bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmentally Sustainable Business Practices in Micro, Small, and Medium Enterprises: A Sub-Saharan African Country Perspective
Authors: Anaman Prince Dacosta , Ahmed Ibrahim Anyass , Suleman Abdul-Razak , Dzakah Gloria Ama
Published: April 2023

In line with the natural resource-based view, this paper explores the sustainable business practices (SBPs) of Ghanaian micro, small, and medium enterprises (MSMEs). Qualitatively, the study interviewed eight MSME operators and middle-level managers purposively to assess their use of SBPs and how it affects their businesses. Data collected were edited, coded, and grouped under themes based on the Braun and Clarke thematic framework. The study identified holistic environmental management, eco-preneurship, and regenerative practices as the environmental stewardship drivers among Ghanaian MSMEs. Also, integrated vision and strategy, process efficiency and resource optimization, and risk profiling drive process excellence. Finally, sustainability-focused leadership, internal advocates and change agents, and ongoing education and awareness as drivers for sustainability-oriented culture. The business practices of organizations have continually impacted the immediate environment within which they operate. Consequently, there is a clarion call for businesses to engage in SBPs to mitigate the effect of their operations on the environment. The study brings to bear the SBPs Ghanaian MSMEs are engaged in and how they affect their operations and survival, especially in this era of sustainability.
Household satisfaction with a pilot community-based health insurance scheme and associated factors in Addis Ababa
Authors: Balcha Biruktawit Abebe , Endeshaw Mulualem , Mebratie Anagaw Derseh
Published: April 2023

Background:

Many countries introduce CBHI as their healthcare financing system to ensure healthcare access. Understanding the level of satisfaction and factors associated with it is essential to ensure the sustainability of the program. Therefore, this study aimed to assess household satisfaction with a CBHI scheme and its associated factors in Addis Ababa.

Design and methods:

Institutional-based cross-sectional study was conducted in the 10 health centers found in the 10 sub-cities of Addis Ababa. Both quantitative and qualitative methods were used. Logistic regression analysis was carried out to identify its associated factors and thematic analysis was used for qualitative data. Finally, variables with a p-value of <0.05 have been considered statistically significant.

Results:

In this study, the overall satisfaction level of households with CBHI was 46.3%. Satisfaction was associated with valid CBHI management regulations (AOR = 1.96, 95% CI: 1.12, 3.46), participants who received the right drug (AOR = 1.77, 95% CI: 1.08, 2.93), households who got immediate care (AOR = 4.95, 95% CI: 2.72, 8.98), those who agreed with the adequacy of medical equipment (AOR = 1.65, 95% CI: 1.02, 2.69), and households who agreed with qualification of health personnel (AOR = 1.89, 95% CI: 1.12, 3.20) were more satisfied with the scheme than their counterparts. The challenges mentioned by the discussants were the shortage of drugs, poor attitude of health professionals, absence of kenema pharmacy, lack of laboratory services, lack of awareness about the CBHI scheme, and tight payment schedule.

Conclusions:

the satisfaction level of households was low. To achieve a better result, the concerned bodies should work to improve the availability of medication, and medical equipment and improve the attitude of healthcare workers.
A Primer on Structural Equation Model Diagrams and Directed Acyclic Graphs: When and How to Use Each in Psychological and Epidemiological Research
Authors: Kunicki Zachary J. , Smith Meghan L. , Murray Eleanor J.
Published: April 2023

Many psychological researchers use some form of a visual diagram in their research processes. Model diagrams used with structural equation models (SEMs) and causal directed acyclic graphs (DAGs) can guide causal-inference research. SEM diagrams and DAGs share visual similarities, often leading researchers familiar with one to wonder how the other differs. This article is intended to serve as a guide for researchers in the psychological sciences and psychiatric epidemiology on the distinctions between these methods. We offer high-level overviews of SEMs and causal DAGs using a guiding example. We then compare and contrast the two methodologies and describe when each would be used. In brief, SEM diagrams are both a conceptual and statistical tool in which a model is drawn and then tested, whereas causal DAGs are exclusively conceptual tools used to help guide researchers in developing an analytic strategy and interpreting results. Causal DAGs are explicitly tools for causal inference, whereas the results of a SEM are only sometimes interpreted causally. A DAG may be thought of as a “qualitative schematic” for some SEMs, whereas SEMs may be thought of as an “algebraic system” for a causal DAG. As psychology begins to adopt more causal-modeling concepts and psychiatric epidemiology begins to adopt more latent-variable concepts, the ability of researchers to understand and possibly combine both of these tools is valuable. Using an applied example, we provide sample analyses, code, and write-ups for both SEM and causal DAG approaches.
Connecting the Dots Through Arts-Infused Activities
Authors: Anderson Louise L.
Published: April 2023

Exploring authentic connections between the arts leads to a deeper understanding of artistic processes and prepares students for formulating connections in our increasingly interrelated world. Differentiated assessments allow students to demonstrate understanding through their choice of artistic media and work at their individual level increasing student motivation and engagement. Student peer-to-peer collaboration further enhances arts-infused activities by encouraging positive social interaction. This article provides step-by-step directions for how to create arts-infused activities and assessments in which multiple arts share common concepts.
Decoding the molecular heterogeneity of pediatric monomorphic post–solid organ transplant lymphoproliferative disorders
Authors: Salmerón-Villalobos Julia , Castrejón-de-Anta Natalia , Guerra-García Pilar , Ramis-Zaldivar Joan Enric , López-Guerra Mónica , Mato Sara , Colomer Dolors , Diaz-Crespo Francisco , Menarguez Javier , Garrido-Pontnou Marta , Andrés Mara , García-Fernández Eugenia , Llavador Margarita , Frigola Gerard , García Noelia , González-Farré Blanca , Martín-Guerrero Idoia , Garrido-Colino Carmen , Astigarraga Itziar , Fernández Alba , Verdú-Amorós Jaime , González-Muñíz Soledad , González Berta , Celis Verónica , Campo Elías , Balagué Olga , Salaverria Itziar
Published: April 2023

Posttransplant lymphoproliferative disorders (PTLDs) represent a broad spectrum of lymphoid proliferations, frequently associated with Epstein-Barr virus (EBV) infection. The molecular profile of pediatric monomorphic PTLDs (mPTLDs) has not been elucidated, and it is unknown whether they display similar genetic features as their counterpart in adult and immunocompetent (IMC) pediatric patients. In this study, we investigated 31 cases of pediatric mPTLD after solid organ transplantation, including 24 diffuse large B-cell lymphomas (DLBCLs), mostly classified as activated B cell, and 7 cases of Burkitt lymphoma (BL), 93% of which were EBV positive. We performed an integrated molecular approach, including fluorescence in situ hybridization, targeted gene sequencing, and copy number (CN) arrays. Overall, PTLD-BL carried mutations in MYC, ID3, DDX3X, ARID1A, or CCND3 resembling IMC-BL, higher mutational burden than PTLD-DLBCL, and lesser CN alterations than IMC-BL. PTLD-DLBCL showed a very heterogeneous genomic profile with fewer mutations and CN alterations than IMC-DLBCL. Epigenetic modifiers and genes of the Notch pathway were the most recurrently mutated in PTLD-DLBCL (both 28%). Mutations in cell cycle and Notch pathways correlated with a worse outcome. All 7 patients with PTLD-BL were alive after treatment with pediatric B-cell non-Hodgkin lymphoma protocols, whereas 54% of patients with DLBCL were cured with immunosuppression reduction, rituximab, and/or low-dose chemotherapy. These findings highlight the low complexity of pediatric PTLD-DLBCL, their good response to low-intensity treatment, and the shared pathogenesis between PTLD-BL and EBV-positive IMC-BL. We also suggest new potential parameters that could help in the diagnosis and the design of better therapeutic strategies for these patients.
EHBP1L1, an apicobasal polarity regulator, is critical for nuclear polarization during enucleation of erythroblasts
Authors: Wu Ji , Moriwaki Kenta , Asuka Tatsuya , Nakai Ritsuko , Kanda Satoshi , Taniguchi Manabu , Sugiyama Tatsuki , Yoshimura Shin-ichiro , Kunii Masataka , Nagasawa Takashi , Hosen Naoki , Miyoshi Eiji , Harada Akihiro
Published: April 2023

Cell polarity, the asymmetric distribution of proteins and organelles, is permanently or transiently established in various cell types and plays an important role in many physiological events. epidermal growth factor receptor substrate 15 homology domain-binding protein 1–like 1 (EHBP1L1) is an adapter protein that is localized on recycling endosomes and regulates apical-directed transport in polarized epithelial cells. However, the role of EHBP1L1 in nonepithelial cells, remains unknown. Here, Ehbp1l1−/− mice showed impaired erythroblast enucleation. Further analyses showed that nuclear polarization before enucleation was impaired in Ehbp1l1−/− erythroblasts. It was also revealed that EHBP1L1 interactors Rab10, Bin1, and dynamin were involved in erythroblast enucleation. In addition, Ehbp1l1−/− erythrocytes exhibited stomatocytic morphology and dehydration. These defects in erythroid cells culminated in early postnatal anemic lethality in Ehbp1l1−/− mice. Moreover, we found the mislocalization of nuclei and mitochondria in the skeletal muscle cells of Ehbp1l1−/− mice, as observed in patients with centronuclear myopathy with genetic mutations in Bin1 or dynamin 2. Taken together, our findings indicate that the Rab8/10-EHBP1L1-Bin1-dynamin axis plays an important role in multiple cell polarity systems in epithelial and nonepithelial cells.
Improving asthma care through implementation of the SENTINEL programme: findings from the pilot site
Authors: Crooks Michael G. , Crowther Lucia , Cummings Helena , Cohen Judith , Huang Chao , Pitel Lukas , Pearson Mark , Morice Alyn , Turgoose John , Faruqi Shoaib , Watt Michael , Morris Tamsin , Xu Yang
Published: April 2023

Aim:

Short-acting β2-agonist (SABA) overuse adversely impacts asthma-related outcomes and the environment. The SABA rEductioN Through ImplemeNting Hull asthma guidELines (SENTINEL) programme aims to reduce SABA overuse through supported implementation of an adult asthma guideline, which advocates for a SABA-free maintenance and reliever therapy (MART)-preferred treatment where appropriate, across six primary care networks (PCNs) in the UK. We present findings on patient/disease characteristics, asthma prescribing patterns and exacerbation rates from the pilot PCN.

Methods:

Patients (aged ≥18 years, prescribed at least one inhaled therapy) and their prescribed asthma treatments were characterised using National Health Service data. Asthma treatments and exacerbations were analysed for three periods: 24‒12 months pre-, 12 months pre- and 12 months post-SENTINEL implementation (November 2020‒January 2021).

Results:

Of the 2571 registered asthma patients, 33.6% (n=864) underwent an asthma review, of whom 44.7% (n=386) were transitioned to MART. Fewer patients were prescribed three or more SABA canisters per year post-implementation in the overall asthma population (45.4% and 46.2% during 24‒12 months and 12 months pre-implementation, respectively, and 23.9% 12 months post-implementation), and in the two subgroups: 1) those who had an asthma review (74.5% and 83.6% during 24‒12 months and 12 months pre-implementation, respectively, and 26.5% post-implementation); and 2) those transitioned to MART following a review (76.4% and 86.5% during 24‒12 months and 12 months pre-implementation, respectively, and 16.3% post-implementation). A higher proportion of patients were exacerbation-free post-implementation in the overall asthma population and in the two subgroups. At least 71.5% of patients transitioned to MART were still prescribed MART 12 months post-implementation, of whom ≥86.7% were SABA-free.

Conclusion:

SENTINEL implementation led to reduced SABA prescribing, increased inhaled corticosteroid uptake and fewer asthma exacerbations. MART was considered appropriate for ∼50% of reviewed patients, with improved prescribing patterns sustained post-implementation.
The esBAF and ISWI nucleosome remodeling complexes influence occupancy of overlapping dinucleosomes and fragile nucleosomes in murine embryonic stem cells
Authors: Klein David C. , Troy Kris , Tripplehorn Sarah A. , Hainer Sarah J.
Published: April 2023

Background

Nucleosome remodeling factors regulate the occupancy and positioning of nucleosomes genome-wide through ATP-driven DNA translocation. While many nucleosomes are consistently well-positioned, some nucleosomes and alternative nucleosome structures are more sensitive to nuclease digestion or are transitory. Fragile nucleosomes are nucleosome structures that are sensitive to nuclease digestion and may be composed of either six or eight histone proteins, making these either hexasomes or octasomes. Overlapping dinucleosomes are composed of two merged nucleosomes, lacking one H2A:H2B dimer, creating a 14-mer wrapped by ~ 250 bp of DNA. In vitro studies of nucleosome remodeling suggest that the collision of adjacent nucleosomes by sliding stimulates formation of overlapping dinucleosomes.

Results

To better understand how nucleosome remodeling factors regulate alternative nucleosome structures, we depleted murine embryonic stem cells of the transcripts encoding remodeler ATPases BRG1 or SNF2H, then performed MNase-seq. We used high- and low-MNase digestion to assess the effects of nucleosome remodeling factors on nuclease-sensitive or “fragile” nucleosome occupancy. In parallel we gel-extracted MNase-digested fragments to enrich for overlapping dinucleosomes. We recapitulate prior identification of fragile nucleosomes and overlapping dinucleosomes near transcription start sites, and identify enrichment of these features around gene-distal DNaseI hypersensitive sites, CTCF binding sites, and pluripotency factor binding sites. We find that BRG1 stimulates occupancy of fragile nucleosomes but restricts occupancy of overlapping dinucleosomes.

Conclusions

Overlapping dinucleosomes and fragile nucleosomes are prevalent within the ES cell genome, occurring at hotspots of gene regulation beyond their characterized existence at promoters. Although neither structure is fully dependent on either nucleosome remodeling factor, both fragile nucleosomes and overlapping dinucleosomes are affected by knockdown of BRG1, suggesting a role for the complex in creating or removing these structures.
P4-ATPase subunit Cdc50 plays a role in yeast budding and cell wall integrity in Candida glabrata
Authors: Chen Ke-Zhi , Wang Lu-Ling , Liu Jin-Yan , Zhao Jun-Tao , Huang Si-Jia , Xiang Ming-Jie
Published: April 2023

Background

As highly-conserved types of lipid flippases among fungi, P4-ATPases play a significant role in various cellular processes. Cdc50 acts as the regulatory subunit of flippases, forming heterodimers with Drs2 to translocate aminophospholipids. Cdc50 homologs have been reported to be implicated in protein trafficking, drug susceptibility, and virulence in Saccharomyces cerevisiae, Candida albicans and Cryptococcus neoformans. It is likely that Cdc50 has an extensive influence on fungal cellular processes. The present study aimed to determine the function of Cdc50 in Candida glabrata by constructing a Δcdc50 null mutant and its complemented strain.

Results

In Candida glabrata, the loss of Cdc50 led to difficulty in yeast budding, probably caused by actin depolarization. The Δcdc50 mutant also showed hypersensitivity to azoles, caspofungin, and cell wall stressors. Further experiments indicated hyperactivation of the cell wall integrity pathway in the Δcdc50 mutant, which elevated the major cell wall contents. An increase in exposure of β-(1,3)-glucan and chitin on the cell surface was also observed through flow cytometry. Interestingly, we observed a decrease in the phagocytosis rate when the Δcdc50 mutant was co-incubated with THP-1 macrophages. The Δcdc50 mutant also exhibited weakened virulence in nematode survival tests.

Conclusion

The results suggested that the lipid flippase subunit Cdc50 is implicated in yeast budding and cell wall integrity in C. glabrata, and thus have a broad influence on drug susceptibility and virulence. This work highlights the importance of lipid flippase, and offers potential targets for new drug research.
Effects of gestational inflammation on age-related cognitive decline and hippocampal Gdnf-GFRα1 levels in F1 and F2 generations of CD-1 Mice
Authors: Luo Bao-Ling , Zhang Zhe-Zhe , Chen Jing , Liu Xue , Zhang Yue-Ming , Yang Qi-Gang , Chen Gui-Hai
Published: April 2023

Background

It has been reported that age-associated cognitive decline (AACD) accelerated by maternal lipopolysaccharide (LPS) insult during late pregnancy can be transmitted to the second generation in a sex-specificity manner. In turn, recent studies indicated that glial cell line‐derived neurotrophic factor (GDNF) and its cognate receptor (GFRα1) are critical for normal cognitive function. Based on this evidence, we aimed to explore whetherGdnf-GFRα1expression contributes to cognitive decline in the F1 and F2 generations of mouse dams exposed to lipopolysaccharide (LPS) during late gestation, and to evaluate also the potential interference effect of pro-inflammatory cytokines.

Methods

During gestational days 15–17, pregnant CD-1 mice (8–10 weeks old) received a daily intraperitoneal injection of LPS (50 μg/kg) or saline (control). In utero LPS-exposed F1 generation mice were selectively mated to produce F2 generation mice. In F1 and F2 mice aged 3 and 15 months, the Morris water maze (MWM) was used to evaluated the spatial learning and memory ability, the western blotting and RT-PCR were used for analyses of hippocampalGdnfandGFRα1expression, and ELISA was used to analyse IL-1β, IL-6 and TNF-α levels in serum.

Results

Middle-aged F1 offspring from LPS-treated mothers exhibited longer swimming latency and distance during the learning phase, lower percentage swimming time and distance in targe quadrant during memory phase, and lower hippocampal levels ofGdnf and GFRα1gene products compared to age-matched controls. Similarly, the middle-aged F2 offspring from the Parents-LPS group had longer swimming latency and distance in the learning phase, and lower percentage swimming time and distance in memory phase than the F2-CON group. Moreover, the 3-month-old Parents-LPS and 15-month-old Parents- and Father-LPS groups had lower GDNF and GFRα1 protein and mRNAs levels compared to the age-matched F2-CON group. Furthermore, hippocampal levels ofGdnfandGFRα1were correlated with impaired cognitive performance in the Morris water maze after controlling for circulating pro-inflammatory cytokine levels.

Conclusions

Our findings indicate that accelerated AACD by maternal LPS exposure can be transmitted across at least two generations through declinedGdnfandGFRα1expression, mainly via paternal linage.
Comparison between the long-axis in-plane and short-axis out-of-plane approaches for ultrasound-guided arterial cannulation: a meta-analysis and systematic review
Authors: Cao Lei , Tan Yu-ting , Wei Ting , Li Hong
Published: April 2023

Background

The two most common methods for ultrasound-guided arterial cannulation are the long-axis in-plane (LA-IP) and short-axis out-of-plane (SA-OOP) approaches. However, it is uncertain which method is more advantageous. We conducted a meta-analysis of reported randomized clinical trials (RCTs) comparing the two techniques in terms of success rate, cannulation time, and complications.

Methods

We systematically searched PubMed, Embase, and the Cochrane Library database for RCTs comparing the LA-IP and SA-OOP techniques for ultrasound-guided arterial cannulation published from inception through April 31, 2022. The Cochrane Collaboration’s Risk of Bias Tool was used to evaluate the methodological quality of each RCT. Review Manager 5.4 and Stata/SE 17.0 were used to analyze the two primary outcome measures (first-attempt success rate and total success rate) and two secondary outcome measures (cannulation time and complications).

Results

A total of 13 RCTs with 1,377 patients were included. There were no significant differences in first-attempt success rate (risk ratio [RR], 0.93; 95% confidence interval [CI], 0.78–1.12; P = 0.45; I2 = 84%) and overall success rate (RR, 0.99; 95% CI, 0.95–1.02; P = 0.48; I2 = 57%). When compared with the LA-IP technique, the SA-OOP technique was associated with an increased incidence of posterior wall puncture (RR, 3.01; 95% CI, 1.27–7.14; P = 0.01; I2 = 79%) and hematoma (RR, 2.15; 95% CI, 1.05–4.37; P = 0.04; I2 = 63%). There was no significant difference in the incidence of vasospasm between techniques (RR, 1.26; 95% CI, 0.37–4.23; P = 0.07; I2 = 53%).

Conclusions

The present results suggest that the SA-OOP technique is associated with a higher incidence of posterior wall puncture and hematoma than the LA-IP technique, whereas success rates are similar for the two ultrasound-guided arterial cannulation techniques. These findings should be experimentally evaluated in a more rigorous manner due to high inter-RCT heterogeneity.
Postcardiac injury syndrome caused by radiofrequency catheter ablation of persistent atrial fibrillation: severe pulmonary arterial hypertension with severe tricuspid regurgitation: a rare case report and literature review
Authors: Shi Jia , Shao Mengjiao , Zhou Xianhui , Lu Yanmei , Tang Baopeng
Published: April 2023

Background

Postcardiac injury syndrome (PCIS) is an easy-to-miss diagnosis, but it is not an uncommon complication. The phenomenon of echocardiography (ECHO) showing both severe pulmonary arterial hypertension (PAH) and severe tricuspid regurgitation (TR) is indeed rare in PCIS after extensive radiofrequency ablation.

Case presentation

A 70-year-old male was diagnosed with persistent atrial fibrillation. The patient received radiofrequency catheter ablation due to his atrial fibrillation being refractory to antiarrhythmic drugs. After the anatomical three-dimensional models were created, ablations were performed on the left and right pulmonary veins, roof linear and bottom linear of the left atrium, and the cavo-tricuspid isthmus. The patient was discharged in sinus rhythm (SR). After 3 days, he was admitted to the hospital for gradually worsening dyspnea. Laboratory examination showed a normal leukocyte count with an increased percentage of neutrophils. The erythrocyte sedimentation rate, C-reactive protein concentration, interleukin-6, and N-terminal pro-B-type natriuretic peptide were elevated. ECG exhibited SR, V1-V4 of precordial lead P-wave amplitude which was increased but not prolonged, PR segment depression, and ST-segment elevation. Computed tomography angiography of the pulmonary artery revealed that the lung had scattered high-density flocculent flakes and a small amount of pleural and pericardial effusion. Local pericardial thickening was seen. ECHO showed severe PAH with severe TR. Diuretics and vasodilators did not relieve the symptoms. Tumors, tuberculosis, and immune system diseases were all excluded. Considering the patient’s diagnosis of PCIS, the patient was treated with steroids. The patient recovered on the 19th day post ablation. The patient’s condition was maintained until 2 years of follow-up.

Conclusions

The phenomenon of ECHO showing severe PAH with severe TR is indeed rare in PCIS. Due to the lack of diagnostic criteria, such patients are easily misdiagnosed, leading to a poor prognosis.
Influenza vaccine uptake among children and older adults in China: a secondary analysis of a quasi-experimental study
Authors: Du Yumeng , Jin Chenqi , Jit Mark , Chantler Tracey , Lin Leesa , Larson Heidi J. , Li Jing , Gong Wenfeng , Yang Fan , Ren Nina , Cheng Weibin , Zhou Yi , Tang Weiming , Tucker Joseph D. , Wu Dan
Published: April 2023

Background

Influenza vaccination is the key to prevent influenza-related disease, especially among high-risk populations. However, influenza vaccine uptake in China is low. This secondary analysis of a quasi-experimental trial aimed to understand factors associated with influenza vaccine uptake among children and older people stratified by funding context.

Methods

A total of 225 children (aged 0.5-8 years) and 225 older people (aged 60 years or above) were recruited from three clinics (rural, suburban and urban) in Guangdong Province. Participants were allocated into two groups based on funding contexts: a self-paid group (N = 150, 75 children and 75 older adults) in which participants paid full price for their vaccination; and a subsidized group (N = 300, 150 children and 150 older adults) in which varying levels of financial support was provided. Univariate and multivariable logistic regressions were conducted stratified by funding contexts.

Results

Overall, 75.0% (225/300) of participants in the subsidized group and 36.7% (55/150) in the self-paid group got vaccinated. Older adults had lower vaccination rates than children in both funding groups, while both age groups showed much higher uptake in the subsidized group than in the self-paid group (aOR = 5.96, 95% CI: 3.77–9.42, p = 0.001). In the self-paid group, having prior influenza vaccination history of children (aOR:2.61, 95%CI: 1.06–6.42) or older people (aOR:4.76, 95%CI: 1.08–20.90) was associated with increased influenza vaccine uptake compared to those who had no prior vaccination experiences in the family. While in the subsidized group, participants who got married or lived with partners (aOR = 0.32, 0.10–0.98) had lower vaccination uptake than single ones. Trust in providers’ advice (aOR = 4.95, 95%CI:1.99, 12.43), perceived effectiveness of the vaccine (aOR: 12.18, 95%CI: 5.21–28.50), and experienced influenza-like illnesses in the family in the past year (aOR = 46.52, 4.10, 533.78) were associated with higher vaccine uptake.

Conclusions

Older people had suboptimal vaccine uptake compared to children in both contexts and need more attention to enhance influenza vaccination. Tailoring interventions to different vaccine funding contexts may help improve influenza vaccination: In self-paid context, motivating people to accept their first ever influenza vaccination may be a promising strategy. In subsidized context, improving public confidence in vaccine effectiveness and providers’ advice would be useful.
Maternal seafood consumption and fetal growth: a birth cohort study in urban China
Authors: Wei Zhang , Li Wang , Lei Cao , Caixia An , Chuan Zhang , Jianqin Wang
Published: April 2023

Background

Seafood is a good source of essential fatty acids which has a presumably beneficial effect on developing embryos and fetuses, although it is also a source of contaminants. In this context, pregnant women are faced with conflicting reports on the risk and benefits of seafood consumption. This study aims to assess whether the consumption of seafood during pregnancy was associated with fetal growth in an inland city in China.

Methods

This study included 10,179 women who delivered a singleton live birth in Lanzhou, China. Seafood consumption was assessed using a Food Frequency Questionnaire. Maternal data including birth outcomes and maternal complications information is extracted from the medical records. Associations between seafood consumption and fetal growth indicators were analyzed using multiple linear regression and multiple logistic regression.

Results

There was a positive association between total seafood consumption and birth weight (β = 0.027, 95%CI:0.030–0.111) but no association concerning birth length or head circumference. Seafood consumption was associated with decreased risk of low birth weight (OR = 0.575, 95% CI: 0.480, 0.689). The frequency of seafood consumption during pregnancy showed a trend toward a positive association with low birth weight. Significantly reduced rates of low birth weight were found in women who consumed more than 75 g of seafood/week during pregnancy as compared to women with no or very low intakes (P for trend 0.021). A significant interaction was observed between pre-pregnancy BMI and seafood consumption on birth weight among underweight women, but not among overweight women. Gestational weight gain partially mediated the association between seafood consumption and birth weight.

Conclusions

Maternal seafood consumption was associated with decreased risk of low birth weight and increased birth weight. This association was mainly driven by freshwater fish and shellfish. These results further corroborate the present dietary recommendation to the Chinese Nutrition Society for pregnant women, especially those with underweight pre-pregnancy BMI and inadequate GWG. In addition, our findings provide implications for future interventions to improve seafood consumption among pregnant women to prevent low birth weight babies in the inland city in China.
Spontaneous uterine venous plexus complicated with ovarian rupture in the third trimester of pregnancy: a case report
Authors: Ruan Jiming , Zhao Gang
Published: April 2023

Background

Spontaneous uterine venous rupture combined with ovarian rupture in late pregnancy is extremely rare. It often has an insidious onset and atypical symptoms, develops rapidly, and is easily misdiagnosed. Wewould like to discuss and share this case of spontaneous uterine venous plexus combined with ovarian rupture in the third trimester of pregnancy with colleagues.

Case presentation

A pregnant woman, G1P0 at 33+4 weeks of gestation,was admitted to the hospital due to threatened preterm labour on March 3, 2022. After admission, she was treated with tocolytic inhibitors and foetal lung maturation agents. The patient's symptoms did not improve during the treatment. After many examinations, tests, discussions, a diagnosis, and a caesarean section, the patient was finally diagnosed with atypical pregnancy complicated by spontaneous uterine venous plexus and ovarian rupture.

Conclusions

Spontaneous rupture of the uterine venous plexus combined with ovarian rupture in late pregnancy is an occult and easily misdiagnosed condition, and the consequences are serious. Clinical attention should be given to the disease and prevention attempted to avoid adverse pregnancy outcomes.
Outcome of carcinoid heart syndrome in patients enrolled in the SwissNet cohort
Authors: Grundmann Eva , Curioni-Fontecedro Alessandra , Christ Emanuel , Siebenhüner Alexander R.
Published: April 2023

Background

Carcinoid heart disease is a rare disease which develops in patients with functional neuroendocrine tumors in an advanced tumor state. Patients diagnosed with carcinoid heart disease have a poor longtime prognosis with respect to morbidity and mortality and long-term data on patient outcomes are lacking.

Methods and results

In this retrospective study, we analyzed outcomes of 23 patients with carcinoid heart disease enrolled into the SwissNet database. We observed that early diagnosis with echocardiographic surveillance of carcinoid heart disease during the course of the neuroendocrine tumor disease was beneficial to overall survival of patients.

Conclusion

Through nationwide patient enrollment, the SwissNet registry is a powerful data tool to identify, follow-up and evaluate long-term patient outcomes in patients with rare neuroendocrine tumor driven pathologies including carcinoid heart syndrome with observational methods enabling better therapy optimization to improve patient`s long-term perspectives and survival. In line with the current ESMO recommendations, our data proposes that heart echocardiography should be included as part of the general physical assessment in patients with newly diagnosed NET.
Increased prevalence of the founder BRCA1 c.5309G>T and recurrent BRCA2 c.1310_1313delAAGA mutations in breast cancer families from Northerstern region of Morocco: evidence of geographical specificity and high relevance for genetic counseling
Authors: Melki Rahma , Melloul Marouane , Aissaoui Souria , EL Harroudi Tijani , Boukhatem Noureddine
Published: April 2023

Background

Inherited mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 (BRCA1/2) confer high risks of breast and ovarian cancer. Because the contribution of BRCA1/2 germline mutations to BC in the Northeastern population of Morocco remains largely unknown, we conducted this first study to evaluate the prevalence and the phenotypic spectrum of two BRCA1/2 pathogenic mutations (the founder BRCA1 c.5309G>T and BRCA2 c.1310_1313delAAGA). This choice was also argued by the presence of an apparent specific geographical connection of these mutations and the Northeastern region of Morocco.

Methods

Screening for the germline mutations c.5309G>T and BRCA2 c.1310_1313delAAGA was performed by sequencing on a total of 184 breast cancer (BC) patients originated from the Northeastern region of Morocco.

The likelihood of identifying a BRCA mutation is calculated using the Eisinger scoring model. The clinical and pathologic features were compared between the BRCA-positive and BRCA-negative groups of patients. Difference in survival outcomes was compared between mutation carriers and non-carriers.

Results

BRCA1 c.5309G>T and BRCA2 c.1310_1313delAAGA are responsible for a significant proportion of all BC cases (12.5%) and at least 20% of familial BC. The screening of BRCA1/2 genes by NGS sequencing confirmed that there are no additional mutations detected among positive patients.

The clinicopathological features in positive patients were in accordance with typical characteristics of BRCA pathogenic mutations. The mean features in the carriers were the early onset of the disease, familial history, triple negative status (for BRCA1 c.5309G>T) and worse prognosis in terms of overall surviving.

Our study indicates that the Eisinger scoring model could be recommended to identify patients for referral to BRCA1/2 oncogenetic counseling.

Conclusion

Our findings suggest that BRCA1 c.5309G>T and BRCA2 c.1310_1313delAAGA mutations may have a strong founder and/or recurrent effect on breast cancer among the Northeastern Moroccan population. There contribution to breast cancer incidence is certainly substantial in this subgroup. Therefore, we believe that BRCA1 c.5309G>T and BRCA2 c.1310_1313delAAGA mutations have to be included in the array of tests aimed at revealing cancer syndrome carriers among subjects of Moroccan origin.
The association of vitamin A, zinc and copper levels with clinical symptoms in children with autism spectrum disorders in Jilin Province, China
Authors: Feng Junyan , Shan Ling , Miao Chunyue , Xue Yang , Yue Xiaojing , Jia Feiyong
Published: April 2023

Background

This study evaluated vitamin A (VA), copper (Cu), and zinc (Zn) levels in the population with autism spectrum disorder (ASD) in Jilin Province, China. Furthermore, we examined their links to core symptoms and neurodevelopment, as well as gastrointestinal (GI) comorbidities and sleep disorders.

Methods

This study included 181 children with autism and 205 typically developing (TD) children. The participants had not taken vitamin/mineral supplements in the prior three months. High-performance liquid chromatography was used to measure serum VA levels. By using inductively coupled plasma–mass spectrometry, Zn and Cu concentrations in plasma were determined. Importantly, the Childhood Autism Rating Scale, the Social Responsiveness Scale, and the Autism Behavior Checklist were used to measure core ASD symptoms. However, the Griffith Mental Development Scales-Chinese were used to measure neurodevelopment. GI comorbidities and sleep abnormalities were assessed with the 6 Item-Gastrointestinal Severity Index and Children’s Sleep Habits Questionnaire, respectively. Children with ASD with GI issues were grouped according to severity (low GI severity and high GI severity groups).

Results

(i) The difference in VA, Zn, Cu levels and the Zn/Cu ratio between ASD and TD children is small. But children with ASD had lower VA levels and Zn/Cu ratio, higher Cu levels than TD children. Cu levels in children with ASD were associated with the severity of core symptoms. (ii) Children with ASD were much more likely than their TD counterparts to suffer from GI comorbidities or sleep problems. Furthermore, it was observed that high GI severity was associated with lower levels of VA, whereas low GI severity was associated with higher levels of VA. (iii) The children with ASD who had both lower VA and lower Zn/Cu ratio had more severe scores on the Autism Behavior Checklist, but not on other measures.

Conclusion

Children with ASD had lower VA and Zn/Cu ratio, and higher Cu levels. Cu levels in children with ASD were weakly correlated with one subscale on social or self-help. ASD children with lower VA levels may face more serious GI comorbidities. Children with ASD combined VA-Zn/Cu lower had more severe core symptoms.

Trial registration

Registration number: ChiCTR-OPC-17013502. Date of registration: 2017-11-23.
Hpgd affects the progression of hypoxic pulmonary hypertension by regulating vascular remodeling
Authors: He Meng , Tao Kelong , Xiang Min , Sun Jian
Published: April 2023

Background

Hypoxic pulmonary hypertension (HPH) is a syndrome of abnormally elevated pulmonary artery pressure, and it is mostly caused by vasoconstriction and remodeling of the pulmonary artery induced by long-term chronic hypoxia. There is a high incidence of HPH, a short survival time of the patients, but currently no effective treatments.

Methods

In this study, HPH-related single cell sequencing (scRNA-seq) and bulk RNA sequencing (RNA-seq) data were downloaded from the public database of Gene Expression Omnibus (GEO) for bioinformatics analysis in order to find out genes with important regulatory roles in the development of HPH. 523 key genes were identified through cell subpopulation identification and trajectory analysis of the downloaded scRNA-seq data, and 41 key genes were identified through weighted correlation network analysis (WGCNA) of the bulk RNA-seq data. Three key genes: Hpgd, Npr3 and Fbln2 were identified by taking intersection of the key genes obtained above, and Hpgd was finally selected for subsequent verification. The human pulmonary artery endothelial cells (hPAECs) were treated with hypoxia for different periods of time, and it was found that the expression of Hpgd decreased in hypoxia-treated hPAECs in a time-dependent manner. In order to further confirm whether Hpgd affects the occurrence and development of HPH, Hpgd was overexpressed in hPAECs.

Results

Hpgd was confirmed to regulate the proliferation activity, apoptosis level, adhesiveness and angiogenesis ability of hypoxia-treated hPAECs through multiple experiments.

Conclusions

Downregulation of Hpgd can improve the proliferation activity, reduce apoptosis, and enhance adhesion and angiogenesis in endothelial cells (ECs), thus promoting the occurrence and development of HPH.
Comparison of femoral neck system versus cannulated screws for treatment of femoral neck fractures: a systematic review and meta-analysis
Authors: Jiang Jiabao , Chen Jialei , Xing Fei , Liu Hao , Xiang Zhou
Published: April 2023

Background

Recently, some studies on the efficacy of the femoral neck system (FNS) in treating femoral neck fractures (FNFs) have been published. Therefore, a systematic review was performed to clarify the efficacy and safety of FNS versus cannulated screws (CS) for the treatment of FNFs.

Method

The PubMed, EMBASE, and Cochrane databases were systematically searched for studies comparing FNS and CS fixations in FNFs. Intraoperative indicators, postoperative clinical indicators, postoperative complications, and postoperative scores were compared between the implants.

Results

A total of eight studies were included in the study, involving 448 FNFs patients. The results showed that patients in FNS group were significantly lower than the CS group in the number of X-ray exposures (WMD = -10.16; 95% CI, -11.44 to -8.88; P < 0.001; I2 = 0%), fracture healing time (WMD = -1.54; 95% CI, -2.38 to -0.70; P < 0.001; I2 = 92%), length of femoral neck shortening (WMD = -2.01; 95% CI, -3.11 to -0.91; P < 0.001; I2 = 0%), femoral head necrosis (OR = 0.27; 95% CI, 0.08 to 0.83; P = 0.02; I2 = 0%), implant failure/cutout (OR = 0.28; 95% CI, 0.10 to 0.82; P = 0.02; I2 = 0%), and Visual Analog Scale Score (WMD = -1.27; 95% CI, -2.51 to -0.04; P = 0.04; I2 = 91%). And the Harris Score was significantly higher in the FNS group than in the CS group (WMD = 4.15; 95% CI, 1.00 to 7.30; P = 0.01; I2 = 89%).

Conclusions

Based on this meta-analysis, FNS shows better clinical efficacy and safety in treating FNFs compared to CS. However, due to the limited quality and number of included studies and the high heterogeneity of the meta-analysis; large samples and multicenter RCTs are needed to confirm this conclusion in the future.

Level of evidence

II, Systematic review and Meta-analysis.

Trial registration

PROSPERO CRD42021283646.
Delayed surgery is associated with adverse outcomes in patients with hip fracture undergoing hip arthroplasty
Authors: Liu Shencai , Qiang Li , Yang Qinfeng , Fan Lei , Wang Jian , Yang Yusheng , Shi Zhanjun , Li Tao
Published: April 2023

Background

Hip arthroplasty (HA) is one of the most effective procedures for patients with hip fractures. The timing of surgery played a significant role in the short-term outcome for these patients, but conflicting evidence has been found.

Methods

The Nationwide Inpatient Sample database was investigated from 2002 to 2014 and identified 247,377 patients with hip fractures undergoing HA. The sample was stratified into ultra-early (0 day), early (1–2 days) and delayed (3–14 days) groups based on time to surgery. Yearly trends, postoperative surgical and medical complications, postoperative length of hospital stay (POS) and total costs were compared after propensity scores were matched between groups by demographics and comorbidity.

Results

From 2002 to 2014, the percentage of hip fracture patients who underwent HA increased from 30.61 to 31.98%. Early surgery groups showed fewer medical complications but higher surgical complications. However, specific complication evaluation showed both ultra-early and early groups decreased most of the surgery and medical complications with increasing post hemorrhagic anemia and fever. Medical complications were also reduced in the ultra-early group, but surgical complications increased. Early surgery groups reduced the POS by 0.90 to 1.05 days and total hospital charges by 32.6 to 44.9 percent than delayed surgery groups. Ultra-early surgery showed no benefit from POS than early group, but reduced total hospital charges by 12.2 percent.

Conclusion

HA surgery performed within 2 days showed more beneficial effects on adverse events than delayed surgery. But surgeons should be cognizant of the potential increased risks of mechanical complications and post-hemorrhagic anemia.
Predictors for hemostatic thrombin-gelatin matrix usage in spine surgery: a multicenter observational study
Authors: Kato So , Miyahara Junya , Matsubayashi Yoshitaka , Taniguchi Yuki , Doi Toru , Kodama Hiroyasu , Higashikawa Akiro , Takeshita Yujiro , Fukushima Masayoshi , Ono Takashi , Hara Nobuhiro , Azuma Seiichi , Iwai Hiroki , Oshina Masahito , Sugita Shurei , Hirai Shima , Masuda Kazuhiro , Tanaka Sakae , Oshima Yasushi ,   University of Tokyo Spine Group
Published: April 2023

Study design

A prospective cohort study.

Objectives

Thrombin-gelatin matrix (TGM) is a rapid and potent hemostatic agent, but it has some limitations, including the cost and its preparation time. The purpose of this study was to investigate the current trend in the use of TGM and to identify the predictors for TGM usage in order to ensure its proper use and optimized resource allocation.

Methods

A total of 5520 patients who underwent spine surgery in a multicenter study group within a year were included in the study. The demographic factors and the surgical factors including spinal levels operated, emergency surgery, reoperation, approach, durotomy, instrumented fixation, interbody fusion, osteotomy, and microendoscopy-assistance were investigated. TGM usage and whether it was routine or unplanned use for uncontrolled bleeding were also checked. A multivariate logistic regression analysis was used to identify predictors for unplanned use of TGM.

Results

Intraoperative TGM was used in 1934 cases (35.0%), among which 714 were unplanned (12.9%). Predictors of unplanned TGM use were female gender (adjusted odds ratio [OR]: 1.21, 95% confidence interval [CI]: 1.02–1.43, p = 0.03), ASA grade ≥ 2 (OR: 1.34, 95% CI: 1.04–1.72, p = 0.02), cervical spine (OR: 1.55, 95% CI: 1.24–1.94, p < 0.001), tumor (OR: 2.02, 95% CI: 1.34–3.03, p < 0.001), posterior approach (OR: 1.66, 95% CI: 1.26–2.18, p < 0.001), durotomy (OR: 1.65, 95% CI: 1.24–2.20, p < 0.001), instrumentation (OR: 1.30, 1.03–1.63, p = 0.02), osteotomy (OR: 5.00, 2.76–9.05, p < 0.001), and microendoscopy (OR: 2.24, 1.84–2.73, p < 0.001).

Conclusions

Many of the predictors for unplanned TGM use have been previously reported as risk factors for intraoperative massive hemorrhaging and blood transfusion. However, other newly revealed factors can be predictors of bleeding that is technically challenging to control. While routine usage of TGM in these cases will require further justification, these novel findings are valuable for implementing preoperative precautions and optimizing resource allocation.
Real-world study of bevacizumab treatment in patients with ovarian cancer: a Chinese single-institution study of 155 patients
Authors: Zhang Nan , Zheng Hong , Gao Yunong , Shu Tong , Wang Hongguo
Published: April 2023

Objective

The purpose of this study was to retrospectively assess the pattern, compliance, efficacy and safety of bevacizumab in Chinese ovarian cancer patients.

Methods

We reviewed the clinicopathological data of patients with histologically confirmed epithelial ovarian cancer, fallopian tube cancer and primary peritoneal adenocarcinoma, who were diagnosed and treated at the Department of Gynecologic Oncology of Peking University Cancer Hospital between May 2012 and January 2022.

Results

A total of 155 patients were eventually enrolled in this study, with 77 as first-line chemotherapy (FL) and 78 as recurrence therapy (RT) among which 37 patients were platinum sensitive and 41 were platinum resistant. Among the 77 patients in the FL group, 35 received bevacizumab during neoadjuvant chemotherapy (NACT) alone (NT), 23 received bevacizumab during both neoadjuvant and first-line chemotherapy (NT + FL) and 19 received bevacizumab during first-line chemotherapy alone (FLA). Among the 43 patients of NT and NT + FL groups undergoing interval debulking surgery (IDS), 38(88.4%) patients achieved optimally debulking and 24 (55.8%) patients had no residual disease after IDS. The patients in the FL group had a median progression free survival (PFS) of 15(95%CI: 9.951–20.049) months, and the 12-month PFS was 61.7%. In the RT group, the overall response rate (ORR) was 53.8%. According to multivariate analysis, the patients' platinum sensitivity had a significant impact on the PFS in the RT group. 13(8.4%) patients discontinued bevacizumab due to toxicity. Seven patients were in the FL group while 4 patients were in the RT group. The most common adverse event associated with bevacizumab therapy was hypertension.

Conclusion

Bevacizumab is effective and well-tolerated in the real world setting of ovarian cancer treatment. Adding bevacizumab to NACT is feasible and tolerable. Receiving the regimen containing bevacizumab in the last preoperative chemotherapy did not result in increased intraoperative bleeding of IDS. Platinum sensitivity is the most important factor affecting the effectiveness of bevacizumab in recurrent patients.