bluuebunny/crossref_metadata_2025 huggingface dataset:
The Hematological Effects of Extracorporeal Membrane Oxygenator Exchange
Authors: Hoffman Kenneth R. , Diehl Arne , Paul Eldho , Burrell Aidan J. C.
Published: May 2023

Membrane oxygenator failure during venovenous (V-V) extracorporeal membrane oxygenation (ECMO) can lead to life-threatening hypoxia, high replacement costs, and may be associated with a hyperfibrinolytic state and bleeding. The current understanding of the underlying mechanisms that drive this is limited. The primary aim of this study therefore is to investigate the hematological changes that occur before and after membrane oxygenator and circuit exchanges (ECMO circuit exchange) in patients with severe respiratory failure managed on V-V ECMO. We analyzed 100 consecutive V-V ECMO patients using linear mixed-effects modeling to evaluate hematological markers in the 72 hours before and 72 hours after ECMO circuit exchange. A total of 44 ECMO circuit exchanges occurred in 31 of 100 patients. The greatest change from baseline to peak were seen in plasma-free hemoglobin (42-fold increase p < 0.01) and the D-dimer:fibrinogen ratio (1.6-fold increase p = 0.03). Bilirubin, carboxyhemoglobin, D-dimer, fibrinogen, and platelets also showed statistically significant changes (p < 0.01), whereas lactate dehydrogenase did not (p = 0.93). Progressively deranged hematological markers normalize more than 72 hours after ECMO circuit exchange, with an associated reduction in membrane oxygenator resistance. This supports the biologic plausibility that ECMO circuit exchange may prevent further complications such as hyperfibrinolysis, membrane failure, and clinical bleeding.
Ketogenic diets, exercise performance, and training adaptations
Authors: Borszcz Fernando Klitzke , Gabiatti Mariana Papini , de Lucas Ricardo Dantas , Hansen Fernanda
Published: May 2023

Purpose of review

The ketogenic diet has been proposed as a nutritional strategy in sports. This review was undertaken to provide an overview of the recent literature concerning the effects of ketogenic diet on exercise performance and training adaptations.

Recent findings

Most recent literature on the ketogenic diet and exercise performance showed no beneficial effects, especially for trained individuals. During a period of intensified training, performance was clearly impaired during the ketogenic intervention, while a diet with high carbohydrates maintained physical performance. The main effect of the ketogenic diet resides in metabolic flexibility, inducing the metabolism to oxidize more fat for ATP resynthesis regardless of submaximal exercise intensities.

The ketogenic diet is not a reasonable nutritional strategy, as it has no advantage over normal/high carbohydrate-based diets on physical performance and training adaptations even when used only in a specific training/nutritional periodization stage.
The role of glucose in cardiac physiology and pathophysiology
Authors: Mylonas Nikolaos , Drosatos Konstantinos , Mia Sobuj
Published: May 2023

Purpose of review

Heart failure is one of the major causes of death worldwide and continues to increase despite therapeutics and pharmacology advances. Fatty acids and glucose are used as ATP-producing fuels in heart to meet its energy demands. However, dysregulation of metabolites’ use plays a pivotal role in cardiac diseases. How glucose becomes toxic or drives cardiac dysfunction is incompletely understood. In the present review, we summarize the recent findings on cardiac cellular and molecular events that are driven by glucose during pathologic conditions and potential therapeutic strategies to tackle hyperglycemia-mediated cardiac dysfunction.

Recent findings

Several studies have emerged recently, demonstrating that excessive glucose utilization has been correlated with impairment of cellular metabolic homeostasis primarily driven by mitochondrial dysfunction and damage, oxidative stress, and abnormal redox signaling. This disturbance is associated with cardiac remodeling, hypertrophy, and systolic and diastolic dysfunction. Both human and animal heart failure studies, report that glucose is a preferable fuel at the expense of fatty acid oxidation during ischemia and hypertrophy, but the opposite happens in diabetic hearts, which warrants further investigation.

A better understanding of glucose metabolism and its fate during distinct types of heart disease will contribute to developing novel therapeutic options for the prevention and treatment of heart failure.
Weighted gene co-expression network analysis identifies the prognosis-related models of left- and right-sided colon cancer
Authors: Long Chenyan , Li Gang , Meng Yongsheng , Huang Xiaoliang , Chen Jianhong , Liu Jungang
Published: May 2023

Left-sided colon cancer (LC) and right-sided colon cancer (RC) are 2 essentially different diseases, and the potential mechanisms regulating them remain unidentified. In this study, we applied weighted gene co-expression network analysis (WGCNA) to confirm a yellow module, mainly enriched in metabolism-related signaling pathways related to LC and RC. Based on the RNA-seq data of colon cancer in The Cancer Genome Atlas (TCGA) and GSE41258 dataset with their corresponding clinical information, a training set (TCGA: LC: n = 171; RC: n = 260) and a validation set (GSE41258: LC: n = 94; RC: n = 77) were divided. Least absolute shrinkage and selection operator (LASSO) penalized COX regression analysis identified 20 prognosis-related genes (PRGs) and helped constructed 2 risk (LC-R and RC-R) models in LC and RC, respectively. The model-based risk scores accurately performed in risk stratification for colon cancer patients. The high-risk group of the LC-R model showed associations with ECM-receptor interaction, focal adhesion, and PI3K-AKT signaling pathway. Interestingly, the low-risk group of the LC-R model showed associations with immune-related signaling pathways like antigen processing and presentation. On the other hand, the high-risk group of the RC-R model showed enrichment for cell adhesion molecules and axon guidance signaling pathways. Furthermore, we identified 20 differentially expressed PRGs between LC and RC. Our findings provide new insights into the difference between LC and RC, and uncover the potential biomarkers for the treatment of LC and RC.
Neural mechanisms of acupuncture for peripheral facial nerve palsy: A protocol for systematic review and meta analysis
Authors: Seon Changwoo , Lee Dong Hyuk , Kwon Bo-In , Yu Jun-Sang , Park Sang Kyun , Woo Yeonju , Kim Joo-Hee
Published: May 2023

Background:

Peripheral facial nerve palsy (PFNP) is a cranial neuropathy that occurs when the seventh facial nerve is damaged. PFNP seriously affects patients’ quality of life, and approximately 30% of patients suffer from sequelae, such as unrecovered palsy, synkinesis, facial muscle contracture, and facial spasm. Many studies have confirmed the effectiveness of acupuncture for the treatment of PFNP. However, the specific mechanism remains unclear and needs to be further explored. Therefore, the purpose of this systematic review is to investigate the neural mechanisms underlying acupuncture treatment for PFNP using neuroimaging methods.

Methods:

We will search all published studies from inception to March 2023 using the following databases: MEDLINE, Cochrane Library, EMBASE, CNKI, KMBASE, KISS, ScienceON, and OASIS. All clinical studies evaluating the effectiveness of acupuncture for treating PFNP using functional neuroimaging will be selected without language restrictions. Two reviewers will independently conduct the study selection, data extraction, and risk of bias assessment, according to a predetermined protocol. The outcomes, including the types of functional neuroimaging techniques, brain function alterations, and clinical outcomes, such as the House-Brackmann scale and Sunnybrook Facial Grading System, will also be analyzed. Coordinate-based meta-analysis and subgroup analyses will be performed if possible.

Results:

This study will analyze the effect of acupuncture on brain activity alterations and clinical improvement in patients with PFNP using functional neuroimaging.

Conclusion:

This study will provide a comprehensive summary and help elucidate the neural mechanisms of acupuncture treatment for PFNP.

PROSPERO registration number:

CRD42022321827.
A risk signature of necroptosis-related lncRNA to predict prognosis and probe molecular characteristics for male with bladder cancer
Authors: Jin Yuzhou , Li Jiacheng , Tang Chenhao , He Kangwei , Shan Donggang , Yan Shenze , Deng Gang
Published: May 2023

Bladder cancer (BC) is a frequently diagnosed cancer with high mortality. Male patients have a higher risk of developing BC than female patients. As a type of caspase-independent cell death, necroptosis plays a significant role in the occurrence and progression of BC. The aberrant function of long non-coding RNAs (lncRNAs) plays an indispensable role in GI. However, the relationship between lncRNA and necroptosis in male patients with BC remains unclear. The clinical information and RNA-sequencing profiles of all BC patients were retrieved from The Cancer Genome Atlas Program. A total of 300 male participants were selected for the study. We conducted to identify the necroptosis-related lncRNAs (NRLs) by Pearson correlation analysis. Subsequently, least absolute shrinkage and selection operator Cox regression were conducted to establish a risk signature with overall survival-related NRLs in the training set and to validate it in the testing set. Finally, we verified the effectiveness of the 15-NRLs signature in prognostic prediction and therapy via survival analysis, receiver operating characteristic curve analysis, and Cox regression. Furthermore, we analyzed the correlation between the signature risk score and pathway enrichment analysis, immune cell infiltration, anticancer drug sensitivity, and somatic gene mutations. We developed 15-NRLs (AC009974.1, AC140118.2, LINC00323, LINC02872, PCAT19, AC017104.1, AC134312.5, AC147067.2, AL139351.1, AL355922.1, LINC00844, AC069503.1, AP003721.1, DUBR, LINC02863) signature, and divided patients into a high-risk group and low-risk group through the median risk score. Kaplan–Meier and receiver operating characteristic curves showed that the prognosis prediction had satisfactory accuracy. Cox regression analysis indicated that the 15-NRLs signature was a risk factor independent of various clinical parameters. Additionally, immune cell infiltration, half-maximal inhibitory concentration, and somatic gene mutations differed significantly among different risk subsets, implying that the signature could assess the clinical efficacy of chemotherapy and immunotherapy. This 15-NRLs risk signature may be helpful in assessing the prognosis and molecular features of male patients with BC and improve treatment modalities, thus can be further applied clinically.
Tuberculosis combined with Burkitt lymphoma in a kidney transplant recipient: A case report and literature review
Authors: Hu Jian-Nan , Yu Mu-Qing , Hua Li-Juan , Bao Chen , Liu Qian , Liu Chao , Li Zi-Ling , Wang Xi , Xu Shu-Yun
Published: May 2023

Rationale:

Tuberculosis (TB) and post-transplant lymphoproliferative disorder are serious complications affecting the long-term survival of kidney transplant recipients (KTRs). Both of complications have overlapping clinical symptoms, signs, and high similar imaging presentation, which make early clinical diagnosis challenging. In this paper, we reported a rare case of post-transplant pulmonary TB combined with Burkitt lymphoma (BL) in KTR.

Patient concerns:

A 20-year-old female KTR presented to our hospital with abdominal pain and multiple nodules throughout the body.

Diagnoses:

TB is diagnosed based on the lung histopathology showed fibrous connective tissue hyperplasia with number of chronic inflammatory changes, localized necrosis, granuloma formation and multinucleated giant cells were seen in the lung tissue. Moreover, lung histopathology specimen tested positive for TB gene. TB The culture for tuberculosis was positive. BL was diagnosed as metastatic after completion of liver and bone marrow biopsy.

Interventions:

After an early diagnosis of TB, the patient received intensification of anti-tubercular therapy. Because the patient was diagnosed with BL, rituximab, cardioprotection, hepatoprotection and alkalinization of urine were added.

Outcomes:

After an early diagnosis of TB, the patient received anti-tubercular therapy and her clinical symptoms and imaging manifestations improved. After the diagnosis of BL was made, the patient’s condition progressed rapidly, followed by multi-organ damage and died 3 months later.

Lessons:

Therefore, in organ transplant patients, who present with multiple nodules and normal tumor markers, they should be alerted to the possibility of concurrent TB and post-transplant lymphoproliferative disorder, and perfect tests such as Epstein–Barr virus, β2-microglobulin, lactate dehydrogenase, γ-interferon release test and Xpert Mycobacterium TB/rifampicin test and perform early lesion site biopsy to clarify the diagnosis with a view to improving the prognosis.
Changes in the intestinal microbiota of children with hand, foot, and mouth disease under 3 years old
Authors: Zhu Su Yue , Jiang Ya Zhou , Shen Nan , Li Min , Yin Han Jun , Qiao Ji Bing
Published: May 2023

This study aimed to clarify the characteristics of intestinal microbiota in children with hand, foot, and mouth disease (HFMD) under 3 years old. Fresh feces were collected from 54 children with HFMD and 30 healthy children. All of them were <3 years old. Sequencing of the 16S rDNA amplicons was performed. Between the 2 groups, the richness, diversity, and structure of the intestinal microbiota were analyzed by α-diversity and β-diversity. Linear discriminant analysis and LEfSe analyses were used to compare different bacterial classifications. The sex and age of the children in the 2 groups were not statistically significant (P = .92 and P = .98, respectively). Compared to healthy children, the Shannon index, Ace index, and Chao index were lower in children with HFMD (P = .027, P = .012, and P = .012, respectively). Based on the weighted or unweighted UniFrac distance analysis, the structure of the intestinal microbiota in HFMD was also significantly changed (P = .002 and P < .001, respectively). Linear discriminant analysis and LEfSe analysis showed that the changes of key bacteria were manifested as a decrease in Prevotella and Clostridium_XIVa (P < .001 and P < .001, respectively), while Escherichia and Bifidobacterium increased (P = .025 and P = .001, respectively). Children with HFMD under 3 years of age have intestinal microbiota disorder and show a decrease in diversity and richness. The decrease in the abundance of Prevotella and Clostridium, which can produce short-chain fatty acids, is also one of the characteristics of the change. These results can offer a theoretical foundation for the pathogenesis and microecological treatment of HFMD in infants.
Mucoepidermoid carcinoma of the breast, 3 cases report and literature review
Authors: He Xin , You Jia , Chen Ying , Tang Hao , Ran Jingni , Guo Deyu
Published: May 2023

Rationale:

Mucoepidermoid carcinoma (MEC) is one of the most common malignant tumors in salivary glands, with specific histomorphological and molecular characteristics. MEC occurring in breast is more rare.

Patient concerns:

We reported 3 cases of female breast mass, diagnosed as benign nodules by ultrasound.

Diagnoses:

The first 2 cases were pathological diagnosed as breast MEC, low grade, and the third case as breast MEC, medium grade.

Interventions:

After pathological diagnosis, 3 patients have expanded the scope of breast resection and lymph node dissection, with negative margin and no lymph node metastasis.

Outcomes:

In the follow-up observation, the first case was followed up for 24 months, the second case was followed up for 30 months, and the third case was followed up for 12 months. All patients had a good prognosis without evidence of recurrence and metastasis.

Conclusion:

Breast MEC is extremely rare and estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2 negative breast cancer with a good prognosis, which is different from other highly malignant triple-negative breast cancers. reviewed its clinicopathologic morphological characteristics, immunohistochemical markers and molecular characteristics, prognosis and clinical treatment through literature, in order to understanding its clinicopathology and providing reference for clinical precise treatment.
Diffuse posterior leukoencephalopathy in MELAS without stroke-like episodes: A case report
Authors: Bai Peng , Feng Yinling , Chen Jin , Chang Hong
Published: May 2023

Rationale:

Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is the most common subtype of mitochondrial encephalopathy. In the past, it was believed that most hereditary white matter lesions were lysosome storage disorders or peroxisome diseases. However, in recent years, white matter lesions have been increasingly regarded as a common feature of patients with mitochondrial diseases. In addition to stroke-like lesions, about half of the patients with MELAS reported white matter lesions in the brain.

Patient concerns:

Herein, we provide a case of A 48-year-old female who presented with episodic loss of consciousness with twitching of extremities. Previous medical history revealed 10 years of history of epilepsy, 10 years of history of diabetes, a history of hearing loss, and unknown etiology. Ancillary findings included brain magnetic fluid-attenuated inversion recovery showed symmetrical lesions in the bilateral parietal lobe with high signal intensity at the edge, and high signal intensity in the bilateral occipital lobe, paraventricular white matter, corona radiata, and the center of semiovale.

Diagnoses:

Mitochondrial deoxyribonucleic acid gene sequencing returned A3243G point mutation and it supports the diagnosis of intracranial hypertension.

Interventions:

Considered the diagnosis of symptomatic epilepsy, the patient was treated with mechanical ventilation, midazolam, and levetiracetam, and the limb twitching symptoms were controlled. The patient was comatose, chronically bedridden, with gastrointestinal dysfunction, and was treated prophylactically with antibiotics against infection, parenteral nutrition, and other supportive measures. B vitamins, vitamin C, vitamin E, coenzyme Q10, and idebenone were given, and mechanical ventilation and midazolam were stopped after 8 days. He was discharged from the hospital on 30 days and continued symptomatic treatment with B-vitamins, vitamin C, vitamin E, coenzyme Q10, and idebenone, and antiepileptic treatment with levetiracetam, with outpatient follow-up.

Outcomes:

No further seizures were recorded and the patient recovered well.

Lessons:

MELAS syndrome without stroke-like episodes of diffuse posterior cerebral white matter lesions is rare in clinical practice, and the possibility of MELAS syndrome should be considered in symmetric posterior cerebral white matter lesions.
Sarcopenia in cirrhosis: epidemiology, diagnosis, management and prognosis
Authors: Liu Yi , Ji Fanpu , Nguyen Mindie H.
Published: May 2023

Purpose of review

With the development of many international guidelines, research on sarcopenia has increased rapidly, showing that sarcopenia is predictive of adverse outcomes, including increased mortality and impaired mobility, in patients with cirrhosis. The purpose of this article is to review the current evidence concerning the epidemiology, diagnosis, management and predictive value of sarcopenia on the prognosis of patients with cirrhosis.

Recent findings

Sarcopenia is a frequent and lethal complication of cirrhosis. Currently, abdominal computed tomography imaging is the most commonly used method to diagnose sarcopenia. In clinical practice, assessing muscle strength and physical performance, such as by measuring handgrip strength and gait speed, is of increasing interest. In addition to the necessary pharmacological therapy, adequate intake of protein, energy and micronutrients, as well as regular moderate-intensity exercise, can help to minimize sarcopenia. Sarcopenia has been shown to be a strong predictor of prognosis in patients with severe liver disease.

A global consensus is needed on the definition and operational parameters for the diagnosis of sarcopenia. Further research should focus on developing standardized screening, management and treatment protocols for sarcopenia. Adding sarcopenia to existing models may better exploit the effect of sarcopenia on prognosis in patients with cirrhosis, which should be investigated further.
Unravelling the controversy with small intestinal bacterial overgrowth
Authors: Shah Ayesha , Ghoshal Uday C. , Holtmann Gerald J.
Published: May 2023

Purpose of review

The aim of this review is to summarize the current and emergent approaches to characterize the small intestinal microbiota and discuss the treatment options for management of small intestinal bacterial overgrowth (SIBO).

Recent findings

This review captures the growing body of evidence for the role of SIBO, a type of small intestinal dysbiosis in the pathophysiology various gastrointestinal and extraintestinal disorders. We have highlighted the drawbacks of the available methods for characterizing the small intestinal microbiota and focus on the new culture-independent techniques to diagnose SIBO. Although recurrence is common, targeted modulation of the gut microbiome as a therapeutic option for management of SIBO is associated with improvement in symptoms and quality of life.

As a first step to precisely characterize the potential link between SIBO and various disorders, we need to address the methodological limitations of the available traditional tests for diagnosing SIBO. There is an urgency to develop culture independent techniques that can be routinely used in clinical setting, that will enable characterization of the gastrointestinal microbiome and explore the response to antimicrobial therapy including the links between long-lasting symptom resolution and the microbiome.
Safety Concerns Associated with Home Care Nursing
Authors: Nix Elizabeth , Altom Kacie
Published: May 2023

Compared to nurses in acute care settings, home care nurses face unique threats to safety, including unsanitary conditions in homes, dangerous pets, firearms in the home, hostile patients or family members, high-crime neighborhoods, and motor vehicle accidents while traveling between patients. The purpose of this descriptive study was to explore specific personal safety and environmental concerns faced by home care nurses. Seventy-five home care and home hospice nurses completed an anonymous Qualtrics survey. Seventy-eight percent admitted to feeling unsafe during a home visit. Safety threats included unsafe neighborhoods, aggressive dogs, aggressive or drug-seeking family members, patients with mental health concerns, sexual harassment, and most alarmingly feeling threatened by a firearm. Participants also identified environmental concerns such as secondhand smoke and bedbugs, and a high number of musculoskeletal injuries they perceived to be related to their work in home care. Home care is a rapidly growing industry with a critical need to attract and retain workers. Safety training specific to the workers' role should be offered at the time of hire and annually thereafter. Home care nurses should be aware of threats to safety and employ the strategies of preparation, awareness, alertness, and prevention before and during visits.
Prevalence of Pressure Injury among Stroke Patients In and Out of Healthcare Settings
Authors: Vanaki Zohreh , Mohammadi Eesa , Hosseinzadeh Kazem , Ahadinezhad Bahman , Rafiei Hossein
Published: May 2023

Pressure injury is a recognized problem for patients with stroke. Knowing the prevalence of pressure injury post stroke can guide clinical professionals and researchers to take appropriate actions for patient care and education. The aim of this study was to systematically review the literature regarding prevalence of pressure injury among patients with stroke in the hospital, and in the home with no home healthcare services and nursing homes. Original articles available in Scopus, Web of Science, PubMed, ProQuest, and Google Scholar databases were searched separately by two researchers using the following keywords: stroke, cerebrovascular attack, pressure injury, pressure ulcer, bedsore, decubitus ulcer, and prevalence. The search was performed according to the PRISMA flow diagram from 2000 to 2020. After the initial review, 14 articles conducted between 2008 and 2019 were included in the final analysis. Eight studies were conducted in healthcare settings, and six studies were conducted out of hospitals. The estimated pooled prevalence for pressure injury in all studies was 3.9%. The estimated pooled prevalence for pressure injury in studies conducted in hospitals and in patients' homes with no home healthcare services and nursing homes were 3.06 and 17.25, respectively. The prevalence of pressure injury among stroke patients after hospital discharge was significantly higher than when they were hospitalized. This could indicate that this group of patients do not receive adequate care and attention for pressure injury after hospital discharge. Given the limitations of the available studies, it is recommended that further studies be conducted on pressure injury among stroke patients both at the time of hospitalization and after hospital discharge.
Predictors of Fertility-Awareness-Based Method Use Among Women Trying to Conceive and Women Contemplating Pregnancy
Authors: Pérez Capotosto Melissa , Lee Christopher S. , Jurgens Corrine Y. , Wang Siwen , Mitsunami Makiko , Charlton Brittany M. , Chavarro Jorge E.
Published: May 2023

Background

Fertility-awareness-based methods have been linked to shorter time to conception; however, little is known about the predictors of fertility-awareness-based method use among women who are currently or will soon be trying to conceive.

Objectives

The aim of this study was to identify predictors of fertility-awareness-based methods use among women trying to conceive or contemplating pregnancy within the next year.

Methods

Women participating in the Nurses' Health Study 3 were asked if they were trying to become pregnant or contemplating pregnancy and whether they are using fertility-awareness-based methods. Multivariable negative binomial regression was used to identify predictors for a number of fertility-awareness-based methods used.

Results

Among the 23,418 women asked about pregnancy intention since 2015, 955 were trying to conceive, and 2,282 were contemplating pregnancy within the next year. The three most used fertility-awareness-based methods among women trying to conceive were menstrual cycle tracking, ovulation prediction kits, and cervical mucus monitoring. Among women contemplating pregnancy, the three most commonly used methods were menstrual cycle tracking, cervical mucus monitoring, and basal body temperature monitoring. The ongoing duration of pregnancy attempts and gravidity were associated with the number of methods used among women actively trying to conceive. When compared with women who were trying for 2 months or less, the number of methods was 29% higher when trying for 3–5 months, 45% higher when trying for 6–12 months, and 38% higher when trying for more than 1 year. Compared with nulligravid women, the number of methods was lower for women with a history of two or more pregnancies. Among women contemplating pregnancy, those who were married or in a domestic partnership used more fertility-awareness-based methods than unpartnered women. No other significant predictors of fertility-awareness-based method use were identified.

Discussion

Duration of ongoing pregnancy attempt and gravidity were the only significant predictors for the number of fertility-awareness-based methods used among women actively trying to conceive, whereas partnership was the only significant predictor of the number of fertility-awareness-based methods among women contemplating pregnancy.
Factor Structure and Construct Validity of a Hospital Survey on Patient Safety Culture Using Exploratory Factor Analysis
Authors: Falcone Maureen L. , Tokac Umit , Fish Anne F. , Van Stee Stephanie K. , Werner Kimberly B.
Published: May 2023

Objective

Nurses' voluntary reporting of adverse events and errors is critical for improving patient safety. The operationalization and application of the concept, patient safety culture, warrant further study. The objectives are to explore the underlying factor structure, the correlational relationship, between items of the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture and examine its construct validity.

Methods

Exploratory factor analysis was conducted using secondary data from the instrument’s database. Using pattern matching, factors obtained through exploratory factor analysis were compared with the 6-component Patient Safety Culture Theoretical Framework: degree of psychological safety, degree of organizational culture, quality of culture of safety, degree of high reliability organization, degree of deference to expertise, and extent of resilience.

Results

6 exploratory factors, explaining 51% of the total variance, were communication lead/speak out/resilience, organizational culture and culture of safety–environment, psychological safety–security/protection, psychological safety-support/trust, patient safety, communication, and reporting for patient safety. All factors had moderate to very strong associations (range, 0.354–0.924). Overall, construct validity was good, but few exploratory factors matched the theoretical components of degree of deference to expertise and extent of resilience.

Conclusions

Factors essential to creating an environment of transparent, voluntary error reporting are proposed. Items are needed, specifically focusing on deference to expertise, the ability of the person with the most experience to speak up and lead, despite hierarchy or traditional roles, and resilience, which is coping and moving forward after adversity or mistakes. With future studies, a supplemental survey with these items may be proposed.
Integrated bioinformatics analysis to identify key genes and pathways involved in the endometria of patients with recurrent implantation failure undergoing in vitro fertilization and embryo transfer
Authors: Sui Yi-Lun , Li Lu , Sun Xiao-Xi
Published: May 2023

Objectives:

Recurrent implantation failure (RIF) is a challenging clinical problem that occurs in approximately 10% of patients undergoing in vitro fertilization and embryo transfer. Because of the varied criteria for RIF, as well as differences in the time and methods of endometrial biopsy, previous studies have not reached an agreement regarding the key genes and pathways of RIF. In this study, bioinformatic analyses were performed in a homogeneous population with consistent biopsy conditions to explore the molecular mechanisms and identify key RIF-associated genes and pathways in the endometrium.

Methods:

Seven datasets from the Gene Expression Omnibus database were reviewed in detail, and GSE111974, GSE103465, and GSE26787 were included for further analysis. Common differentially expressed genes (DEGs) were identified using the GEO2R online tool. Gene Ontology and pathway enrichment analyses were performed and a protein–protein interaction (PPI) network was constructed. The RNA and protein expression files of the hub genes were obtained.

Results:

A total of 402 common DEGs were identified between patients with RIF and controls. The enrichment of these DEGs was mainly associated with tube morphogenesis, vasculature development, and positive regulation of cell migration. Pathway enrichment indicated that pathways involved in cancer, the vascular endothelial growth factor A-vascular endothelial growth factor receptor 2 signaling pathway, and cell cycle pathways were mainly involved. Moreover, a PPI network was constructed, and the three most significant submodules were mainly involved in rRNA processing and the regulation of proteolysis. The following ten DEGs with high degrees of connectivity were identified as hub genes: CDC42, VEGFA, MAP2K1, APP, CYCS, UBE2I, PLEK, LMNA, SMAD2, and ATRX.

Conclusion:

Key genes and pathways identified in this study could improve our understanding of the underlying molecular events in RIF and be used as potential biomarkers and therapeutic targets. Further studies are required to confirm these results and explore the functions of hub genes in the endometrium during the implantation window in patients with RIF.
Does Failure to Rescue Drive Race/Ethnicity-based Disparities in Survival After Heart Transplantation?
Authors: Abrahim Orit , Premkumar Akash , Kubi Boateng , Wolfe Stanley B. , Paneitz Dane C. , Singh Ruby , Thomas Jason , Michel Eriberto , Osho Asishana A.
Published: May 2023

Objective

The objective was to assess whether race/ethnicity is an independent predictor of failure to rescue (FTR) after orthotopic heart transplantation (OHT).

Summary Background Data

Outcomes following OHT vary by patient level factors; for example, non-White patients have worse outcomes than White patients after OHT. Failure to rescue is an important factor associated with cardiac surgery outcomes, but its relationship to demographic factors is unknown.

Methods

Using the United Network for Organ Sharing database, we included all adult patients who underwent primary isolated OHT between 1/1/2006-6/30/2021. FTR was defined as the inability to prevent mortality after at least one of the UNOS-designated postoperative complications. Donor, recipient, and transplant characteristics, including complications and FTR, were compared across race/ethnicity. Logistic regression models were created to identify factors associated with complications and FTR. Kaplan Meier and adjusted Cox proportional hazards models evaluated the association between race/ethnicity and post-transplant survival.

Results

There were 33,244 adult, isolated heart transplant recipients included: the distribution of race/ethnicity was 66% (n=21,937) White, 21.2% (7,062) Black, 8.3% (2,768) Hispanic, and 3.3% (1,096) Asian. The frequency of complications and FTR differed significantly by race/ethnicity. After adjustment, Hispanic recipients were more likely to experience FTR than White recipients (OR 1.327, 95% CI[1.075-1.639], P=0.02). Black recipients had lower 5-year survival compared with other races/ethnicities (HR 1.276, 95% CI[1.207-1.348], P<0.0001).

Conclusions

In the US, Black recipients have an increased risk of mortality after OHT compared with White recipients, without associated differences in FTR. In contrast, Hispanic recipients have an increased likelihood of FTR, but no significant mortality difference compared with White recipients. These findings highlight the need for tailored approaches to addressing race/ethnicity-based health inequities in the practice of heart transplantation.
Rabbit Antithymocyte Globulin for Treatment of Corticosteroid Refractory Acute Cellular Rejection After Lung Transplantation
Authors: Rudzik Katelyn N. , Moore Cody A. , Sacha Lauren M. , Rivosecchi Ryan M. , Saul Melissa , Pilewski Joseph M. , Kilaru Silpa D. , Snyder Mark E. , McDyer John F. , Iasella Carlo J.
Published: May 2023

Background.

Chronic lung allograft dysfunction (CLAD) remains a major cause of death after the first year posttransplant, with acute cellular rejection (ACR) being a major risk factor for CLAD. We evaluated the use of rabbit antithymocyte globulin (rATG) for corticosteroid refractory ACR in lung transplant recipients.

Methods.

We retrospectively identified 112 adult lung transplant recipients who received rATG for refractory ACR after lung transplantation. The primary endpoint was the incidence of ACR on follow-up transbronchial biopsy. Secondary endpoints included freedom from ACR within 1 y post-rATG, CLAD progression at 1 y post-rATG, and all-cause mortality at 1 y post-rATG.

Results.

A complete resolution of ACR was observed in 60.2% of patients, an improvement but not complete resolution in 22.1%, and no response on follow-up biopsy in 17.8%. Mean A grade 1 y post-rATG was 0.51 in complete responders, 1.01 in partial responders, and 2.19 in nonresponders (P < 0.001). Complete responders had significantly less new or worsening CLAD at 1 y than partial responders (17% versus 40%; P = 0.02). All-cause mortality rate was 14.9% in complete responders, 40% in partial responders, and 30% in nonresponders (P < 0.01).

Conclusions.

rATG appears to be an effective treatment of refractory ACR in lung transplant recipients. Failure to respond to rATG carries an increased risk of early CLAD and death.
Effectiveness of High-Frequency Repetitive Transcranial Magnetic Stimulation in Patients With Spinocerebellar Ataxia Type 3
Authors: Zhou Menglu , Qiu Mengqiu , Jin Yi , Li Dan , Tao Chenjuan , Lou Danning , Hu Zhouyao , Wang Yuchen , You Zhiyuan , Shao Yimeng , Zhu Yingying , Qu Mingyue , Lu Xiaodong
Published: May 2023

Objective

To investigate the effectiveness of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on improvement of clinical symptoms in patients with spinocerebellar ataxia type 3 (SCA3).

Methods

Sixteen SCA3 participants diagnosed by genetic testing were enrolled in this sham-controlled and double-blind trial. They received either a 2-week 10-Hz rTMS intervention or sham stimulation targeting the vermis and cerebellum. The Scale for Assessment and Rating of Ataxia and the International Cooperative Ataxia Rating Scale were completed at baseline and poststimulation.

Results

Compared with baseline, the HF-rTMS group demonstrated a significant improvement in the total Scale for Assessment and Rating of Ataxia (P < 0.0001) and the International Cooperative Ataxia Rating Scale scores (P = 0.002). After 2-week treatment, the real group exhibited decreasing pattern in 3 subgroups, especially for limb kinetic function (P < 0.0001).

Conclusions

Short-term HF-rTMS treatment is a potentially promising and feasible tool for rehabilitation in patients with SCA3. Studies with long-term follow-up need to be carried out in the future and further need to assess gait, limb kinetic function, speech and oculomotor disorders.
A case series and literature review of infections due to Myroides spp.: identification of contributing factors and emerging antibiotic susceptibility trends
Authors: Khan Uzair , Pandey Ellora , Gandham Nageswari , Das Nikunja , Mukhida Sahjid , Kannuri Sriram , Bhaumik Shalini , Mirza Shahzad
Published: May 2023

Introduction. Infections forby

Myroides

spp. can lead to significant morbidity and mortality, particularly in immunocompromised patients with underlying co-morbidities. Recent reports have highlighted its intrinsic and acquired drug resistance, making it a particularly challenging infectious agent to combat.

Methods.

Myroides

spp. isolated and reported in clinically significant urine samples were considered for the study. Identification of the organism was done via the VITEK 2C system. Antibiotic susceptibility testing was done using both manual and automated methods following Clinical and Laboratory Standards Institute (CLSI) guidelines. Existing literature was searched on MEDLINE using PubMed.

Results. We present a series of five catheter-associated urinary tract infections due to

Myroides odoratimimus

, with sensitivity to only minocycline. This is the first case from Western India, and the third case in the existing literature that shows

Myroides

sensitivity only to minocycline. Our literature review is the first to systematically describe contributory factors to infection, allowing us to devise a clinically relevant tool that delineates contributory factors and efficacious drugs in

Myroides

spp. infection.

Conclusion.

Myroides

spp. infections, previously considered rare and opportunistic, need cognizance and diagnostic suspicion especially in particular associated conditions.
Combined assessment ofKRASmutational status and tumor size has no impact on prognosis in early-stage non-small cell lung cancer
Authors: Eklund Ella A. , Mourad Ali , Wiel Clotilde , Sayin Sama I. , Fagman Henrik , Hallqvist Andreas , Sayin Volkan I.
Published: May 2023

Background

KRASmutation status, stage and tumor size at the time of diagnosis are well-established independent prognostic factors in non-small cell lung cancer (NSCLC). Here, we investigate the prognostic value of combining survival data onKRASmutation status and tumor size in early-stage NSCLC.

Methods

We studied the combined impact ofKRASmutational status and tumor size on overall survival (OS) and risk of death in patients with stage I-II NSCLC. We performed a retrospective study including 310 consecutively diagnosed patients with early (stage I-II) NSCLCs. All consecutive patients molecularly assessed and diagnosed between 2016-2018 with stage I-II NSCLC in the Västra Götaland region of western Sweden were included in this multi-center retrospective study. The primary study outcome was OS and risk of death (hazard ratio).

Results

Out of 310 patients with stage I-II NSCLC, 37% harbored an activating mutation in theKRASgene. Our study confirmed staging and tumor size as prognostic factors. However,KRASmutational status was not found to impact OS and there was no difference in the risk of death when combiningKRASmutational status and primary tumor size.

Conclusions

In our patient cohort,KRASmutations in combination with primary tumor size are not associated with a worse prognosis in stage I-II NSCLC.
Interaction of inherited genetic variants in the NLRP3 inflammasome/IL-6 pathway with acquired clonal hematopoiesis to modulate mortality risk in patients with HFrEF
Authors: Cremer Sebastian , Katsaouni Nikoletta , Abplanalp Wesley Tyler , Berkowitsch Alexander , Kirschbaum Klara , Rieger Michael A. , Rapp Steffen , Wild Philipp S. , Dimmeler Stefanie , Schulz Marcel H. , Zeiher Andreas M.
Published: May 2023

Aims

Clonal hematopoiesis (CH), defined as the presence of an expanded blood cell clone due to acquired somatic mutations in leukemia driver genes, was shown to be associated with increased mortality in patients with chronic ischemic heart failure with reduced ejection fraction (HFrEF). Mechanistically, circulating monocytes of mutation carriers display increased expression of proinflammatory genes involved in inflammasome and IL-6 signaling. Inherited genetic variants (SNP) in the IL-6 pathway are well known to affect inflammatory activation. Therefore, we investigated whether known SNPs in genes encoding for components of the inflammasome/IL-6 signaling pathway modulate fatal outcomes in HFrEF patients with CH.

Methods and Results

In a total of 446 patients with chronic HFrEF, peripheral blood or bone marrow mononuclear cells were analyzed for the CH driver mutations DNMT3A and TET2 as well as 48 preselected SNPs affecting genes in the NLRP3 inflammasome/IL-6 signaling pathway. The 103 patients carrying a CH driver mutation demonstrated significantly increased mortality compared to the 343 patients without CH mutations (25,24% vs 13.99% at five years; p=0.0064). We identified three commonly occurring variants known to disrupt IL-6 signaling (rs2228145, rs4129267 and rs4537545), which are in strong linkage disequilibrium and present in more than 50% of CH carriers. Harboring one of those SNPs abrogated the increased mortality risk in patients with HFrEF and CH (p≤0.05 for each SNP). On the contrary, three different SNPs (rs2250417, which is associated with increased IL-18 levels; rs4722172 and rs4845625, which are known to activate IL-6 signaling) were identified to mediate fatal outcomes in patients with HFrEF and CH; p<0.05 for each). None of the assessed SNPs influenced outcomes in patients without DNMT3A or TET2 mutations. Single Cell RNA-sequencing of circulating monocytes of patients with HFrEF revealed increased inflammatory signaling in DNMT3A mutation carriers harboring IL6/IL18 activating SNPs with genes upregulated in pathways such as “cellular response to stress”, “regulation of cell activation” and “cytokine signaling in the immune system”.

Conclusion

Among CH carriers with HFrEF, inherited variants in loci encoding for genes involved in inflammatory signaling interact with mortality risk. These data not only provide mechanistic insights into inflammatory mechanisms contributing to fatal outcome of HFrEF in CH carriers, but may also inform trials evaluating precision-targeted anti-inflammatory therapy in patients with DNMT3A and TET2 mutations and chronic HFrEF.
Predicting sensitivity to general anesthesia: Bispectral index versus Checkpoint-Decomposition Algorithm
Authors: Sun C. , Constant I. , Holcman D.
Published: May 2023

Despite a large effort in EEG signal processing, classification algorithms, deep-learning approach, predicting the sensitivity to general anesthesia (GA) remains a daunting hurdle. We compare here the ability of the Bispectral Index™ (BIS™), developed more that twenty years ago to monitor the depth of anesthesia, with the real-time checkpoint-decomposition algorithm (CDA) to evaluate the patient sensitivity from the early induction phase of GA. Using EEG recorded in children anesthetised with propofol, we computed three parameters extracted from the BIS: 1-the minimum value (nadir) of the BIS, 2-the time to reach the minimum and 3-the duration spent below 40 during the first 10 minutes. Using a logistic regression procedure, we report that these parameters provide a poor prediction of sensitivity compared to the CDA, that combined the first occurrence time of iso-electric EEG traces, fraction of suppressions of theα-band and its first occurrence time. Finally, we correlate the BIS values with the maximum power frequency of theα−band, the proportion ofα−suppressions (αS) and iso-electric suppressions (IES) as well as theαandδpower ratios. To conclude, the checkpoint-decomposition algorithm complements the EEG indices such as the BIS to anticipate the sensitivity to GA.