bluuebunny/crossref_metadata_2025 huggingface dataset:
Conducting health services research during the COVID-19 pandemic: experiences from the veterans health administration
Authors: Connelly Brigid , Hess Edward , Daus Marguerite , Battaglia Catherine , Gilmartin Heather M.
Published: November 2023

Background

Health services researchers within the Veterans Health Administration (VA) seek to improve the delivery of care to the Veteran population, whose medical needs often differ from the general population. The COVID-19 pandemic and restricted access to medical centers and offices forced VA researchers and staff to transition to remote work. This study aimed to characterize the work experience of health service researchers during the COVID-19 pandemic.

Methods

A REDCap survey developed from the management literature was distributed in July 2020 to 800 HSR&D researchers and staff affiliated with VA Centers of Innovation. We requested recipients to forward the survey to VA colleagues. Descriptive analyses and logistic regression modeling were conducted on multiple choice and Likert scaled items. Manifest content analysis was conducted on open-text responses.

Results

Responses were received from 473 researchers and staff from 37 VA Medical Centers. About half (48%; n = 228) of VA HSR&D researchers and staff who responded to the survey experienced some interference with their research due to the COVID-19 pandemic, yet 55% (n = 260) reported their programs of research did not slow or stop. Clinician investigators reported significantly greater odds of interference than non-clinician investigators and support staff. The most common barriers to working remotely were loss of face-to-face interactions with colleagues (56%; n = 263) and absence of daily routines (25%; n = 118). Strategies teams used to address COVID-19 related remote work challenges included videoconferencing (79%; n = 375), virtual get-togethers (48%; n = 225), altered timelines (42%; n = 199), daily email updates (30%; n = 143) and virtual team huddles (16%; n = 74). Pre-pandemic VA information technology structures along with systems created to support multidisciplinary research teams working across a national healthcare system maintained and enhanced staff engagement and well-being.

Conclusions

This study identifies how the VA structures and systems put in place prior to the COVID-19 pandemic to support a dispersed workforce enabled the continuation of vital scientific research, staff engagement and well-being during a global pandemic. These findings can inform remote work policies and practices for researchers during the current and future crises.
Association of glycemic variability with death and severe consciousness disturbance among critically ill patients with cerebrovascular disease: analysis of the MIMIC-IV database
Authors: Cai Weimin , Li Yaling , Guo Kun , Wu Xiao , Chen Chao , Lin Xinran
Published: November 2023

Background

The association of glycemic variability with severe consciousness disturbance and in-hospital all-cause mortality in critically ill patients with cerebrovascular disease (CVD) remains unclear, This study aimed to investigate the association of glycemic variability with cognitive impairment and in-hospital death.

Method

We extracted all blood glucose measurements of patients diagnosed with CVD from the Medical Information Mart for Intensive Care IV (MIMIC-IV). Glycemic variability was defined as the coefficient of variation (CV), which was determined using the ratio of standard deviation and the mean blood glucose levels. Cox hazard regression models were applied to analyze the link between glycemic variability and outcomes. We also analyzed non-linear relationship between outcome indicators and glycemic variability using restricted cubic spline curves.

Results

The present study included 2967 patients diagnosed with cerebral infarction and 1842 patients diagnosed with non-traumatic cerebral hemorrhage. Log-transformed CV was significantly related to cognitive impairment and in-hospital mortality, as determined by Cox regression. Increasing log-transformed CV was approximately linearly with the risk of cognitive impairment and in-hospital mortality.

Conclusion

High glycemic variability was found to be an independent risk factor for severe cognitive decline and in-hospital mortality in critically ill patients with CVD. Our study indicated that enhancing stability of glycemic variability may reduced adverse outcomes in patients with severe CVD.
Development of an efficient protein expression system in the thermophilic fungus Myceliophthora thermophila
Authors: Li Jinyang , Wang Yidi , Yang Kun , Wang Xiaolu , Wang Yuan , Zhang Honglian , Huang Huoqing , Su Xiaoyun , Yao Bin , Luo Huiying , Qin Xing
Published: November 2023

Background

Thermophilic fungus Myceliophthora thermophila has been widely used in industrial applications due to its ability to produce various enzymes. However, the lack of an efficient protein expression system has limited its biotechnological applications.

Results

In this study, using a laccase gene reporting system, we developed an efficient protein expression system in M. thermophila through the selection of strong constitutive promoters, 5’UTRs and signal peptides. The expression of the laccase was confirmed by enzyme activity assays. The results showed that the Mtpdc promoter (Ppdc) was able to drive high-level expression of the target protein in M. thermophila. Manipulation of the 5’UTR also has significant effects on protein expression and secretion. The best 5’UTR (NCA-7d) was identified. The transformant containing the laccase gene under the Mtpdc promoter, NCA-7d 5’UTR and its own signal peptide with the highest laccase activity (1708 U/L) was obtained. In addition, the expression system was stable and could be used for the production of various proteins, including homologous proteins like MtCbh-1, MtGh5-1, MtLPMO9B, and MtEpl1, as well as a glucoamylase from Trichoderma reesei.

Conclusions

An efficient protein expression system was established in M. thermophila for the production of various proteins. This study provides a valuable tool for protein production in M. thermophila and expands its potential for biotechnological applications.
Investigating gait-responsive somatosensory cueing from a wearable device to improve walking in Parkinson’s disease
Authors: Li Dongli , Hallack Andre , Gwilym Sophie , Li Dongcheng , Hu Michele T. , Cantley James
Published: November 2023

Freezing-of-gait (FOG) and impaired walking are common features of Parkinson’s disease (PD). Provision of external stimuli (cueing) can improve gait, however, many cueing methods are simplistic, increase task loading or have limited utility in a real-world setting. Closed-loop (automated) somatosensory cueing systems have the potential to deliver personalised, discrete cues at the appropriate time, without requiring user input. Further development of cue delivery methods and FOG-detection are required to achieve this. In this feasibility study, we aimed to test if FOG-initiated vibration cues applied to the lower-leg via wearable devices can improve gait in PD, and to develop real-time FOG-detection algorithms. 17 participants with Parkinson’s disease and daily FOG were recruited. During 1 h study sessions, participants undertook 4 complex walking circuits, each with a different intervention: continuous rhythmic vibration cueing (CC), responsive cueing (RC; cues initiated by the research team in response to FOG), device worn with no cueing (NC), or no device (ND). Study sessions were grouped into 3 stages/blocks (A-C), separated by a gap of several weeks, enabling improvements to circuit design and the cueing device to be implemented. Video and onboard inertial measurement unit (IMU) data were analyzed for FOG events and gait metrics. RC significantly improved circuit completion times demonstrating improved overall performance across a range of walking activities. Step frequency was significantly enhanced by RC during stages B and C. During stage C, > 10 FOG events were recorded in 45% of participants without cueing (NC), which was significantly reduced by RC. A machine learning framework achieved 83% sensitivity and 80% specificity for FOG detection using IMU data. Together, these data support the feasibility of closed-loop cueing approaches coupling real-time FOG detection with responsive somatosensory lower-leg cueing to improve gait in PD.
Contribution of macrophages to neural survival and intracochlear tissue remodeling responses following cochlear implantation
Authors: Rahman Muhammad Taifur , Mostaert Brian J. , Hunger Bryce , Saha Utsow , Claussen Alexander D. , Razu Ibrahim , Nasrin Farjana , Khan Nashwaan Ali , Eckard Peter , Coleman Sarah , Oleson Jacob , Kirk Jonathon R. , Hirose Keiko , Hansen Marlan R.
Published: November 2023

Background

Cochlear implants (CIs) restore hearing to deafened patients. The foreign body response (FBR) following cochlear implantation (post-CI) comprises an infiltration of macrophages, other immune and non-immune cells, and fibrosis into the scala tympani, a space that is normally devoid of cells. This FBR is associated with negative effects on CI outcomes including increased electrode impedances and loss of residual acoustic hearing. This study investigates the extent to which macrophage depletion by an orally administered CSF-1R specific kinase (c-FMS) inhibitor, PLX-5622, modulates the tissue response to CI and neural health.

Main text

10- to 12-week-old CX3CR1 + /GFP Thy1 + /YFP mice on C57BL/6J/B6 background was fed chow containing 1200 mg/kg PLX5622 or control chow for the duration of the study. 7 days after starting the diet, 3-channel cochlear implants were implanted in the ear via the round window. Serial impedance and neural response telemetry (NRT) measurements were acquired throughout the study. Electric stimulation began 7 days post-CI until 28 days post-CI for 5 h/day, 5 days/week, with programming guided by NRT and behavioral responses. Cochleae harvested at 10, 28 or 56 days post-CI were cryosectioned and labeled with an antibody against α-smooth muscle actin (α-SMA) to identify myofibroblasts and quantify the fibrotic response. Using IMARIS image analysis software, the outlines of scala tympani, Rosenthal canal, modiolus, and lateral wall for each turn were traced manually to measure region volume. The density of nuclei, CX3CR1 + macrophages, Thy1 + spiral ganglion neuron (SGN) numbers, and the ratio of the α-SMA + volume/scala tympani volume were calculated. Cochlear implantation in control diet subjects caused infiltration of cells, including macrophages, into the cochlea. Fibrosis was evident in the scala tympani adjacent to the electrode array. Mice fed PLX5622 chow showed reduced macrophage infiltration throughout the implanted cochleae across all time points. However, scala tympani fibrosis was not reduced relative to control diet subjects. Further, mice treated with PLX5622 showed increased electrode impedances compared to controls. Finally, treatment with PLX5622 decreased SGN survival in implanted and contralateral cochleae.

Conclusion

The data suggest that macrophages play an important role in modulating the intracochlear tissue response following CI and neural survival.
“They try to suppress us, but we should be louder”: a qualitative exploration of intimidation in tobacco control
Authors: Matthes Britta K , Alebshehy Raouf , Gilmore Anna B
Published: November 2023

Background

Tobacco control advocates and researchers face powerful opponents who go to great lengths to protect their interests. While threats and attacks are documented in the grey literature, research into intimidation remains scarce. Building on previous exploratory research, this study seeks to offer in-depth insights into experiences of intimidation in the global tobacco control community.

Methods

Using qualitative description, we conducted a focus group and semi-structured interviews with tobacco control advocates and researchers to explore their experiences, including forms of, and responses to, intimidation, and ways forward. Data were analysed using qualitative content analysis.

Results

Twenty-nine individuals from across the globe participated in the study. They reported several forms of intimidation including attacks in the media; online harassment; legal threats; non-legal threats, including death threats; Freedom of Information requests; perceived or actual surveillance; as well as burglary and theft. Responses included non-action (i.e. ignoring attacks); withdrawal (i.e. abandoning a project, area or field); defensive adaptation, for example through self-censorship; and offensive measures, including exposing attacks or filing complaints. Responses were shaped by several factors, including type and level of support from within internal and external networks; as well as an individual’s mindset, skills and experiences; and state-civil society relations. Participants suggested several measures that could help address intimidation: 1) report and monitor intimidation; 2) (better) prepare individuals through awareness raising and training (e.g. IT security, legal); 3) support those in need through legal advice, a peer-support network and involvement in response; and 4) look beyond tobacco control to learn and build connections.

Conclusion

Intimidation is a significant challenge to tobacco control that needs urgent attention. This study suggests measures to address intimidation that require commitment from, and collaboration amongst, multiple actors including governments, international organisations, funders, researchers and civil society. Moreover, collective action beyond tobacco control is needed to not only manage but move beyond intimidation.
Consideration of vaping products as an alternative to adult smoking: a narrative review
Authors: Foster Jane A.
Published: November 2023

Tobacco harm reduction is a public health approach to reduce the impact of cigarette smoking on individuals. Non-combustible alternatives to cigarettes, such as electronic cigarettes (e-cigarettes), deliver nicotine to the user in the absence of combustion. The absence of combustion in e-cigarettes reduces the level of harmful or potentially harmful chemicals in the aerosol generated. This narrative review examines the published literature that studied the chemistry of e-cigarette aerosols, the related toxicology in cell culture and animal models, as well as clinical studies that investigated short- and long-term changes in biomarkers of smoke exposure after switching to e-cigarettes. In the context of the literature reviewed, the evidence supports the harm reduction potential for adult smokers who switch to e-cigarettes.
Wolfram syndrome type 1: a case series
Authors: Du Danyang , Tuhuti Aihemaitijiang , Ma Yanrong , Abuduniyimu Munila , Li Suli , Ma Guoying , Zynat Jazyra , Guo Yanying
Published: November 2023

Background

Wolfram syndrome (WS) is a rare autosomal recessive multisystem neurodegenerative disease characterized by non-autoimmune insulin-dependent diabetes mellitus, optic atrophy, sensorineural deafness, and diabetes as the main features. Owing to clinical phenotypic heterogeneity, the misdiagnosis rate is high. However, early accurate diagnosis and comprehensive management are key to improving quality of life and prolonging life.

Results

Eleven patients from seven WS pedigrees with 10 mutation sites (c.1314_1317delCTTT, c.C529T, c.C529A, c.G2105A, c.C1885T, c.1859_1860del, c.G2020A, c.C529A, c.G2105A, and c.G1393C) in the WFS1 gene were included. We conducted further expert department analysis to clarify the diagnosis and analyze the correlation between genes and phenotypes.

Conclusions

The genotypes of these patients were closely associated with their phenotypes. The clinical data of the patients were analyzed to provide a basis for the diagnosis and clinical management of the disease.
Multi-modal proteomic characterization of lysosomal function and proteostasis in progranulin-deficient neurons
Authors: Hasan Saadia , Fernandopulle Michael S. , Humble Stewart W. , Frankenfield Ashley M. , Li Haorong , Prestil Ryan , Johnson Kory R. , Ryan Brent J. , Wade-Martins Richard , Ward Michael E. , Hao Ling
Published: November 2023

Background

Progranulin (PGRN) is a lysosomal glycoprotein implicated in various neurodegenerative diseases, including frontotemporal dementia and neuronal ceroid lipofuscinosis. Over 70 mutations discovered in the GRN gene all result in reduced expression of the PGRN protein. Genetic and functional studies point toward a regulatory role for PGRN in lysosome functions. However, the detailed molecular function of PGRN within lysosomes and the impact of PGRN deficiency on lysosomes remain unclear.

Methods

We developed multifaceted proteomic techniques to characterize the dynamic lysosomal biology in living human neurons and fixed mouse brain tissues. Using lysosome proximity labeling and immuno-purification of intact lysosomes, we characterized lysosome compositions and interactome in both human induced pluripotent stem cell (iPSC)-derived glutamatergic neurons (i3Neurons) and mouse brains. Using dynamic stable isotope labeling by amino acids in cell culture (dSILAC) proteomics, we measured global protein half-lives in human i3Neurons for the first time.

Results

Leveraging the multi-modal proteomics and live-cell imaging techniques, we comprehensively characterized how PGRN deficiency changes the molecular and functional landscape of neuronal lysosomes. We found that PGRN loss impairs the lysosome’s degradative capacity with increased levels of v-ATPase subunits on the lysosome membrane, increased hydrolases within the lysosome, altered protein regulations related to lysosomal transport, and elevated lysosomal pH. Consistent with impairments in lysosomal function, GRN-null i3Neurons and frontotemporal dementia patient-derived i3Neurons carrying GRN mutation showed pronounced alterations in protein turnover, such as cathepsins and proteins related to supramolecular polymerization and inherited neurodegenerative diseases.

Conclusion

This study suggested PGRN as a critical regulator of lysosomal pH and degradative capacity, which influences global proteostasis in neurons. Beyond the study of progranulin deficiency, these newly developed proteomic methods in neurons and brain tissues provided useful tools and data resources for the field to study the highly dynamic neuronal lysosome biology.

Graphical Abstract
Invasive FoxM1 phosphorylated by PLK1 induces the polarization of tumor-associated macrophages to promote immune escape and metastasis, amplified by IFITM1
Authors: Xu Rong , Lee Young-Joo , Kim Chang-Hyeon , Min Ga-Hong , Kim Yeo-Bin , Park Jung-Won , Kim Dae-Hoon , Kim Jung-Hyun , Yim Hyungshin
Published: November 2023

Background

Understanding the mechanism behind immune cell plasticity in cancer metastasis is crucial for identifying key regulators. Previously we found that mitotic factors regulate epithelial-mesenchymal transition, but how these factors convert to metastatic players in the tumor microenvironment (TME) is not fully understood.

Methods

The clinical importance of mitotic factors was analyzed by heatmap analysis, a KM plot, and immunohistochemistry in lung adenocarcinoma (LUAD) patients. Immunoprecipitation, LC–MS/MS, kinase assay, and site-directed mutagenesis were performed for the interaction and phosphorylation. A tail-vein injection mouse model, Transwell-based 3D culture, microarray analysis, coculture with monocytes, and chromatin immunoprecipitation assays were used to elucidate the function of phosphorylated FoxM1 in metastasis of TME.

Results

The phosphorylated FoxM1 at Ser25 by PLK1 acquires the reprogramming ability to stimulate the invasive traits in cancer and influence immune cell plasticity. This invasive form of p-FoxM1 upregulates the expression of IL1A/1B, VEGFA, and IL6 by direct activation, recruiting monocytes and promoting the polarization of M2d-like tumor-associated macrophages (TAMs). Upregulation of PD-L1 in LUAD having phosphomimetic FoxM1 facilitates immune evasion. In invasive LUAD with phosphomimetic FoxM1, IFITM1 is the most highly expressed through the activation of the STING-TBK1-IRF3 signaling, which enhances FoxM1-mediated signaling. Clinically, higher expression of FOXM1, PLK1, and IFITM1 is inversely correlated with the survival rate of advanced LUAD patients, providing a promising therapeutic strategy for the treatment of LUAD.

Conclusion

FoxM1-based therapy would be a potential therapeutic strategy for LUAD to reduce TAM polarization, immune escape, and metastasis, since FoxM1 functions as a genetic reprogramming factor reinforcing LUAD malignancy in the TME.
Protocol for a randomized controlled trial to reduce pediatric anesthesia emergence delirium by titration of sevoflurane anesthesia using brain function monitoring
Authors: Suzuki Yasuyuki , Miyasaka Kiyoyuki W. , Hayashi Kuniyoshi , Takahashi Osamu , Nagasaka Yasuko
Published: November 2023

Background

Emergence agitation or emergence delirium is a common complication of unknown etiology in pediatric anesthesia. Pediatric anesthesia emergence delirium (PAED) has been reported most commonly in younger children and may occur in about 30% of children up to 5–6 years old. Exposure to anesthetic agents may contribute to PAED, and we hypothesized that a management strategy to minimize exposure to volatile anesthetics may reduce PAED. Electroencephalography (EEG) signatures captured and displayed by brain function monitors during anesthesia change with concentration of sevoflurane and level of unconsciousness, and these EEG signatures may be used to inform titration of anesthetics.

Methods

A single-center, parallel-group, two-arm, superiority trial with a 1:1 allocation ratio will be performed to compare the incidence of PAED following standard sevoflurane anesthesia (maintained at 1.0MAC) and EEG-guided anesthesia (minimum concentration to sustain surgical anesthesia as determined by monitoring of EEG signatures). Participants between 1 and 6 years of age undergoing surgical procedures involving minimal postoperative pain will be randomly assigned to receive standard (n = 90) or EEG-guided (n = 90) anesthesia. PAED score will be assessed by a blinded observer in the PACU on arrival and after 5, 10, 15, and 30 min.

Discussion

Anesthesia management with proactive use of brain function monitoring is expected to reduce exposure to sevoflurane without compromising surgical anesthesia. We expect this reduced exposure should help prevent PAED. Routinely administering what may be considered standard levels of anesthetic such as 1.0 MAC sevoflurane may be excessive and potentially associated with unfavorable sequelae such as PAED.

Trial registration

Japan Registry of Clinical Trials (jRCT) jRCTs032210248. Prospectively registered on 17 August 2021.
The role of Culex territans mosquitoes in the transmission of Batrachochytrium dendrobatidis to amphibian hosts
Authors: Reinhold Joanna M. , Halbert Ella , Roark Megan , Smith Sierra N. , Stroh Katherine M. , Siler Cameron D. , McLeod David S. , Lahondère Chloé
Published: November 2023

Background

Mosquitoes are the deadliest organisms in the world, killing an estimated 750,000 people per year due to the pathogens they can transmit. Mosquitoes also pose a major threat to other vertebrate animals. Culex territans is a mosquito species found in temperate zones worldwide that feeds almost exclusively on amphibians and can transmit parasites; however, little is known about its ability to transmit other pathogens, including fungi. Batrachochytrium dendrobatidis (Bd) is a topical pathogenic fungus that spreads through contact. With amphibian populations around the world experiencing mass die-offs and extinctions due to this pathogen, it is critical to study all potential modes of transmission. Because Cx. territans mosquitoes are in contact with their hosts for long periods of time while blood-feeding, we hypothesize that they can transmit and pick up Bd.

Methods

In this study, we first assessed Cx. territans ability to transfer the fungus from an infected surface to a clean one under laboratory conditions. We also conducted a surveillance study of Bd infections in frogs and mosquitoes in the field (Mountain Lake Biological station, VA, USA). In parallel, we determined Cx. territans host preference via blood meal analysis of field caught mosquitoes.

Results

We found that this mosquito species can carry the fungus to an uninfected surface, implying that they may have the ability to transmit Bd to their amphibian hosts. We also found that Cx. territans feed primarily on green frogs (Rana clamitans) and bullfrogs (Rana catesbeiana) and that the prevalence of Bd within the frog population at our field site varied between years.

Conclusions

This study provides critical insights into understanding the role of amphibian-biting mosquitoes in transmitting pathogens, which can be applied to disease ecology of susceptible amphibian populations worldwide.

Graphical Abstract
Efficacy of nano encapsulated herbal extracts in the treatment of induced wounds in animal models: a systematic review protocol
Authors: Namuga Catherine , Ocan Moses , Kinengyere Alison A. , Richard Ssenono , Namisango Eve , Muwonge Haruna , Kirabira John Baptist , Lawrence Mugisha , Obuku Ekwaro A.
Published: November 2023

Background

Wounds inflict pain and affect human health causing high expenditure on treatment and management. Herbal crude extracts are used in traditional medicine as a treatment for wounds and other illnesses. However, the progress in the use of plants has been deterred due to their poor solubility and poor bioavailability requiring administration at high doses. It has been established that nanoencapsulation of herbal products in nanocarriers (size 1 nm to 100 nm) such as nanofibers, nanoparticles, nanospheres, and nanoliposomes greatly improves their efficacy. Due to their small and large surface area, nanocarriers are more biologically active, improve bioavailability, protect the drug from deterioration, and release it to the targeted site in a sustainable manner.

Aim

The review aims to collate and appraise evidence on the efficacy of nano encapsulated herbal extracts in the treatment of induced wounds in animal models.

Methods

The review will be protocol-driven and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols (PRISMA-P) and protocol guidelines for systematic review and meta-analysis for animal intervention studies. The final review will be conducted and reported with reference to PRISMA 2020 statement. Studies will be searched in Pub Med, ProQuest, Web of Science, Medline Ovid, EMBASE, and Google Scholar. The PRISMA flow criteria will be followed in screening the articles for inclusion. Data extraction form will be designed in Excel spreadsheet 2013 and data extracted based on the primary and secondary outcomes. Risk of bias assessment will be done using SYRCLE’s risk of bias tool for animal studies. Data analysis will be done using narrative and quantitative synthesis.

Expected results

We hope to make meaningful comparisons between the effectiveness of the herb-loaded nanomaterials and other interventions (controls) in the selected studies, based on the primary and secondary outcome measures. We expect that these findings to inform clinical practice on whether preclinical studies show enough quality evidence on the efficacy and safety of herbal-loaded nanomaterials that can be translated into clinical trials and further research.

Systemic review registration

PROSPERO 330330. The protocol was submitted on the 11th of May 2022.
Serum growth differentiation factor-15 (GDF-15) is a biomarker of cardiac manifestations in children with COVID-19
Authors: Ishak Sally Raafat , Ganzoury Mona Mostafa El , Fouda Eman Mahmoud , Anwar Maha Ahmad , Kamal Amany Moustafa , Hamza Heba Mostafa , Bakry Nehad Ahmed
Published: November 2023

Background

COVID-19 leads to severe overwhelming inflammation in some patients mediated by various cytokines (cytokine storm) that usually leads to severe illness accompanied by cardiovascular manifestations. Growth differentiation factor-15 is a cytokine induced by stress and is associated with inflammatory processes in the lung and heart. This study aimed to measure the level of serum growth differentiation factor (GDF-15) in children with COVID-19 and to correlate it with the disease severity, cardiac affection, and the outcome of COVID-19.

Methods

A cross-sectional study was conducted on 144 children; 72 children diagnosed with COVID-19, and 72 healthy children. The severity of COVID-19 was assessed clinically, laboratory, and radiologically. Echocardiography was done within 48 h of admission for COVID-19 patients. Serum GDF-15 was measured by ELISA for both patients and controls.

Results

Serum GDF-15 level was significantly higher in patients with COVID-19 than in controls (p < 0.01). In COVID-19 patients with severe clinical grading, those who were hospitalized in the PICU, and those who died, serum GDF-15 levels were greater. individuals with cardiac manifestations exhibited significantly higher serum GDF-15 levels than individuals without them. In children with COVID-19, increased GDF-15 was correlated to poorer ejection fraction and higher INR using multivariate linear regression analysis.

Conclusion

Serum GDF-15 is a promising biomarker of COVID-19, it can be used as a predictor of cardiac manifestations in children with COVID-19 and severe disease.
Ultrasound guidance practices used for the placement of vascular accesses in intensive care units: an observational multicentre study
Authors: van der Mee-Marquet Nathalie , Valentin Anne-Sophie , Duflot Isabelle , Farizon Mathilde , Petiteau Agnès ,   the collaboration group SPIADI, Allaire Alexandra , Sovic Elise Balestrat , Barbut Frédéric , Barthelemy Patrick , Berger Pierre , Betti Marie-Camille , Blanié Mathilde , Cattaneo Isabelle , Cecille Agnès , Chakaroun Hiba , Cholley Anne-Clémence , David Marion , Davy Aude , Delhomme Joël , Duval Catherine , Edouard Stéphanie , Gabriele Laure , Gallais Séverine , Gerbier Colette , Manquat Gilles , Goldstein Valérie , Gourdon Florence , Joron Sylvie , Kayoulou-Bour Anne-Marie , Laethem Gratienne , Lemann Florence , Lemenager Martine , Lier Marie-Laure , Mesnil Malcie , Mertel Nadine , Morange Virginie , Mottet Benoit , Niot Stella , Ouzani Souad , Perdrix Christophe , Renaud Amélie , Richaud Clémence , Rougier Catherine , Tarsac Maryline , Venelle Myriam , Vidal Isabelle
Published: November 2023

Background

Central catheters expose ICU patients at risk of catheter-related bloodstream infections. A mechanism by which these infections occur is the contamination of the catheter during its insertion if aseptic techniques are not strictly applied. Recent studies suggest that the use of ultrasound guidance (USG) may increase the risk of catheter contamination during insertion. We assessed current practices regarding the use of USG during catheter insertion, with a focus on identifying breaches of the surgical asepsis required for this invasive procedure.

Methods

In 26 intensive care units, we evaluated the use of USG during catheter insertion, using a questionnaire addressed to intensivists and direct observation of their practices.

Results

We analyzed 111 questionnaires and 36 observations of intensivists placing catheters. The questionnaires revealed that 88% of intensivists used USG for catheter insertion. Among those using USG, 56% had received specific training, 17% benefited from specific recommendations, 76% marked the insertion site before skin antisepsis, and during catheter insertion, 96% used sterile gel and 100% used a sterile sheath and sterile gloves. We identified potential deviations from strict aseptic technique, including contact between the sheath and the needle (19.4%), handling of the US system during catheter insertion (2.8%), and use of sterile devices, where they were not yet necessary (during the marking site or skin antisepsis), resulting in their contamination at the time of catheter insertion.

Conclusions

Interventions aimed at ensuring compliance with measures to prevent CRBs should be organized to prevent an increase in infections associated with US-guided catheter insertion.
Hotspots and bottlenecks for the enhancement of the environmental sustainability of pig systems, with emphasis on European pig systems
Authors: Pexas Georgios , Kyriazakis Ilias
Published: November 2023

Although pig systems start from a favourable baseline of environmental impact compared to other livestock systems, there is still scope to reduce their emissions and further mitigate associated impacts, especially in relation to nitrogen and phosphorous emissions. Key environmental impact hotspots of pig production systems are activities associated with feed production and manure management, as well as direct emissions (such as methane) from the animals and energy use. A major contributor to the environmental impacts associated with pig feed is the inclusion of soya in pig diets, especially since European pig systems rely heavily on soya imported from areas of the globe where crop production is associated with significant impacts of land use change, deforestation, carbon emissions, and loss of biodiversity. The “finishing” pig production stage contributes most to these environmental impacts, due to the amount of feed consumed, the efficiency with which feed is utilised, and the amount of manure produced during this stage. By definition therefore, any substantial improvements pig system environmental impact would arise from changes in feed production and manure management. In this paper, we consider potential solutions towards system environmental sustainability at these pig system components, as well as the bottlenecks that inhibit their effective implementation at the desired pace and magnitude. Examples include the quest for alternative protein sources to soya, the limits (perceived or real) to the genetic improvement of pigs, and the implementation of alternative manure management strategies, such as production of biogas through anaerobic digestion. The review identifies and discusses areas that future efforts can focus on, to further advance understanding around the potential sustainability benefits of modifications at various pig system components, and key sustainability trade-offs across the environment—economy—society pillars associated with synergistic and antagonistic effects when joint implementation of multiple solutions is considered. In this way, the review opens a discussion to facilitate the development of holistic decision support tools for pig farm management that account for interactions between the “feed * animal * manure” system components and trade-offs between sustainability priorities (e.g., environmental vs economic performance of pig system; welfare improvements vs environmental impacts).
Prevalence and outcome of chronic hepatitis C patients admitted with COVID-19 to intensive care units: a blessing in disguise
Authors: Negm Essamedin M. , El-Sokkary Rehab H. , Malek Mai M. , Ezzat Heba M. , Tawfik Ahmed E. , Abed Heba Ali , ELdeeb Seham Mahmoud , Mohamed Mohamed Sorour , Kassem Hamdy M. , Mosallem Ahmed , Mowafy Sherif M. S.
Published: November 2023

Background

Managing COVID-19 pneumonia is, in reality, one of the biggest challenges in the history of intensive care medicine. The link between comorbidity and COVID-19 remains unclear. Worldwide, Egypt has the highest prevalence of hepatitis C virus (HCV). The study’s objectives were to assess the prevalence of chronic hepatitis C as a risk factor among COVID-19 patients and to investigate the impact of it and the prior exposure to different HCV management protocols on the clinical characteristics and outcome of COVID-19 patients.

Results

Of 2106 confirmed cases of COVID-19, CLD, malignancy, and chronic kidney disease were significant risk factors for death [OR (95% CI) = 2.78 (1.29–5.98), 2.72 (1.14–6.46) and 3.79 (1.39–10.36) respectively]. The mortality rate was 24.3%. A total of 99 cases (4.7%) with CLD were investigated during the study period; 69 patients (3.3%) were categorized as HCV-positive. Among the positive HCV cases, 49 patients (2.3%) received anti-hepatitis C medications. The mortality rate was 46.4% and 73.3% between HCV and non-HCV hepatic patients, respectively. Triple therapy showed a statistically significant association with a better outcome (p value = 0.009).

Conclusions

In the present report, chronic liver diseases, chronic kidney disease, and malignancy were significant risk factors for mortality among COVID-19 patients. The Egyptian mass management of chronic hepatitis C may explain the favorable outcome of COVID-19 among these patients. Intervention trials are required to prove that direct-acting antivirals are effective in preventing COVID-19.
Prediction of gap balancing based on 2-D radiography in total knee arthroplasty for knee osteoarthritis patients
Authors: Zhang Zhuo , Luo Yang , Zhang Chong , Wang Xin , Zhang Tianwei , Zhang Guoqiang
Published: November 2023

Background

To investigate the influence of osteophytes on postoperative gap balancing, and to work out a predictive model of the relationship between osteophyte size and gap gaining in primary total knee replacement.

Methods

One hundred and ten patients were enrolled in the study. Pre- and postoperative radiographs were collected and analyzed. They were assigned to the training dataset and test dataset randomly at a ratio of 9:1 by using the statistical package R (version 4.0.5). Size and marginal distances of osteophytes, planned bone cut planes, predicted bone cuts and joint gaps were labeled on the preoperative standing anteroposterior and lateral views, while actual bone cuts and joint gaps were recorded on the postoperative plain films, respectively. Statistical analysis was performed.

Results

Actual joint gaps were significantly related to the distances of medial and lateral predictive bone cutting lines, bone cut thickness on tibial side and posterior condylar, as well as size and marginal distances of osteophytes (P < 0.05). A predictive equation was generated, with a root mean square error (RMSE) of 3.4761 in validation. A 2-D planning system with adjustable input parameters and dim predictive outputs on joint gap was developed. The equation is $$S \left(Joint Gap\right)=1.82+0.15*y+0.552*Tibial cut+0.953*Femoral cut+0.197*Post Condyle$$

S

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1.82
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0.953

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0.197

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Conclusion

Postoperative joint gap can be predicted on the basis of preoperative measurements on 2-D plain films. Larger sample size may help improve the effectiveness and accuracy of the predictive equation.
Frequency of hepatitis C virus infection in patients with pediatric inflammatory bowel disease: a cross-sectional study
Authors: Tarek Sara , Eskander Ayman E. , Meshaal Safa , Badr Eman , El-Hakeem Asmaa Abd
Published: November 2023

Background

Patients with pediatric inflammatory bowel disease (PIBD) are believed to be at higher risk of hepatitis C virus (HCV) infection not only due to using of immunosuppressive drugs but also because of repeated blood transfusion and endoscopic and other invasive procedures used for diagnoses and effective controlling of the disease, so this study aimed to assess the frequency of HCV infection, in patients with PIBD at the New Children’s Hospital, Cairo University, and identify the potential risk factors.

Methods

This cross-sectional analytic study included 165 IBD patients between 1 and 16 years old of both sexes who were attending the Pediatric Gastroenterology Clinic in the New Children’s University Hospital, Cairo University. All patients were screened for anti-HCV antibodies using ELISA. Factors related to IBD (severity, modalities of the treatment, and invasive procedures), to infection (blood transfusion history and family history of hepatitis), and liver enzymes were registered. The risk factors were evaluated by multivariate logistic regression analysis.

Results

Present and/or past HCV infection was found in five (3%) of the IBD patients. The multivariate logistic regression to detect independent predictors of HCV +ve antibodies patients had statistically significant value with number of hospital admission related to IBD with p-value = 0.002, odd ratio (OR) = 1.467, and confidence interval (CI) = 95% (1.145–1.879) and with number of hospital admission unrelated to IBD with p-value = 0.024, OR = 0.750, and CI 95% (0.585–0.963).

Conclusion

The frequency of HCV infection in PIBD patients was 3%. Thus, the frequency of HCV infection in PIBD patients is similar to that in the normal population of the developing countries, and it is strongly related to hospital admission due to IBD or non-IBD causes.
Extrahepatic bile duct fibroma in an infant: a case report
Authors: Hasan Md. Samiul , Islam S. M. Nazmul , Huq Umama , Parvez Mashud , Khan Hasiba Mahshed , Mahmud Refoyez , Rahman Ashrarur
Published: November 2023

Background

Extrahepatic bile duct tumor in neonates and infants is extremely rare. Fibroma in neonates and infants has been reported in different body parts but not in the bile duct. We report a 2-month-old girl with common bile duct (CBD) fibroma.

Case presentation

A 2-month-old girl presented with jaundice and pale stool for 15 days. Her perinatal period was uneventful. On examination, we found the girl deeply icteric and having hepatomegaly but no palpable lump. Laboratory investigations revealed direct hyperbilirubinemia with elevated liver enzymes. Ultrasonography revealed hepatomegaly with focal dilatation of the extrahepatic bile duct (2.1 × 0.5 cm). Our preliminary diagnosis was a type I choledochal cyst. Considering the clinical scenario, we planned for exploration without further imaging. On exploration, we found the liver blackish and a hard mass involving the common CBD and cystic duct. The gall bladder was filled with clear mucus. After excising the mass, the gall bladder, and CBD, we reconstructed the anatomy with Roux-N-Y hepaticojejunostomy. The postoperative period was uneventful except for minor bile leakage during the first four postoperative days, which stopped spontaneously. Histopathology revealed spindle-shaped fibrous tissue admixed with collagenous tissue, compatible with a fibroma. A liver biopsy showed the features of cirrhosis. However, liver function tests were normal 2 weeks after surgery. The baby was thriving at 6 months of follow-up, hepatomegaly was resolved, and there was no clinical or radiological sign of recurrence.

Conclusions

CBD fibroma is a rare cause of obstructive jaundice in neonates and infants. The earliest possible excision of the tumor and bile drainage restoration are necessary to halt the progression of liver damage.
Oncology Clinicians' Perspectives on Online Patient Portal Use in Pediatric and Adolescent Cancer
Authors: Sisk Bryan A. , Bereitschaft Christine , Enloe Madi , Schulz Ginny , Mack Jennifer , DuBois James
Published: November 2023

PURPOSE

Online patient portals represent widely available communication tools in pediatric oncology. Previous studies have not evaluated clinicians' perspectives on portal use, including issues related to access to adolescents' portals.

METHODS

We performed semistructured interviews with physicians and advanced practice providers (APPs) who care for children or adolescents with cancer. We performed thematic analysis of benefits, problems, and accommodations related to portal use in oncology.

RESULTS

We interviewed 29 physicians and 24 APPs representing 26 institutions. Participants described five themes of benefits provided by portals: (1) empowering adolescents, (2) improving efficiency and accuracy of communication, (3) promoting open and adaptive communication, (4) supporting parents in managing care, and (5) bolstering clinical relationships. Participants described eight themes of problems caused by portal access: (1) creating emotional distress and confusion, (2) increasing workload and changing workflows, (3) threatening adolescent confidentiality, (4) adolescents lacking interest to engage, (5) diminishing clinical relationship, (6) misusing portal messages, (7) diminishing quality of sensitive documentation, and (8) parents losing access to adolescents' records. Participants described three themes related to accommodations they made as a result of portal access: (1) modifying note writing, (2) providing anticipatory guidance about viewing results, and (3) adapting workflows. Some portal functions created either benefits or problems depending on the clinical context.

CONCLUSION

Oncologists identified benefits and problems created by portal use, which were sometimes in tension, depending on the clinical context. To make portals useful, we must take steps to mitigate risks while preserving functionality for parents and adolescent patients.
Exploring Challenges Related to Breast Cancer to Identify Opportunities for Advocacy in Hawassa City, Southern Ethiopia: A Community-Based, Qualitative Study
Authors: Bogale Netsanet , Balta Bargude , Demissie Gulema , Geleta Dereje , Rakoff Michele , Anderson Brandon , Johnson Natalie , Yee Lisa , Taylor Lesley
Published: November 2023

PURPOSE

The aim of this study was to explore breast cancer (BC) challenges to identify opportunities for advocacy in southern Ethiopia in 2022.

METHODS

Twenty-five participants from four local districts (kebeles) in Hawassa City were selected as key contributors to future work. Semistructured in-depth interviews were held for two clinicians, two local health bureau managers, two media managers, and three religious leaders. Two focus group discussions were conducted: one included six BC survivors and a caregiver; the other included two health extension workers, three members of the Women's Development Group, two community volunteers, one kebele leader, and one traditional healer.

RESULTS

To our knowledge, our study was the first time that most participants had assembled. Many referred to patients as victims and BC as a killer disease or curse. Community and religious leaders were concerned about challenges and willing to collaborate. Survivors, providers, and religious leaders were identified as key sources of information, positive messages, and leadership.

CONCLUSION

Recommendations for advocacy work in Hawassa include lobbying for BC as a health priority; including BC within the health extension package; initiating programs for earlier detection; educating the community to remove stigmas of the disease and treatments; working with media to disseminate messages that are inclusive of people in remote areas and speaking different languages; improving availability, affordability, and access to care; and assisting patients with psychosocial support. A strategic collaboration between religious leaders and health care providers was identified to increase community awareness and support advocacy for patients.