bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential diagnoses of inguinal swellings: a case series of atypical diagnoses
Authors: Ilgeldiev Semen , Tabidze David , Stoeckel Soeren , Rudolph Hagen , Mirow Lutz
Published: February 2024

This case series highlights the importance of a thorough differential diagnosis in patients with groin swelling, often mistaken for inguinal hernias. It presents three patients with groin swelling initially suspected of having inguinal hernias but diagnosed differently upon further investigation. Patient 1 had a recurrence of endometrial adenocarcinoma in the right groin, Patient 2 had penile carcinoma with left inguinal metastasis, and Patient 3 had a metastasis of prostate carcinoma in the left groin. These cases underline the need to consider various pathologies beyond the common diagnosis of inguinal hernia. Accurate diagnosis requires a careful clinical examination and appropriate diagnostic tools, ensuring correct treatment.
When Paul Berg meets Donald Crothers: an achiral connection through protein biosynthesis
Authors: Kumar Pradeep , Sankaranarayanan Rajan
Published: February 2024

Outliers in scientific observations are often ignored and mostly remain unreported. However, presenting them is always beneficial since they could reflect the actual anomalies that might open new avenues. Here, we describe two examples of the above that came out of the laboratories of two of the pioneers of nucleic acid research in the area of protein biosynthesis, Paul Berg and Donald Crothers. Their work on the identification of D-aminoacyl-tRNA deacylase (DTD) and ‘Discriminator hypothesis’, respectively, were hugely ahead of their time and were partly against the general paradigm at that time. In both of the above works, the smallest and the only achiral amino acid turned out to be an outlier as DTD can act weakly on glycine charged tRNAs with a unique discriminator base of ‘Uracil’. This peculiar nature of glycine remained an enigma for nearly half a century. With a load of available information on the subject by the turn of the century, our work on ‘chiral proofreading’ mechanisms during protein biosynthesis serendipitously led us to revisit these findings. Here, we describe how we uncovered an unexpected connection between them that has implications for evolution of different eukaryotic life forms.
Low-input and single-cell methods for Infinium DNA methylation BeadChips
Authors: Lee Sol Moe , Loo Christian E , Prasasya Rexxi D , Bartolomei Marisa S , Kohli Rahul M , Zhou Wanding
Published: February 2024

The Infinium BeadChip is the most widely used DNA methylome assay technology for population-scale epigenome profiling. However, the standard workflow requires over 200 ng of input DNA, hindering its application to small cell-number samples, such as primordial germ cells. We developed experimental and analysis workflows to extend this technology to suboptimal input DNA conditions, including ultra-low input down to single cells. DNA preamplification significantly enhanced detection rates to over 50% in five-cell samples and ∼25% in single cells. Enzymatic conversion also substantially improved data quality. Computationally, we developed a method to model the background signal's influence on the DNA methylation level readings. The modified detection P-value calculation achieved higher sensitivities for low-input datasets and was validated in over 100 000 public diverse methylome profiles. We employed the optimized workflow to query the demethylation dynamics in mouse primordial germ cells available at low cell numbers. Our data revealed nuanced chromatin states, sex disparities, and the role of DNA methylation in transposable element regulation during germ cell development. Collectively, we present comprehensive experimental and computational solutions to extend this widely used methylation assay technology to applications with limited DNA.
Cryptic proteins translated from deletion-containing viral genomes dramatically expand the influenza virus proteome
Authors: Ranum Jordan N , Ledwith Mitchell P , Alnaji Fadi G , Diefenbacher Meghan , Orton Richard , Sloan Elizabeth , Güereca Melissa , Feltman Elizabeth M , Smollett Katherine , da Silva Filipe Ana , Conley Michaela , Russell Alistair B , Brooke Christopher B , Hutchinson Edward , Mehle Andrew
Published: February 2024

Productive infections by RNA viruses require faithful replication of the entire genome. Yet many RNA viruses also produce deletion-containing viral genomes (DelVGs), aberrant replication products with large internal deletions. DelVGs interfere with the replication of wild-type virus and their presence in patients is associated with better clinical outcomes. The DelVG RNA itself is hypothesized to confer this interfering activity. DelVGs antagonize replication by out-competing the full-length genome and triggering innate immune responses. Here, we identify an additionally inhibitory mechanism mediated by a new class of viral proteins encoded by DelVGs. We identified hundreds of cryptic viral proteins translated from DelVGs. These DelVG-encoded proteins (DPRs) include canonical viral proteins with large internal deletions, as well as proteins with novel C-termini translated from alternative reading frames. Many DPRs retain functional domains shared with their full-length counterparts, suggesting they may have activity during infection. Mechanistic studies of DPRs derived from the influenza virus protein PB2 showed that they poison replication of wild-type virus by acting as dominant-negative inhibitors of the viral polymerase. These findings reveal that DelVGs have a dual inhibitory mechanism, acting at both the RNA and protein level. They further show that DPRs have the potential to dramatically expand the functional proteomes of diverse RNA viruses.
Peirce’s Philosophy of Logic
Authors: Haaparanta Leila
Published: February 2024

The present chapter focuses on a few aspects of Peirce’s philosophy of logic and seeks to show that the idea of the primacy of the practical lies behind Peirce’s conception of logic. It first discusses Peirce’s classification of the sciences and tries to reveal the philosophical background and content of his logical discoveries. It then considers his view of logic as calculus, makes a few remarks on his conception of modalities, and takes notice of his introduction of three-valued logic. Special attention is paid to Peirce’s fallibilism and its relevance to his philosophy of logic. At the end, the chapter discusses Peirce’s writings on the relation between logic and psychology and argues that Peirce’s emphasis on practical reason cannot be reconciled with logical psychologism.
Peirce’s Journey to the End of Inquiry
Authors: Everett Daniel L.
Published: February 2024

This chapter considers and rejects the popular idea that in spite of his brilliance and academic pedigree, Peirce was a failure. Although he died in poverty and obscurity, it is argued here that, to the contrary, Peirce was a success by the standards of most academics, for the simple reason that he knowingly and willingly dedicated himself to the pursuit of truth and excellence, refusing to compromise his intellectual values to please those in power over him, even when this faithfulness to himself brought poverty and ostracism. He demonstrated what the chapter refers to as a “tenure of the soul”—an indestructible commitment to the pursuit of understanding and helping others to understand with him. He spent his life engaged in fulfilling, meaningful work, forging an intellectual freedom to explore his many interests that few academics ever experience. This chapter examines his work ethic, his inventiveness, the sheer magnitude of his accomplishments, and evidence of his success, as well as his personal life.
Peirce’s Universal Grammar
Authors: Everett Daniel L.
Published: February 2024

This chapter discusses ideas of Peirce’s philosophy, especially his semeiotics, that bear on the development and assessment of the methods, results, and objectives of modern linguistics, especially in regard to the theme of universal grammar. Because a single chapter must restrict its scope, this chapter will keep to those topics that seem to distinguish Peirce’s views, and those of any future Peircean linguistics, from current theories of language. As a further narrowing of the latter subtopic, the discussion of universal grammar will focus on the ideas of Peirce and Noam Chomsky.
Peirce on Reality and Existence
Authors: Lane Robert
Published: February 2024

This chapter explains some of Peirce’s most fundamental metaphysical concepts. First among those concepts is that of the real, which Peirce distinguishes from the concepts of the external, the internal, and the fictional. After explaining the relationships among those concepts, this chapter describes Peirce’s attempt to pragmatically clarify the concept of reality, an attempt that relies on his idea that a true belief is one that would be permanently fixed as a result of investigation. It then describes how his eventual concept of existence gradually emerged out of his concept of reality. The chapter concludes with an examination of Peirce’s idea that whether or not something is real can be a matter of degree.
The Cosmopolitan Peirce
Authors: Nubiola Jaime , Barrena Sara
Published: February 2024

Charles Peirce traveled to Europe on five different occasions. The five trips took place between 1870 and 1883, all of them in the service of the Coast and Geodetic Survey, at the time the chief scientific agency of the United States. Those trips were a rich mixture of scientific research and tourism, communication with other scientists, and enjoyment of the artistic treasures of Europe. The impact of this extensive traveling was so important to Peirce’s life and thought that it makes perfect sense to identify this period of time as his “cosmopolitan period.” The common image of Peirce as an isolated thinker writing in Arisbe without any contact with the world not only is historically inaccurate, but also makes it difficult to understand some key elements of his philosophy. The chapter concludes asserting that Peirce is not so much an American philosopher, but more a cosmopolitan philosopher with strong European influences.
Love and the Growth of Justice
Authors: Acosta López de Mesa Juliana , Campos Daniel G.
Published: February 2024

This chapter focuses on agape as a sentiment that nourishes and sustains human ethical life in such a way that it fosters the growth of concrete reasonableness—especially the ideal of justice—in human communities. It introduces agape as a cosmological power of evolution in Charles Peirce’s architectonic and then argues that, in the case of human agency, it is a sentiment that propels and guides ethical life. This sentiment allows creative, loving agents (1) to cherish the freedom of their beloved to choose their own ends and (2) to help their beloved grow toward those ends. The chapter explains the relationship between eros and agape, the role of self-control in loving activity, the communal environment in which agape operates, and creative love’s contribution to the growth of loving reasonableness in human communities, focusing primarily on the ideal of justice as harmony.
Genetic dissection of mutagenic repair and T-DNA capture at CRISPR-induced DNA breaks in Arabidopsis thaliana
Authors: Kamoen Lycka , Kralemann Lejon E M , van Schendel Robin , van Tol Niels , Hooykaas Paul J J , de Pater Sylvia , Tijsterman Marcel
Published: February 2024

A practical and powerful approach for genome editing in plants is delivery of CRISPR reagents via Agrobacterium tumefaciens transformation. The double-strand break (DSB)-inducing enzyme is expressed from a transferred segment of bacterial DNA, the T-DNA, which upon transformation integrates at random locations into the host genome or is captured at the self-inflicted DSB site. To develop efficient strategies for precise genome editing, it is thus important to define the mechanisms that repair CRISPR-induced DSBs, as well as those that govern random and targeted integration of T-DNA. In this study, we present a detailed and comprehensive genetic analysis of Cas9-induced DSB repair and T-DNA capture in the model plant Arabidopsis thaliana. We found that classical nonhomologous end joining (cNHEJ) and polymerase theta-mediated end joining (TMEJ) are both, and in part redundantly, acting on CRISPR-induced DSBs to produce very different mutational outcomes. We used newly developed CISGUIDE technology to establish that 8% of mutant alleles have captured T-DNA at the induced break site. In addition, we find T-DNA shards within genomic DSB repair sites indicative of frequent temporary interactions during TMEJ. Analysis of thousands of plant genome–T-DNA junctions, followed up by genetic dissection, further reveals that TMEJ is responsible for attaching the 3′ end of T-DNA to a CRISPR-induced DSB, while the 5′ end can be attached via TMEJ as well as cNHEJ. By identifying the mechanisms that act to connect recombinogenic ends of DNA molecules at chromosomal breaks, and quantifying their contributions, our study supports the development of tailor-made strategies toward predictable engineering of crop plants.
Fresh air eases work—the effect of air quality on individual investor activity
Authors: Meyer Steffen , Pagel Michaela
Published: February 2024

This article shows that contemporaneous and lagged air pollution negatively affects the likelihood of German individual investors to log in and trade in their brokerage accounts, using intraday data and controlling for investor-, weather-, traffic-, and market-specific factors. A 1 SD increase in air pollution leads to a 1.3 percent reduction in the probability of logging in, which is larger than the response to a 1 SD increase in sunshine. We argue that changes in air pollution affect productivity in cognitively demanding tasks, such as trading. Our results are robust to macroeconomic productivity shocks, nonlinearities, or measurement error.
Examining the Effectiveness of a Digital Media Campaign at Reducing the Duration of Untreated Psychosis in New York State: Results From a Stepped-wedge Randomized Controlled Trial
Authors: Birnbaum Michael L , Garrett Chantel , Baumel Amit , Germano Nicole T , Sosa Danny , Ngo Hong , John Majnu , Dixon Lisa , Kane John M
Published: February 2024

Background and Hypothesis

Longer duration of untreated psychosis (DUP) predicts worse outcomes in First Episode Psychosis (FEP). Searching online represents one of the first proactive step toward treatment initiation for many, yet few studies have informed how best to support FEP youth as they engage in early online help-seeking steps to care.

Study Design

Using a stepped-wedge randomized design, this project evaluated the effectiveness of a digital marketing campaign at reducing DUP and raising rates of referrals to FEP services by proactively targeting and engaging prospective patients and their adult allies online.

Study Results

Throughout the 18-month campaign, 41 372 individuals visited our website, and 371 advanced to remote clinical assessment (median age = 24.4), including 53 allies and 318 youth. Among those assessed (n = 371), 53 individuals (14.3%) reported symptoms consistent with psychotic spectrum disorders (62.2% female, mean age 20.7 years) including 39 (10.5%) reporting symptoms consistent with either Clinical High Risk (ie, attenuated psychotic symptoms; n = 26) or FEP (n = 13). Among those with either suspected CHR or FEP (n = 39), 20 (51.3%) successfully connected with care. The campaign did not result in significant differences in DUP.

Conclusion

This study highlights the potential to leverage digital media to help identify and engage youth with early psychosis online. However, despite its potential, online education and professional support alone are not yet sufficient to expedite treatment initiation and reduce DUP.
Chronic exposure to BDE-47 aggravates acute pancreatitis and chronic pancreatitis by promoting acinar cell apoptosis and inflammation
Authors: Qi Xiaoyan , Liu Qiong , Wei Zuxing , Hou Xuyang , Jiang Yuhong , Sun Yin , Xu Shu , Yang Leping , He Jun , Liu Kuijie
Published: February 2024

The effect of 2,2′,4,4′-tetrabromodiphenyl ether (BDE-47), a persistent environmental pollutant commonly used as a flame retardant in various consumer products, on pancreatitis has not been clearly elucidated, although it has been reported to be toxic to the liver, nervous system, and reproductive system. Acute pancreatitis (AP) and chronic pancreatitis (CP) models were induced in this study by intraperitoneal injection of caerulein. The aim was to investigate the impact of BDE-47 on pancreatitis by exposing the animals to acute (1 week) or chronic (8 weeks) doses of BDE-47 (30 mg/kg in the low-concentration group and 100 mg/kg in the high-concentration group). Additionally, BDE-47 was utilized to stimulate mouse bone marrow-derived macrophages, pancreatic primary stellate cells, and acinar cells in order to investigate the impact of BDE-47 on pancreatitis. In vivo experiments conducted on mice revealed that chronic exposure to BDE-47, rather than acute exposure, exacerbated the histopathological damage of AP and CP, leading to elevated fibrosis in pancreatic tissue and increased infiltration of inflammatory cells in the pancreas. In vitro experiments showed that BDE-47 can promote the expression of the inflammatory cytokines Tnf-α and Il-6 in M1 macrophages, as well as promote acinar cell apoptosis through the activation of the PERK and JNK pathways via endoplasmic reticulum stress. The findings of this study imply chronic exposure to BDE-47 may exacerbate the progression of both AP and CP by inducing acinar cell apoptosis and dysregulating inflammatory responses.
Deep Trade Agreements and Firm Ownership in GVCs
Authors: Egger Peter H , Masllorens Gerard
Published: February 2024

This paper focuses on the effect of preferential trade agreements and their depth on firm-to-firm ownership, in particular, along global value chains. It measures shareholder–affiliate ownership links at the country-sector-pair level to distinguish between vertical and horizontal links. The findings show that preferential trade agreements boost vertical international investment links (both backward and forward) while reducing horizontal investment. Deep preferential trade agreements stimulate investment particularly for sector pairs, where a high input specificity prevails.
Racial and Ethnic Disparities in Obstetric Anesthesia: A Scoping Review
Authors: Lee W. , Martins M.S. , George R.B. , Fernandez A.
Published: February 2024

(Can J Anaesth. 2023;70(6):1035–1046)

Racial and ethnic disparities in obstetric anesthesia are the subject of this comprehensive scoping review, shedding light on a rather sparse body of literature in this domain. The majority of existing studies focus on the utilization of anesthesia and analgesia during labor and delivery, specifically highlighting comparisons between Hispanic and non-Hispanic Black patients against non-Hispanic White patients.
Structural Racism and Adverse Pregnancy Outcomes Through the Lens of the Maternal Microbiome
Authors: Hadley M. , Oppong A.Y. , Coleman J. , Powell A.M.
Published: February 2024

(Obstet Gynecol. 2023;142:911–919)

Research has clearly shown that health care outcomes are riddled with disparities surrounding race, but arguments exist about whether these disparities are due to biological differences, environmental, structural, or social elements of overall health, or systemic racism and inherent racial bias. Many observed differences in pregnancy outcomes are consistent even when correcting for poverty, educational status, or income level, suggesting that there are other factors that have not yet been identified. This commentary proposes that structural racism is a major contributing factor to health disparities between those of different races, including aspects such as access to healthy food options, psychosocial stressors, and safe and healthy living environments, and these differences will be manifest in the gut and vaginal microbiomes, thus affecting pregnancy-related outcomes related to the microbiome.
Vasa Previa
Authors: Oyelese Y. , Javinani A. , Shamsirsaz A.A.
Published: February 2024

(Obstet Gynecol. 2023;142:503–518)

Vasa previa is defined as unprotected fetal blood vessels that run through placental tissue or the umbilical cord, either over or in proximity to the internal cervical os. The exposed nature of these vessels presents a significant risk of tear or rupture during labor or after amniotic membrane breaking, which can lead to serious complications such as fetal exsanguination, stillbirth, or neonatal death. This article examines the history of vasa previa, along with epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment.
Cardiac Arrest During Delivery Hospitalization: A Cohort Study
Authors: Ford N.D. , DeSisto C.L. , Galang R.R. , Kuklina E.V. , Sperling L.S. , Ko J.Y.
Published: February 2024

(Ann Intern Med. 2023;176:472–479)

Cardiac arrest is a rare but serious complication in the parturient and is associated with very poor outcomes. The objective of this study was to assess the incidence of cardiac arrest from 2017 to 2019 in the United States by patient demographics, co-morbidity, and type and size of hospital. This analysis can aid in identifying strategies to reduce pregnancy-related maternal morbidity and mortality.
Pregnancy-Associated Stroke and Outcomes Related to Timing and Hypertensive Disorders
Authors: Bitar G. , Sibai B.M. , Chen H.Y. , Neff N. , Blackwell S. , Chauhan S.P. , Fishel Bartal M.
Published: February 2024

(Obstet Gynecol. 2023;142:393–401)

Pregnancy-associated stroke has been occurring with increasing frequency in recent years, both antepartum and postpartum. It is associated with a high rate of maternal mortality along with a short-term morbidity of seizures, infections, mechanical ventilation, and venous thromboembolism. There is also a recorded association of stroke during pregnancy with fetal morbidity. Research is lacking, however, in powerful statistics; most studies up to this point have been limited by a very small sample size or a focus on specific risk groups, age groups, or epidemiology. This study was designed to address these shortcomings by assessing the temporal trend of pregnancy-associated stroke between 2016 and 2019, the relationship between timing of stroke (antepartum or postpartum) and adverse outcomes, and the relationship between hypertensive disorders and adverse outcomes.
External Validation of a Multivariable Prediction Model for Placenta Accreta Spectrum
Authors: Singh S. , Carusi D. , Wang P. , Reitman-Ivashkov E. , Landau R. , Fields K. , Weiniger C. , Farber M.
Published: February 2024

(Anesth Analg. 137(3):537–547)

Placenta accreta spectrum (PAS) encompasses various forms of abnormal placental attachment and uterine invasion. PAS is a leading cause of severe postpartum hemorrhage and often leads to an emergency hysterectomy. Managing PAS and its associated complications, such as preterm birth, maternal morbidity, and neonatal intensive care unit admissions, is best achieved in tertiary-level hospitals equipped with specialized multidisciplinary care. To ensure the highest quality of care, proactive planning is essential. This involves identifying risk factors associated with PAS, facilitating rapid transfers to appropriate delivery facilities, efficient resource allocation, and minimizing the occurrence of life-threatening postpartum hemorrhage and its associated complications.
The sFlt1/PIGF Ratio Predicts Faster Fetal Deterioration in Early Fetal Growth Restriction: A Historical Cohort Study
Authors: Palma Dos Reis C.R. , Brás S. , Meneses T. , Cerdeira A.S. , Vatish M. , Martins A.T.
Published: February 2024

(Acta Obstet Gynecol Scand. 2023;102:635–643)

Both placental growth factor (PlGF) and tyrosine kinase 1 (sFlt1) are predicted to be factors in impaired placentation, which is known to lead to diseases such as pre-eclampsia and fetal growth restriction (FGR). Previous studies have shown fluctuations in the levels of PlGF and sFlt1 in patients with these diseases. This study aimed to determine the effects that high levels of PlGF and sFlt1 have on the deterioration of FGR in neonates.
Vacuum Extraction or Cesarean Section in the Second Stage of Labor: A Systematic Review
Authors: Thierens S. , van Binsbergen A. , Nolens B. , van den Akker T. , Bloemenkamp K. , Rijken M.J.
Published: February 2024

(BJOG. 2023;130(6):586–598)

Prolonged second-stage labor poses a significant risk for increased perinatal and maternal adverse outcomes. Two common interventions to expedite delivery during this stage are vacuum extraction (VE) and second-stage cesarean section (SSCS). The occurrence of each intervention procedure varies globally. This systematic review aimed to compare outcomes for both mother and baby associated with VE and SSCS.
Fentanyl in the Labor Epidural Impacts the Results of Intrapartum and Postpartum Maternal and Neonatal Toxicology Tests
Authors: Siegel M.R. , Mahowald G.K. , Uljon S.N. , James K. , Leffert L. , Sullivan M.W. , Hernandez S.J. , Gray J.R. , Schiff D.M. , Bernstein S.N.
Published: February 2024

(Am J Obstet Gynecol. 2023;228(6):741.e1–741.e7)

In obstetrics, toxicology testing is often used to gather data about maternal substance use. A positive maternal or neonatal toxicology test can result in significant consequences, including referrals to child protective services, dismissal from substance use treatment programs, and possibly incarceration. The aim of this study was to evaluate the impact of administering neuraxial fentanyl during labor on toxicology test outcomes for mothers and neonates.
Clinical and Ultrasonographic Assessment of Airway Indices Among Nonpregnant, Normotensive Pregnant, and Pre-eclamptic Patients: A Prospective Observational Study
Authors: Bala R. , Budhwar D. , Kumar V. , Singhal S. , Kaushik P. , Sharma J.
Published: February 2024

(Int J Obstet Anesth. 2023:54:103637)

Improper airway management is one of the leading causes of death for pregnant individuals. An ultrasound of the airway is a noninvasive tool that can be used to assess a patient’s airway and evaluate the risk of severe complications. This study aimed to compare the airways of pregnant and nonpregnant individuals using both a physical exam and an ultrasound exam.
Maternal Opioid Treatment After Delivery and Risk of Adverse Infant Outcomes: A Population-Based Cohort Study
Authors: Zipursky J.S. , Gomes T. , Everett K. , Calzavara A. , Paterson J.M. , Austin P.C. , Mamdani M.M. , Ray J.G. , Juurlink D.N.
Published: February 2024

(BMJ. 2023;380:e074005)

The use of opioids for pain relief following delivery is common; however, there is increasing concern that opioids are being passed to infants in large quantities during breastfeeding. This study aimed to determine if maternal postpartum use of opioids is associated with long-term side effects and complications in breastfeeding infants.
Validation of a Tool to Evaluate Nursing Students’ Electronic Health Record Competency in Simulation
Authors: McBride Susan , Thomas Laura , Decker Sharon , Pierce Matthew , Burson Shelley , Song Huaxin , Haerling (Adamson) Katie
Published: February 2024

AIM

The aim of the study was to establish reliability and validity of the Competency Assessment in Simulation of Electronic Health Records (CASE) tool.

BACKGROUND

Effective teaching and learning practices, including valid and reliable assessment of students’ electronic health record (EHR) competency, contribute to safe, high-quality, efficient nursing care.

METHOD

The study used a mixed-methods design to test reliability and validity of the CASE tool.

RESULTS

A nationally representative sample of faculty from universities representing 27 states provided scores for videos using the CASE tool. Forty-seven participants completed the first scoring survey; 22 of the 47 participants (47%) completed the second-round scoring. Intraclass correlation for the final score between the first and second responses shows the consistency of test-retest reliability (ICC = .78, p < .001).

CONCLUSION

The CASE tool provided evidence of validity and reliability in evaluating EHR competency in simulation.
The Interdisciplinary Doula Project
Authors: Vignato Julie , Horak Teresa , Goodrich Amber , Shier Emily , Coleman Lastasica , Nicholson Anita , Thompson Meagan
Published: February 2024

People giving birth report overwhelmingly positive experiences with nursing students acting as doulas. However, no programs report on improving diversity among students, pregnant people, and curricula. This article describes the Interdisciplinary Doula Project, a program to enhance diverse perspectives and clinical skills of university students. Nursing (n = 21, 77.8%) and other health students (n = 6, 22.2%) completed doula training, diversity seminars, and 36 hours of intrapartum care. Seven nursing students were hired to work on labor and delivery upon graduation. This innovative program may increase registered nurses trained to provide culturally congruent labor support for vulnerable pregnant populations.
Formal Radiologist Interpretations of Intraoperative Spine Radiographs Have Low Clinical Value
Authors: Lin Ryan T. , Dalton Jonathan F. , Como Christopher J. , Chang Audrey Y. , Tang Melissa Yunting , Oyekan Anthony A. , Sadhwani Shaan , Wawrose Richard A. , Lee Joon Y. , Shaw Jeremy D.
Published: February 2024

Study Design.

Retrospective cohort.

Objective.

To evaluate the clinical relevance, usefulness, and financial implications of intraoperative radiograph interpretation by radiologists in spine surgery.

Summary of Background Data.

Due to rising health care costs, spine surgery is under scrutiny to maximize value-based care. Formal radiographic analysis remains a potential source of unnecessary health care costs, especially for intraoperative radiographs.

Materials and Methods.

A retrospective cohort analysis was performed on all adult elective spine surgeries at a single institution between July 2020 and July 2021. Demographic and radiographic data were collected, including intraoperative localization and post-instrumentation radiographs. Financial data were obtained through the institution’s price estimator. Radiographic characteristics included time from radiographic imaging to completion of radiologist interpretation report, completion of radiologist interpretation report before the conclusion of surgical procedure, clinical relevance, and clinical usefulness. Reports were considered clinically relevant if the spinal level of the procedure was described and clinically useful if completed before the conclusion of the procedure and deemed clinically relevant.

Results.

Four hundred eighty-one intraoperative localization and post-instrumentation radiographs from 360 patients revealed a median delay of 128 minutes between imaging and completion of the interpretive report. Only 38.9% of reports were completed before the conclusion of surgery. There were 79.4% deemed clinically relevant and only 33.5% were clinically useful. Localization reports were completed more frequently before the conclusion of surgery (67.2% vs. 34.4%) but with lower clinical relevance (90.1% vs. 98.5%) and clinical usefulness (60.3% vs. 33.6%) than post-instrumentation reports. Each patient was charged $32 to $34 for the interpretation fee, cumulating a minimum total cost of $15,392.

Conclusions.

Formal radiographic interpretation of intraoperative spine radiographs was of low clinical utility for spine surgeons. Institutions should consider optimizing radiology workflows to improve timeliness and clinical relevance or evaluate the necessity of reflexive consultation to radiology for intraoperative imaging interpretation to ensure that value-based care is maximized during spine surgeries.

Level of Evidence.

3.
Toward Equitable Kidney Function Estimation in Critical Care Practice. Guidance From the Society of Critical Care Medicine’s Diversity, Equity, and Inclusion in Renal Clinical Practice Task Force
Authors: Miano Todd A. , Barreto Erin F. , McNett Molly , Martin Niels , Sakhuja Ankit , Andrews Adair , Basu Rajit K. , Ablordeppey Enyo Ama
Published: February 2024

Objectives:

Accurate glomerular filtration rate (GFR) assessment is essential in critically ill patients. GFR is often estimated using creatinine-based equations, which require surrogates for muscle mass such as age and sex. Race has also been included in GFR equations, based on the assumption that Black individuals have genetically determined higher muscle mass. However, race-based GFR estimation has been questioned with the recognition that race is a poor surrogate for genetic ancestry, and racial health disparities are driven largely by socioeconomic factors. The American Society of Nephrology and the National Kidney Foundation (ASN/NKF) recommend widespread adoption of new “race-free” creatinine equations, and increased use of cystatin C as a race-agnostic GFR biomarker.

Data Sources:

Literature review and expert consensus.

Study Selection:

English language publications evaluating GFR assessment and racial disparities.

Data Extraction:

We provide an overview of the ASN/NKF recommendations. We then apply an Implementation science methodology to identify facilitators and barriers to implementation of the ASN/NKF recommendations into critical care settings and identify evidence-based implementation strategies. Last, we highlight research priorities for advancing GFR estimation in critically ill patients.

Data Synthesis:

Implementation of the new creatinine-based GFR equation is facilitated by low cost and relative ease of incorporation into electronic health records. The key barrier to implementation is a lack of direct evidence in critically ill patients. Additional barriers to implementing cystatin C-based GFR estimation include higher cost and lack of test availability in most laboratories. Further, cystatin C concentrations are influenced by inflammation, which complicates interpretation.

Conclusions:

The lack of direct evidence in critically ill patients is a key barrier to broad implementation of newly developed “race-free” GFR equations. Additional research evaluating GFR equations in critically ill patients and novel approaches to dynamic kidney function estimation is required to advance equitable GFR assessment in this vulnerable population.
Mortality, morbidity, and care practices for 1750 very low birth weight infants, 2016–2021
Authors: He Yang , Zhang Meng , Tang Jun , Liu Wanxiu , Hu Yong , Shi Jing , Wang Hua , Xiong Tao , Zhang Li , Ying Junjie , Mu Dezhi
Published: February 2024

Background:

Very low birth weight (VLBW) infants are the key populations in neonatology, wherein morbidity and mortality remain major challenges. The study aimed to analyze the clinical characteristics of VLBW infants.

Methods:

A retrospective cohort study was conducted in West China Second Hospital between January 2016 and December 2021. Neonates with a birth weight of <1500 g were included. Mortality, care practices, and major morbidities were analyzed, and compared with those of previous 7 years (2009–2015).

Results:

Of the total 1750 VLBW, 1386 were infants born with birth weight between 1000–1499 g and 364 infants were born with weight below 1000 g; 42.9% (751/1750) required delivery room resuscitation; 53.9% (943/1750) received non-invasive ventilation only; 38.2% (669/1750) received invasive ventilation; 1517 VLBW infants received complete treatment. Among them, 60.1% (912/1517) of neonates had neonatal respiratory distress syndrome (NRDS), 28.7% (436/1517) had bronchopulmonary dysplasia (BPD), 22.0% (334/1517) had apnea, 11.1% (169/1517) had culture-confirmed sepsis, 8.4% (128/1517) had pulmonary hemorrhage, 7.6% (116/1517) had severe intraventricular hemorrhage (IVH)/periventricular leukomalacia (PVL), 5.7% (87/1517) had necrotizing enterocolitis (NEC), and 2.0% (31/1517) had severe retinopathy of prematurity. The total and in-hospital mortality rates were 9.7% (169/1750) and 3.0% (45/1517), respectively. The top three diagnoses of death among those who had received complete treatment were sepsis, NRDS, and NEC. In 2009–2015, 1146 VLBW were enrolled and 895 infants received complete treatment. The proportions of apnea, IVH, and IVH stage ≥3/PVL, were higher in 2009–2015 compared with those in 2016–2021, while the proportions of NRDS and BPD were characterized by significant increases in 2016–2021. The total and in-hospital mortality rates were 16.7% (191/1146) and 5.6% (50/895) respectively in 2009–2015.

Conclusion:

Among VLBW infants born in 2016–2021, the total and in-hospital mortality rates were lower than those of neonates born in 2009–2015. Incidences of NRDS and BPD increased in 2016–2021, which affected the survival rates and long-term prognosis of VLBW.
Hot words and overseas hotspots on traditional Chinese medicine in 2020
Authors: Tong Yuanyuan , Zhang Yuqi , Gao Man , Li Haiyan
Published: February 2024

To analyze the hot words of traditional Chinese medicine (TCM) research and the hotspots of overseas concern in 2020. With the core collection of Web of Science as the data source and 827 TCM-related concepts as the search terms, the research papers related to TCM were obtained through subject search, the authors’ keywords were extracted for frequency statistics, and the top 100 hot words in the field of TCM were obtained. The top 10 overseas hotspots are obtained through cluster analysis. Some suggestions are provided for the hot research areas in the field of TCM.
Aged females unilaterally hypersensitize, lack descending inhibition, and overexpress alpha1D adrenergic receptors in a murine posttraumatic chronic pain model
Authors: Hirsch Silke J. , Budig Alexandra , Husam Sanar , Birklein Frank
Published: February 2024

Vulnerability to chronic pain is found to depend on age and sex. Most patients with chronic pain are elderly women, especially with posttraumatic pain after bone fracture that prevails beyond the usual recovery period and develops into a complex regional pain syndrome (CRPS). There, a distal bone fracture seems to initiate a pathophysiological process with unknown mechanism. To investigate whether sex, age, and alpha adrenergic receptors also contribute to a CRPS-like phenotype in animals, we performed experiments on tibia-fractured mice. Those mice commonly are resilient to the development of a CRPS-like phenotype. However, we found them to be vulnerable to long-lasting pain after distal bone fracture when they were of old age. These mice expressed mechanical and thermal hypersensitivity, as well as weight-bearing and autonomic impairment following bone trauma, which persisted over 3 months. Site-specific and body side–specific glycinergic and α1D-noradrenergic receptor expression in the spinal cord and the contralateral locus coeruleus were misbalanced. Aged female tibia-fractured mice lost descending noradrenergic inhibition and displayed enhanced spinal activity on peripheral pressure stimuli. Together, changes in the noradrenergic, hence, glycinergic system towards excitation in the pain pathway—ascending and descending—might contribute to the development or maintenance of long-lasting pain. Conclusively, changes in the noradrenergic system particularly occur in aged female mice after trauma and might contribute to the development of long-lasting pain. Our data support the hypothesis that some patients with chronic pain would benefit from lowering the adrenergic/sympathetic tone or antagonizing α1(D).
Differences in coronary angiographic findings and outcomes between men and postmenopausal women with stable chest pain
Authors: Kang In Sook , Shin Mi-Seung , Lee Hye Ah , Kim Mi-Na , Kim Hack-Lyoung , Yoon Hyun-Ju , Park Seong-Mi , Hong Kyung-Soon , Kim Myung-A
Published: February 2024

Background

Despite the significant increase in cardiovascular events in women after menopause, studies comparing postmenopausal women and men are scarce.

Methods

We analyzed data from a nationwide, multicenter, prospective registry and enrolled 2412 patients with stable chest pain who underwent elective coronary angiography. Binary coronary artery disease (b-CAD) was defined as the ≥50% stenosis of epicardial coronary arteries, including the left main coronary artery.

Results

Compared with the men, postmenopausal women were older (66.6 ± 8.5 vs. 59.5 ± 11.4 years) and had higher high-density lipoprotein cholesterol levels (49.0 ± 12.8 vs. 43.6 ± 11.6 mg/dl, P < 0.01). The prevalence of diabetes did not differ significantly (P = 0.40), and smoking was more common in men than in postmenopausal women (P ≤ 0.01). At enrollment, b-CAD and revascularization were more common in men than in postmenopausal women (50.3% vs. 41.0% and 14.4% vs. 9.7%, respectively; both P < 0.01). However, multivariate analyses revealed that revascularization [odds ratio (OR): 0.72; 95% confidence interval (CI): 0.49–1.08] was not significantly related to sex and a similar result was found in age propensity-matched population (OR: 0.80; 95% CI: 0.52–1.24). During the follow-up period, the secondary composite cardiovascular outcomes were lower in postmenopausal women than in men (OR: 0.55; 95% CI: 0.31–0.98), also consistent with the result using the age propensity-mated population (OR: 0.33; 95% CI: 0.13–0.85).

Conclusion

Postmenopausal women experienced coronary revascularization comparable to those in men at enrollment, despite the average age of postmenopausal women was 7 years older than that of men.

Postmenopausal women exhibit better clinical outcomes than those of men if optimal treatment is provided.
Intermittent fasting regimens for metabolic dysfunction-associated steatotic liver disease: a systematic review and network meta-analysis of randomized controlled trials
Authors: Abuelazm Mohamed T. , Mohamed Islam , Naeem Ahmed , Khlidj Yehya , Tanashat Mohammad , Katamesh Basant E. , Abusuilik Husam , Altobaishat Obieda , Abdelnabi Mohamed , Abdelazeem Basel
Published: February 2024

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent metabolic disorder characterized by excessive hepatic fat accumulation. Intermittent fasting (IF) has emerged as a potential therapeutic strategy with the ability to induce weight loss, improve insulin sensitivity and reduce hepatic steatosis. We aim to compare the efficacy of different IF regimens for MASLD management. A systematic review and network meta-analysis of randomized controlled trials investigating different IF regimens for MASLD. PubMed, EMBASE, WOS, SCOPUS and Cochrane Central Register of Controlled Trials were searched until 10 April 2023. Analysis was performed using R software with the meta and netmeta packages. Mean difference (MD) was used to pool continuous outcomes with 95% confidence intervals (CIs). Our meta-analysis was registered in PROSPERO (CRD42023418467). Our meta-analysis included eight randomized controlled trials with a total of 635 participants. The 5 : 2 diet significantly improved liver stiffness (MD, −0.32; 95% CI, −0.55 to −0.09; P < 0.01). Time-restricted feeding significantly improved liver steatosis (controlled attenuation parameter score) (MD, −39.83; 95% CI, −64.78 to −14.87; P < 0.01). No significant changes were observed in asparate aminotransferase, gamma-glutamyl transpeptidase, low-density lipoproteins cholesterol, total cholesterol, triglyceride levels, basal metabolic index, blood pressure, Homeostatic Model Assessment of Insulin Resistance, fasting blood sugar, lean body mass or waist circumference across all IF regimens. However, alternate-day fasting showed positive results in anthropometric measures, including significant improvements in lean body mass, waist circumference, fat mass and weight reduction (P < 0.05). IF regimens showed various positive effects on clinical outcomes in MASLD patients; however, these effects were not consistent. Therefore, a patient-tailored IF regimen should be considered.
Can quantitative surface antigen levels and systemic immune-inflammation index be predictive as a new indicator for the initiation of treatment in chronic hepatitis b?
Authors: Koroglu Mehmet , Ayvaz Muhammed Ali , Bakan Suat Baran , Sirin Abdullatif , Akyuz Umit
Published: February 2024

Objectives

The natural history of chronic HBV infection (CHB) is generally divided into four phases: HBeAg-positive chronic HBV infection (EPCI) and –hepatitis (EPCH), HBeAg-negative chronic HBV infection (ENCI) and –hepatitis (ENCH). This study aimed to investigate changes in serum quantitative surface antigen (qHBsAg), systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI) in a large number of CHB patients.

Method

Three hundred seventy-two CHB patients who underwent liver biopsy between January 2015 and February 2020 were evaluated.

Results

The SII-values were strongly significant between EPCI–EPCH (P = 0.002), however, there was significant difference between ENCI–ENCH (P = 0.025). Considering the SIRI results, there was a significant difference between both EPCI–EPCH (P = 0.009) and ENCI-ENCH (P = 0.118). In HBeAg-positive patients HBV-DNA, qHBsAg, and SII were found to be predictive (P = 0.029, P = 0.039, P = 0.027, respectively) while in HBeAg-negative patients, age, AST, HBV-DNA, qHBsAg, SII, and SIRI were found to be predictive (P = 0.047, P = 0.084, P = <0.001, P = 0.001, P = 0.012, P = 0.002, respectively). In EPCH phase, whereby accuracy rate results of HBV-DNA, qHBsAg, and SII were 75.3%, 73.4%, and 60.4%, respectively, while in the ENCH phase the accuracy rates of age, AST, HBV-DNA, qHBsAg, SII, and SIRI values were 57.8%, 65.6%, 68.3%, 63.8%, 57.3% and 53.2%, respectively.

Conclusion

HBV-DNA, qHBsAg, and SII are predictive in EPCH patients. Age, AST, HBV-DNA, qHBsAg, SII and SIRI are all predictive in ENCH patients. In patients with CHB, we recommend using SII to distinguish between EPCI-EPCH and ENCI-ENCH. Based on its sensitivity and features, we believe that qHBsAg and SII are suitable measuring instruments in discrimination both of EPCI-EPCH and ENCI-ENCH.
Performance assessment of a new G12/A1 antibody-based rapid ELISA using commercially available and gluten-spiked food samples
Authors: Verma Anil K. , Monachesi Chiara , Catassi Giulia N. , Franceschini Elisa , Gatti Simona , Lionetti Elena , Catassi Carlo
Published: February 2024

Objective

Food products with <20 mg/kg gluten can be labeled ‘gluten-free’ according to international regulations. Several antibodies-based ELISAs have been develop to track gluten traces in food products. Among them, R5 and G12 antibody-based ELISAs are the frequently used methods. However, these antibodies have certain limitations. We evaluated the accuracy of G12/A1 antibody-based ‘Glutentox ELISA Rapid G12’ and compared the results with the current reference method i.e., R5 antibody-based ‘Ridascreen R5 ELISA’.

Methods

In the first step, the performance of Glutentox ELISA Rapid G12 kit was inspected by determination of the threshold value i.e., > or <20 mg/kg gluten in different food products. In the second step, quantification accuracy was assessed by quantification of gluten in gluten-free food products spiked with gliadin reference material.

Results

In total 47 food products (naturally and labeled gluten-free, and food with traces of gluten) were included. Of them, 29 products were quantified with <20 mg/kg, and 18 with a low level of gluten by both the kits. Six out of 29 gluten-free products were used for the recovery test at different spike levels. Gluten concentration and mean recovery rates of individual kits showed consistency.

Conclusion

GlutenTox Rapid G12 ELISA could be an appropriate choice for detecting gluten in food products but needs more in-house validation and collaborative tests.