bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and trends of 17 notifiable bacterial infectious diseases in China, 2004–2019
Authors: Zhu Yuliang , Lin Shenghong , Dong Shuaibing , Zhang Cuihong , Shi Lusha , Ren Xiang , Li Zhongjie , Wang Liping , Fang Liqun
Published: May 2023

Background

Certain bacterial infectious diseases are categorized as notifiable infectious diseases in China. Understanding the time-varying epidemiology of bacterial infections diseases can provide scientific evidence to inform prevention and control measures.

Methods

Yearly incidence data for all 17 major notifiable bacterial infectious diseases (BIDs) at the province level were obtained from the National Notifiable Infectious Disease Reporting Information System in China between 2004 and 2019. Of them 16 BIDs are divided into four categories, respiratory transmitted diseases (RTDs, 6 diseases), direct contact/fecal-oral transmitted diseases (DCFTDs, 3 diseases), blood-borne/sexually transmitted diseases (BSTDs, 2 diseases), and zoonotic and vector-borne diseases (ZVDs, 5 diseases), and neonatal tetanus is excluded in the analysis. We characterized the demographic, temporal, and geographical features of the BIDs and examined their changing trends using a joinpoint regression analysis.

Results

During 2004‒2019, 28 779 thousand cases of BIDs were reported, with an annualized incidence rate of 134.00 per 100 000. RTDs were the most commonly reported BIDs, accounting for 57.02% of the cases (16 410 639/28 779 000). Average annual percent changes (AAPC) in incidence were − 1.98% for RTDs, − 11.66% for DCFTDs, 4.74% for BSTDs, and 4.46% for ZVDs. Females had a higher incidence of syphilis than males, and other BIDs were more commonly reported in males. Among 0-5-year-olds, the diseases with the largest increases in incidence were pertussis (15.17% AAPC) and scarlet fever (12.05%). Children and students had the highest incidence rates of scarlet fever, pertussis, meningococcal meningitis, and bacillary dysentery. Northwest China had the highest incidence of RTDs, while South and East China had the highest incidences of BSTDs. Laboratory confirmation of BIDs increased from 43.80 to 64.04% during the study period.

Conclusions

RTDs and DCFTDs decreased from 2004 to 2019 in China, while BSTDs and ZVDs increased during the same period. Great attention should be paid to BSTDs and ZVDs, active surveillance should be strengthened, and timely control measures should be adopted to reduce the incidence.
Understanding the self-management experiences and support needs during pregnancy among women with pre-existing diabetes: a qualitative descriptive study
Authors: Sushko Katelyn , Strachan Patricia , Butt Michelle , Nerenberg Kara A. , Sherifali Diana
Published: May 2023

Background

With the increasing prevalence of pre-existing type 1 and type 2 diabetes in pregnancy and their associated perinatal risks, there is a need to focus on interventions to achieve optimal maternal glycemia to improve pregnancy outcomes. One strategy focuses on improving diabetes self-management education and support for expectant mothers with diabetes. This study’s objective is to describe the experience of managing diabetes during pregnancy and identify the diabetes self-management education and support needs during pregnancy among women with type 1 and type 2 diabetes.

Methods

Using a qualitative descriptive study design, we conducted semi-structured interviews with 12 women with pre-existing type 1 or 2 diabetes in pregnancy (type 1 diabetes, n = 6; type 2 diabetes, n = 6). We employed conventional content analyses to derive codes and categories directly from the data.

Results

Four themes were identified that related to the experiences of managing pre-existing diabetes in pregnancy; four others were related to the self-management support needs in this population. Women with diabetes described their experiences of pregnancy as terrifying, isolating, mentally exhausting and accompanied by a loss of control. Self-management support needs reported included healthcare that is individualized, inclusive of mental health support and support from peers and the healthcare team.

Conclusions

Women with diabetes in pregnancy experience feelings of fear, isolation and a loss of control, which may be improved through personalized management protocols that avoid “painting everybody with the same brush” as well as peer support. Further examination of these simple interventions may yield important impacts on women’s experience and sense of connection.
Smokers’ utilization of quitting methods and vaping during pregnancy: an empirical cluster analysis of 2016–2018 Pregnancy Risk Assessment Monitoring System (PRAMS) data in seven US states
Authors: Wang Xi , Lee Nora L. , Burstyn Igor
Published: May 2023

Background

Patterns of utilization of numerous smoking cessation methods among pregnant women amidst the increasing popularity of vaping (use of e-cigarettes) remains unknown.

Methods

This study included 3,154 mothers who self-reported smoking around the time of conception and delivered live births in 2016–2018 in seven US states. Latent class analysis was used to identify subgroups of smoking women based on their utilization of 10 surveyed quitting methods and vaping during pregnancy.

Results

We identified four subgroups of smoking mothers with different utilization patterns of quitting methods during pregnancy: 22.0% reported “not trying to quit”; 61.4% tried to “quit on my own” without any behavioral or pharmacological assistance; 3.7% belonged to the “vaping” subgroup; and 12.9% utilized “wide-ranging methods” with higher use rate of multiple approaches, such as quit line and nicotine patch. Compared to mothers “not trying to quit,” the subgroup trying to “quit on my own” were more likely to be abstinent (adjusted OR 4.95, 95% CI 2.82–8.35) or to reduce the number of cigarettes smoked daily (adjusted OR 2.46, 95% CI 1.31–4.60) in late pregnancy, and these improvements lasted into early postpartum. We did not observe a measurable reduction in smoking among the “vaping” subgroup or women trying to quit with “wide-ranging methods”.

Conclusions

We identified four subgroups of smoking mothers with different utilization patterns of eleven quitting methods during pregnancy. Pre-pregnancy smokers who tried to “quit on my own” were most likely to be abstinent or to reduce smoking amount.
Adverse neonatal outcomes and associated factors among mothers who gave birth through induced and spontaneous labor in public hospitals of Awi zone, Northwest Ethiopia: a comparative cross-sectional study
Authors: Laikemariam Melaku , Aklilu Almaz , Waltengus Fikadu , Addis Melkamu , Gezimu Wubishet , Baye Fekadu , Getaneh Temesgen
Published: May 2023

Background

Adverse neonatal outcomes are one of the most common causes of neonatal mortality and morbidity. Empirical evidence across the world shows that induction of labor potentiates adverse neonatal outcomes. In Ethiopia, there has been limited data that compares the frequency of adverse neonatal outcomes between induced and spontaneous labor.

Objectives

To compare the prevalence of adverse neonatal outcomes between induced and spontaneous labor and to determine associated factors among women who gave birth in public hospitals of Awi Zone, Northwest Ethiopia.

Methods

A comparative cross-sectional study was conducted at Awi Zone public hospitals from May 1 to June 30, 2022. A simple random sampling technique was employed to select 788 (260 induced and 528 spontaneous) women. The collected data were analyzed using statistical package for social science (SPSS) software version 26. The Chi-square test and an independent t-test were used for categorical and continuous variables, respectively. A binary logistic regression was used to assess the association between the outcome and explanatory variables. In the bivariate analysis, a p-value ≤ 0.2 at a 95% confidence interval was used to consider the variables in the multivariate analysis. Finally, statistical significance was stated at a p-value of less than 0.05.

Result

The adverse neonatal outcomes among women who gave birth through induced labor were 41.1%, whereas spontaneous labor was 10.3%. The odds of adverse neonatal outcomes in induced labor were nearly two times higher than in spontaneous labor (AOR = 1.89, 95% CI: 1.11–3.22). No education (AOR = 2.00, 95% CI: 1.56, 6.44), chronic disease (AOR = 3.99, 95% CI: 1.87, 8.52), male involvement (AOR = 2.23, 95% CI: 1.23, 4.06), preterm birth (AOR = 9.83, 95% CI: 8.74, 76.37), operative delivery (AOR = 8.60, 95% CI: 4.63, 15.90), cesarean section (AOR = 4.17, 95% CI: 1.94, 8.95), and labor complications (AOR = 5.16, 95% CI: 2.90, 9.18) were significantly associated factors with adverse neonatal outcomes.

Conclusion and recommendation

Adverse neonatal outcomes in the study area were higher. Composite adverse neonatal outcomes were significantly higher in induced labor compared to spontaneous labor. Therefore, it is important to anticipate the possible adverse neonatal outcomes and plan management strategies while conducting every labor induction.
Exploring the associations between auditory hallucinations and psychopathological experiences in 10,933 patient narratives: moving beyond diagnostic categories and surveys
Authors: Ghosh Chandril Chandan , McVicar Duncan , Davidson Gavin , Shannon Ciaran , Armour Cherie
Published: May 2023

Background

Previous research suggests that auditory hallucinations are prevalent within both the clinical and general populations. Yet, we know little about how these phenomena are associated with other psychopathology symptoms and experiences. The current study aids investigations towards preventing, predicting and more effectively responding to such distressing occurrences. There have been substantial efforts in the literature to propose models of auditory hallucination and attempts to verify them. However, many of these studies used survey methods that restrict the person’s responses to a set of pre-defined criteria or experiences and do not allow exploration of potential important other symptoms beyond them. This is the first study to explore the correlates of auditory hallucination using a qualitative dataset consisting of unrestricted responses of patients about their lived experiences with mental illness.

Method

The study used a dataset consisting of 10,933 narratives from patients diagnosed with mental illnesses. For analysis, the study used correlation on the text-based data. This approach is an alternative to the knowledge-based approach where experts manually read the narratives and infer the rules and relationships from the dataset.

Result

This study found at least 8 correlates of auditory hallucination (small correlation coefficients), with the unusual ones being “pain.” The study also found that auditory hallucinations were independent of obsessive thoughts and compulsive behaviours, and dissociation, in contrast with the literature.

Conclusion

This study presents an innovative approach to explore the possible associations between symptoms without the restrictions of (or outside the confines of) traditional diagnostic categories. The study exemplified this by finding the correlates of auditory hallucination. However, any other symptom or experience of interest can be studied similarly. Potential future directions of these findings are discussed in the context of mental healthcare screening and treatment.
Sex, cognitive state and falls as factors associated with malnutrition: a cross-sectional study of institutionalized older adults living in a rural area of Portugal
Authors: Carrasco Cristina , Reis Gorete , Sim-Sim Margarida , Parraca Jose A. , Fernandes Orlando , Tomas-Carus Pablo
Published: May 2023

Background

Malnutrition is an underestimated geriatric problem, with a high prevalence in institutionalized older adults. The identification of risk factors for malnutrition in elderly individuals must be a priority for governmental organizations worldwide.

Methods

A total of 98 institutionalized seniors were enrolled in a cross-sectional study. For the assessment of risk factors, sociodemographic characteristics and health-related information were collected. The Mini-Nutritional Assessment Short-Form test was used to assess malnutrition in the sample population.

Results

A significantly greater proportion of women than men were malnourished or at risk of malnutrition. In addition, the comparative analysis revealed that comorbidity, arthritis, balance impairment, dementia and fall episodes with serious injuries were significantly more frequent in the older adults categorized as malnourished or at risk of malnutrition than in those categorized as well-nourished.

Conclusions

Multivariable regression analysis revealed that being female, having a poor cognitive status and experiencing falls with injuries are the main independent factors influencing nutritional status in institutionalized older adults living in a rural area of Portugal.
Association of quality of prenatal care with contraceptive planning in a United States population: a retrospective cohort study
Authors: Chapman Hannah L. , Chase Dana , Bhattarai Bikash , Sutton Maureen , Meyer Isuzu , Schofield Caleb
Published: May 2023

Background

Understanding how prenatal care influences planned postpartum contraception can help guide shared decision-making. This study looks to examine the association of the quality of prenatal care with planned postpartum contraception.

Methods

This is a retrospective cohort study conducted in a single tertiary, academic urban institution in the southwest United States. The institutional review board (IRB) for human research at Valleywise Health Medical Center approved this study. Using a validated measure of prenatal care, the Kessner index, prenatal care was classified as adequate, intermediate, or inadequate. The World Health Organization (WHO) protocol for contraceptive effectiveness was used to classify contraceptives as very effective, effective, and less effective. The planned contraceptive choice was determined at the time of hospital discharge after delivery by discharge summary. Chi-squared testing and logistic regression were used to measure associations between the adequacy of prenatal care and contraceptive planning.

Results

This study included 450 deliveries, 404 (90%) patients with adequate prenatal care, and 46 (10%) patients without adequate (intermediate or inadequate) prenatal care. There was not a statistically significant difference in planning for very effective or effective methods of contraception at hospital discharge between adequate (74%) and non-adequate (61%) prenatal care groups (p = 0.06). There was no association between the adequacy of prenatal care and the effectiveness of contraceptive planning after controlling for age and parity (aOR = 1.7, 95% CI 0.89–3.22).

Conclusions

Many women chose very effective and effective methods of postpartum contraception; however, there was no statistically significant association between the quality of prenatal care and planned contraception at hospital discharge.
The risk of sexual dysfunction associated with alcohol consumption in women: a systematic review and meta-analysis
Authors: Salari Nader , Hasheminezhad Razie , Almasi Afshin , Hemmati Mahvan , Shohaimi Shamarina , Akbari Hakimeh , Mohammadi Masoud
Published: May 2023

Background

Alcohol abuse among women is a significant health problem. Consuming alcohol in high amounts causes decreased sexual stimulation, vaginal lubrication, dyspareunia, and difficulty reaching orgasm. Due to the different effects of alcohol consumption on sexual function, this study aimed to investigate the effect of alcohol consumption on sexual dysfunction in women.

Methods

In this study, the researchers conducted a systematic search of several databases, including PubMed, Google Scholar, Scopus, Web of Science, Embase, and ScienceDirect, as well as the Google Scholar search engine, to identify studies reporting the impact of alcohol consumption on female sexual dysfunction. The search was conducted up until July 2022. A total of 225 articles were searched in the databases, and an additional 10 relevant articles were identified through manual search. After removing 93 articles due to duplication, 90 articles were excluded based on the study's inclusion and exclusion criteria. During the merit evaluation phase, 26 articles were excluded through the full-text study based on the study’s inclusion and exclusion criteria, while 26 articles were excluded due to their low quality. Ultimately, only 7 studies were deemed suitable for the final evaluation. The analysis was conducted using a random effects model, while the heterogeneity of the studies was assessed using the I2 index. Data analysis was performed using the Comprehensive Meta-Analysis Version 2 software.

Results

Based on the review of 7 studies involving a total sample size of 50,225 women and using the random effects method, the calculated odds ratio was 1.74 (95% CI: 1.006–3.04). This indicates that alcohol consumption increases the likelihood of sexual dysfunction in women by 74%. The Begg and Mazumdar rank correlation test, was used to analyze the distribution bias, but the results were not significant at the 0.1 significance level (p = 0.763).

Conclusion

The findings of this study demonstrate a significant correlation between alcohol consumption and an increased risk of sexual dysfunction in women. These results highlight the need for policymakers to prioritize this issue and raise awareness regarding the harmful effects of alcohol consumption on female sexual function and its impact on population health and reproduction.
Factors associated with the perception of university professors about academic dishonesty in dental students from two peruvian universities: analysis under multivariable regression model
Authors: Ladera-Castañeda Marysela , León-Málaga Flavia , Espinoza-Olórtegui Mary , Nicho-Valladares Miriam , Cervantes-Ganoza Luis , Verástegui-Sandoval Arturo , Solís-Dante Fredy , Castro-Rojas Miriam , Cayo-Rojas César Félix
Published: May 2023

Background

Academic dishonesty is an intentional behavior that transgresses ethics in the teaching-learning process. The present study aimed to evaluate the factors associated with the perception of university professors about academic dishonesty in dental students from two universities in the Peruvian capital.

Methods

This cross-sectional, analytical study evaluated 181 professors from two Peruvian universities between March and July 2022. A validated 28-item questionnaire was used to measure the perceived academic dishonesty of their students. Alogitmodel was used to evaluate the influence of the variables gender, marital status, place of origin, academic degree, specialization, academic area, years of teaching experience, scientific publications, ethical training and university of origin, considering a significance level of p < 0.05.

Results

According to the median, professors perceived that their students sometimes had attitudes and motivations to commit academic dishonesty. The professors whose origin was the capital city were twice as likely to perceive dishonest attitudes in dental students as those whose origin was a province (OR = 2.04; 95% CI: 1.06–3.93). University professors in pre-clinical courses were 0.37 times less likely to perceive dishonest attitudes than those teaching in the dental clinic (OR = 0.37; CI: 0.15–0.91). University professors in basic science courses and professors in preclinical courses were 0.43 times (OR = 0.43; CI: 0.19–0.96) and 0.39 times (OR = 0.39; CI: 0.15–0.98) less likely to perceive dishonest motivations in their students compared to university professors in the dental clinic. Gender, marital status, academic degree, specialty, years of teaching experience, scientific publications and ethical training were not found to be influential factors (p > 0.05).

Conclusion

Although all university professors surveyed perceived dishonest attitudes and motivations in their students, university professors from the capital city perceived such attitudes more. In addition, being a preclinical university professor was a hindered factor for perceiving such dishonest attitudes and motivations. It is advisable to implement and constantly disseminate regulations that empower academic integrity as well as to manage a system for reporting misconduct and to make students aware of the impact of dishonesty in their professional training.
Burnout and coping strategies among health system pharmacists in Lebanon: a cross-sectional study
Authors: Abilmona Rosa , Dimassi Hani , Aboulhosn Rafah , Chamoun Nibal
Published: May 2023

Background

Burnout in health system pharmacists has been studied in several countries. To date, no data exists on burnout among healthsystem pharmacists in Lebanon. This study aimed to determine the prevalance of burnout, identify factors and describe coping strategies related to burnout among healthsystem pharmacists in Lebanon.

Methods

A cross-sectional study utilizing the Maslach Burnout Inventory- Human Services Survey for Medical Personnel (MBI-HSS (MP))was conducted in Lebanon. A convenience sample of hospital pharmacists in Mount Lebanon and Beirut area filled a paper-based survey in person or via a phone interview. Burnout was defined as having an emotional exhaustion score ≥ 27 and/or depersonalization score ≥ 10. To identify factors associated with burnout, the survey also contained questions on socio-demographic characteristics, professional status, hospital characteristics, professional stressors and professional satisfaction. Participants were also asked about their coping strategies. To adjust for potential confounding, a multivariable logistic regression was used to estimate the adjusted odds ratios of factors and coping strategies associated with burnout. The authors also evaluated burnout according to the broader definition, emotional exhaustion score ≥ 27 or depersonalization score ≥ 10 or low personal accomplishment ≤ 33.

Results

Of the 153 health system pharmacists who were contacted, 115 filled the survey (response rate of 75.1%). The overall burnout prevalence reported was n = 50 (43.5%) and was largely driven by high emotional exhaustion n = 41(36.9%). Following multivariate logistic regression, seven factors were associated with increased burnout: older age, B.S. in Pharmacy degree, involvement in student training, no involvement in procurement, divided attention at work, overall dissatisfaction with career, dissatisfaction to neutrality with balance between professional and personal life. Low personal accomplishment was noted in n = 55 (49.5%). The main coping strategies identified were holidays, leisure, hobbies, sports activities, and relaxation. There was no association between the coping strategies used and burnout. The prevalence of burnout according to the broader definition was n = 77 (67%). The factors associated with the broader definition of burnout were older age, overall dissatisfaction with career and dissatisfaction with work life balance.

Conclusion

Approximately n = 50(43.5%)of health system pharmacists in Lebanon may be at risk for burnout. If using broader definitions incorporating all three subscales of the (MBI-HSS (MP)), the prevalence of burnout was n = 77(67%). This study highlights the need to advocate for pratice reforms to improve the low personal acoomplishment and recommends strategies to mitigate burnout. Further research to assess the current prevalence of burnout and evaluate effective interventions in alleviating burnout amongst health system pharmacists is needed.
Social determinants of health and adolescent childbearing in WHO Eastern Mediterranean countries
Authors: Boutayeb Abdesslam
Published: May 2023

Objectives

Teenage pregnancy and motherhood is a crucial problem in countries of the World Health Organisation Eastern Mediterranean Region (WHO–EMR). The aim of this paper is to describe and analyse the phenomenon of adolescent childbearing in ten countries according to social determinants like milieu (rural–urban), education level, wealth quintiles, territoriality (countries, regions) and nationality.

Methods

Inequity in terms of adolescent childbearing was analysed using disaggregated data given by Demographic Health Surveys (DHS), UNICEF Multiple Indicator Cluster Surveys (MICS) and the Pan Arab Project for Family Health (PAPFAM) surveys. Beside the absolute differences (gaps) and relative differences (ratios), the index of dissimilarity (ID) was used to compare the distributions of adolescent pregnancy and motherhood by social determinants in each country.

Results

Data analysis indicates that the average percentage of adolescent women aged 15–19 years who have begun childbearing shows a large difference between countries, varying from 0.4% in Tunisia to 15.1% in Sudan, combined with huge gaps within each country as indicated by the values of the index of dissimilarity. Poor, rural and non-educated adolescent girls are more exposed to teenage childbearing than their counterparts—rich, urban and educated girls.

Conclusion

According to different social determinants, sensible variations are seen in terms of adolescent pregnancy and motherhood within the ten countries considered in this study. This is a clear appeal to decision makers to reduce child marriage and pregnancy by acting on social determinants of health, targeting disadvantaged girls coming mainly from marginalised groups and poor families living in remote rural zones.
Genomic alterations of cerebrospinal fluid cell-free DNA in leptomeningeal metastases of gastric cancer
Authors: Chen Xin , Bai Kaixuan , Zhang Yu , Xu Yang , Huo Yinghao , Wang Sha , Zou Yueli , Qi Xuejiao , Guo Rongyun , Ou Qiuxiang , Liu Dengxiang , Yin Shaohua , Chen Shubo , Bu Hui
Published: May 2023

Background

Leptomeningeal metastases (LM) were rare in gastric cancer (GC), and GC patients with LM (GCLM) generally suffer from poor prognosis. Nevertheless, the clinical utility of cerebrospinal fluid (CSF) circulating tumor DNA (ctDNA) was underinvestigated in GCLM.

Methods

We retrospectively studied 15 GCLM patients, and all patients had paired primary tumor tissue samples and post-LM CSF samples while 5 patients also had post-LM plasma samples. All samples were analyzed using next-generation sequencing (NGS), and the molecular and clinical features were correlated with clinical outcomes.

Results

CSF had higher mutation allele frequency (P = 0.015), more somatic mutations (P = 0.032), and more copy-number variations (P < 0.001) than tumor or plasma samples. Multiple genetic alterations and aberrant signal pathways were enriched in post-LM CSF, including CCNE1 amplification and cell cycle-related genes, and CCNE1 amplification was significantly associated with patients’ overall survival (P = 0.0062). More potential LM progression-related markers were detected in CSF samples than in tumor samples, including PREX2 mutation (P = 0.014), IGF1R mutation (P = 0.034), AR mutation (P = 0.038), SMARCB1 deletion (P < 0.001), SMAD4 deletion (P = 0.0034), and TGF-beta pathway aberration (P = 0.0038). Additionally, improvement in intracranial pressure (P < 0.001), improvement in CSF cytology (P = 0.0038), and relatively low levels of CSF ctDNA (P = 0.0098) were significantly associated with better PFS. Lastly, we reported a GCLM case whose CSF ctDNA dynamic changes were well correlated with his clinical assessment.

Conclusions

CSF ctDNA could more sensitively detect molecular markers and metastasis-related mechanisms than tumor tissues in GCLM patients, and our study sheds light on utilizing CSF ctDNA in prognostic estimation and clinical assessment in GCLM.
Results of salvage therapy with mini-hyper-CVD and inotuzumab ozogamicin with or without blinatumomab in pre-B acute lymphoblastic leukemia
Authors: Kantarjian Hagop , Haddad Fadi G. , Jain Nitin , Sasaki Koji , Short Nicholas J. , Loghavi Sanam , Kanagal-Shamanna Rashmi , Jorgensen Jeffrey , Khouri Issa , Kebriaei Partow , Alvarado Yesid , Kadia Tapan , Paul Shilpa , Garcia-Manero Guillermo , Dabaja Bouthaina , Yilmaz Musa , Jacob Jovitta , Garris Rebecca , O’Brien Susan , Ravandi Farhad , Jabbour Elias
Published: May 2023

Background

Historically, adults with relapsed-refractory acute lymphoblastic leukemia (ALL) experienced poor outcomes with intensive chemotherapy. This mature analysis explores the benefit of the addition of sequential blinatumomab to low-intensity mini-Hyper-CVD chemotherapy with inotuzumab ozogamicin in this setting.

Methods

Mini-Hyper-CVD (cyclophosphamide and dexamethasone at 50% dose reduction, no anthracycline, methotrexate at 75% dose reduction, cytarabine at 83% dose reduction) was combined with inotuzumab during the first 4 courses. From Patient #68 and onwards, inotuzumab was given in reduced and fractionated doses, and blinatumomab was added sequentially for 4 courses. Maintenance therapy with prednisone, vincristine, 6-mercaptopurine and methotrexate was given for 12 courses, and blinatumomab for 4 additional courses.

Results

Among 110 patients (median age, 37 years) treated, 91 (83%) responded (complete response, 69 patients, 63%). Measurable residual disease negativity was documented in 75 patients (82% of responders). Fifty-three patients (48%) received allogeneic stem cell transplantation (SCT). Hepatic sinusoidal obstruction syndrome occurred in 9/67 patients (13%) on the original inotuzumab schedule and in 1/43 (2%) on the modified schedule. With a median follow-up of 48 months, the median overall survival (OS) was 17 months, and the 3 year OS was 40%. The 3 year OS was 34% with mini-Hyper-CVD plus inotuzumab and 52% with additional blinatumomab (P = 0.16). By landmark analysis at 4 months, the 3 year OS was 54%, similar between patients who did or did not receive allogeneic SCT.

Conclusion

Low-intensity mini-Hyper-CVD plus inotuzumab with or without blinatumomab showed efficacy in patients with relapsed-refractory ALL, with better survival after the addition of blinatumomab.

Trial registrationThe trial was registered on clinicaltrials.gov with the identifier NCT01371630.
Multiple trauma in pregnant women: injury assessment, fetal radiation exposure and mortality. A multicentre observational study
Authors: Abback Paer-Selim , Benchetrit Alison , Delhaye Nathalie , Daire Jean-Luc , James Arthur , Neuschwander Arthur , Boutonnet Mathieu , Cook Fabrice , Vinour Hélène , Hanouz Jean-Luc , Cotte Jean , Pastene Bruno , Jouffroy Viridiana , Gauss Tobias , Group Traumabase
Published: May 2023

Background

Fetal radiation exposure in pregnant women with trauma is a concern. The purpose of this study was to evaluate fetal radiation exposure with regard to the type of injury assessment performed.

Methods

It is a multicentre observational study. The cohort study included all pregnant women suspected of severe traumatic injury in the participating centres of a national trauma research network. The primary outcome was the cumulative radiation dose (mGy) received by the fetus with respect to the type of injury assessment initiated by the physician in charge of the pregnant patient. Secondary outcomes were maternal and fetal morbi-mortality, the incidence of haemorrhagic shock and the physicians’ imaging assessment with consideration of their medical specialty.

Results

Fifty-four pregnant women were admitted for potential major trauma between September 2011 and December 2019 in the 21 participating centres. The median gestational age was 22 weeks [12–30]. 78% of women (n = 42) underwent WBCT. The remaining patients underwent radiographs, ultrasound or selective CT scans based on clinical examination. The median fetal radiation doses were 38 mGy [23–63] and 0 mGy [0–1]. Maternal mortality (6%) was lower than fetal mortality (17%). Two women (out of 3 maternal deaths) and 7 fetuses (out of 9 fetal deaths) died within the first 24 h following trauma.

Conclusions

Immediate WBCT for initial injury assessment in pregnant women with trauma was associated with a fetal radiation dose below the 100 mGy threshold. Among the selected population with either a stable status with a moderate and nonthreatening injury pattern or isolated penetrating trauma, a selective strategy seemed safe in experienced centres.
Geriatric Nutrition Risk Index as a predictor of cardiovascular and all-cause mortality in older Americans with diabetes
Authors: Shen Xia , Yang Long , Gu Xue , Liu Yuan-Yuan , Jiang Lei
Published: May 2023

Background and aims

Few studies have examined the relationship between malnutrition, as defined by the Geriatric Nutrition Risk Index (GNRI), and all-cause mortality and cardiovascular mortality events, particularly in persons with diabetes. The study aimed at the association between GNRI and all-cause mortality and cardiovascular mortality in older Americans with diabetes.

Methods

Data from this retrospective study were obtained from the National Health and Nutrition Examination (NHANES) 1999–2016. Using data from The NHANES Public-Use Linked Mortality Files to assess all-cause mortality (ACM) and cardiovascular mortality (CVM). After excluding participants younger than 60 years and without diabetes, and with missing follow-up data, 4400 cases were left in this study. Persons with diabetes were divided by GNRI into 3 groups: GNRI ≥ 98; 92 ≤ GNRI < 98; and GNRI < 92; (No; Low; Moderate/Severe (M/S) group). We used Cox proportional hazard regression model to explore the predictive role of GNRI on ACM and CVM in elderly persons with diabetes. Restricted cubic splines to investigate the existence of a dose–response linear relationship between them.

Result

During a median follow-up period of 89 months, a total of 538 (12.23%) cardiovascular deaths occurred and 1890 (42.95%) all-cause deaths occurred. Multifactorial COX regression analysis showed all-cause mortality (hazard ratio [HR]: 2.58, 95% CI: 1.672–3.994, p < 0.001) and cardiovascular mortality (HR: 2.29, 95% CI: 1.063–4.936, p = 0.034) associated with M/S group risk of malnutrition in GNRI compared to no group. A negative association between GNRI and all-cause mortality was observed across gender and ethnicity. However, the same negative association between GNRI and cardiovascular mortality was observed only for males (HR:0.94, 95% CI:0.905–0.974, p < 0.001) and other races (HR:0.92, 95% CI:0.861–0.976, p = 0.007). And there was no significant correlation between low malnutrition and cardiovascular mortality (p = 0.076). Restricted cubic splines showed a nonlinear relationship between GNRI and all-cause mortality and cardiovascular mortality (non-linear p < 0.001, non-linear p = 0.019).

Conclusions

Lower GNRI levels are associated with mortality in older patients with diabetes. GNRI may be a predictor of all-cause mortality and cardiovascular mortality risk in older patients with diabetes.
Long-term effects of immunotherapy with a brain penetrating Aβ antibody in a mouse model of Alzheimer’s disease
Authors: Gustavsson Tobias , Metzendorf Nicole G. , Wik Elin , Roshanbin Sahar , Julku Ulrika , Chourlia Aikaterini , Nilsson Per , Andersson Ken G. , Laudon Hanna , Hultqvist Greta , Syvänen Stina , Sehlin Dag
Published: May 2023

Background

Brain-directed immunotherapy is a promising strategy to target amyloid-β (Aβ) deposits in Alzheimer’s disease (AD). In the present study, we compared the therapeutic efficacy of the Aβ protofibril targeting antibody RmAb158 with its bispecific variant RmAb158-scFv8D3, which enters the brain by transferrin receptor-mediated transcytosis.

Methods

AppNL−G−Fknock-in mice received RmAb158, RmAb158-scFv8D3, or PBS in three treatment regimens. First, to assess the acute therapeutic effect, a single antibody dose was given to 5 months oldAppNL−G−Fmice, with evaluation after 3 days. Second, to assess the antibodies’ ability to halt the progression of Aβ pathology, 3 months oldAppNL−G−Fmice received three doses during a week, with evaluation after 2 months. Reduction of RmAb158-scFv8D3 immunogenicity was explored by introducing mutations in the antibody or by depletion of CD4+T cells. Third, to study the effects of chronic treatment, 7-month-oldAppNL−G−Fmice were CD4+T cell depleted and treated with weekly antibody injections for 8 weeks, including a final diagnostic dose of [125I]RmAb158-scFv8D3, to determine its brain uptake ex vivo. Soluble Aβ aggregates and total Aβ42 were quantified with ELISA and immunostaining.

Results

Neither RmAb158-scFv8D3 nor RmAb158 reduced soluble Aβ protofibrils or insoluble Aβ1-42 after a single injection treatment. After three successive injections, Aβ1-42 was reduced in mice treated with RmAb158, with a similar trend in RmAb158-scFv8D3-treated mice. Bispecific antibody immunogenicity was somewhat reduced by directed mutations, but CD4+T cell depletion was used for long-term therapy. CD4+T cell-depleted mice, chronically treated with RmAb158-scFv8D3, showed a dose-dependent increase in blood concentration of the diagnostic [125I]RmAb158-scFv8D3, while concentration was low in plasma and brain. Chronic treatment did not affect soluble Aβ aggregates, but a reduction in total Aβ42 was seen in the cortex of mice treated with both antibodies.

Conclusions

Both RmAb158 and its bispecific variant RmAb158-scFv8D3 achieved positive effects of long-term treatment. Despite its ability to efficiently enter the brain, the benefit of using the bispecific antibody in chronic treatment was limited by its reduced plasma exposure, which may be a result of interactions with TfR or the immune system. Future research will focus in new antibody formats to further improve Aβ immunotherapy.
Inaccessibility of care and inequitable conceptions of suffering: a collective response to the construction of “terminal” anorexia nervosa
Authors: Sharpe Sam L. , Adams Marissa , Smith Emil K. , Urban Bek , Silverstein Scout
Published: May 2023

Informed by our lived experiences with eating disorders, our work providing direct support to communities underserved by existing healthcare structures, and our commitment to social justice, we are deeply troubled by several aspects of the proposed characteristics for “terminal” anorexia nervosa outlined by Gaudiani et al. in Journal of Eating Disorders (10:23, 2022). We have identified two substantial areas of concern in the proposed characteristics provided by Gaudiani et al. and the subsequent publication by Yager et al. (10:123, 2022). First, the original article and the subsequent publication fail to adequately address the widespread inaccessibility of eating disorder treatment, the lack of parameters for what constitutes “high quality care”, and the prevalence of trauma experienced in treatment settings for those who do access treatment. Second, the characteristics proposed for “terminal” anorexia nervosa are constructed largely based on subjective and inconsistent valuations of suffering which build on and contribute to harmful and inaccurate eating disorder stereotypes. Overall, we believe these proposed characteristics in their current form stand to detract from, rather than assist, the ability of patients and providers to make informed, compassionate, and patient-centered decisions about safety and autonomy both for individuals with enduring eating disorders and for individuals with more recently diagnosed eating disorders.
The prevalence of adjustment disorder and predisposing factors in infertile women
Authors: Shafierizi Shiva , Basirat Zahra , Nasiri-Amiri Fatemeh , Kheirkhah Farzan , Chehrazi Mohammad , Pasha Hajar , Faramarzi Mahbobeh
Published: May 2023

Background

Infertility is a stressful life event that increases the risk of developing mental disorders, particularly adjustment disorder (AD). Given the paucity of data on the prevalence of AD symptoms in infertility, the purpose of this study was to ascertain the prevalence, clinical presentation, and risk factors for AD symptoms in infertile women.

Method

In a cross-sectional study, 386 infertile women completed questionnaires including the Adjustment Disorder New Module-20 (ADNM), the Fertility Problem Inventory (FPI), the Coronavirus Anxiety Scale (CAS), and the Primary Care Posttraumatic Stress Disorder (PC-PTSD-5) at an infertility center between September 2020 and January 2022.

Result

The results indicated that 60.1% of infertile women exhibited AD symptoms (based on ADNM > 47.5). In terms of clinical presentation, impulsive behavior was more common. No significant relationship was observed between prevalence and women's age or duration of infertility. Infertility stress (β = 0.27, p < 0.001), coronavirus anxiety (β = 0.59, p = 0.13), and a history of unsuccessful assisted reproductive therapies (β = 2.72, p = 0.008) were several predisposing factors for AD symptoms in infertile women.

Conclusions

The findings suggest that all infertile women be screened from the start of infertility treatment. Additionally, the study suggests that infertility specialists should focus on combining medical and psychological treatments for individuals predisposed to AD, particularly infertile women who exhibit impulsive behaviors.
Tobacco microbial screening and application in improving the quality of tobacco in different physical states
Authors: Ning Ying , Zhang Li-Yuan , Mai Jing , Su Jia-En , Cai Jie-Yun , Chen Yi , Jiang Yong-Lei , Zhu Ming-Jun , Hu Bin-Bin
Published: May 2023

The first-cured tobacco contains macromolecular substances with negative impacts on tobacco products quality, and must be aged and fermented to mitigate their effects on the tobacco products quality. However, the natural fermentation takes a longer cycle with large coverage area and low economic efficiency. Microbial fermentation is a method to improve tobacco quality. The change of chemical composition of tobacco during the fermentation is often correlated with shapes of tobacco. This study aimed to investigate the effects of tobacco microorganisms on the quality of different shapes of tobacco. Specifically,Bacillus subtilisB1 andCytobacillus oceanisediminisC4 with high protease, amylase, and cellulase were isolated from the first-cured tobacco, followed by using them for solid-state fermentation of tobacco powder (TP) and tobacco leaves (TL). Results showed that strains B1 and C4 could significantly improve the sensory quality of TP, enabling it to outperform TL in overall texture and skeleton of tobacco products during cigarette smoking. Compared with the control, microbial fermentation could increase reducing sugar; regulate protein, starch, and cellulose, reduce nicotine, improve total aroma substances, and enable the surface of fermented TP and TL to be more loose, wrinkled, and porous. Microbial community analysis indicated that strains B1 and C4 could change the native structure of microbial community in TP and TL. LEfSe analysis revealed that the potential key biomarkers in TP and TL wereBacilli,Pseudonocardia, Pantoea, andJeotgalicoccus, which may have cooperative effects with other microbial taxa in improving tobacco quality. This study provides a theoretical basis for improving tobacco fermentation process for better cigarettes quality.

Graphical Abstract
Frequency and risk factors of abnormal nerve conduction studies in accidentally diagnosed diabetes
Authors: El-Bably Mona M. , Abdallah Amany M. , Metwaly Mohamed M. , El Mahdi Amira R. , Rashad Samia M.
Published: May 2023

Background

Diabetic peripheral neuropathy (DPN) is one of the major diabetic complication and affects quality of life (QoL).This study aims at assessing the frequency of DPN among accidentally diagnosed diabetic patients, identifying risk factors linked to DPN in those patients, and determine the potential effect on QoL.

Results

According to nerve conduction study (NCS), 32 patients (44.4%) had polyneuropathy. Polyneuropathy is significantly associated with older age, higher hip and waist measurements, higher weight, and body mass index (BMI).

About 53% of patients with polyneuropathy were current smokers versus 25% of non-smokers. Longer duration since the first diagnosis, higher fasting blood sugar (FBG), 2-h post-prandial (2-hPP) glucose, and HbA1c are also associated with peripheral neuropathy (PN) (p < 0.001). Being on insulin was associated with PN (p = 0.002). Increasing BMI, current smoking, and increased HbA1c significantly increase the risk of PN by 1.314, 19.963, and 3.302-folds, respectively. An unhealthy diet is also associated with PN.Hyperlipidemia was also associated with PN (p = 0.028). A significant positive association was found between DQoL scores and symptom scores.

Conclusion

A significant proportion of type 2 diabetic patients had DPN at the time of diagnosis, which adversely affects QoL. At the time of diagnosis, it is highly suggested that proper screening. procedures be used for DPN. Obesity, smoking, and elevated HbA1c significantly increase the risk of DPN.
A pharmacological challenge paradigm to assess neural signatures of script-elicited acute dissociation in women with post-traumatic stress disorder
Authors: Mertens Yoki L. , Manthey Antje , Sierk Anika , de Jong Peter , Walter Henrik , Daniels Judith K.
Published: May 2023

Background

There is limited experimentally controlled neuroimaging research available that could explain how dissociative states occur and which neurobiological changes are involved in acute post-traumatic dissociation.

Aims

To test the causal hypothesis that acute dissociation is triggered bottom-up by a selective noradrenergic-mediated increase in amygdala activation during the processing of autobiographical trauma memories.

Method

Women with post-traumatic stress disorder (n = 47) and a history of interpersonal childhood trauma underwent a within-participant, placebo-controlled pharmacological challenge paradigm (4.0 mg reboxetine versus placebo) employing script-driven imagery (traumatic versus neutral autobiographical memory recall). Script-elicited brain activation patterns (measured via functional magnetic resonance imagery) were analysed by means of whole-brain analyses and a pre-registered region of interest (i.e. amygdala).

Results

Self-reported acute dissociation increased significantly during trauma (versus neutral) recall but did not differ between pharmacological conditions. The pharmacological manipulation was also unsuccessful in eliciting increased amygdala activation following script-driven imagery in the reboxetine (versus placebo) condition. In the reboxetine condition, trauma retrieval resulted in similar activation patterns as in the placebo condition (e.g. elevated brain activation in the middle occipital gyrus and supramarginal gyrus), albeit with different peaks.

Conclusions

Current (null) findings cast doubt on the suggested role of the amygdala in subserving dissociative processing of trauma memories. Alternative pharmacological manipulation approaches (e.g. ketamine) and analysis techniques (e.g. event-related independent component analysis) might provide better insight into the spatiotemporal dynamics and network shifts involved in dissociative experiences and autobiographical trauma memory recall.