bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacillus Cereus prevalence in human milk donations in a North Italy human milk bank
Authors: Abdul M E , Magagna G , Todeschi S , Finazzi G , Filipello V , Rossi F , Risso F M , Pezzotti E , Dioni E , Losio M N
Published: October 2023

Background

The importance of human milk in infants’ diets is well-known in the medical community. Unfortunately, breastfeeding isn't always possible for various reasons, human milk donation represents the main solution to this problem. The donated milk goes through a pasteurization treatment (62.5 °C for 30 minutes). Before consumption, the milk is tested to analyze the microbiological safety aspect, specifically: the protocol of a North Italian bank, provides for the total count of microorganisms and of Bacillus Cereus. The presence of B. Cereus in pasteurized milk samples has been witnessed in the last few years. B. Cereus infections in infants have consistently been reported and banked human milk could be one of the possible sources. This work aims to study the prevalence of B. Cereus in banked human milk sampled before and after pasteurization treatment.

Methods

Between 2020 and 2023 we tested 1055 samples, before and after the pasteurization treatment. The enumeration of B. cereus is performed in accordance with ISO 7932:2004. 100 µL of pure raw milk and two consecutive decimal dilutions in buffered peptone water were seeded on Bacillus cereus Agar (BCA) at 30° for 24h-48h. B. Cereus strains isolated were typed using the hemolysis test and BCA.

Results

We found 46 samples positives for B. Cereus from 1055 samples analyzed before the heat treatment. The number increased to 57 in the pasteurized samples. These data are confirmed by the typing of the isolated strains from the human milk.

Conclusions

The 4% of not pasteurized milk is discarded due to B. Cereus presence, and the rate increase to 5% in pasteurized milk. This information suggests that the heat treatment isn't capable to inhibit all the B. Cereus, and the increase of B. Cereus from not pasteurized to pasteurized need to be studied.

Key messages

• B. Cereus represents one of the main causes of noncompliance in banked human milk.

• Implementation of preventive/corrective actions is needed to prevent the contaminations led by the operators.
Key Performance Indicators in the Emergency Medical System: barriers and facilitators
Authors: Licata S , Valent F , Deroma L
Published: October 2023

Background

Within the EASY-NET research program (NET-2016-02364191), we developed and calculated a set of KPIs on time dependent conditions (trauma, acute myocardial infarction, stroke) to analyse the Emergency Medical System (EMS) of the Friuli Venezia Giulia Region (FVG, 1.2M inhabitants), Italy. The results were returned to health professionals by three annual written reports, a webinar, and a workshop (2019-2023). We aim to describe the major barriers and facilitators to the implementation, use and acceptance of those KPIs in FVG.

Methods

Barriers and facilitators were investigated in 2020 through an online survey (5 questions on the report's clarity, quality, and relevance) e-mailed to doctors and ward managers (Cardiology, Neurology, Intensive Care, Emergency Department) and in 2023 through a debriefing within the research team.

Results

The geographical reorganisation of the regional health service and the succession of different political and professional representatives were important barriers, which also made it difficult to have access to raw data. Moreover, metadata were rarely available and several changes in variable coding occurred. In addition, the KPI results were difficult to convey to professionals, especially with a text-only feedback (457 e-mails sent, 71 surveys completed; 21/71 knew the report, 4 had read it). On the other hand, since these were the first KPIs to be calculated on the EMS, professionals collaborated enthusiastically and found them useful (60/71 of the survey responders), the multimodal presentation being the most effective feedback (40 webinar users, 100 workshop participants, despite the pandemic). Last but not least, dealing with data was easier thanks to the unofficial help of former colleagues.

Conclusions

The implementation, use and acceptance of the KPIs are driven by close collaborations, but may be hindered by organisational rearrangements and a difficult access to raw data, especially when metadata are lacking.

Key messages

• KPIs are well accepted by the EMS professionals, although they are difficult to implement and introduce when political and organisational rearrangements take place.

• A difficult access to raw data and the lack of metadata hinder the KPIs’ calculation but close collaborations among data professionals are precious to overcome the problem.
Environmental sustainability and healthiness of nursing homes meals: an exploratory study from Italy
Authors: Conti A , Binala J G , Cortese L , Opizzi A , Gigante D , Barone-Adesi F , Panella M
Published: October 2023

Background

The food sector is responsible for more than the 30% of the total greenhouse gases emissions (GHGE), one of the leading causes of global warming. The adoption of healthy and sustainable food models has been identified as one of the possible effective interventions to face this challenge. In this regard, the healthcare sector's food chain is underinvestigated, with a lack of a global and comprehensive approach. Specifically, no research has been conducted yet in nursing homes. The aim of our study is to evaluate the environmental impact of the menu among residents of an Italian 130-beds nursing home, and to assess their adherence to the Planetary Health Diet (PHD), a dietary framework conceived by the EAT-Lancet Commission aimed to promote both human and environmental health.

Methods

We assessed a random sample of 20,000 combinations of servings. For each of them we estimated the Carbon Foodprint (CF) and the adherence to PHD using the life cycle assessment methodology and the Modified EAT-Lancet Diet Score, respectively. Threshold was set to 2.027 KgCO2eq/day for CF and to 23 for PHD adherence. Afterwards, we evaluated the composition of the menus and estimated the CF of each day with relative permutations given by the possibility of the different choices of dishes.

Results

We found a substantial variability of both CF and PHD adherence among permutations, with only a small proportion of them reaching the benchmarks. Furthermore, we found a negative association between CF and PHD adherence, with healthier menus generating less CO2eq emissions.

Conclusions

To our knowledge, this is the first study specifically assessing the environmental impact of food in a nursing home. The observed variability suggests the possibility of improving the proposed menus, with a potential beneficial impact on both human and environmental health. Further studies are needed, to deeply explore the current situation and the strategies for improvements on this topic.

Key messages

• Despite the relevance of the topic, this is the first study assessing both the environmental and health aspects of meals served in a nursing home.

• We found that healthier servings had a lower environmental impact, suggesting the possibility to improve menus with a beneficial impact for both human and environmental health.
Translating risk-benefit assessment evidence for policy making: outcomes of an international workshop
Authors: De Matteu Monteiro C , Membré J M , Thomsen S T , Monteiro Pires S
Published: October 2023

Background

Transitioning to sustainable, healthy, and inclusive food systems requires a multi-domain risk analysis approach. Integrated methods, such as health risk-benefit assessment (RBA), can support the formulation of coherent regulations by providing comparative information on potential trade-offs within the areas of food safety and nutrition. Despite extensive scientific developments and applications, RBAs have not yet been fully adopted by regulatory bodies. Hence, participatory science is needed to identify obstacles for implementation and communication of RBAs to optimize and ensure that generated evidence is compatible to regulatory needs.

Methods

As part of the EU funded project HOLiFOOD, an international workshop held in May 2023 brought together food regulators and other stakeholders from across Europe to identify bottlenecks in the use of RBA outputs in decision-making. The meeting included a key-note presentation, surveys, and group discussions.

Results

Thirty-seven participants from 19 institutions based in 13 countries attended the workshop. Obstacles identified were classified into one of the following themes: challenges of using RBAs to inform policymaking, opportunities and needs (e.g., reliability of methods), and communication of RBA outputs. Case studies targeting various foods groups or diets in different contexts is recommended.

Conclusions

Health RBA is a multidisciplinary method useful for prioritizing actions and ensuring transparency in decision-making. Case studies addressing the identified obstacles could increase the reliability of RBA methods and favour the adoption by regulatory bodies. Finally, moving towards holistic approaches may require further cross-departmental collaboration and, potentially, organizational changes of authorities in the future.

Key messages

• Risk-benefit assessment of foods is a robust tool to support public health policymaking.

• Engagement with risk managers and other stakeholders is essential to deliver, and effectively translate, fit-for-purpose scientific evidence.
Clinical and socio-economic characteristics of a cohort of MDR/XDR TB patients in Bucharest, Romania
Authors: Ivanova O , Baiceanu D , Bakuli A , Vogel M , Popa C , Dumitrescu A , Hoelscher M , Lange C , Ibraim E , Rachow A
Published: October 2023

Background

Multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) patients are likely to suffer from TB-related morbidity, social and economic consequences during and beyond anti-TB treatment. The aim of this study is to describe clinical and socio-economic outcomes of TB patients in Bucharest, Romania.

Methods

We have established a prospective cohort of patients with MDR/XDR TB followed for more than 2 years from TB diagnosis. We have collected TB-related, laboratory and clinical data, including chest X-ray, lung function measured by spirometry, St. George's Respiratory Questionnaire (SGRQ), and socio-economic information.

Results

From 50 enrolled participants, 31 remained in the study till month 6. 71% were male with mean age 46.7 (SD 15.4). 41.9% had a previous TB infection and median BMI of 20.3 kg/m2. Baseline CXR showed that on average 47.3% of the lung was affected, with 32.7% at month 6. The majority (71%) of participants had lung impairment at baseline, which remained stable till month 6. The total SGRQ score improved between baseline and month 6 (30 vs 22.8), but remained significantly worse compared to healthy individuals. 52% of participants stated that TB affected their social or private life as well as their household financially at treatment start.

Conclusions

From the start of anti-TB treatment patients are suffering from lung impairment and experiencing socio-economic impact of TB. This cohort demonstrates a slow and slight longitudinal improvement of these outcomes and brings awareness to the need of employing social and rehabilitation programs to target TB impact.

Key messages

• MDR/XDR TB patients suffer from a significant morbidity and socio-economic burden in Romania.

• Targeted measures are needed to address this burden during and after TB treatment.
The Musée Napoléonien: objects, performance and encountering the ‘spectacular past’ in the long nineteenth century
Authors: O’Brien Laura
Published: October 2023

In the early months of 1903, a new play opened at the Théâtre du Château-d’Eau in Paris, La Chute de l’Aigle, telling the story of the weeks following Napoléon’s defeat at Waterloo. Though the play itself was not particularly remarkable, it is notable for the presence of a ‘Musée Napoléonien’, containing a selection of original Napoleonic objects, in the theatre’s foyer. This article takes this unusual coming together of Napoleonic display in theatre and material culture as a starting point to examine the interplay between these forms of historical representation in France in the long nineteenth century. It argues that, like theatrical performance, exhibitions of Napoleonic things—especially personal items and belongings—constituted part of the broader turn towards a ‘spectacular past’, where historical narratives and biography were mediated via entertainment and spectacle. It demonstrates how contemporaries read the display of the personal items of a historical figure in dramatic, narrative terms, underlining the interaction between the visions of the historical past being constructed in performance and in the display of historical objects. In looking at these popular opportunities for experiential engagement with the past, it suggests that—whether in theatre, in exhibitions or, as in La Chute de l’Aigle, in both—such phenomena should be understood as important elements in how historical knowledge is acquired.
Assembly and annotation of the black spruce genome provide insights on spruce phylogeny and evolution of stress response
Authors: Lo Theodora , Coombe Lauren , Gagalova Kristina K , Marr Alex , Warren René L , Kirk Heather , Pandoh Pawan , Zhao Yongjun , Moore Richard A , Mungall Andrew J , Ritland Carol , Pavy Nathalie , Jones Steven J M , Bohlmann Joerg , Bousquet Jean , Birol Inanç , Thomson Ashley
Published: October 2023

Black spruce (Picea mariana [Mill.] B.S.P.) is a dominant conifer species in the North American boreal forest that plays important ecological and economic roles. Here, we present the first genome assembly of P. mariana with a reconstructed genome size of 18.3 Gbp and NG50 scaffold length of 36.0 kbp. A total of 66,332 protein-coding sequences were predicted in silico and annotated based on sequence homology. We analyzed the evolutionary relationships between P. mariana and 5 other spruces for which complete nuclear and organelle genome sequences were available. The phylogenetic tree estimated from mitochondrial genome sequences agrees with biogeography; specifically, P. mariana was strongly supported as a sister lineage to P. glauca and 3 other taxa found in western North America, followed by the European Picea abies. We obtained mixed topologies with weaker statistical support in phylogenetic trees estimated from nuclear and chloroplast genome sequences, indicative of ancient reticulate evolution affecting these 2 genomes. Clustering of protein-coding sequences from the 6 Picea taxa and 2 Pinus species resulted in 34,776 orthogroups, 560 of which appeared to be specific to P. mariana. Analysis of these specific orthogroups and dN/dS analysis of positive selection signatures for 497 single-copy orthogroups identified gene functions mostly related to plant development and stress response. The P. mariana genome assembly and annotation provides a valuable resource for forest genetics research and applications in this broadly distributed species, especially in relation to climate adaptation.
Minding the source: toward an integrative theory of human–machine communication
Authors: Lee Eun-Ju
Published: October 2023

According to the computers are social actors (CASA) paradigm, a dominant theoretical framework for research on human–computer interaction, people treat computers as if they were people. Recent studies on human–machine communication (HMC) and human–artificial intelligence (AI) interaction, however, appear to focus on when and how people respond to machines differently than to human agents. To reconcile this apparent contradiction, this study reviews critically the two overarching theoretical explanations proposed and tested in each respective tradition, the mindlessness account and the machine heuristic. After elaborating on several conceptual and operational issues with each explanatory mechanism, an alternative theoretical model of HMC is proposed that integrates both research traditions and generates predictions that potentially deviate from the dual-process models. Lastly, it is discussed how recent developments in AI technology invite modifications to the current understanding of HMC and beyond.
Inflammatory Bowel Disease in Adults and Elderly: The Use of Selected Non-IBD Medication Examined in a Nationwide Cohort Study
Authors: Lund Ken , Zegers Floor Dijkstra , Nielsen Jan , Brodersen Jacob Broder , Knudsen Torben , Kjeldsen Jens , Larsen Michael Due , Nørgård Bente Mertz
Published: October 2023

Background

Real-world data on medications used for conditions other than inflammatory bowel disease (IBD) are sparse. We examined how the onset of IBD affects the prescription pattern of selected non-IBD medication and the risk of becoming an incident user.

Methods

This nationwide cohort study utilized data from Danish health registers. We included incident patients with young adult–onset IBD (18-39 years of age), adult-onset IBD (40-59 years of age), and elderly-onset IBD (60+ years of age), from 1998 to 2018 and followed all for 3 years. We examined redeemed prescriptions before and after the onset of IBD and estimated the risk of becoming a user of non-IBD medications using logistic regression models.

Results

We identified 36165 patients, 16 771 (46%) with young adult onset, 10615 (29%) with adult onset, and 8779 (24%) with elderly onset. The onset of IBD increased the use of antidepressants, antipsychotics, sedatives/hypnotics, opioids, nonopioid analgesics, antidiabetics, and proton pump inhibitors, even in patients with no other underlying comorbid diseases. The adjusted odds ratio for using antidepressants 1 year after the onset of IBD in elderly was 1.50 (95% confidence interval [CI], 1.14-1.82), in opioids 1.69 (95% CI, 1.45-1.95), in nonopioid analgesics 2.10 (95% CI, 1.77-2.48), in cardiovascular medication 2.20 (95% CI, 1.86-2.61), and in proton pump inhibitors 1.51 (95% CI, 1.31-1.74) compared with adults.

Conclusions

In all 3 age groups, the proportions of patients with redeemed prescriptions for several groups of non-IBD medication were significantly increased after the IBD diagnosis compared with before. The risk of becoming an incident user for several groups of non-IBD medication was increased in elderly patients.
Giant intrathoracic cystic schwannoma resected by video-assisted thoracoscopic surgery
Authors: Pourmolkara Domenico , Napolitano Antonio Giulio , Coviello Eleonora , Puma Francesco
Published: October 2023

Schwannoma is a benign tumour originating from the Schwann cells. Patients can remain asymptomatic, as the onset of symptoms usually depends on the compressive effect on adjacent organs; dimensional and morphological variability increase the time for the diagnosis. We report the case of a successful surgical resection, performed by video-assisted thoracoscopic surgery, on a patient with radiological evidence of a massive cystic intrathoracic neoformation, histologically revealed to be a peculiar Schwannoma.
Shortcomings of a Showpiece
Authors: Epik Aziz , Steinl Leonie
Published: October 2023

The German Code of Crimes Against International Law can be considered a ‘well-crafted’ law. It has not only been put to test in practice in several high-profile cases before German Higher Regional Courts, but it also serves as a model for the implementation of international criminal law into domestic legislation. Nevertheless, 20 years after its entry into force and from a point of view of substantive law, it is possible to identify areas of the Code that are in need of legislative reform, such as sexual and reproductive crimes, crimes against the environment, the crime of aggression, war crimes against property and the applicable sentencing ranges. This article provides an overview of these areas and discusses possible ways forward.
Genus-Wide Transcriptional Landscapes Reveal Correlated Gene Networks Underlying Microevolutionary Divergence in Diatoms
Authors: Walworth Nathan G , Espinoza Josh L , Argyle Phoebe A , Hinners Jana , Levine Naomi M , Doblin Martina A , Dupont Chris L , Collins Sinéad
Published: October 2023

Marine microbes like diatoms make up the base of marine food webs and drive global nutrient cycles. Despite their key roles in ecology, biogeochemistry, and biotechnology, we have limited empirical data on how forces other than adaptation may drive diatom diversification, especially in the absence of environmental change. One key feature of diatom populations is frequent extreme reductions in population size, which can occur both in situ and ex situ as part of bloom-and-bust growth dynamics. This can drive divergence between closely related lineages, even in the absence of environmental differences. Here, we combine experimental evolution and transcriptome landscapes (t-scapes) to reveal repeated evolutionary divergence within several species of diatoms in a constant environment. We show that most of the transcriptional divergence can be captured on a reduced set of axes, and that repeatable evolution can occur along a single major axis of variation defined by core ortholog expression comprising common metabolic pathways. Previous work has associated specific transcriptional changes in gene networks with environmental factors. Here, we find that these same gene networks diverge in the absence of environmental change, suggesting these pathways may be central in generating phenotypic diversity as a result of both selective and random evolutionary forces. If this is the case, these genes and the functions they encode may represent universal axes of variation. Such axes that capture suites of interacting transcriptional changes during diversification improve our understanding of both global patterns in local adaptation and microdiversity, as well as evolutionary forces shaping algal cultivation.
Daydreaming
Authors: Reynolds Paige
Published: October 2023

Modernist technique, most obviously stream of consciousness, has frequently been employed to make visible and public the reveries of women. Irish women’s contemporary fiction uses such tactics to underscore the ways in which real life intrudes on and reshapes this imaginative practice. In Night (1972), which riffs off the narrative techniques depicting Molly Bloom’s ruminations in Ulysses, Edna O’Brien demonstrates the limits of feminism and the sexual revolution in revamping individual psychology as well as in reworking modernist form. At the cusp of the twenty-first century, Ireland grappled with cultural alterations arising from the newfound affluence of the Celtic Tiger, widespread revelations of childhood sexual abuse across the island, and the promise of peace in Northern Ireland. Anne Enright’s The Gathering (2007) and Deirdre Madden’s Molly Fox’s Birthday (2008) focus on female characters in the throes of these contemporary conditions, adapting stream of consciousness to portray how the twenty-first century’s flush of goods and capital influenced the reveries of Irish women.
The Participatory Turn in Museum Curation as a Model for Person-centred Clinical Care
Authors: Fulford K. W. M. , Bergqvist Anna
Published: October 2023

The participatory turn in museum curation offers a powerful model for person-centred clinical care. The first section gives an outline of contemporary person-centred care focusing on the contested values arising (particularly but not only in mental health) from shared clinical decision-making between clinician and patient. The section then outlines the growing range of philosophical resources available for tackling contested values of this kind. With notable exceptions, aesthetics has to date been largely absent from these resources. The next section describes the participatory turn in museums curating and illustrates it with a museum-based project involving refugee migrants, The Silent University. This is an example of what the curator Maria Lind (2019, 2020, 2021) has characterized as ‘curating in the extended field’. The final section combines the considerations of the first two sections by exploring some of the features of the participatory turn that make it a powerful model for person-centred care. First and foremost in this regard are partnership working and dialogue. Interpreted through the philosopher, Hilde Hein’s (2006), agentic account of the participatory turn, these features point to the need for a similarly agentic understanding of shared clinical decision-making. Further features of the participatory turn important for person-centred care, particularly in mental health, include its focus on strengths. Interpreted within Lind’s concept of ‘curation in the extended field’, recovery in mental health can be described as ‘recovery in the extended field’. We conclude with brief comments on the wider significance of aesthetics in contemporary science-based and person-centred clinical care.
Chronic warming and dry soils limit carbon uptake and growth despite a longer growing season in beech and oak
Authors: Didion-Gency Margaux , Vitasse Yann , Buchmann Nina , Gessler Arthur , Gisler Jonas , Schaub Marcus , Grossiord Charlotte
Published: October 2023

Progressively warmer and drier climatic conditions impact tree phenology and carbon cycling with large consequences for forest carbon balance. However, it remains unclear how individual impacts of warming and drier soils differ from their combined effects and how species interactions modulate tree responses. Using mesocosms, we assessed the multiyear impact of continuous air warming and lower soil moisture alone or in combination on phenology, leaf-level photosynthesis, nonstructural carbohydrate concentrations, and aboveground growth of young European beech (Fagus sylvatica L.) and Downy oak (Quercus pubescens Willd.) trees. We further tested how species interactions (in monocultures and in mixtures) modulated these effects. Warming prolonged the growing season of both species but reduced growth in oak. In contrast, lower moisture did not impact phenology but reduced carbon assimilation and growth in both species. Combined impacts of warming and drier soils did not differ from their single effects. Under warmer and drier conditions, performances of both species were enhanced in mixtures compared to monocultures. Our work revealed that higher temperature and lower soil moisture have contrasting impacts on phenology vs. leaf-level assimilation and growth, with the former being driven by temperature and the latter by moisture. Furthermore, we showed a compensation in the negative impacts of chronic heat and drought by tree species interactions.
Dissemination of Traditional Chinese Medicine in Latin America and the Caribbean: the Cases of Peru, Chile, and Cuba
Authors: Palma Patricia
Published: October 2023

Traditional Chinese medicine (TCM) arrived from China to Latin America and the Caribbean in the 1840s due to the massive migration of Chinese people to the region. In a few years, the press noticed the presence of Chinese herbalists practicing in different cities and countries regardless of the demographic weight of the Chinese community. The fascination with Chinese doctors implicated not only the press but also the literature, a phenomenon particularly observed in Cuba. In the first decades of the 20th century, the reactivation of Chinese immigration to the region fostered an anti-Chinese climate that materialized in more significant migratory restrictions and control of their businesses, such as what happened with Chinese herbalists. These herbalists who practiced inside and outside the Chinese community started to object to criticism and persecution by the conservative press and professional doctors. Despite this, Chinese doctors will continue to maintain their support of a significant number of ill persons. This work seeks to illuminate the historical relevance of TCM in Latin America and the Caribbean, focusing on the cases of Peru, Chile, and Cuba. This last country was far from China culturally and geographically, but as in many other small towns in the region, Chinese medicine presented an alternative to the treatment of illnesses.
Sleep-EEG in comorbid pain and insomnia: implications for the treatment of pain disorders
Authors: Reid Matthew J. , Quigg Mark , Finan Patrick H.
Published: October 2023

Introduction:

Patients with chronic pain experience a high prevalence of comorbid insomnia, which is associated with functional impairment. Recent advances in sleep electroencephalography (sleep-EEG) may clarify the mechanisms that link sleep and chronic pain. In this clinical update, we outline current advancements in sleep-EEG assessments for pain and provide research recommendations.

Results:

Promising preliminary work suggests that sleep-EEG spectral bands, particularly beta, gamma, alpha, and delta power, may create candidate neurophysiological signatures of pain, and macro-architectural parameters (e.g., total sleep time, arousals, and sleep continuity) may facilitate EEG-derived sleep phenotyping and may enable future stratification in the treatment of pain.

Conclusion:

Integration of measures obtained through sleep-EEG represent feasible and scalable approaches that could be adopted in the future. We provide research recommendations to progress the field towards a deeper understanding of their utility and potential future applications in clinical practice.
Risk of Recurrence after Surgical Resection for Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasia (IPMN) with Patterns of Distribution and Treatment
Authors: Lucocq James , Hawkyard Jake , Robertson Francis P. , Haugk Beate , Lye Jonathan , Parkinson Daniel , White Steve , Mownah Omar , Zen Yoh , Menon Krishna , Furukawa Takaaki , Inoue Yosuke , Hirose Yuki , Sasahira Naoki , Feretis Michael , Balakrishnan Anita , Zelga Piotr , Ceresa Carlo , Davidson Brian , Pande Rupaly , Dasari Bobby , Tanno Lulu , Karavias Dimitrios , Helliwell Jack , Young Alistair , Nunes Quentin , Urbonas Tomas , Silva Michael , Gordon-Weeks Alex , Barrie Jenifer , Gomez Dhanny , van Laarhoven Stijn , Doyle Joseph , Bhogal Ricky , Harrison Ewen , Roalso Marcus , Ciprani Debora , Aroori Somaiah , Ratnayake Bathiya , Koea Jonathan , Capurso Gabriele , Bellotti Ruben , Stättner Stefan , Alsaoudi Tareq , Bhardwaj Neil , Jeffery Fraser , Connor Saxon , Cameron Andrew , Jamieson Nigel , Sheen Amy , Mittal Anubhav , Samra Jas , Gill Anthony , Roberts Keith , Soreide Kjetil , Pandanaboyana Sanjay
Published: October 2023

Objective:

This international multicentre cohort study aims to identify recurrence patterns and treatment of first and second recurrence in a large cohort of patients after pancreatic resection for adenocarcinoma arising from IPMN.

Summary Background Data:

Recurrence patterns and treatment of recurrence post resection of adenocarcinoma arising from IPMN are poorly explored.

Method:

Patients undergoing pancreatic resection for adenocarcinoma from IPMN between January 2010 to December 2020 at 18 pancreatic centres were identified. Survival analysis was performed by the Kaplan-Meier log rank test and multivariable logistic regression by Cox-Proportional Hazards modelling. Endpoints were recurrence (time-to, location, and pattern of recurrence) and survival (overall survival and adjusted for treatment provided).

Results:

Four hundred and fifty-nine patients were included (median, 70 y; IQR, 64-76; male, 54 percent) with a median follow-up of 26.3 months (IQR, 13.0-48.1 mo). Recurrence occurred in 209 patients (45.5 percent; median time to recurrence, 32.8 months, early recurrence [within 1 y], 23.2 percent). Eighty-three (18.1 percent) patients experienced a local regional recurrence and 164 (35.7 percent) patients experienced distant recurrence. Adjuvant chemotherapy was not associated with reduction in recurrence (HR 1.09;P=0.669) One hundred and twenty patients with recurrence received further treatment. The median survival with and without additional treatment was 27.0 and 14.6 months (P<0.001), with no significant difference between treatment modalities. There was no significant difference in survival between location of recurrence (P=0.401).

Conclusion:

Recurrence after pancreatic resection for adenocarcinoma arising from IPMN is frequent with a quarter of patients recurring within 12 months. Treatment of recurrence is associated with improved overall survival and should be considered.
Predicting high-intensity resuscitation needs in injured patients in the post-hemostasis phase of care following intervention
Authors: Weykamp Michael B. , Beni Catherine E. , Stern Katherine E. , O’Keefe Grant E. , Brakenridge Scott C. , Chan Kwun C.G. , Robinson Bryce R.H.
Published: October 2023

BACKGROUND

Best resuscitation practices in the posthemostasis phase of care are poorly defined; this phase of care is characterized by a range of physiologic derangements and multiple therapeutic modalities used to address them. Using a cohort of injured patients who required an immediate intervention in the operating room or angiography suite following arrival to the emergency department, we sought to define high-intensity resuscitation (HIR) in this posthemostasis phase of care; we hypothesized that those who would require HIR could be identified, using only data available at intensive care unit (ICU) admission.

METHODS

Clinical data were extracted for consecutive injured patients (2016–2019) admitted to the ICU following an immediate procedure in the operating room or angiography suite. High-intensity resuscitation thresholds were defined as the top decile of blood product (≥3 units) and/or crystalloid (≥4 L) use in the initial 12 hours of ICU care and/or vasoactive medication use between ICU hours 2 and 12. The primary outcome, HIR, was a composite of any of these modalities. Predictive modeling of HIR was performed using logistic regression with predictor variables selected using Least Absolute Shrinkage and Selection Operator (LASSO) estimation. Model was trained using 70% of the cohort and tested on the remaining 30%; model predictive ability was evaluated using area under receiver operator curves.

RESULTS

Six hundred five patients were included. Patients were 79% male, young (median age, 39 years), severely injured (median Injury Severity Score, 26), and an approximately 3:2 ratio of blunt to penetrating mechanisms of injury. A total of 215 (36%) required HIR. Predictors selected by LASSO included: shock index, lactate, base deficit, hematocrit, and INR. The area under receiver operator curve for the LASSO-derived HIR prediction model was 0.82.

CONCLUSION

Intensive care unit admission data can identify subsequent HIR in the posthemostasis phase of care. Use of this model may facilitate triage, nursing ratio determination, and resource allocation.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
When Is It Safe to Start VTE Prophylaxis after Blunt Solid Organ Injury? A Prospective AAST Multi-Institutional Trial
Authors: Schellenberg Morgan , Owattanapanich Natthida , Emigh Brent , Van Gent Jan-Michael , Egodage Tanya , Murphy Patrick B. , Ball Chad G. , Spencer Audrey L. , Vogt Kelly N. , Keeley Jessica A. , Doris Stephanie , Beiling Marissa , Donnelly Megan , Ghneim Mira , Schroeppel Thomas , Bradford James , Breinholt Connor S. , Coimbra Raul , Berndtson Allison E. , Anding Catherine , Charles Michael S. , Rieger William , Inaba Kenji ,   The AAST VTE Prophylaxis Study Group
Published: October 2023

Background

The optimal time to initiate venous thromboembolism (VTE) chemoprophylaxis (VTEp) after blunt solid organ injury remains controversial as VTE mitigation must be balanced against bleeding promulgation. Evidence from primarily small, retrospective, single-center work suggests VTEp ≤48 h is safe and effective. This study was undertaken to validate this clinical practice.

Methods

Blunt trauma patients presenting to 19 participating trauma centers in North America were screened over a one-year study period beginning between August 1 and October 1, 2021. Inclusions were age > 15 years; ≥1 liver, spleen, or kidney injury; and initial nonoperative management (NOM). Exclusions were transfers, ED death, pregnancy, and concomitant bleeding disorder/anticoagulation/antiplatelet medication. A priori power calculation stipulated the need for 1,158 patients. Time of VTEp initiation defined study groups: Early (≤48 h of admission) vs. Late (>48 h). Bivariate and multivariable analyses compared outcomes.

Results

In total, 1,173 patients satisfied study criteria with 571 (49%) liver, 557 (47%) spleen, and 277 (24%) kidney injuries. Median patient age was 34 [25-49] years and 67% (n = 780) were male. Median ISS was 22 [14-29] with AIS Abdomen 3 [2-3] and median AAST grade of solid organ injury 2 [2-3]. Early VTEp patients (n = 838, 74%) had significantly lower rates of VTE (n = 28, 3% vs. n = 21, 7%, p = 0.008); comparable rates of NOM failure (n = 21, 3% vs. n = 12, 4%, p = 0.228); and lower rates of post-VTEp blood transfusion (n = 145, 17% vs. n = 71, 23%, p = 0.024) when compared to Late VTEp patients (n = 301, 26%). Late VTEp was independently associated with VTE (OR 2.251, p = 0.046).

Conclusion

Early initiation of VTE chemoprophylaxis was associated with significantly reduced rates of VTE with no increase in bleeding complications. VTEp initiation ≤48 hours is therefore safe and effective and should be the standard of care for patients with blunt solid organ injury.

Level of Evidence

II, Therapeutic and Care Management
Firearm injuries treated at trauma centers in the United States
Authors: Rivara Frederick P. , Hink Ashley B. , Kuhls Deborah A. , Banks Samantha , Agoubi Lauren L. , Kirkendoll Shelbie , Winchester Alex , Hoeft Christopher , Patel Bhavin , Nathens Avery
Published: October 2023

BACKGROUND

While firearm injuries and deaths continue to be a major public health problem, the number of nonfatal firearm injuries and the characteristics of patients are not well-known. The American College of Surgeons Committee on Trauma leveraged an existing data system to collect additional data on fatal and nonfatal firearm injuries presenting to trauma centers. This report provides an overview of this initiative and highlights the challenges associated with capturing actionable data on firearm-injured patients.

METHODS

A total of 128 trauma centers that are part of the American College of Surgeons Trauma Quality Improvement Program collected data on individuals of any age arriving alive between March 1, 2021, and February 28, 2022, with a firearm injury. In addition to the standard data collected for Trauma Quality Improvement Program, abstractors also extracted additional data specific to this study. We linked data from the Distressed Community Index to patient records using zip code of residence.

RESULTS

A total of 17,395 patients were included, with mean (SD) age of 30.2 (13.5) years, 82.5% were male, and the majority were Black and non-Hispanic. The mean proportion of variables with missing data varied among trauma centers, with a mean of 20.7% missing data. Injuries occurred most commonly in homes (31.2%) or on the street (26.6%); 70.4% of injuries were due to assaults. Nearly one third of patients were discharged from the emergency department, 25.9% were admitted directly to the operating room, and 10.9% were admitted to the intensive care unit; 5.9% died in the emergency department, and 10.3% died overall during their course of care. Nearly two thirds of patients lived in the two highest distressed categories of communities; only 7.5% lived in the least distressed quintile.

CONCLUSION

Using trauma center data can be a valuable tool to improve our knowledge of firearm injuries if clinical practices and documentation of patient risks and circumstances are standardized.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.
CXCR5+CD8+ T Cell–Mediated Suppression of Humoral Alloimmunity and AMR in Mice Is Optimized With mTOR and Impaired With Calcineurin Inhibition
Authors: Han Jing L. , Zimmerer Jason M. , Zeng Qiang , Chaudhari Sachi R. , Hart Madison , Satoskar Anjali A. , Abdel-Rasoul Mahmoud , Breuer Christopher K. , Bumgardner Ginny L.
Published: October 2023

Background.

Adoptive cellular therapy (ACT) with antibody-suppressor CXCR5+CD8+ T cells (CD8+ TAb-supp) inhibits alloantibody production, antibody-mediated rejection (AMR), and prolongs graft survival in multiple transplant mouse models. However, it is not known how conventional immunosuppressive agents impact the efficacy of CD8+ TAb-supp ACT.

Methods.

We investigated the efficacy of CD8+ TAb-supp cell ACT when combined with calcineurin inhibitor (CNi) or mammalian target of rapamycin inhibitor (mTORi) in a murine model of kidney transplant.

Results.

ACT-mediated decrease in germinal center B cells, posttransplant alloantibody titer, and amelioration of AMR in high alloantibody-producing CCR5 knockout kidney transplant recipients were impaired when ACT was combined with CNi and enhanced when combined with mTORi. CNi (but not mTORi) reduced ACT-mediated in vivo cytotoxicity of IgG+ B cells and was associated with increased quantity of germinal center B cells. Neither CNi nor mTORi treatment impacted the expression of cytotoxic effector molecules (FasL, Lamp1, perforin, granzyme B) by CD8+ TAb-supp after ACT. Concurrent treatment with CNi (but not mTORi) reduced in vivo proliferation of CD8+ TAb-supp after ACT. The increase in quantity of splenic CD44+CXCR5+CD8+ T cells that occurs after ACT was reduced by concurrent treatment with CNi but not by concurrent treatment with mTORi (dose-dependent).

Conclusions.

Impaired efficacy of ACT by CNi is attributed to reduced persistence and/or expansion of CD8+ TAb-supp cells after ACT. In contrast, concurrent immunosuppression with mTORi preserves CD8+ TAb-supp cells quantity, in vivo proliferation, and in vivo cytotoxic effector function after ACT and enhances suppression of humoral alloimmunity and AMR.
Bifurcations and synchrony in a ring of delayed Wilson–Cowan oscillators
Authors: Pinder I. , Nelson M. R. , Crofts J. J.
Published: October 2023

Ring structures are crucial in network neuroscience, enabling the integration of neural information through closed loop circuits within feedback systems. Here, we use numerical bifurcation analysis to explore time delay effects on a ring of delay-coupled Wilson–Cowan masses. Investigating a low-dimensional ‘self-coupled’ version of the aforementioned system, we uncover the bifurcation structure of the synchronization manifold, and unveil a diverse array of dynamic synchronization patterns that emerge as a consequence of Hopf branch crossings and subsequent higher-order bifurcations. Analysis of the full system reveals transverse instabilities in the synchronized state for large regions of parameter space, with the ring network architecture promoting various dynamics depending on the balance between coupling strength and delay time. Under weak coupling, emergent oscillations are generally synchronous or anti-phase synchronous, with transitions between them triggered by a torus bifurcation of a periodic orbit. Regions of synchronous and anti-phase synchronous solutions are delineated by weakly chaotic borders due to the breakdown of the torus. As coupling strength increases, the bifurcation diagram displays more overlapped branching structure, resulting in increasingly complicated, multistable dynamics.
Association of non-HDL-C/apoB ratio with long-term mortality in the general population: a cohort study
Authors: Zhang Kerui , Wei Chenchen , Shao Yaqing , Wang Li , Zhao Zongquan , Yin Song , Tang Xuejun , Li Yuan , Gou Zhongshan
Published: October 2023

Background

In general, the identification of cholesterol-depleted lipid particles can be inferred from non-high-density lipoprotein cholesterol (non-HDL-C) concentration to apolipoprotein B (apoB) concentration ratio, which serves as a reliable indicator for assessing the risk of cardiovascular disease. However, the ability of non-HDL-C/apoB ratio to predict the risk of long-term mortality among the general population remains uncertain. The objective of this study is to explore the association of non-HDL-C/apoB ratio with long-term all-cause and cardiovascular mortality in the adult population of the United States.

Methods

This retrospective cohort study was a further analysis of existing information from the National Health and Nutrition Examination Survey (NHANES). In the ultimate analysis, 12,697 participants from 2005 to 2014 were included. Kaplan-Meier (K-M) curves and the log-rank test were applied to visualize survival differences between groups. Multivariate Cox regression and restricted cubic spline (RCS) models were applied to evaluate the association of non-HDL-C/apoB ratio with all-cause and cardiovascular mortality. Subgroup analysis was conducted for the variables of age, sex, presence of coronary artery disease, diabetes and hypertriglyceridemia and usage of lipid-lowering drugs.

Results

The average age of the cohort was 46.8 ± 18.6 years, with 6,215 (48.9%) participants being male. During a median follow-up lasting 68.0 months, 891 (7.0%) deaths were documented and 156 (1.2%) patients died of cardiovascular disease. Individuals who experienced all-cause and cardiovascular deaths had a lower non-HDL-C/apoB ratio compared with those without events (1.45 ± 0.16vs.1.50 ± 0.17 and 1.43 ± 0.17vs.1.50 ± 0.17, bothP< 0.001). The results of adjusted Cox regression models revealed that non-HDL-C/apoB ratio exhibited independent significance as a risk factor for both long-term all-cause mortality [hazard ratio (HR) = 0.51, 95% confidence interval (CI): 0.33-0.80] and cardiovascular mortality (HR = 0.33, 95% CI: 0.12-0.90). Additionally, a significant sex interaction was discovered (Pfor interaction < 0.05), indicating a robust association between non-HDL-C/apoB ratio and long-term mortality among females. The RCS curve showed that non-HDL-C/apoB ratio had a negative linear association with long-term all-cause and cardiovascular mortality (Pfor non-linearity was 0.098 and 0.314).

Conclusions

The non-HDL-C/apoB ratio may serve as a potential biomarker for predicting long-term mortality among the general population, independent of traditional risk factors.
Context-invariant socioemotional encoding by prefrontal ensembles
Authors: Frost Nicholas A. , Donohue Kevin C. , Sohal Vikaas
Published: October 2023

The prefrontal cortex plays a key role in social interactions, anxiety-related avoidance, and flexible context- dependent behaviors, raising the question: how do prefrontal neurons represent socioemotional information across different environments? Are contextual and socioemotional representations segregated or intermixed, and does this cause socioemotional encoding to remap or generalize across environments? To address this, we imaged neuronal activity in the medial prefrontal cortex of mice engaged in social interactions or anxiety-related avoidance within different environments. Neuronal ensembles representing context and social interaction overlapped more than expected while remaining orthogonal. Anxiety-related representations similarly generalized across environments while remaining orthogonal to contextual information. This shows how prefrontal cortex multiplexes parallel information streams using the same neurons, rather than distinct subcircuits, achieving context-invariant encoding despite context-specific reorganization of population-level activity.