can confer resistance to all the beta-lactams including carbapenems. Zinc is an essential co-factor in the IMP MBL enzymatic hydrolysis of carbapenems. Tests for the presence of IMP carbapenemase, such as the Carba NP, include zinc-sulfate (ZnSO4) although broth dilution methods for determining minimum inhibitory concentration (MIC) for carbapenems do not. We hypothesized that ZnSO4 availability would improve the accuracy of carbapenem MIC determination for Enterobacterales expressing blaIMP. Thus, the objective of this study was to determine if supplemental ZnSO4 affects the carbapenem MICs of Enterobacterales and other bacteria expressing blaIMP. Isolates utilized for this study were originally recovered from environmental samples collected at farms, wastewater treatment plants, and from surface water. They were selected based on phenotypic non-susceptibility to carbapenems and genetic confirmation of bacterial carriage of blaIMP. Cation-adjusted Mueller-Hinton broth suspensions of each isolate standardized to a 0.5 MacFarland standard were tested with and without ZnSO4 at 0.1 mmol/L concentration to determine MICs using standard extended-spectrum beta-lactamase micro-broth dilution MIC panels. Although we observed that Morganellaceae imipenem MICs were higher (P < 0.001) than those from other Enterobacterales harboring blaIMP, the inclusion of supplemental ZnSO4 did not influence carbapenem MIC. Additional research will be required to identify important factors that may influence the expression of carbapenemase including IMP, and the accurate determination of clinical MICs which is critical to appropriate therapeutic decision-making.
Investigating the presence of hypervirulent carbapenemase-producing Klebsiella  pneumoniae, through three phenotypic tests, in the Maltese islands

Authors: Fenech Kamel El Din Jasmine , Haider Julie , Zahra Graziella , Moore John
Published: December 2024

Hypervirulence and multi-drug resistance are two separate qualities of Klebsiella pneumoniae that  have posed a public health threat in separate strains for decades now. The convergence of these two phenotypes into singular strains of Klebsiella pneumoniae have created a super bug, causing both severe infections in the young and healthy and having limited antibiotic treatment available against them. These strains were first discovered in Asia in 2013 but are now emerging all around the globe.  In this study, hypervirulence was assessed in 493 known carabapenemase-producing Klebsiella  pneumoniae strains isolated and cryopreserved between 2019 and 2021 from various specimen types  from health institutions around the Maltese islands. Three phenotypic tests were used, namely, the  string test for hypermucoviscosity, lateral flow assays for the identification of K1 and K2 capsular  serotypes, and quantification of siderophore production. Since the latter test was the one that was  known to be the most significant for the detection of hypervirulence, and none of the strains surpassed  the set limit of a concentration of 30µg/ml, none of the 493 assayed strains were deemed  hypervirulent. Hypermucoviscous, K1 and K2 capsular serotype belonging strains were found,  though, so much so that a statistically significant relationship was found between  hypermucoviscosity and capsular serotype. Other statistical tests carried out exploring the  relationship between hypermucoviscosity and siderophore concentration and hypermucoviscosity  and type of carabapenemase gene were not found to be statistically significant. According to this 
research, hypervirulent carabapenemase-producing Klebsiella pneumoniae strains have not yet  arrived in the Maltese archipelago.
SENSITIVITY OF MEDIAL/LATERAL BALANCE CONTROL TO VISUAL DISTURBANCES WHILE WALKING IN YOUNG AND OLDER ADULTS
Authors: DiBianca Stephen J. , Reimann Hendrik , Gray Julia , Peterka Robert J. , Jeka John J.
Published: December 2024

Humans integrate multiple sources of sensory information to estimate body orientation in space. Balance control experiments while standing provide evidence that the contributions of these sensory channels change under different conditions in a process called sensory reweighting. This study aims to address whether there is evidence for sensory reweighting while walking and explores age-related differences in medial/lateral balance control under visually perturbing walking conditions. Thirty young adults (18–35 years) and thirty older adults (55–79 years) walked on a self-paced treadmill within a virtual environment that delivered frontal plane multi-sine visual disturbances at three amplitudes (6°, 10°, and 15°). Frequency response functions were used to quantify visual sensitivity to balance disturbances, while spatiotemporal gait parameters (e.g., step width, step-width variability) were measured to assess balance control. Visual sensitivity decreased in both populations with increasing stimulus amplitude, analogous to the sensory reweighting hypothesis in balance control while standing. Despite the decrease in visual sensitivity, the compensatory upweighting of other sensory systems was not observed through measurements of remnant sway. Older adults exhibited higher visual sensitivity at all amplitudes compared to young adults, indicating a more sensitive response to visual disturbances to balance control. Both groups showed increases in step width and step width variability with higher visual amplitudes, with older adults demonstrating more pronounced effects. Weak correlations existed between changes in visual sensitivity and changes in step width and step width variability suggesting a limited interaction between sensory reweighting and gait stability.
IgA displays site- and subclass-specific glycoform differences despite equal glycoenzyme expression
Authors: Falck David , Sokolova Maria V. , Koeleman Carolien A.M. , Irumva Vanessa , Kirchner Philipp , Schulz Sebastian R. , Schmidt Katja G. , Harrer Thomas , Ekici Arif B. , Spriewald Bernd , Schett Georg , Wuhrer Manfred , Herrmann Martin , Steffen Ulrike
Published: December 2024

Background

Glycosylation is an important posttranslational modification of proteins and in most cases indispensable for proper protein function. Like most soluble proteins, IgA, the second most prevalent antibody in human serum, contains several N- and O-glycosylation sites. While for IgG the impact of Fc glycosylation on effector functions and inflammatory potential has been intensively studied, only little is known for IgA. In addition, only glimpses exist regarding the regulation of IgA glycosylation. We have previously shown that IgA1 and IgA2 differ functionally and also show differences in their glycosylation pattern. The more pro-inflammatory IgA2 which is linked to autoimmune diseases displays decreased sialylation, galactosylation, fucosylation and bisection as compared to IgA1. In the present study, we aimed to investigate these differences in glycosylation in detail and to explore the mechanisms underlying them.

Methods

IgA1 and IgA2 was isolated from serum of 12 healthy donors. Site specific glycosylation was analyzed by mass spectrometry. In addition, human bone marrow plasma cells were investigated using single cell mRNA sequencing, flow cytometry and ELISpot.

Results

We found that certain glycoforms greatly differ in their abundance between IgA1 and IgA2 while others are equally abundant. Overall, the IgA2 glycans displayed a more immature phenotype with a higher prevalence of oligomannose and fewer fully processed glycans. Of note, these differences can’t be explained by differences in the glycosylation enzyme machinery as mRNA sequencing and flow cytometry analysis showed equal enzyme expression in IgA1 and IgA2 producing plasma cells. ELISpot analysis suggested a slightly increased antibody production rate in IgA2 producing plasma cells which might contribute to its lower glycan processing rates. But this difference was only minor, suggesting that further factors such as steric accessibility determine glycan processing. This is supported by the fact that glycans at different positions on the same IgA chain differ dramatically in fucosylation, sialylation and bisection.

Conclusion

In summary, our detailed overview of IgA1 and IgA2 glycosylation shows a class, subclass, and site-specific glycosylation fingerprint, most likely due to structural differences of the protein backbones.
Is intron removal by recursive splicing necessitated by the evolution of genomic gigantism?
Authors: Adams Alexander Nichols , Mueller Rachel Lockridge
Published: December 2024

Splicing of introns is an important step that pre-mRNA transcripts undergo during processing in the nucleus to become mature mRNAs. Although long thought to occur in a single step, introns are now also known to be removed in multiple steps through a process called recursive splicing. This non-canonical form of splicing is hypothesized to increase splicing fidelity, particularly in longer introns. In species that have evolved gigantic genome sizes, overall intron lengths are much longer than in genomes of typical size. Using West African lungfish (Protopterus annectens; genome size ∼40Gb) as a model, we use total RNA-seq data to test the hypothesis that gigantic genomes have shifted to rely predominantly on recursive splicing to manage their long introns. Our results suggest levels of recursive splicing at conserved sites in the lungfish that are similar to those seen in humans, indicating that genome-wide intronic expansion accompanying genomic gigantism does not necessitate ubiquitous use of recursive splicing. However, in addition to these results, we also observed patterns of decreasing RNA-seq read depths across entire intron lengths and note that both canonical co-transcriptional splicing and stochastic recursive splicing using many random splice sites could produce this pattern. Thus, we infer canonical co-transcriptional splicing and/or stochastic recursive splicing – but not ubiquitous recursive splicing at conserved sites – manage the removal of long introns in gigantic genomes. We conclude that the vast increase in intron length in gigantic genomes does not appear to have coincided with a fundamental shift in splicing mechanisms.

Statement and Declarations

The authors declare no competing interests.