bluuebunny/crossref_metadata_2025 huggingface dataset:
109 The Impact of Extended Reality on Surgery: A Scoping Review
Authors: Lu V , Zhang J , Logishetty K , Khanduja V
Published: November 2022

Aim

Extended reality (XR) is a spectrum of technologies encompassing augmented reality (AR), virtual reality (VR), augmented virtuality (AV), mixed reality (MR). This scoping review maps out current utilisation and future prospects of XR-assisted surgery.

Method

A systematic search of PubMed, Scopus, Embase was performed. Primary studies describing surgical procedures on human subjects, dentistry, anaesthetic procedures for surgery were included. Non-surgical, rehabilitation, bedside, veterinary procedures, robotic surgery were excluded.

Studies were classified into preoperative planning, intraoperative navigation/guidance, patient pain, patient anxiety, surgical training, surgeon confidence.

Results

213 studies were included for analysis. Thirty-six studies on pre-operative planning noted VR improved surgeon's understanding of anatomical sites, leading to reduced operating time and surgical trauma. Fifty-nine studies on intra-operative planning noted AR headsets highlight ‘negative structures’, reducing chance of accidental incision. Fourteen studies on patients’ pain found VR-induced meditative state resulted in less analgesics for patient comfort. Twelve studies on patient anxiety found VR failed to change patients’ physiological parameters such as arterial blood pressure, cortisol levels, heart rate. Sixty-eight studies explored surgical training, with VR being most cost-effective. Thirteen studies documented increased surgeon confidence.

Conclusions

XR-assisted surgery's growth is fuelled by hardware and software innovations. Training and pre-operative planning are mostly achieved by VR; intraoperative guidance is mostly supplemented with AR. The other sections of XR spectrum, AV and MR, are underexplored. Working time restrictions during surgical training, COVID-19's impact on limiting physical presence and increasing complexity of surgical procedures means that XR-assisted surgery may assume a greater role in coming decades.
1001 Surgical Escape Rooms: A Novel Approach for Teaching Surgical Skills
Authors: Thakkar R , Wharf O , Hanson M , Badenoch T , Hunter I , Bamford R , Cooper S
Published: November 2022

Aim

Traditional classroom-based teaching of surgical skills has been used commonly in the past. Although, use of an escape room is a new form of a practical teaching method to deliver surgical skills teaching. We compared and assessed effectiveness of the traditional classroom teaching versus practical escape room teaching of the basic surgical skills.

Method

Two teaching sessions were delivered to third year medical students. Each session consisted of two groups and two sessions. Each group received either the classroom-based teaching or the escape room teaching, then switching over to the other teaching. Each student was asked to complete a questionnaire before the session, after the first and the second teaching session. Teaching covered interrupted suturing, wound management, and administration of local aesthetic. Likert scores were used to collect feedback.

Results

Total 24 third year medical students attended the two teaching sessions. 100% either agreed or strongly agreed the classroom teaching was useful, compared to 75% for the escape room. 67% either agreed or strongly agreed that escape room style teaching is a better learning method than traditional teaching. Although, 79% either agree or strongly agree that escape room style teaching is a useful adjunct to the traditional teaching. 100% either agree or strongly agree that this teaching will improve their clinical practice.

Conclusions

Traditional classroom-based teaching is a more useful form of teaching compared to the escape room. Although escape room teaching is a useful adjunct to the current common form of classroom based surgical teaching.
173 Debridement, Antibiotics and Implant Retention (DAIR) in the Management of Prosthetic Joint Infections Following Primary Hip and Knee Arthroplaty: A DGH Experience
Authors: Feathers J , Awad F , Punjabi S , Prasad K , Silva C , Sarasin S , Lewis P
Published: November 2022

Aim

Prosthetic joint infections (PJI) are a devastating complication of arthroplasty surgery. Current gold standard one or two-stage revision, poses sincere surgical challenges and carry significant patient morbidity. If diagnosed promptly, a debridement, antibiotics, and implant retention (DAIR) procedure can be performed. We report the results of our experience with the DAIR procedure in a District General Hospital setting.

Method

Our study comprises of a single centre retrospective review of a prospectively updated database. All patients who underwent a DAIR procedure following hip or knee arthroplasty from August 2012 to July 2019 were included in the study with no exclusions.

Results

Four total knee replacements, sixteen total hip replacements (THR), two revision THR and three hemiarthroplasties were included in the study. Average duration from onset of symptoms to DAIR was 22 days for immediate post-operative patients and 6 days in patients presenting later with an acute infection. All patients had exchange of modular components during the DAIR procedure. Out of 25 DAIR procedures, 23 identified a positive microbiology culture. Most common causative organisms identified were Staphylococcos aureus (23%) and Staphylococcus epidermidis (23%). Average follow up in clinic was 55 months. 76% of patients had a stable post-operative recovery with no recurrence of infection. One patient required a revision THR for aseptic loosening; one patient required a knee arthrodesis and four patients died.

Conclusions

Infection was successfully eradicated in 19 patients. The success reported within the literature stem predominantly from tertiary units. Our study reflects this success in a DGH setting.
906 Schistosomiasis: The New ‘Gap Year’ Problem
Authors: Humayon D , Baby A , Mahesan T
Published: November 2022

Introduction

Schistosomiasis is endemic in Africa, Asia, and South America. The parasite, found in freshwater lakes, ultimately deposits eggs in the veins around organs including the bladder. It causes chronic inflammation resulting in fibrosis of the urogenital tract and malignancy. In the UK, cases of schistosomiasis are unusual and historically confined to the immigrant population.

The patient

We present the case of a British born 21-year-old who returned from a round-the-world gap year. Upon return he reported dysuria, abdominal pain, poor flow, and malaise. He was investigated for tropical diseases, treated for recurrent urine infections, and sexually transmitted infections before disclosing on direct questioning to swimming in Malawi. Cystoscopy demonstrated tight pan-urethral strictures. Sandy patches were seen throughout the bladder. Histology from bladder biopsy confirmed schistosomiasis eggs. The patient was treated with Praziquantel. Despite treatment he will likely require repeat urethral dilatations.

Discussion

Changes in travel practice has led to a shift in patients who present with schistosomiasis. Clinicians should consider the diagnosis in anyone with lower urinary tract symptoms who has visited Asia, Africa, or South America. In those diagnosed, clinicians have a duty to encourage them to urge fellow swimmers to seek urological input. Similarly travel-clinics should be encouraged to warn travellers against fresh-water swimming prior to travel.

To avoid long term schistosomiasis sequelae, prevention is preferable, but early and prompt intervention is the next best alternative. Clinicians need a low threshold to suspect and exclude this damaging diagnosis.
548 A 10-Year Longitudinal Cohort Study Assessing Growth Rates and Surveillance Intervals for Common Iliac Artery Aneurysms
Authors: Laloo R , Aimar K , Khanom J , Jamjoom A , Bailey M , Scott J
Published: November 2022

Aim

The European Society for Vascular Surgery defines common iliac artery (CIA) aneurysms as greater than 1.8cm in men and 1.5cm in women. Their reported growth rate is 1–4mm/year depending on their diameter. This study aimed to assess the natural history and surveillance intervals for CIA aneurysms as intervention threshold is based on low-quality evidence.

Method

Patients diagnosed with an IAA at a single vascular centre between 1st January 2010 and 31st August 2021 were identified from a prospectively collected departmental database and Caldicott-approved data collection performed. The primary outcomes included diameter-based mean aneurysm growth rates and median surveillance intervals. Statistical analysis with SPSS® was performed using chi-squared tests.

Results

Of the 203 patients included, 90.6% were men and median (IQR) age at detection was 77 (71–83). IAA were located in the CIA (85.2%), IIA (21.7%) and EIA (2.0%) with the majority being asymptomatic (78.8%). CT was most frequently used as the imaging modality for IAA surveillance (66.3%), followed by ultrasound scan (29.8%) and MRA (3.9%). Growth rate for CIA aneurysms measuring 1.0–1.9cm were -2.1mm/year, 2.0–2.9cm were 0.8mm/year, 3.0–3.9cm were 3.5mm/year, 4.0–4.9cm were 9.4mm/year, 5.0–5.9cm were 2.9mm/year and >6.0cm were 13.8mm/year. Median surveillance intervals for CIA aneurysms at 1.0–1.9cm were 12-monthly, 2.0–2.9cm were 11-monthly, 3.0–3.9cm were 5-monthly, 4.0–4.9cm were 5-monthly, 5.0–5.9cm were 5.5-monthly and >6.0cm were 14.5-monthly. Mean(SD) CIA diameter at rupture was 4.6 (2.4)cm.

Conclusions

CIA aneurysms demonstrate faster growth rates as they enlarge and may require more frequent clinical assessments, surveillance, and consideration for repair prior to rupture.
Predicting performance of the HAS-BLED and ORBIT bleeding risk scores in patients with atrial fibrillation treated with Rivaroxaban: Observations from the prospective EMIR Registry
Authors: Esteve-Pastor María A , Rivera-Caravaca José M , Roldán Vanessa , Sanmartin Fernández Marcelo , Arribas Fernando , Masjuan Jaime , Barrios Vivencio , Cosin-Sales Juan , Freixa-Pamias Román , Recalde Esther , Pérez-Cabeza Alejandro I , Manuel Vázquez Rodríguez José , Ràfols Priu Carles , Anguita Sánchez Manuel , Lip Gregory Y H , Marin Francisco
Published: November 2022

Background

Assessing bleeding risk during the decision-making process of starting oral anticoagulation (OAC) therapy in atrial fibrillation (AF) patients is essential. Several bleeding risk scores have been proposed for vitamin K antagonist users but, few studies have focused on validation of these bleeding risk scores in patients taking direct oral anticoagulants (DOACs). The aim was to compare the predictive ability of HAS-BLED and ORBIT bleeding risk scores in AF patients taking rivaroxaban in the EMIR (‘Estudio observacional para la identificación de los factores de riesgo asociados a eventos cardiovasculares mayores en pacientes con fibrilación auricular no valvular tratados con un anticoagulante oral directo [Rivaroxaban]) Study.

Methods and results

EMIR Study was an observational, multicenter, post-authorization, and prospective study that involved AF patients under OAC with rivaroxaban at least 6 months before enrolment. We analysed baseline clinical characteristics and adverse events after 2.5 years of follow-up and validated the predictive ability of HAS-BLED and ORBIT scores for major bleeding (MB) events.

We analysed 1433 patients with mean age of 74.2 ± 9.7 (44.5% female). Mean HAS-BLED score was 1.6 ± 1.0 and ORBIT score was 1.1 ± 1.2. The ORBIT score categorised a higher proportion of patients as ‘low-risk’ (87.1%) compared with 53.5% using the HAS-BLED score. There were 33 MB events (1.04%/year) and 87 patients died (2.73%/year). Both HAS-BLED and ORBIT had a good predictive ability for MB{Area under the curve (AUC) 0.770, [95% confidence interval (CI) 0.693–0.847; P <0.001] and AUC 0.765 (95% CI 0.672–0.858; P <0.001), respectively}. There was a non-significant difference for discriminative ability of the two tested scores (P = 0.930) and risk reclassification in terms of net reclassification improvement (NRI) −5.7 (95% CI −42.4–31.1; P = 0.762). HAS-BLED score showed the best calibration and ORBIT score showed the largest mismatch in calibration, particularly in higher predicted risk patients.

Conclusion

In a prospective real-world AF population under rivaroxaban from EMIR registry, the HAS-BLED score had good predictive performance and calibration compared with ORBIT score for MB events. ORBIT score presented worse calibration than HAS-BLED in this DOAC treated population.
The Genesis of Miracle Stories in Jihad
Authors: de la Paz Alexander
Published: November 2022

Stories of miracles, or karamat, are ubiquitous and influential in jihad. Yet, they remain poorly understood. Current treatments are limited to descriptions of reports in individual conflicts. None have systematically studied their genesis: from whom, and where do they originate? Some, to be sure, imply origins—especially in deception. But they have done so based on impressions, and not systematic investigation. However, the question is of considerable interest and warrants closer study. Examining it would not only illuminate an understudied aspect of the movements in question but also advance scholarship on religion on the battlefield, a budding field of inquiry. This article thus traces the genesis of official and semiofficial reports of karamat, drawing on a wide range of evidence, including hundreds of reports culled from books, magazines, and video and audio recordings from multiple groups and individuals spanning decades, and interviews. The results point to origins in experience, misrepresentation, rumor, and tradition. The findings advance our understanding of karamat, and the documentary value of reports of them. More generally, they sensitize us to the significance of elusive phenomena seldom studied in the conflict literature: religious experience, propaganda about religious experience, rumor about religious experience, and folklore about religious experience.
When Are Female Suicide Bombings More Likely? The Case of Boko Haram
Authors: Weeraratne Suranjan
Published: November 2022

This research delineates the conditions more conducive to the use of female suicide bombings through a detailed analysis of attacks carried out by Boko Haram. Using a novel dataset of 473 suicide attacks, the study finds that females are more likely to be deployed against non-religious civilian targets. Further, fragmentation of the group increases the likelihood of more female suicide bombers as different factions seek to outbid one another. Third, the expectation of extensive and favorable coverage in non-local (Western) media sources increases the odds of female suicide attacks.
Kidney utilization in the Netherlands – do we optimally use our donor organs?
Authors: Schutter Rianne , Vrijlandt Willemijn A L , Weima Gelske M , Pol Robert A , Sanders Jan-Stephan F , Crop Meindert J , Leuvenink Henri G D , Moers Cyril
Published: November 2022

Background

To ensure optimal utilization of deceased donor kidneys, it is important to understand the precise reasons why kidneys are discarded. In this study we aimed to obtain a comprehensive overview of kidney utilization and discard during the entire donation process in the Netherlands.

Methods

In this retrospective cohort study we analysed kidney utilization of 3856 kidneys in the Netherlands between 1 January 2015 and 31 December 2020. For every kidney that was not transplanted, we determined the moment of and reason for discard through a unique case-by-case assessment.

Results

Kidney discard according to the traditional definition (procured but not transplanted) was 7.8%. However, when kidneys that seemed medically suitable at the beginning of the donation process were also included, many more potential donor kidneys were lost and the total non-utilization was 24.4%. Subjectively presumed impaired organ quality was responsible for 34.2% of all discarded kidneys. Two-thirds of kidneys discarded due to acute kidney injury (AKI) had only AKI stage 1 or 2.

Conclusion

The classical definition of organ discard underestimates the non-utilization of deceased donor kidneys. Strategies to improve kidney utilization could be a revision of the maximum allowed agonal time in donation after circulatory death, careful consideration in reporting and accepting kidneys from donors with AKI and a prospectively filled registry of detailed organ discard reasons, including the ‘silent’ non-utilization before procurement.
In-situ constructed Cu/CuNC interfaces for low-overpotential reduction of CO2 to ethanol
Authors: Yang Yan , Fu Jiaju , Ouyang Yixin , Tang Tang , Zhang Yun , Zheng Li-Rong , Zhang Qing-Hua , Liu Xiao-Zhi , Wang Jinlan , Hu Jin-Song
Published: November 2022

Electrochemical CO2 reduction (ECR) to high-value multi-carbon (C2+) products is critical to sustainable energy conversion, yet the high energy barrier of C-C coupling causes catalysts to suffer high overpotential and low selectivity toward specific liquid C2+ products. Here, the electronically asymmetric Cu-Cu/Cu-N-C (Cu/CuNC) interface site is found, by theoretical calculations, to enhance the adsorption of *CO intermediates and decrease the reaction barrier of C-C coupling in ECR, enabling efficient C-C coupling at low overpotential. The catalyst consisting of high-density Cu/CuNC interface sites (noted as ER-Cu/CuNC) is then accordingly designed and constructed in situ on the high-loading Cu-N-C single atomic catalysts. Systematical experiments corroborate the theoretical prediction that the ER-Cu/CuNC boosts electrocatalytic CO2-to-ethanol conversion with a Faradaic efficiency toward C2+ of 60.3% (FEethanol of 55%) at a low overpotential of −0.35 V. These findings provide new insights and an attractive approach to creating electronically asymmetric dual sites for efficient conversion of CO2 to C2+ products.
High-efficiency retron-mediated single-stranded DNA production in plants
Authors: Jiang Wenjun , Sivakrishna Rao Gundra , Aman Rashid , Butt Haroon , Kamel Radwa , Sedeek Khalid , Mahfouz Magdy M
Published: November 2022

Retrons are a class of retroelements that produce multicopy single-stranded DNA (ssDNA) and participate in anti-phage defenses in bacteria. Retrons have been harnessed for the overproduction of ssDNA, genome engineering and directed evolution in bacteria, yeast and mammalian cells. Retron-mediated ssDNA production in plants could unlock their potential applications in plant biotechnology. For example, ssDNA can be used as a template for homology-directed repair (HDR) in several organisms. However, current gene editing technologies rely on the physical delivery of synthetic ssDNA, which limits their applications. Here, we demonstrated retron-mediated overproduction of ssDNA in Nicotiana benthamiana. Additionally, we tested different retron architectures for improved ssDNA production and identified a new retron architecture that resulted in greater ssDNA abundance. Furthermore, co-expression of the gene encoding the ssDNA-protecting protein VirE2 from Agrobacterium tumefaciens with the retron systems resulted in a 10.7-fold increase in ssDNA production in vivo. We also demonstrated clustered regularly interspaced short palindromic repeats-retron-coupled ssDNA overproduction and targeted HDR in N. benthamiana. Overall, we present an efficient approach for in vivo ssDNA production in plants, which can be harnessed for biotechnological applications.

Graphical Abstract
Innovation in Nursing Practice
Authors: Rylee Tina L. , Cvanagh Stephen J.
Published: November 2022

Conceptual clarity on nursing innovation is vital in educating and supporting innovative nurses. This analysis aimed to determine the state of innovation within nursing through a scoping review of the literature. Twenty-four articles were identified, and a constant comparison analysis discovered 3 components essential to the successful innovation: the innate characteristics of the nurse, teams, leader, workplace, and organization; the culture or environmental factors; and then the process components, which include the translation, assessment, outcome, and sustainability of an innovation. This review highlights the need to clarify what does or does not qualify something to be innovative. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A68.
All-Cause Mortality in Reproductive-Aged Females by State
Authors: Harper Lorie M. , Leach Justin M. , Robbins Lindsay , Blanchard Christina , Metz Torri D. , Mazzoni Sara , Nash Elizabeth , Szychowski Jeff
Published: November 2022

OBJECTIVE:

To estimate the association between state-level abortion legislation and all-cause mortality among all females of reproductive age and maternal, fetal, and infant mortality.

METHODS:

We conducted a retrospective cohort study using the Centers for Disease Control and Prevention’s WONDER (Wide-ranging ONline Data for Epidemiologic Research) database. Generalized estimating equations were used to estimate the association between supportive, moderate, and restrictive state abortion regulations and all-cause mortality in reproductive-aged females. Secondary outcomes included maternal, fetal, and infant mortality. The association of the number and type of laws on mortality were estimated.

RESULTS:

Moderate and supportive states were not associated with a significant decrease in all-cause mortality compared with restrictive states. Maternal mortality (per 100,000 live births) was significantly lower in moderate (−5.79, 95% CI −9.88 to −1.70) compared with restrictive states, but not supportive states (−2.51, 95% CI −6.75 to 1.72). Infant mortality (per 1,000 live births) was significantly lower in both moderate (−0.56, 95% CI −1.09 to −0.04) and supportive (−1.10, 95% CI −1.56 to −0.64) states. Fetal mortality was lower in moderate states (−0.69, 95% CI −1.18 to −0.20) but not in supportive states (−0.64, 95% CI −1.14 to 0.13). Each additional abortion regulation was associated with an increase in maternal mortality (1.09/100,000 live births, 95% CI 0.36–1.82) and infant mortality (0.20/1,000 live births, 95% CI 0.12–0.26).

CONCLUSION:

Moderate state abortion legislation was associated with lower rates of maternal, fetal, and infant mortality but not lower all-cause mortality in reproductive-aged females compared with restrictive laws. An increasing number of laws restricting abortion was associated with increased maternal and infant mortality.
Long-term Management of Patients with Myocardial Infarction: An Updated Review
Authors: Chen Runzhen , Zhao Hanjun , Yan Hongbing
Published: November 2022

The outcomes of patients with myocardial infarction (MI) have substantially improved given the rapid progress that has occurred in revascularization techniques and secondary prevention, and the majority of MI patients subsequently enter a chronic stable phase. Therefore, the long-term management of patients with MI has become a core issue in daily clinical practice for cardiologists. The long-term incidence of adverse events can be further reduced using newly developed medications and therapies ranging from lipid-lowering agents (eg, proprotein convertase subtilisin/kexin type 9 inhibitors) to anti-thrombotic treatments (eg, shortened dual anti-platelet therapy). However, a considerable number of patients still experience adverse events, as some residual risk can remain despite intensive secondary prevention, such as continuously elevated cholesterol levels, chronic cardiovascular inflammation, and rapid atherosclerosis progression due to increased plaque instability. Therefore, the present review sought to summarize and discuss recent advances in several key aspects regarding the long-term management of MI patients, with the expectation of clarifying the available treatment strategies for various clinical scenarios, examining the gaps between trial evidence and clinical practice, and providing possible directions for future research.
Dose Assessment Following a 238Pu Inhalation Incident at Los Alamos National Laboratory
Authors: Poudel Deepesh , Dumit Sara , Bertelli Luiz , Miller Guthrie , Macsik Zsuzsanna , Klumpp John
Published: November 2022

A glovebox breach at the plutonium facility at Los Alamos National Laboratory potentially exposed 15 individuals to 238Pu aerosols. One of the individuals (P0) received two 1-g intravenous DTPA treatments, one on the day of the intake and another the following day. Several urine samples were collected from the individuals involved in the incident. Particle size analysis on the PPE and solubility analysis of the particles on a filter sample were conducted in vitro. The applicability of the results from the in vitro studies for dose assessment was questionable because of the effect of the cloth mask the workers were wearing for COVID-related protection. Based on several considerations, including the effect of cloth masks on the “effective” particle size inhaled and the analysis of fecal-to-urine ratio, the default Type M 1 μm AMAD model was used to estimate intakes and doses. Using the urinary excretion data collected after 100 d post last chelation treatment, the committed effective dose, E(50), for P0 was calculated to be 5.2 mSv. For all others, the bioassay data were consistent with no intakes or very small intakes [corresponding to E(50) less than 0.1 mSv].
Health Care Organization Policies for Employee Safety and COVID-19 Pandemic Response
Authors: Siddique Sundus , Rice Serena , Bhardwaj Mansi , Gore Rebecca , Coupal Haylee , Punnett Laura
Published: November 2022

Objective

The coronavirus (COVID-19) pandemic impacted the well-being of health care workers. We examined the association between prepandemic perceptions of perceived organizational support for safety (using NOSACQ-50), safety hazards and the pandemic's impact on individual workers and institutions.

Methods

Questionnaires from health care staff of five public health care facilities were collected in 2018 (n = 1059) and 2021 (n = 1553). In 2021, 17 workers were interviewed from the same facilities.

Results

Interviewees reported that their organizations struggled to communicate due to changing guidelines, inadequate personal protective equipment, training, and infection control, early in the pandemic. Questionnaire reports of decreased staffing and increased workload during the pandemic were associated with lower baseline NOSACQ scores.

Conclusion

Survey findings predicted some variation in organizational response to the pandemic. Better organizational policies for employee safety and pandemic planning could improve health care institutions’ preparedness.
Alcohol and cannabis consumption in patients with inflammatory bowel disease: prevalence, pattern of consumption and impact on the disease
Authors: Martinho-Grueber Maude , Kapoglou Ioannis , Bravo Francisco , Sarraj Riad , Benz Eileen , Restellini Sophie , Biedermann Luc , Rogler Gerhard , Vavricka Stephan R. , Schoepfer Alain , Maillard Michel H. , Michetti Pierre , Brunner Felix , Clair Carole , Barry Mamadou Pathe , Pittet Valérie , von Känel Roland , Juillerat Pascal
Published: November 2022

Objectives of the study

There is little guidance regarding the impact of alcohol and cannabis on the clinical course of inflammatory bowel disease. The aim of this study was to assess the prevalence, sociodemographic characteristics and impact of alcohol and cannabis use on the clinical course of the disease.

Methods

We performed an analysis of prospectively collected data within the Swiss Inflammatory Bowel Disease Cohort Study with yearly follow-ups and substance-specific questionnaires. We analyzed the prevalence of use, the profile of users at risk for addiction and the impact of alcohol and cannabis on the course of the disease.

Results

We collected data of 2828 patients included between 2006 and 2018 and analyzed it according to their completion of specific surveys on alcohol and cannabis use. The prevalence of patient-reported active use was 41.3% for alcohol and 6% for cannabis. Heavy drinkers were over-represented among retired, married smokers receiving mostly aminosalicylates and less immunosuppression. In ulcerative colitis patients, low-to-moderate drinking was associated with less extensive disease. Cannabis users were often students with ileal Crohn’s disease.

Conclusion

A significant proportion of patients with inflammatory bowel disease consume alcohol or cannabis. Heavy alcohol consumption is most likely in male smokers >50 years, whereas young men with ileal disease rather use cannabis.
The prognostic role of controlling nutritional status and skeletal muscle mass in patients with hepatocellular carcinoma after curative treatment
Authors: Tamai Yasuyuki , Iwasa Motoh , Eguchi Akiko , Shigefuku Ryuta , Sugimoto Ryosuke , Tanaka Hideaki , Kobayashi Yoshinao , Mizuno Shugo , Nakagawa Hayato
Published: November 2022

Background

Nutritional status and skeletal muscle mass affect the prognosis of hepatocellular carcinoma (HCC). Nutritional status is closely associated with skeletal muscle mass. Here, we investigate the effect of controlling preoperative nutritional status and skeletal muscle mass on the prognosis of HCC after curative treatment.

Methods

This retrospective analysis contained 181 patients who received curative treatment of HCC including liver resection or radiofrequency ablation (RFA) therapy. Nutritional status and skeletal muscle mass were evaluated prior to therapy using the controlling nutritional status (CONUT) score and psoas muscle mass index (PMI), respectively. Associations of predictor variables with overall survival (OS) and progression-free survival (PFS) were determined using Cox proportional hazards regression and CHAID decision tree algorithm analysis.

Results

A total of 111 patients (61.3%) were determined to be of poor nutritional status and 100 patients (55.2%) had muscle mass depletion. Patients with PS 0, Barcelona clinic liver cancer (BCLC) stage 0, low CONUT score, and high PMI showed significantly better OS than those with PS 1, BCLC stage A, high CONUT score, and low PMI. Multivariate analysis indicated that a high CONUT score [hazard ratio (HR) 4.130; 95% confidence interval (CI), 1.713–9.958; P < 0.01) and low PMI (HR 4.625; 95% CI, 1.704–12.549; P < 0.01) found to be useful for predicting OS in patients after curative treatment of HCC. Regarding PFS, a significant predictor was only tumor numbers in univariate analysis (HR 2.147; 95% CI, 1.350–3.414; P = 0.001). In decision tree analysis, the mortality rate was 28.8%, 12.5%, and 1.9% in patients with a high CONUT score, with a low CONUT score-low PMI, or with a low CONUT score-high PMI, respectively.

Conclusion

The combined CONUT score and PMI were found to be independent predictors of OS in HCC patients after liver resection or RFA.
MoCA Intraindividual Cognitive Variability in Older Adults With Type 1 Diabetes
Authors: Mascarenhas Fonseca Luciana , Sheppard David P. , Chaytor Naomi S.
Published: November 2022

Older adults with type 1 diabetes (T1D) may have an elevated risk of developing Alzheimer disease and related dementia. Higher intraindividual cognitive variability (IICV) has been proposed as a novel risk factor of Alzheimer disease and related dementia. Here, we examined the association between cross-domain IICV measured using the Montreal Cognitive Assessment (MoCA) and cognitive impairment measured using traditional neuropsychological tests in older individuals with T1D. Participants with T1D (N=201) completed both the MoCA and a battery of traditional neuropsychological tests. Participants with cognitive impairment, determined using traditional tests, had significantly higher IICV scores and significantly lower total MoCA scores (P<0.001). However, the effect of the total score was greater than that of the IICV score on the likelihood of cognitive impairment (total odds ratio=3.50, IICV odds ratio=2.03, P<0.001). The MoCA total score performed better than the MoCA IICV score in identifying T1D individuals classified with cognitive impairment.
Respiratory Bacterial coinfections in COVID-19 Patients at a Tertiary Care Center in India
Authors: Kar Mitra , Siddiqui Tasneem , Dubey Akanksha , Hashim Zia , Sahu Chinmoy , Ghoshal Ujjala
Published: November 2022

Introduction: Patients suffering from Coronavirus disease-2019 (COVID-19) are prone to develop respiratory bacterial infections irrespective of their need for mechanical ventilatory support.
Hypothesis/Gap Statement: Information about the incidence of concomitant respiratory bacterial infections in COVID- 19 patients from India is limited.
Aim: This study denotes the incidence of concomitant respiratory bacterial pathogens and their drug resistance in these patients.
Methodology: A prospective study was performed by including the patients who were admitted to our tertiary care center from March 2021 to May 2021 to evaluate secondary bacterial respiratory co-infections in patients with Real-time polymerase chain reaction (RT-PCR) confirmed cases of COVID-19 disease caused by SARS CoV-2 virus.
Results: Sixty-nine culture-positive respiratory samples from patients suffering from COVID-19 were incorporated into this study. The most commonly isolated bacterial microorganism was Klebsiella pneumoniae (23, 33.33%) and Acinetobacter baumannii (15, 21.73%), followed by Pseudomonas aeruginosa (13, 18.84%). Among the microorganisms isolated, 41 (59.4%) were multidrug-resistant (MDR), and 9 (13%) were extensively drug-resistant (XDR). Among the Gram-negative bacteria isolated, Klebsiella pneumoniae showed high drug resistance. Fifty carbapenem-resistant microorganisms were isolated from the patients included in our study. Concerning the hospital stay of the patients enrolled, there was an increased length of intensive care unit (ICU) stay, which was 22.25 ± 15.42 days among patients needing mechanical ventilation in comparison to 5.39 ± 9.57 days of intensive care unit stay in patients on ambient air or low/high flow oxygen.
Conclusion: COVID-19 patients need increased length of hospitalization and have a high incidence of secondary respiratory bacterial infections and high anti-microbial drug resistance.
Exploring functional interplay amongst Escherichia coli efflux pumps
Authors: Goetz James A. , Kuehfuss Noah M. , Botschner Alexander J. , Zhu Shawna , Thompson Laura K. , Cox Georgina
Published: November 2022

Bacterial efflux pumps exhibit functional interplay that can translate to additive or multiplicative effects on resistance to antimicrobial compounds. In diderm bacteria, two different efflux pump structural types – single-component inner membrane efflux pumps and cell envelope-spanning multicomponent systems – cooperatively export antimicrobials with cytoplasmic targets from the cell. Harnessing our recently developed efflux platform, which is built upon an extensively efflux-deficient strain of

Escherichia coli

, here we explore interplay amongst a panel of diverse

E. coli

efflux pumps. Specifically, we assessed the effect of simultaneously expressing two efflux pump-encoding genes on drug resistance, including single-component inner membrane efflux pumps (MdfA, MdtK and EmrE), tripartite complexes (AcrAB, AcrAD, MdtEF and AcrEF), and the acquired TetA(C) tetracycline resistance pump. Overall, the expression of two efflux pump-encoding genes from the same structural type did not enhance resistance levels regardless of the antimicrobial compound or efflux pump under investigation. In contrast, a combination of the tripartite efflux systems with single-component pumps sharing common substrates provided multiplicative increases to antimicrobial resistance levels. In some instances, resistance was increased beyond the product of resistance provided by the two pumps individually. In summary, the developed efflux platform enables the isolation of efflux pump function, facilitating the identification of interactions between efflux pumps.
MRI-to-Synthetic 3D Gel Brain: Proof-of-Concept Fabrication For Intra-Parenchymal Diffusion Studies
Authors: Ray Lawrence , Shaw Caleb , Otto Stephanie , Riviere-Cazaux Cecile , Strother Lars , Burns Terry , Khan M. Rashed
Published: November 2022

Bioprinting technologies utilize hydrogel-based biomaterials to more accurately depictin vivophysical conditions withinin vitrostudies, yet, manufacturing the human brain from soft, poroelastic hydrogels remains a fundamental challenge. Conventional manufacturing routes to fabricate hydrogel brain models using techniques, i.e., 3D printing, seems challenging. This study aims to demonstrate an inverse replica molding fabrication technique that can overcome these challenges while maintaining the complex shape of an individual subject’s brain in a miniaturized model—allowing for a more robust hydrogel model that can capture the interactions between diffusing molecules and brain boundaries. This is done by taking a subject’s magnetic resonance imaging (MRI) scan and reconstructing the outer pial surface into a mesh surface. The mesh was then converted to an STL and printed out using an extrusion printer. A silicon mold was made from this print into which agarose was gelled. Once fully gelated, the synthetic gel brain was then carefully removed. Two infusion trials were run in the gel brain, each using a different infusion site. Then a diffusion profile was established and compared to a simple gel infusion model. The result shows different diffusion profiles at each location and between the simple and complex models. This model can better represent the interference the complex shape of the brain has on particle movement compared to simple gel models.
Refining structural models of membrane proteins with disordered domains in phospholipid nanodiscs
Authors: Pedersen Martin Cramer , Johansen Nicolai Tidemand , Roche Jennifer , Järvå Michael , Törnroth-Horsefield Susanna , Arleth Lise
Published: November 2022

Small-angle scattering can be used to derive structural information about membrane proteins reconstituted in suitable carrier systems enabling solubilization of the membrane proteins in question. Since the studies are done in solution, there is no need for crystallization or deposition on sample grids, and it is in principle possible to obtain structural information about intrinsically disordered regions which cannot be resolved by crystallography or the quantitative link to which is hard to establish using e.g. electron microscopy methods. In this study, tetramers of the gated spinach aquaporin SoPIP2;1 were reconstituted into nanodiscs and small-angle x-ray scattering data were recorded. From these data, we refine structural models of the entire nanodisc-membrane protein complex including the flexible regions using newly developed models based on Fast Debye sums. We introduce software for these computations available via online repositories and discuss the implications and limitations of these methods.

Author summary

When it comes to investigating the structure and function of the proteins, a particular class of proteins are known to be cumbersome and problematic: membrane proteins that reside in the cell membrane and regulate and facilitate a number of critical biological processes. Such proteins can often not be studied by conventional means as they unravel and denature structurally or even precipitate in solution. To add insult to injury, such membrane proteins also often contain parts that are intrinsically disordered rendering them irresolvable by e.g. traditional crystallographic techniques and hard to describe structurally. Here, we present a combined computational and experimental approach (as well as the necessary software) to analyze and determine the structure of such proteins in close-to-native conditions in so-called nanodiscs, a biological carrier systems, using small-angle scattering and molecular simulations.
Purkinje cardiomyocytes of the ventricular conduction system are highly diploid but not regenerative
Authors: Watanabe Hirofumi , Tao Ge , Gan Peiheng , Westbury Baylee C. , Cox Kristie D. , Tjen Kelsey , Song Ruolan , Fishman Glenn I. , Makita Takako , Sucov Henry M.
Published: November 2022

Inefficiency of regeneration underlies many of the pathologies associated with heart injury and disease. Ventricular diploid cardiomyocytes (CMs) are a candidate population that may have enhanced proliferative and regenerative properties [1-3], but subpopulations of diploid CMs and their regenerative capacities are not yet known. Here, using the expression marker Cntn2-GFP and the lineage marker Etv1CreERT2, we demonstrate that peripheral ventricular conduction CMs (Purkinje CMs) are disproportionately diploid (35%, vs. 4% of bulk ventricular CMs). However, this lineage had no enhanced competence to support regeneration after adult infarction. Furthermore, the CM-specific kinase Tnni3k, which strongly influences bulk ventricular CM ploidy [3] and is also associated with conduction system defects [4], had no influence on the ploidy or organization of the ventricular conduction system. Unlike the bulk diploid CM population, a significant fraction of conduction CMs remain diploid by avoiding neonatal cell cycle activity, likely contributing to these properties.
Evaluation of real and perceived risk to health care workers caring for patients with the Omicron variant of the SARS-CoV-2 virus in surgery and obstetrics
Authors: Nair Chaithanya , Kozak Robert , Alavi Nasrin , Mbareche Hamza , Kung Rose C. , Murphy Kellie E. , Perruzza Darian , Jarvi Stephanie , Salvant Elsa , Ladhani Noor Niyar N. , Yee Albert J.M. , Gagnon Louise-Helene , Jenkinson Richard , Liu Grace Y. , Lee Patricia E.
Published: November 2022

Introduction

The Omicron variant of the SARS-CoV-2 virus is described as more contagious than previous variants. We sought to assess risk to healthcare workers (HCWs) caring for patients with COVID-19 in surgical/obstetrical settings, and the perception of risk amongst this group.

Methods

From January to April, 2022, reverse transcription polymerase chain reaction was used to detect the presence of SARS-CoV-2 viral RNA in patient, environmental (floor, equipment, passive air) samples, and HCW’s masks (inside surface) during urgent surgery or obstetrical delivery for patients with SARS-CoV-2 infection. The primary outcome was the proportion of HCWs’ masks testing positive. Results were compared with our previous cross-sectional study involving obstetrical/surgical patients with earlier variants (2020/21). HCWs completed a risk perception electronic questionnaire.

Results

11 patients were included: 3 vaginal births and 8 surgeries. 5/108 samples (5%) tested positive (SARS-CoV-2 Omicron) viral RNA: 2/5 endotracheal tubes, 1/22 floor samples, 1/4 patient masks and 1 nasal probe. No samples from the HCWs masks (0/35), surgical equipment (0/10) and air samples (0/11) tested positive. No significant differences were found between the Omicron and 2020/21 patient groups’ positivity rates (Mann-Whitney U test, p = 0.838) or the level of viral load from the nasopharyngeal swabs (p = 0.405). Nurses had a higher risk perception than physicians (p = 0.038).

Conclusion

No significant difference in contamination rates were found between SARS-CoV-2 Omicron BA.1 and previous variants in surgical/obstetrical settings. This is reassuring as no HCW mask was positive and no HCW tested positive for COVID-19 post-exposure.
Activation of innate immune cGAS-STING pathway contributes to Alzheimer’s pathogenesis in 5×FAD mice
Authors: Xie Xiaochun , Ma Guanqin , Li Xiaohong , Zhao Jiebin , Zhao Zhen , Zeng Jianxiong
Published: November 2022

cGAS senses microbial and host-derived double-stranded DNA (dsDNA) in cytoplasm to trigger cellular innate immune response in a STING-dependent manner. However, it remains unknown whether the cGAS-STING pathway in innate immunity contributes to Alzheimer’s disease (AD). Here we demonstrated the detectable binding of the cGAS-dsDNA in cytoplasm and the activation of microglial cGAS-STING pathway in brains of human AD and aged mice, suggesting a role for the cGAS-STING pathway in this neurodegenerative disease.Cgas−/−;5×FAD mice were largely protected from cognitive impairment, amyloid-β (Aβ) pathology, neuroinflammation and other sequelae associated with AD. Furthermore,Cgasdeficiency in microglia inhibited the conversion of astrocytes into neurotoxic A1 phenotype, and thus alleviated oligomeric Aβ peptides-induced neuronal toxicity. Finally, administration of STING inhibitor H-151 potently suppressed the activation of the cGAS-STING pathway and ameliorated AD pathogenesis in 5×FAD mouse model. In conclusion, our present study has identified a critical molecular link between innate immunity and AD, and suggests that therapeutic targeting of the cGAS-STING pathway activity might effectively interfere with the progression of AD.
High-Resolution EEG Source Reconstruction with Boundary Element Fast Multipole Method Using Reciprocity Principle and TES Forward Model Matrix
Authors: Wartman William A. , Raij Tommi , Rachh Manas , Lin Fa-Hsuan , Weise Konstantin , Knoesche Thomas , Maess Burkhard , Wolters Carsten H. , Hämäläinen Matti , Nummenmaa Aapo R. , Makaroff Sergey N.
Published: November 2022

Background

Accurate high-resolution EEG source reconstruction (localization) is important for several tasks, including rigorous and rapid mental health screening.

Objective

The present study has developed, validated, and applied a new source localization algorithm utilizing a charge-based boundary element fast multipole method (BEM-FMM) coupled with the Helmholtz reciprocity principle and the transcranial electrical stimulation (TES) forward solution.

Methods

The unknown cortical dipole density is reconstructed over the entire cortical surface by expanding into global basis functions in the form of cortical fields of active TES electrode pairs. These pairs are constructed from the reading electrodes. An analog of the minimum norm estimation (MNE) equation is obtained after substituting this expansion into the reciprocity principle written in terms of measured electrode voltages. Delaunay (geometrically balanced) triangulation of the electrode cap is introduced first. Basis functions for all electrode pairs connected by the edges of a triangular mesh are precomputed and stored in memory. A smaller set of independent basis functions is then selected and employed at every time instant. This set is based on the highest voltage differences measured.

Results

The method is validated against the classic, yet challenging problem of median nerve stimulation and the tangential cortical sources located at the posterior wall of the central sulcus for an N20/P20 peak (2 scanned subjects). The method is further applied to perform source reconstruction of synthesized tangential cortical sources located at the posterior wall of the central sulcus (12 different subjects). In the second case, an average source reconstruction error of 7 mm is reported for the best possible noiseless scenario.

Conclusions

Once static preprocessing with TES electrodes has been done (the basis functions have been computed), our method requires fractions of a second to complete the accurate high-resolution source localization.