bluuebunny/crossref_metadata_2025 huggingface dataset:
Unmet need for gender-affirming care as a social determinant of mental health inequities for transgender youth in Aotearoa/New Zealand
Authors: Tan Kyle K H , Byrne Jack L , Treharne Gareth J , Veale Jaimie F
Published: December 2022

Background

Past studies have demonstrated better mental health and well-being among transgender youth who had accessed gender-affirming care. However, few existing studies have assessed unmet need for gender-affirming care as a social determinant of mental health inequities.

Methods

Data on unmet need for gender-affirming care, distress and suicidality were analysed from the 2018 Counting Ourselves nationwide community-based survey of transgender people in Aotearoa/New Zealand. Associations between unmet need for gender-affirming care and mental health indicators were tested for transgender youth within the sample (aged 14–26 years; n = 608; Mage = 20.5).

Results

Transgender youth reported unmet needs ranging from 42% for gender-affirming hormone to 100% for feminizing surgeries and voice surgeries. Overall unmet need for gender-affirming care was associated with worse mental health. Trans men with an unmet need for chest reconstruction (84%) scored an average of 7.13 points higher on the K10 Psychological Distress Scale relative to those whose need had been met. Participants reporting unmet need for hormones (42%) had twice the odds (adjusted odds ratios = 2.01; CI = 1.02–3.98) of having attempted suicide in the last 12 months.

Conclusions

Dismantling barriers to accessing gender-affirming care could play a crucial role in reducing mental health inequities faced by transgender youth.
Optimizing antibiotic use in culture-negative healthcare-associated infection with a ‘stop’ policy: a descriptive analytical study
Authors: Sathyan Sajina , Pournami Femitha , Prithvi Ajai Kumar , Nandakumar Anand , Prabhakar Jyothi , Jain Naveen
Published: December 2022

Background and objectives

Many sick neonates receive antibiotics for the clinical diagnosis of probable/possible sepsis. Reports suggest rampant antibiotic use in culture-negative sepsis. We introduced an antibiotic stop policy (ASP), by defining ‘completed course duration of antibiotics’ in the setting of culture-negative suspected healthcare-associated infection (HAI). Antibiotic overuse days (AOD) before antibiotic stop policy (BASP) and after antibiotic stop policy (AASP) were compared.

Methods

This descriptive analytical study was conducted to measure the change in AOD after implementing ASP in culture-negative HAI. We also sought to evaluate situations in which antibiotic overuse is likely (lower gestation, ventilation, central lines) and safety of the ASP, measured as not having to restart antibiotics in the week following completed course.

Results

A total of 126 neonates were initiated on a new antibiotic (started or changed) for suspected HAI. Of these, 43 were excluded. Patient days of 5175 and 5208 were analyzed in BASP and AASP, respectively. Implementation of an ASP reduced AOD (from 14.49 to 3.26 AOD per 1000 patient days; p value <0.01). Safety was ensured; the number of babies who had to be restarted on antibiotics within 1 week of stopping therapy was similar in both groups. All-cause mortality and relevant morbidities were comparable between groups.

Conclusions

A significant decrease in AOD after the introduction of an ASP was noted, in neonates with culture-negative suspected HAI. This difference was noted even in the most vulnerable extreme preterm babies and those requiring ventilation and central lines.
Prenatal Opioid Exposure and Neurodevelopmental Outcomes
Authors: Lee Jennifer J. , Saraiya Neeta , Kuzniewicz Michael W.
Published: December 2022

The opioid epidemic in the United States has resulted in a significant increase in opioid use disorder among pregnant women and a concomitant increase in the incidence of neonatal opioid withdrawal syndrome. The long-term consequences of prenatal opioid exposure on neurodevelopmental outcomes are not fully understood. Animal studies indicate increased neuronal apoptosis and decreased neuronal proliferation and myelination with opioid exposure in-utero. Meta-analyses of human studies suggest decreased cognition and psychomotor performance in infancy and deficits in cognition and language in preschool. However, current studies have primarily focused on heroin or methadone exposure and have been limited by small sample size, inadequate comparison groups, and the inability to account for additional risk factors and exposures such as polysubstance abuse, poor prenatal care, neonatal withdrawal and treatment with opioids, and unsupportive home environment. Future studies should aim to better understand the potential impact of these confounding factors on the neurodevelopmental trajectory of exposed infants. This review discusses the up-to-date literature, current gaps in knowledge, and considerations for future studies in the arena of prenatal opioid exposure and neurodevelopmental outcomes.
Long Stay and Frequent Readmission in the Pediatric Intensive Care in The Netherlands; 15-Year Time Trends
Authors: van de Riet Liz , Otten Marieke H. , van Karnebeek Clara D. , van Woensel Job B. M. ,   on behalf of the PICE study group
Published: December 2022

OBJECTIVES:

To describe time trends and the burden of long-stay patients (LSP) and frequent-readmission patients (FRP) in the PICUs in The Netherlands.

DESIGN:

Retrospective analysis of data from the nationwide Pediatric Intensive Care Evaluation registry including all PICU admissions in The Netherlands.

SETTING:

All PICUs in The Netherlands.

PATIENTS:

All PICU patients less than 18 years old admitted between 2003 and 2017. Two groups of patients were identified: LSP (admitted ≥30 d) and FRP (≥3 readmissions within the first year after their first admission).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 47,424 children were admitted on 59,759 occasions. LSP (3.3% of total cohort) and FRP (2.1%) accounted for 37.5% and 14.5% of cumulative admission days, respectively. Patients fulfilling both LSP and FRP criteria (0.6%) accounted for 9.9% of cumulative admission days. No significant time trends were observed between 2003 and 2017 for the number of LSP and FRP, nor for accounted cumulative admission days. Age and disease severity-adjusted mortality was significantly higher for LSP (odds ratio [OR], 2.16; 95% CI, 1.66–2.82; p < 0.001) and FRP OR 1.40 (95% CI, 0.97–2.01; p = 0.069) compared with the general PICU population. Overall PICU mortality decreased significantly between 2003 (6.5%) and 2017 (3.7%; p = 0.004), but remained constant over time for both LSP (17.2%) and FRP (6.3%).

CONCLUSIONS:

The proportion of LSP and FRP and their burden on PICU capacity are considerable and remained constant between 2003 and 2017. Whereas age and disease severity-adjusted mortality decreased in the general PICU population, it did not change in LSP and FRP.
Age and Comorbidities Predict COVID-19 Outcome, Regardless of Innate Immune Response Severity: A Single Institutional Cohort Study
Authors: Mohan Aditya A. , Olson Lyra B. , Naqvi Ibtehaj A. , Morrison Sarah A. , Kraft Bryan D. , Chen Lingye , Que Loretta G. , Ma Qing , Barkauskas Christina E. , Kirk Allan , Nair Smita K. , Sullenger Bruce A. , Kasotakis George
Published: December 2022

OBJECTIVES:

The COVID-19 pandemic has claimed over eight hundred thousand lives in the United States alone, with older individuals and those with comorbidities being at higher risk of severe disease and death. Although severe acute respiratory syndrome coronavirus 2–induced hyperinflammation is one of the mechanisms underlying the high mortality, the association between age and innate immune responses in COVID-19 mortality remains unclear.

DESIGN:

Flow cytometry of fresh blood and multiplexed inflammatory chemokine measurements of sera were performed on samples collected longitudinally from our cohort. Aggregate impact of comorbid conditions was calculated with the Charlson Comorbidity Index, and association between patient factors and outcomes was calculated via Cox proportional hazard analysis and repeated measures analysis of variance.

SETTING:

A cohort of severely ill COVID-19 patients requiring ICU admission was followed prospectively.

PATIENTS:

In total, 67 patients (46 male, age 59 ± 14 yr) were included in the study.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Mortality in our cohort was 41.8%. We identified older age (hazard ratio [HR] 1.09 [95% CI 1.07–1.11]; p = 0.001), higher comorbidity index (HR 1.24 [95% CI 1.14–1.35]; p = 0.039), and hyponatremia (HR 0.90 [95% CI 0.82–0.99]; p = 0.026) to each independently increase risk for death in COVID-19. We also found that neutrophilia (R = 0.2; p = 0.017), chemokine C-C motif ligand (CCL) 2 (R = 0.3; p = 0.043), and C-X-C motif chemokine ligand 9 (CXCL9) (R = 0.3; p = 0.050) were weakly but significantly correlated with mortality. Older age was associated with lower monocyte (R = –0.2; p = 0.006) and cluster of differentiation (CD) 16+ cell counts (R = –0.2; p = 0.002) and increased CCL11 concentration (R = 0.3; p = 0.050). Similarly, younger patients (< 65 yr) demonstrated a rise in CD4 (b-coefficient = 0.02; p = 0.036) and CD8 (0.01; p = 0.001) counts, as well as CCL20 (b-coefficient = 6.8; p = 0.036) during their ICU stay. This CD8 count rise was also associated with survival (b-coefficient = 0.01; p = 0.023).

CONCLUSIONS:

Age, comorbidities, and hyponatremia independently predict mortality in severe COVID-19. Neutrophilia and higher CCL2 and CXCL9 levels are also associated with higher mortality, while independent of age.
Catastrophic COVID-19 Delta Variant Surge in French West Indies: Report of an ICU Triage Policy*
Authors: Pommier Jean-David , Martino Frederic , Delamare Floran , Jarrige Bruno , Foucan Tania , Markowicz Samuel , Valette Marc , Demoule Alexandre , Camous Laurent
Published: December 2022

OBJECTIVES:

Here, we report the management of a catastrophic COVID-19 Delta variant surge, which overloaded ICU capacity, using crisis standards of care (CSC) based on a multiapproach protocol.

DESIGN:

Retrospective observational study.

SETTING:

University Hospital of Guadeloupe.

PATIENTS:

This study retrospectively included all patients who were hospitalized for COVID-19 pneumonia between August 11, 2021, and September 10, 2021, and were eligible for ICU admission.

Intervention:

Based on age, comorbidities, and disease severity, patients were assigned to three groups: Green (ICU admission as soon as possible), Orange (ICU admission after the admission of all patients in the Green group), and Red (no ICU admission).

MEASUREMENTS AND MAIN RESULTS:

Among the 328 patients eligible for ICU admission, 100 (30%) were assigned to the Green group, 116 (35%) to the Orange group, and 112 (34%) to the Red group. No patient in the Green group died while waiting for an ICU bed, whereas 14 patients (12%) in the Orange group died while waiting for an ICU bed. The 90-day mortality rates were 24%, 37%, and 78% in the Green, Orange, and Red groups, respectively. A total of 130 patients were transferred to the ICU, including 79 from the Green group, 51 from the Orange group, and none from the Red group. Multivariate analysis revealed that among patients admitted to the ICU, death was independently associated with a longer time between ICU referral and ICU admission, the Sequential Organ Failure Assessment score, and the number of comorbidities, but not with triage group.

CONCLUSIONS:

CSC based on a multiapproach protocol allowed admission of all patients with a good prognosis. Higher mortality was associated with late admission, rather than triage group.
A qualitative thematic analysis of mentorship for new psychiatric-mental health nurse practitioners
Authors: Fox Isadora , Champion Jane D.
Published: December 2022

Background:

A volume of literature reflects that mentorship is key in producing quality nurse practitioners. Mentoring leads to increased confidence, role clarity, and other benefits improving practice. However, there is little to no research focusing specifically on the impact of mentoring in psychiatric nurse mental health nurse practitioners (PMHNPs).

Purpose:

To explore process of acquiring mentorship and mentoring experiences of newly graduated PMHNPs, all of whom obtained their respective degrees partially or completely online. The study also seeks to describe perceptions of mentoring in PMHNP leaders.

Methods:

Nine new graduate PMHNPs and 10 PMHNP leaders were recruited from membership rosters of professional organizations in the Southwestern United States. Informants participated in semi-structured interviews with questions sourced from an interview guide. Interviews were conducted via videoconference or telephone from informants' homes. Data were coded via an in vivo approach and analyzed by thematic methods.

Results:

New graduates reported that mentoring was dependent on four themes: connectivity, educational stewardship, practice confidence, and luck. Mentor access via work, institutions, or schools was inconsistent. Leaders were concerned about limited educational and professional investment in mentorship because this process is an important component of professional development.

Conclusion:

Mentorship for new graduates is based on a variety of factors, some of which are out of their control. Lack of mentoring may affect practice, which affects patient care. Dialogue between educators, professionals, and organizations may improve mentoring stewardship.

Implications:

Enhanced communication between educational institutions and professional organizations to create a more fluid process from graduate to mentorship is needed.
Detection strategies for elevated lipoprotein(a): will implementation let the genie out of the bottle?
Authors: Loh Wann Jia , Watts Gerald F.
Published: December 2022

Purpose of review

Elevated Lp(a) level is an important causal risk factor for atherosclerotic cardiovascular disease (ASCVD), principally coronary artery disease. Selective testing for Lp(a) is highly recommended in patients at intermediate and high risk for ASCVD. Lp(a) levels are predominantly genetically determined, and this has implications for cascade testing.

Recent findings

Recent studies show that cascade testing is effective in identifying elevated Lp(a) in close relatives of probands with high Lp(a). Apart from selective testing and cascade testing as detection strategies, some recent guidelines recommend testing of Lp(a) in all adults at least once in their lifetime and various implementation strategies have been suggested.

Hyper-Lp(a) is an important global health problem that can be easily detected. Hyper-Lp(a) meets all the criteria for universal screening except that there is not yet supportive evidence from clinical interventional trials showing a reduction of ASCVD events. The cost-effectiveness of the various detection and implementation strategies need to be further evaluated.
Prediction of acute lung injury in severe acute pancreatitis by routine clinical data
Authors: Jia Mengyu , Xu Xiaorong , Zhou Shu , Liu Hua , Zhao Yan , Xu Yaping , Tang Maochun , Wu Deqing
Published: December 2022

Aim

Acute lung injury (ALI) is a common complication of severe acute pancreatitis (SAP) with a high mortality. Early prediction of patients at risk in initial stage can improve the long-term survival.

Methods

A total of 91 patients with SAP out of 1647 acute pancreatitis patients from January 2015 to December 2020 were considered. A predictive model for SAP-associated ALI was constructed based on the valuable risk factors identified from routine clinical characteristics and plasma biomarkers. The value of the model was evaluated and compared with Lung Injury Prediction Score (LIPS). A nomogram was built to visualize the model.

Results

Diabetes, oxygen supplementation, neutrophil count and D-dimer were found to be associated with ALI in SAP. The predictive model based on these factors had an area under the receiver operating characteristic curve [AUC: 0.88, 95% confidence interval (CI): 0.81–0.95], which was superior to LIPS (AUC: 0.71, 95% CI: 0.60–0.83), also with the higher sensitivity (65%) and specificity (96%) than LIPS (62%, 74%, respectively). Decision curve analysis of the model showed a higher net benefit than LIPS. Visualization by a nomogram facilitated the application of the model.

Conclusion

Diabetes, oxygen supplementation, neutrophil count and D-dimer were risk factors for SAP-associated ALI. The combination of these routine clinical data and the model visualization by a nomogram provided a simple and effective way in predicting ALI in the early phase of SAP.
Pharmacotherapeutic efficacy on noninvasive fibrosis progression in nonalcoholic fatty liver disease: a systematic review and network meta-analysis
Authors: Kovalic Alexander J. , Gozar Martin , Da Ben L. , Bernstein David , Satapathy Sanjaya K.
Published: December 2022

Background

Fibrosis impacts long-term outcomes among patients with nonalcoholic fatty liver disease (NAFLD). Due to well-documented flaws associated with liver biopsy, there has been a recent emphasis on prioritizing noninvasive testing over liver biopsy for the assessment of fibrosis.

Methods

A comprehensive systematic review and frequentist random effects network meta-analysis was performed among randomized controlled trials reporting pharmacologic intervention in NAFLD. The primary endpoint was the absolute change in liver stiffness measurement (LSM) via elastography. Secondary endpoints included changes in noninvasive serologic tests including APRI, fibrosis-4 index, NAFLD fibrosis score, enhanced liver fibrosis (ELF) and FibroTest (FibroSure in the USA).

Results

Forty-five randomized controlled trials enrolling 6932 patients were identified for this network meta-analysis. Across the primary endpoint, firsocostat, semaglutide, montelukast, cilofexor plus firsocostat, obeticholic acid and diacerein (change in LSM via vibration controlled transient elastography), in addition to lubiprostone and pemafibrate (change in LSM via magnetic resonance elastography) were found to be the most effective and statistically significant treatment interventions. Similarly, the following interventions were determined to be most effective as compared to placebo among secondary endpoints: saroglitazar, lubiprostone, and obeticholic acid (change in APRI); saroglitazar, semaglutide, firsocostat and cilofexor plus firsocostat (change in ELF); obeticholic acid and belapectin [change in FibroTest/FibroSure].

Conclusion

This is the first systematic review and network meta-analysis reporting pharmacologic efficacy in the progression of fibrosis based on noninvasive testing among patients with NAFLD. Semaglutide, obeticholic acid, firsocostat, cilofexor plus firsocostat and lubiprostone were found to be the most effective treatments based on their consistent efficacy reproduced across multiple endpoints, both via elastography and noninvasive blood tests.
DQA1*0102 DQB1*0602 haplotype distinguishes coeliac disease and its complications from gluten unrelated enteropathies
Authors: De Silvestri Annalisa , Schiepatti Annalisa , Fowler Bryce D , Badulli Carla , Belvisi Fabrizio , Cacciatore Rosalia , Pasi Annamaria , Zingone Fabiana , Goodwin John , Key Tim , Rej Anupam , Sanders David S , Biagi Federico
Published: December 2022

Background

Duodenal villous atrophy is due not only to coeliac disease and its complications but also to other rare enteropathies unrelated to gluten consumption, defined as noncoeliac enteropathies. The diagnosis of noncoeliac enteropathies remains challenging, and HLA typing has been widely used to exclude coeliac disease if DQ2 and DQ8 alleles are absent. However, the frequency of the various HLA alleles in noncoeliac enteropathies is still unknown.

Aims

To describe the HLA genetic profile of patients affected by noncoeliac enteropathies who have been evaluated at our centres between 2000 and 2021, and to investigate the diagnostic role of HLA typing.

Methods

Genomic DNA was collected from 44 Italian and 19 British adult patients with noncoeliac enteropathies. Patient genotypes were compared with those of healthy Italian and British populations obtained from HLA bone marrow donors’ banks. In addition, genotypes were also compared with those of patients with coeliac disease and complicated coeliac disease.

Results

Both in the Italian and in the British group, the DQA1*0102 DQB1*0602 haplotype and related alleles occurred significantly more frequently in patients with noncoeliac enteropathies compared to coeliac disease and complicated coeliac disease.

Conclusions

Together with negative HLA-DQ2 and DQ8 haplotypes, the DQA1*0102 DQB1*0602 haplotype can be used to guide the differential diagnosis between coeliac disease and noncoeliac enteropathies.
68Ga-DOTATATE PET/CT of ACTH-Independent Cushing Syndrome Due to Ectopic Adrenocortical Adenoma
Authors: Jiang Yuanyuan , Liu Qingxing , Zhu Zhaohui
Published: December 2022

Adrenocorticotropic hormone–independent Cushing syndrome due to ectopic adrenocortical adenoma is a very rare entity. We herein present a case of a 57-year-old woman who was referred to our hospital with persistent Cushing syndrome after undergoing unnecessary laparoscopic left adrenalectomy. 68Ga-DOTATATE PET/CT revealed increased uptake in the nodule in the right hilum, which was histologically confirmed to be ectopic adrenocortical adenoma. Removal of the tumor was followed by the disappearance of clinical symptoms of Cushing syndrome. In this case, 68Ga-DOTATATE PET/CT contributed to the diagnosis of ectopic adrenocortical adenoma.
99mTc-Pyrophosphate Scintigraphy Can Image Tracer Uptake in Skeletal Trunk Muscles of Transthyretin Cardiac Amyloidosis
Authors: Takahashi Koji , Hiratsuka Yoshiyasu , Sasaki Daisuke , Sakaue Tomoki , Enomoto Daijiro , Morioka Hiroe , Uemura Shigeki , Okura Takafumi , Ikeda Shuntaro , Kono Taizo , Iwamura Takaaki , Yamamura Nobuhisa , Kitazawa Sohei , Ueda Mitsuharu
Published: December 2022

Purpose

99mTc-pyrophosphate (99mTc-PYP) uptake in the skeletal muscles is minimal in patients with transthyretin cardiac amyloidosis (ATTR-CA) when assessed qualitatively and quantitatively. We previously demonstrated moderate- to high-grade 99mTc-PYP uptake in the subcutaneous abdominal fat of some patients with ATTR-CA and showed that this abnormal finding could reflect the regional amyloid burden of this tissue. We aimed to investigate the frequency of 99mTc-PYP uptake in skeletal trunk muscles of patients with ATTR-CA.

Methods

Chest- and abdomen-centered 99mTc-PYP scintigraphy images were obtained 2 hours after IV injections of the tracer (20 mCi) in 36 patients with ATTR-CA. The frequency of 99mTc-PYP uptake in the following 11 skeletal trunk muscles was investigated: pectoralis major, deltoid, subscapularis, infraspinatus, trapezius, latissimus dorsi, erector spinae, psoas major, abdominal oblique, rectus abdominis, and the gluteus muscles.

Results

Ten of the 11 muscles were involved in patients with the highest number of 99mTc-PYP uptake in the skeletal trunk muscles examined, whereas no muscle was involved in a patient with the least uptake. The muscle with the highest rate of 99mTc-PYP uptake, observed in 34 of 36 patients (94.4%), was the abdominal oblique. No tracer uptake was observed in the psoas major. The frequency of radiotracer uptake in the remaining examined muscles was between those of abdominal oblique and psoas major muscles.

Conclusions

Radiotracer uptake was often detectable in some skeletal trunk muscles of ATTR-CA, although the muscles of patients examined and the skeletal trunk muscles of 1 patient showed heterogeneity in the uptake of 99mTc-PYP.
Process of Hard Palate Osteonecrosis Demonstrated on Serial 18F-FDG PET/CT Scans
Authors: Song Le , Li Hui , Zhang Weifang
Published: December 2022

Osteonecrosis of the hard palate is rare. Here, we demonstrated the dynamic metabolic and structural changes during the process of osteonecrosis of the hard palate by serial 18F-FDG PET/CT scans in a patient with nasal NK/T-cell lymphoma. On the baseline scan, increased FDG uptake in the periphery of the hard palate could be observed. On the following scans after treatment, a focal metabolic defect on the hard palate with no structural changes and with bone sequestration and perforation have been observed successively. Our case indicates that the metabolic defect on 18F-FDG PET/CT may be an early sign of osteonecrosis.
Epidermal Cyst Mimicking Thyroid Cancer Metastasis
Authors: Luo Lingling , Xia Junyong , Bian Qianyu , Xiao Linlin , Yao Xiaobo
Published: December 2022

A 26-year-old woman with pulmonary metastasis of thyroid cancer underwent a total thyroidectomy and cervical lymph node dissection followed by 2 courses of 131I therapy. The posttherapeutic whole-body scan after the second dose of 131I therapy showed diffuse tracer uptake in both lungs. Besides this, there is a local abnormal radiotracer uptake in the left axillary region. SPECT/CT images localized this abnormal radioactivity in a subcutaneous, oval-shaped, approximately 2.2-cm slightly hyperdense lesion, which was pathologically confirmed as an epidermal cyst.
68Ga-FAPI PET/CT in a Patient With Statin-Induced Rhabdomyolysis
Authors: Liu Ya , Guo Chunmei , Chen Liming , Huang Zhanwen
Published: December 2022

Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of muscle cell contents into blood circulation. There is ample clinical evidence that it is one of the adverse effects of statins. 68Ga-FAPI PET/CT was performed on a 78-year-old man with newly diagnosed with mediastinal tumor and statin-induced rhabdomyolysis. 68Ga-FAPI PET/CT showed symmetrical and diffuse increased FAPI uptake in whole-body muscles. Our case indicated that 68Ga-FAPI PET/CT might be valuable in the evaluation of patients with rhabdomyolysis.
Histological Validation of FDG and PSMA-Targeted PET/CT Imaging in a Rare Tracheal Adenoid Cystic Carcinoma
Authors: Sandach Patrick , Seifert Robert , Slama Alexis , Theegarten Dirk , Hautzel Hubertus
Published: December 2022

Adenoid cystic carcinomas are the second most common entity of tracheal malignancies, which have an overall incidence as low as only 0.2 in 100,000 persons per year. We present the case of a 64-year-old man with a histologically confirmed adenoid cystic carcinoma who sequentially underwent 18F-FDG PET/CT and 68Ga-PSMA-11 PET/CT within 1 day for staging 3 days before surgical resection of the tumor. Immunohistochemistry revealed PSMA expression of the tumor corroborating the PSMA PET findings.
18F-FDG PET/CT in Primary Mesothelioma of the Liver
Authors: Pernthaler Birgit , Brcic Luka , Aigner Reingard Maria , Fuchsjäger Michael , Talakic Emina
Published: December 2022

Primary malignant mesothelioma is a rarity among malignant liver tumors. We present the case of a 48-year-old woman presenting with increasing upper abdominal discomfort and inappetence accompanied by a weight loss of approximately 10 kg. CT and MRI revealed a highly suspicious mass lesion in the liver. 18F-FDG PET/CT performed for staging showed a pathological 18F-FDG uptake of the known liver tumor. Histology and immunohistochemistry indicated mesothelioma of the liver. Herein we present a rare case of primary mesothelioma in the liver with CT, MRI, and 18F-FDG PET/CT.
First Report With Medium-term Follow-up of Intestinal Transplantation for Advanced and Recurrent Nonresectable Pseudomyxoma Peritonei
Authors: Reddy Srikanth , Punjala Sai Rithin , Allan Philip , Vaidya Anil , Borle Deeplaxmi P. , Geiele Henk , Udupa Venkatesha , Smith Alison , Vokes Lisa , Vrakas Georgios , Mohamed Faheez , Dayal Sanjeev , Moran Brendan , Friend Peter J. , Cecil Tom
Published: December 2022

Objective:

To report our experience with the combination of radical surgical excision and intestinal transplantation in patients with recurrent pseudomyxoma peritonei (PMP) not amenable to further cytoreductive surgery (CRS).

Background:

CRS and heated intraoperative peritoneal chemotherapy are effective treatments for many patients with PMP. In patients with extensive small bowel involvement or nonresectable recurrence, disease progression results in small bowel obstruction, nutritional failure, and fistulation, with resulting abdominal wall failure.

Methods:

Between 2013 and 2022, patients with PMP who had a nutritional failure and were not suitable for further CRS underwent radical debulking and intestinal transplantation at our centre.

Results:

Fifteen patients underwent radical exenteration of affected intra-abdominal organs and transplantation adapted according to the individual case. Eight patients had isolated small bowel transplantation and 7 patients underwent modified multivisceral transplantation. In addition, in 7 patients with significant abdominal wall tumor involvement, a full-thickness vascularized abdominal wall transplant was performed. Two of the 15 patients died within 90 days due to surgically related complications. Actuarial 1-year and 5-year patient survivals were 79% and 55%, respectively. The majority of the patients had significant improvement in quality of life after transplantation. Progression/recurrence of disease was detected in 91% of patients followed up for more than 6 months.

Conclusion:

Intestinal/multivisceral transplantation enables a more radical approach to the management of PMP than can be achieved with conventional surgical methods and is suitable for patients for whom there is no conventional surgical option. This complex surgical intervention requires the combined skills of both peritoneal malignancy and transplant teams.
Actinomyces and Shewanella algae complicated paediatric mastoiditis: a case report of a multidisciplinary approach
Authors: Martins Sousa Mafalda , von Hafe Madalena , Reis-Melo Ana , Silveira Helena , Coutinho Gil , Moura Carla Pinto
Published: December 2022

Cerebral venous sinus thrombosis in children is a rare complication of acute mastoiditis that can potentially be fatal. Clinical expertise is essential for early diagnosis and management due to its subtle course. We present the first known case of paediatric acute mastoiditis with venous sinus thrombosis caused by

Shewanella algae

and

Actinomyces europaeus

.

A 17-year-old male presented clinical signs of right acute otitis media and mastoiditis. Brain computed tomography showed mastoid opacification, cerebral sinus thrombosis and an extradural collection. Microbiology revealed the presence of

S. algae

and

A. europaeus

. A multidisciplinary approach combining medical and surgical treatment allowed the patient to make a full recovery.
The combination of aggressive hydration and rectal non-steroidal anti-inflammatory drugs is not superior to rectal non-steroidal anti-inflammatory drugs alone in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography: a systematic review and meta-analysis
Authors: Cheng Xiang , Yang Feixiang , Yang Xingxin , Zhang Ning , Li Xiaoming , Chen Bo
Published: December 2022

Background

endoscopic retrograde cholangiopancreatography (ERCP) can lead to many high-risk complications, of which acute pancreatitis is the most prevalent and serious one. Whether patients who receive prophylactic rectal non-steroidal anti-inflammatory drugs (NSAIDs) need to be combined with aggressive hydration remains controversial.

Aim

The study was performed to determine whether there is collaborative facilitation between rectal NSAIDs and aggressive hydration in preventing post-ERCP pancreatitis (PEP).

Methods

We searched all eligible studies on the preventive effects of active rehydration and NSAIDs on PEP from multiple databases including ClinicalTrials, PubMed, CQVIP, Embase, Web of Science, CNKI, Cochrane Library, and Wanfang Data. We performed a meta-analysis of the data related to the incidence of PEP as well as the serious cases including the incidence of severe PEP and mortality.

Results

This meta-analysis included three published studies of randomized controlled trials with 1110 patients. Our results showed that additional aggressive hydration was not significantly effective for the prevention of PEP in patients who were already receiving rectal NSAIDs (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.12-1.57; P=0.20). With regard to the prevention of serious cases, compared with rectal NSAIDs alone, aggressive fluid hydration combined with rectal NSAIDs did not reduce the morbidity of severe PEP (OR, 0.32; 95% CI, 0.10-1.08; P=0.07), nor did it reduce overall mortality (OR, 0.81; 95% CI, 0.28-2.36; P=0.70).

Conclusion

Aggressive perioperative hydration combined with rectal NSAIDs was not superior to rectal NSAIDs along in the prevention of PEP.
Biosynthesis of pleuromutilin congeners using anAspergillus oryzaeexpression platform
Authors: Alberti Fabrizio , Khairudin Khairunisa , Davies Jonathan A. , Sangmalee Suphattra , Willis Christine L. , Foster Gary D. , Bailey Andy M.
Published: December 2022

Pleuromutilin is an antibiotic diterpenoid made byClitopilus passeckerianusand related fungi, and it is the progenitor of a growing class of semi-synthetic antibiotics used in veterinary and human medicine. To harness the biotechnological potential of this natural product class, a full understanding of its biosynthetic pathway is essential. Previously, a linear pathway for pleuromutilin biosynthesis was established. Here we report two shunt pathways involving Pl-sdr and Pl-atf that were identified through the rational heterologous expression of combinations of pleuromutilin biosynthetic genes inAspergillus oryzae. Three novel pleuromutilin congeners were isolated, and their antimicrobial activity was investigated, alongside that of an additional derivative produced through a semi-synthetic approach. It was observed that the absence of substituents – C-3 keto, C-11 hydroxy or C-21 keto – from the pleuromutilin core affected the antibacterial activity of pleuromutilin congeners. This study expands our knowledge on the biosynthesis of pleuromutilin and provides avenues for the development of novel pleuromutilin analogues by combining synthetic biology and synthetic chemistry.
Evolutionary trajectory of organelle-derived nuclear DNAs in theTriticum/Aegilopscomplex species
Authors: Zhang Zhibin , Zhao Jing , Li Juzuo , Yao Jinyang , Wang Bin , Ma Yiqiao , Li Ning , Wang Tianya , Wang Hongyan , Liu Bao , Gong Lei
Published: December 2022

Organelle-derived nuclear DNAs, nuclear plastid DNAs (NUPTs) and nuclear mitochondrial DNAs (NUMTs), have been identified in plants. Most, if not all, genes residing in NUPTs/NUMTs (NUPGs/NUMGs) are known to be inactivated and pseudogenized. However, the role of epigenetic control in silencing NUPGs/NUMGs and the dynamic evolution of NUPTs/NUMTs with respect to organismal phylogeny remain barely explored. Based on the available nuclear and organellar genomic resources of theTriticum/Aegilopscomplex species, we investigated the evolutionary fates of NUPTs/NUMTs in terms of their epigenetic silencing and their dynamic occurrence rates in the nuclear diploid genomes and allopolyploid subgenomes. NUPTs and NUMTs possessed similar genomic atlas, including preferential integration to the transposable element-rich intergenic regions and generating sequence variations in the nuclear genome. The global transcriptional silencing of NUPGs/NUMGs with disrupted and intact open reading frames can be mainly attributed to their repressive chromatin states, namely high levels of DNA methylation and low levels of active histone modifications. Phylogenomic analyses suggested that the species-specific and gradual accumulation of NUPTs/NUMTs accompanied the speciation processes. Moreover, based on further pan-genomic analyses, we found significant subgenomic asymmetry in the NUPT/NUMT occurrence, which accumulated during allopolyploid wheat evolution. Our findings provide novel insights into the dynamic evolutionary fates of organelle-derived nuclear DNA in plants.
Genome sequencing ofC. elegansbalancer strains reveals previously unappreciated complex genomic rearrangements
Authors: Maroilley Tatiana , Flibotte Stephane , Jean Francesca , Rodrigues Alves Barbosa Victoria , Galbraith Andrew , Chida Afiya Razia , Cotra Filip , Li Xiao , Oncea Larisa , Edgley Mark , Moerman Don , Tarailo-Graovac Maja
Published: December 2022

Genetic balancers inCaenorhabditis elegansare complex variants that allow lethal or sterile mutations to be stably maintained in a heterozygous state by suppressing crossover events. Balancers constitute an invaluable tool in theC. elegansscientific community and have been widely used for decades. The first/traditional balancers were created by applying X-rays, UV, or gamma radiation onC. elegansstrains, generating random genomic rearrangements. Their structures have been mostly explored with low-resolution genetic techniques (e.g., fluorescence in situ hybridization or PCR), before genomic mapping and molecular characterization through sequencing became feasible. As a result, the precise nature of most chromosomal rearrangements remains unknown, whereas, more recently, balancers have been engineered using the CRISPR-Cas9 technique for which the structure of the chromosomal rearrangement has been predesigned. Using short-read whole-genome sequencing (srWGS) and tailored bioinformatic analyses, we previously interpreted the structure of four chromosomal balancers randomly created by mutagenesis processes. Here, we have extended our analyses to five CRISPR-Cas9 balancers and 17 additional traditional balancing rearrangements. We detected and experimentally validated their breakpoints and have interpreted the balancer structures. Many of the balancers were found to be more intricate than previously described, being composed of complex genomic rearrangements (CGRs) such as chromoanagenesis-like events. Furthermore, srWGS revealed additional structural variants and CGRs not known to be part of the balancer genomes. Altogether, our study provides a comprehensive resource of complex genomic variations inC. elegansand highlights the power of srWGS to study the complexity of genomes by applying tailored analyses.
Prevalence of genital mycoplasmas and co-occurrence with Gardnerella vaginalis in high vaginal swabs from adult females in Bahrain: point-prevalence observational study
Authors: AL-Enezi Shaikha Khaled , Saeed Nermin Kamal , Mahmood Naeema A.A. , Shadab Mohd , Al Mahmeed Ali , Shahid Mohammad
Published: December 2022

Purpose

Bacterial vaginosis (BV) is quite common and linked with serious public health issues such as premature delivery and spread of sexually transmitted infections. The study aims to identify different genital mycoplasmas (GM) in high vaginal swabs (HVS) from adult females in Bahrain.

Design/methodology/approach

In total, 401 HVS were collected and cultured on MYCOFAST® RevolutioN 2 test for identification and antibiotic susceptibility. Polymerase chain reaction (PCR) was performed for detection of Mycoplasma genitalium (Mg), Mycoplasma hominis (Mh) and Ureaplasma species. DNA-probe based detection for Gardnerella, Candida and Trichomonas was performed by BD Affirm Assay. Representative PCR amplicons were sequenced by Sanger sequencing.

Findings

In PCR, Ureaplasma sp. was the most common GM, followed by Mg and Mh; the prevalence being 21.2, 5.2 and 1.5%, respectively. On the contrary, 10.7% samples showed positivity for Ureaplasma urealyticum (Uu) and 1.7% for Mh in MYCOFAST® RevolutioN 2. The concordance rates between MYCOFAST® RevolutioN 2 and PCR for Mh and Ureaplasma sp. were 97.7 and 84%, respectively. Considering PCR as gold standard, sensitivity, specificity, positive predictive value, and negative predictive value of MYCOFAST® RevolutioN 2 were 33.3, 98.8, 28.6, 98.9 and 37.7, 96.5, 74.4, 85.2% for Mh and Ureaplasma sp., respectively. The Uu and Mh isolates showed antibiotic-resistance ranging from 53%–58% and 71%–86%, respectively.

Research limitations/implications

The prevalence of Ureaplasma sp. was high. Significant co-occurrence of GM was noticed with BV. MYCOFAST® RevolutioN 2 had lower detection-rate than PCR, so a combination is suggested for wider diagnostic coverage.

Practical implications

The research reflects on status of prevalence of GM in adult females in Bahrain, and their co-occurrence with bacterial vaginosis. Diagnostic approach with combination of tests is suggested for wider coverage. The research has epidemiologic, diagnostic, and therapeutic implications.

Originality/value

This is the first report from the Kingdom of Bahrain reflecting on burden of GM from this geographic location. The diagnostic efficacy of MYCOFAST® RevolutionN 2 test and polymerase chain reaction was evaluated for GM detection.
FDI motives and city location preferences in the automotive and commercial banking industries
Authors: Danes Dan , van Eijck Patrick , Lindeque Johan P. , Meyer Mona A. , Peter Marc K.
Published: December 2022

Purpose

Cities remain an understudied unit of analysis for understanding the motives of multinational enterprises’ (MNE) foreign direct investment (FDI), with subnational locations in International Business (IB) research to date predominantly captured via the phenomenon of agglomeration. As regional integration projects, such as the European Union and to a lesser degree NAFTA, increasingly reduce the importance of national institutional environments, this paper argues regional and subnational levels become more important for studying MNE location choice. This paper aims to evaluate the explanatory contribution of regional and subnational levels of analysis to understanding MNE location choice.

Design/methodology/approach

A qualitative deductive bottom-up multiple-case study research design is adopted to study the city location choices and FDI motives of six automotive and six commercial banking companies. These purposefully sampled manufacturing and service MNEs have different home countries and regional orientations. Data on their foreign investments across the extended Triad of Europe, North America and Asia-Pacific were collected for the time period of 2000–2021.

Findings

Findings suggest that different classes of city tend to attract specific types of FDI and that these patterns might vary across sectors and be influenced by the regional strategic orientations of MNEs. Industry-specific findings reveal the importance of related and support industries and partners in a city location for the automotive MNEs, while the commercial banks seek investment opportunities in cities that allow acquisition targets that have an attractive customer based and will improve their local market knowledge.

Originality/value

The findings provide evidence in support of MNEs in manufacturing and service industries perceiving the attractiveness of three city types in different ways across the Triad regions.
What is digital transformation? Investigating the metaphorical meaning of digital transformation and why it matters
Authors: Owoseni Adebowale
Published: December 2022

Purpose

This study used a visual research approach to investigate how small business (SB) entrepreneurs in Nigeria, a low-income country, perceive digital transformation (DT). The study aims to improve and broaden the understanding of DT by uncovering its metaphors. Making metaphorical sense of DT will increase its knowledge among populations who are unfamiliar with digital technology concepts, as well as communicating and collaborating with them to develop future research and strategies on the subject of DT. This study is significant because scholars have paid little attention to social imaginations of DT depicted through metaphors, more so when considered from a worldview of SBs in low-income countries.

Design/methodology/approach

The uniqueness of the research objective motivated the use of social theory to frame the research approach, and picture-elicitation techniques to drive data collection through in-depth interviews with 17 SB entrepreneurs and business owners in Nigeria. Data were analyzed using a content analysis procedure known as metaphor analysis.

Findings

The study revealed three metaphors of DT: a drama, a war and a pregnant elephant. A triangulation of the metaphors with English lexicon, extant literature and interview excerpts supported the war and drama perceptions of DT but opposed “DT as a pregnant elephant.”

Practical implications

It argued that the social perception of DT can improve the sustainable, purposeful and successful execution of DT strategies for SB DT. As a result, this study pushes the boundaries of DT, particularly for SB entrepreneurs in low-income countries.

Social implications

Metaphors pervade our daily lives, not only in our language and communications, but also in how we think and act; as such, they can play an important role in understanding and implementing DT, a concept that has received little attention in the SB settings.

Originality/value

This is one of the first empirical studies to figuratively explain DT and its implications for literature and practice in SB entrepreneurship and information systems domains.
Oil prices, news-based uncertainty measures and exchange rate returns in BRICS countries
Authors: Adeosun Opeoluwa Adeniyi , Tabash Mosab I. , Vo Xuan Vinh
Published: December 2022

Purpose

This paper aims to accommodate the influence of both economic policy uncertainty and geopolitical risks in the relationship between oil price and exchange-rate returns in the Brazil, Russia, India, China and South Africa (BRICS) countries through an interaction term (EPGR).

Design/methodology/approach

The authors use continuous wavelet transform (CWT), wavelet coherence (WC) and partial wavelet coherence (PWC). First, the authors apply the CWT to examine the evolution of oil prices, EPGR and exchange rate returns. Second, the authors use WC to investigate the relationship between oil price and exchange rate returns (excluding EPGR). Third, the authors use PWC to account for EPGR’s impact on the oil exchange rate returns dynamics and explore partial correlations in the oil and exchange rate returns dynamics.

Findings

The empirical results generally show that EPGR is a key driver in the oil and exchange rate returns nexus.

Practical implications

The relevance of EPGR in influencing exchange rate volatility is confirmed by the findings. As a result, it is critical for government officials and foreign exchange investors to use EPGR as a leading indicator when establishing foreign exchange trading strategies and economic forecasts.

Originality/value

This study is the first, to the best of the authors’ knowledge, to apply a wavelet-based technique to account for EPGR in the relationship between oil and exchange rate returns in the BRICS countries.