bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal Relationship Between Handgrip Strength and Cognitive Function in a European Multicentric Population Older Than 50 Years
Authors: Haagsma Ariele B , Souza Dyego L B , Vasconcellos Graziella M , Olandoski Márcia , Jerez-Roig Javier , Baena Cristina P
Published: May 2023

Objective

The aim of this study was to analyze the bidirectional association between handgrip strength (HGS) and cognitive performance in different cognitive functions in a European population and to evaluate the predictive validity of HGS for the risk of future cognitive impairment in aging individuals.

Methods

This was a prospective cohort study conducted using data on individuals over 50 years of age from the Survey of Health, Aging and Retirement in Europe (SHARE). HGS measures and scores in numeracy, recall, and verbal fluency were repeated and analyzed biannually for 4 years and were used in generalized estimating equations to test the bidirectional association, categorized by sex.

Results

Of the 8236 individuals included, 55.73% were women with a mean age of 67.55 (standard deviation [SD] = 8.4) years and 44.27% were men with a mean age of 68.42 (SD = 7.7) years. HGS predicted cognitive decline in both sexes, except for numeracy in men, even after adjustments. The strongest association with HGS in women was in verbal fluency (β = .094; 95% CI = 0.039 to 0.151), whereas the strongest association with HGS in men was in delayed verbal recall (β = .095; 95% CI = 0.039 to 0.151). Conversely, the greatest cognitive predictor of HGS decline was verbal fluency in men (β = .796; 95% CI = 0.464 to 1.128), and in women (β = .801; 95% CI= 0.567 to 1.109).

Conclusion

There is a significant and bidirectional association between HGS and different cognitive functions in a European multicentric population. This bidirectional association differed between sexes.

Impact

Both men and women who presented with cognitive decline also showed early changes in their HGS measures, and vice versa, but there still were differences between the sexes. These findings reinforce that HGS may be a simple and inexpensive method to identify early signs of cognitive decline, and that studies and rehabilitation strategies should be more sex specific.
Modulation of polar auxin transport identifies the molecular determinants of source–sink carbon relationships and sink strength in poplar
Authors: Balasubramanian Vimal K , Rivas-Ubach Albert , Winkler Tanya , Mitchell Hugh , Moran James , Ahkami Amir H
Published: June 2023

Source-to-sink carbon (C) allocation driven by the sink strength, i.e., the ability of a sink organ to import C, plays a central role in tissue growth and biomass productivity. However, molecular drivers of sink strength have not been thoroughly characterized in trees. Auxin, as a major plant phytohormone, regulates the mobilization of photoassimilates in source tissues and elevates the translocation of carbohydrates toward sink organs, including roots. In this study, we used an ‘auxin-stimulated carbon sink’ approach to understand the molecular processes involved in the long-distance source–sink C allocation in poplar. Poplar cuttings were foliar sprayed with polar auxin transport modulators, including auxin enhancers (AE) (i.e., IBA and IAA) and auxin inhibitor (AI) (i.e., NPA), followed by a comprehensive analysis of leaf, stem and root tissues using biomass evaluation, phenotyping, C isotope labeling, metabolomics and transcriptomics approaches. Auxin modulators altered root dry weight and branching pattern, and AE increased photosynthetically fixed C allocation from leaf to root tissues. The transcriptome analysis identified highly expressed genes in root tissue under AE condition including transcripts encoding polygalacturonase and β-amylase that could increase the sink size and activity. Metabolic analyses showed a shift in overall metabolism including an altered relative abundance levels of galactinol, and an opposite trend in citrate levels in root tissue under AE and AI conditions. In conclusion, we postulate a model suggesting that the source–sink C relationships in poplar could be fueled by mobile sugar alcohols, starch metabolism-derived sugars and TCA-cycle intermediates as key molecular drivers of sink strength.
Marked variability in institutional deliveries and neonatal outcomes during the COVID-19 lockdown in Nigeria
Authors: Ezenwa Beatrice N , Fajolu Iretiola B , Pius Simon , Ezeanosike Obumneme B , Iloh Kenechukwu , Umoru Dominic , Tongo Olukemi , Abdulkadir Isa , Okolo Angela A , Nabwera Helen M , Oleolo-Ayodeji Khadijah , Daniel Nelson , Abubakar Ismaela , Obu Chinwe , Onwe-Ogah Emeka , Daniyan Olapeju , Adeke Azuka , Nwegbu Obinna , Bisumang J D , Hassan Laila , Abdullahi Fatimah , Mohammad Aisha , Nasir Usman , Ezeaka Veronica Chinyere , Allen Stephen
Published: June 2023

Background

The coronavirus disease 2019 (COVID-19) pandemic and the interventions to mitigate its spread impacted access to healthcare, including hospital births and newborn care. This study evaluated the impact of COVID-19 lockdown measures on newborn service utilization in Nigeria.

Methods

The records of women who delivered in hospitals and babies admitted to neonatal wards were retrospectively reviewed before (March 2019–February 2020) and during (March 2020–February 2021) the COVID-19 pandemic lockdown in selected facilities in Nigeria.

Results

There was a nationwide reduction in institutional deliveries during the COVID-19 lockdown period in Nigeria, with 14 444 before and 11 723 during the lockdown—a decrease of 18.8%. The number of preterm admissions decreased during the lockdown period (30.6% during lockdown vs 32.6% pre-lockdown), but the percentage of outborn preterm admissions remained unchanged. Newborn admissions varied between zones with no consistent pattern. Although neonatal jaundice and prematurity remained the most common reasons for admission, severe perinatal asphyxia increased by nearly 50%. Neonatal mortality was significantly higher during the COVID-19 lockdown compared with pre-lockdown (110.6/1000 [11.1%] vs 91.4/1000 [9.1%], respectively; p=0.01). The odds of a newborn dying were about four times higher if delivered outside the facility during the lockdown (p<0.001).

Conclusions

The COVID-19 lockdown had markedly deleterious effects on healthcare seeking for deliveries and neonatal care that varied between zones with no consistent pattern.
Factors associated with mortality after snakebite envenoming in children: a scoping review
Authors: Guile Lucy , Lee Adrienne , Gutiérrez José María
Published: June 2023

Snakebite envenoming is an important public health issue in many tropical and subtropical countries, where the burden of morbidity and mortality falls particularly on impoverished rural communities. Children are an especially vulnerable group. This scoping review provides an overview of the extent, type and content of peer-reviewed evidence regarding factors associated with mortality in snakebite-envenomed children. A comprehensive literature search of MEDLINE and the Global Index Medicus yielded 623 articles, of which 15 met the criteria for inclusion; 67% of studies were conducted in India, with the remaining studies taking place in Papua New Guinea, Morocco and The Gambia. There was a notable scarcity of eligible studies from sub-Saharan Africa and Latin America despite the high burden of envenoming in these regions. The risk factors for mortality that were identified by the greatest number of studies were younger patient age (n=4), delay in administration of antivenom (n=4) and acute kidney injury (n=3). Identification of poor prognostic factors can assist clinicians in making timely referrals to centres with paediatric critical care capability. Future research must address the lack of studies from key geographical regions so that evidence-based improvements to the care of this vulnerable group can be implemented.
Insufficient oxygen inhalation during cardiopulmonary resuscitation induces early changes in hemodynamics followed by late and unfavorable systemic responses in post‐cardiac arrest rats
Authors: Aoki Tomoaki , Wong Vanessa , Endo Yusuke , Hayashida Kei , Takegawa Ryosuke , Shoaib Muhammad , Miyara Santiago J. , Choudhary Rishabh C. , Yin Tai , Saeki Kota , Robson Simon C. , Becker Lance B. , Shinozaki Koichiro
Published: May 2023

Cardiac arrest (CA) and concomitant post‐CA syndrome lead to a lethal condition characterized by systemic ischemia–reperfusion injury. Oxygen (O2) supply during cardiopulmonary resuscitation (CPR) is the key to success in resuscitation, but sustained hyperoxia can produce toxic effects post CA. However, only few studies have investigated the optimal duration and dosage of O2 administration. Herein, we aimed to determine whether high concentrations of O2 at resuscitation are beneficial or harmful. After rats were resuscitated from the 10‐min asphyxia, mechanical ventilation was restarted at an FIO2 of 1.0 or 0.3. From 10 min after initiating CPR, FIO2 of both groups were maintained at 0.3. Bio‐physiological parameters including O2 consumption (VO2) and mRNA gene expression in multiple organs were evaluated. The FIO2 0.3 group decreased VO2, delayed the time required to achieve peak MAP, lowered ejection fraction (75.1 ± 3.3% and 59.0 ± 5.7% with FIO2 1.0 and 0.3, respectively; p < .05), and increased blood lactate levels (4.9 ± 0.2 mmol/L and 5.6 ± 0.2 mmol/L, respectively; p < .05) at 10 min after CPR. FIO2 0.3 group had significant increases in hypoxia‐inducible factor, inflammatory, and apoptosis‐related mRNA gene expression in the brain. Likewise, significant upregulations of hypoxia‐inducible factor and apoptosis‐related gene expression were observed in the FIO2 0.3 group in the heart and lungs. Insufficient O2 supplementation in the first 10 min of resuscitation could prolong ischemia, and may result in unfavorable biological responses 2 h after CA. Faster recovery from the impairment of O2 metabolism might contribute to the improvement of hemodynamics during the early post‐resuscitation phase; therefore, it may be reasonable to provide the maximum feasible O2 concentrations during CPR.
Development of oxidative stress‐associated disease models using feto‐maternal interface organ‐on‐a‐chip
Authors: Richardson Lauren S. , Kammala Ananth Kumar , Kim Sungjin , Lam Po Yi , Truong Nina , Radnaa Enkhtuya , Urrabaz‐Garza Rheanna , Han Arum , Menon Ramkumar
Published: May 2023

Oxidative stress (OS) and inflammation arising from cellular derangements at the fetal membrane‐decidual interface (feto‐maternal interface [FMi]) is a major antecedent to preterm birth (PTB). However, it is impractical to study OS‐associated FMi disease state during human pregnancy, and thus it is difficult to develop strategies to reduce the incidences of PTB. A microfluidic organ‐on‐chip model (FMi‐OOC) that mimics the in vivo structure and functions of FMi in vitro was developed to address this challenge. The FMi‐OOC contained fetal (amnion epithelial, mesenchymal, and chorion) and maternal (decidua) cells cultured in four compartments interconnected by arrays of microchannels to allow independent but interconnected co‐cultivation. Using this model, we tested the effects of OS and inflammation on both fetal (fetal → maternal) and maternal (maternal → fetal) sides of the FMi and determined their differential impact on PTB‐associated pathways. OS was induced using cigarette smoke extract (CSE) exposure. The impacts of OS were assessed by measuring cell viability, disruption of immune homeostasis, epithelial‐to‐mesenchymal transition (EMT), development of senescence, and inflammation. CSE propagated (LC/MS‐MS analysis for nicotine) over a 72‐hour period from the maternal to fetal side, or vice versa. However, they caused two distinct pathological effects on the maternal and fetal cells. Specifically, fetal OS induced cellular pathologies and inflammation, whereas maternal OS caused immune intolerance. The pronounced impact produced by the fetus supports the hypothesis that fetal inflammatory response is a mechanistic trigger for parturition. The FMi disease‐associated changes identified in the FMi‐OOC suggest the unique capability of this in vitro model in testing in utero conditions.
Lymphedematous Fibroepithelial Polyp Without Associated Condom Catheter Use: A Case Report With Review of the Literature
Authors: Zeches Breann A. , Maher Mohamed , Alomari Ahmed K.
Published: May 2023

Lymphedematous fibroepithelial polyps are rare proliferations involving the glans penis typically associated with chronic condom catheter usage. To the best of our knowledge, less than 20 cases have been reported in the literature with relatively similar clinical presentation. Herein, we report a case of lymphedematous fibroepithelial polyp not associated with condom usage in a 74-year-old man treated with surgical excision. On histopathological examination, the lesion displayed a hypocellular proliferation of spindled and stellate fibroblasts with intermixed Touton-like giant cells embedded within an edematous stroma with thickened vasculature. Immunohistochemical profiling exhibits strong immunoreactivity for smooth muscle actin, weak positivity for factor XIIIa, and no reactivity for CD34 or desmin. We also conducted a review of the reported range of clinical and histopathological features of this entity in addition to the various hypotheses regarding its pathogenesis. We hope to increase awareness and accurate diagnosis of this entity, which could affect clinical management.
Prognostic Analysis of Patients With Extramammary Paget Disease Treated With Conservative Excision
Authors: Seo Takashi , Kitamura Shinya , Yanagi Teruki , Maeda Takuya , Ujiie Hideyuki
Published: May 2023

BACKGROUND

Extramammary Paget disease (EMPD) is a malignant skin tumor with a relatively good prognosis. The standard treatment is wide local resection or Mohs micrographic surgery. However, conservative excision may be a better option when radical wide local excision is difficult to perform due to the patients' mental or physical condition. There have been no studies on the prognosis of patients with EMPD who underwent conservative excision.

OBJECTIVE

To compare the prognosis of conservative excision cases to wide excision cases of EMPD.

MATERIALS AND METHODS

The authors retrospectively analyzed the clinical data of 69 cases of EMPD without metastases to lymph nodes or organs (11 cases treated with conservative excision, 58 cases treated with wide local excision) who underwent resection of the primary tumor from 2002 to 2022 in the Department of Dermatology at Hokkaido University Hospital.

RESULTS

The log-rank test showed no significant differences in overall survival or metastasis-free survival between the wide excision group and the conservative excision group, although conservative surgery was often chosen in elderly patients or patients with lower performance status.

CONCLUSION

This study suggests that conservative surgery should be considered as a treatment option for EMPD.
The Journey From Drug Addiction to Drug Withdrawal: A Christian Gospel Rehabilitation Program in Taiwan
Authors: YEH Pi-Ming
Published: May 2023

Background

World Drug Report estimates the number of opioid users at 53 million and identifies opioids as responsible for two thirds of the 585,000 people who died as a result of drug use in 2017.

Purpose

The purpose of this study was to analyze the testimonies of 30 people regarding their journeys from drug addiction to drug withdrawal in Taiwan.

Methods

This was a qualitative research design. The sample inclusion criteria were as follows: (a) being a drug abuser, (b) completed the Christian Gospel Drug Withdrawal Program or church-sponsored program, and (c) shared their related testimony on the Good TV television channel in Taiwan. The participants' stories were posted in Chinese, transcribed by the author, and translated from Chinese into English. Content analysis was used to identify the major themes.

Results

Of the 30 participants, 24 were male (80%) and six were female (20%). The major themes identified in their testimonies were: (a) Using illegal drugs related to peer recognition, lack of knowledge, and temptations; (b) drug addiction was an endless pain cycle; (c) turning points related to love, repentance, and hope; (d) drug withdrawal was related to avoiding temptation and overcoming the drug withdrawal syndrome through the Holy Spirit; and (e) outcomes were faith and new life.

Conclusions/Implications for Practice

In this study, people who received the gospel drug withdrawal programs expressed that their lives had changed, they had withdrawn from drugs successfully, they had become volunteers to help others, and interactions with their family had improved. These programs may be applied in the mental health nursing profession.
Cancer cachexia – adopting a systems wide approach
Authors: Sayers Judith , Skipworth Richard JE. , Laird Barry JA.
Published: June 2023

Purpose of review

Cancer cachexia results in the death of approximately 2 million people worldwide annually. Despite the impact of this devastating condition, there is limited therapy and no standard of care. Although multiple definitions exist, confusion remains as a true understanding of the biology has not yet been achieved and distinct phases of cachexia have not been examined. Research has mainly focused on weight loss and muscle wasting, but cachexia is increasingly recognized as a multiorgan disorder involving adipose tissue, liver, brain, gut and heart, with systemic inflammation a central unifying feature.

Recent findings

In this review, we will discuss some of the extra-muscular features and multisystem interactions in cachexia, and describe how moving our focus beyond muscle can lead to a greater understanding of the mechanisms and clinical features seen in cachexia.

We describe the need for robust characterization of patients with cachexia, to allow clinical phenotypes and multisystem mechanisms to be untangled, and to enable the implementation of multimodal treatment strategies.
Prediabetes and skeletal health
Authors: Lindsay Catherine , Shieh Albert
Published: May 2023

Purpose of review

Type 2 diabetes mellitus (T2D) confers a greater risk of skeletal fragility and fracture. Whether prediabetes is detrimental to bone health is uncertain.

Recent findings

We summarize the current data on the associations of prediabetes with bone turnover, bone mineral density, bone quality, bone material properties and fracture risk.

In cross-sectional studies, prediabetes was associated with lower bone turnover and worse trabecular bone quality. A longitudinal analysis showed that larger increase in insulin resistance (in the absence of T2D) correlated with faster bone loss. Future research to examine the longitudinal associations of prediabetes with bone health parameters is warranted.
Mediators of Ethnic Differences in Dropout Rates From a Randomized Controlled Treatment Trial Among Latinx and Non-Latinx White Primary Care Patients With Anxiety Disorders
Authors: Escovar Emily L. , Bocanegra Elizabeth S. , Craske Michelle G. , Bystritsky Alexander , Roy-Byrne Peter , Sherbourne Cathy D. , Stein Murray B. , Chavira Denise A.
Published: May 2023

Disparities in treatment engagement and adherence based on ethnicity have been widely recognized but are inadequately understood. Few studies have examined treatment dropout among Latinx and non-Latinx White (NLW) individuals. Using Andersen's Behavioral Model of Health Service Use (A behavioral model of families' use of health services. 1968; J Health Soc Behav. 1995; 36:1–10) as a framework, we examine whether pretreatment variables (categorized as predisposing, enabling, and need factors) mediate the relationship between ethnicity and premature dropout in a sample of Latinx and NLW primary care patients with anxiety disorders who participated in a randomized controlled trial (RCT) of cognitive behavioral therapy. Data from a total of 353 primary care patients were examined; 96 Latinx and 257 NLW patients participated. Results indicated that Latinx patients dropped out of treatment more often than NLW patients, resulting in roughly 58% of Latinx patients failing to complete treatment compared with 42% of NLW, and approximately 29% of Latinx patients dropping out before engaging in modules related to cognitive restructuring or exposure, relative to 11% of NLW patients. Mediation analyses suggest that social support and somatization partially explained the relationship between ethnicity and treatment dropout, highlighting the importance of these variables in understanding treatment disparities.
The Effect of Education Planned According to Health Literacy Level on Functionality, Problems Experienced, and Quality of Life in Patients Undergoing Total Knee Replacement
Authors: Özbaş Nilgün , Karadağ Mevlüde
Published: June 2023

Total knee arthroplasty procedures significantly improve quality of life for persons with debilitating pain. It is essential to plan patient education according to the level of health literacy. This nonrandomized comparison group intervention study examines the effect of education planned according to health literacy level on functionality, postoperative problems (pain and anxiety), and quality of life in patients who undergo total knee replacement. During the study, patients in the intervention group (n = 51) were provided with the planned patient education according to their health literacy level, whereas patients in the comparison group were given routine care (n = 51). Patients in the postoperative intervention group experienced fewer problems (p < .05). Education tailored to patients' health literacy levels had a positive effect on their functionality and quality of life (p < .05). Our findings suggest planning education according to patient health literacy levels may have a positive influence on functionality, postoperative problems, and quality of life among patients undergoing total knee replacement.
Using Forensic Toxicology to Enhance Medicolegal Death Investigations
Authors: Schreiber Sara J. , Peterson Brian L.
Published: May 2023

The Milwaukee County Medical Examiner's Office performed an evidence-based review of natural deaths certified without autopsy or toxicology testing. Three hundred fifteen such cases from 2020 and 2021 were selected. This study reviewed the deaths to determine if the cause was drug-related instead due to natural disease.

Blood samples were screened by liquid chromatography-quadrupole mass spectrometry with time-of-flight detector. The analytes detected were evaluated for contribution to the cause resulting in a change in manner from natural to accident or suicide. Confirmatory analysis was performed where appropriate, and results were reported to the forensic pathologist for evaluation. Where appropriate, the death certificate was amended.

As a result of the screening and confirmatory work, 18 cases were identified where significant drugs were detected, and thus the cause and manner of death were amended. One case was amended from natural to suicide after a conversation with the family about the toxicology findings. The remaining cases were amended to a manner of accident. The scope of drugs responsible for the deaths included prescription and illicit.
Gross Heart Dimensions From Postmortem Computed Tomography and Postmortem Examination Measurements
Authors: Garland Jack , Thompson Melissa , Ondruschka Benjamin , Da Broi Ugo , Thompson Isabella , Olumbe Alex , Tse Rexson
Published: May 2023

An increased heart weight (cardiac hypertrophy) is associated with underlying heart disease and sudden cardiac death. Gross heart dimensions can be used to estimate heart weight as a surrogate for cardiac hypertrophy. These dimensions can be obtained from either postmortem computed tomography or postmortem examination. This study compared the gross heart dimensions, heart weight estimations, and ability to determine cardiac hypertrophy (>400 and >500 g) between these 2 methods. The results showed that gross dimensions from postmortem computed tomography were significantly smaller and overall had less accuracy in estimating heart weight than dissection. In terms of cardiac hypertrophy, both methods were comparable and had reasonably high sensitivity and specificity, albeit having slightly varied characteristics, to determine whether the heart showed hypertrophy.
A Novel Orthognathic Surgery With a Half-Millimeter Accuracy for the Maxillary Positioning Using Prebent Plates and Computer-Aided Design and Manufacturing Osteotomy Guide
Authors: Yamashita Yosuke , Imai Haruki , Takasu Hikaru , Omura Susumu , Fujita Koichi , Iwai Toshinori , Hirota Makoto , Mitsudo Kenji
Published: May 2023

This retrospective study aimed to assess the accuracy of prebent plates and computer-aided design and manufacturing osteotomy guide for orthognathic surgery. The prebent plates correspondent to the planning model were scanned with a 3-dimensional printed model for guide design and used for fixation. Forty-two patients who underwent bimaxillary orthognathic surgery using computer-aided design and manufacturing intermediate splint with the guide (guided group: 20 patients) or with conventional fixation under straight locking miniplates (SLMs) technique (SLM group: 20 patients) were analyzed. A deviation of the maxilla between the planned and postoperative positions was evaluated using computed tomography, which was taken 2 weeks before and 4 days after the surgery. The surgery time and the infraorbital nerve paranesthesia were also evaluated. The mean deviations in the mediolateral (x), anteroposterior (y), and vertical directions (z) were 0.25, 0.50, and 0.37 mm, respectively, in the guided group, while that in the SLM group were 0.57, 0.52, and 0.82 mm, respectively. There were significant differences in x and z coordinates (P<0.001). No significant difference in the surgery duration and paranesthesia was seen, suggesting the present method offers a half-millimeter accuracy for the maxillary repositioning without increasing the risk of extending surgery duration and nerve complication.
Characterization of Regional Morphological Changes in Sagittal Craniosynostosis Following Endoscopic Strip Craniectomy With Post-operative Helmeting: Predictors for Success
Authors: Nguyen Huan T. , Washington George N. , Cepeda Alfredo , Littlefield Tim , Obinero Chioma G. , Greives Matthew R. , Nguyen Phuong D.
Published: May 2023

Background:

Sagittal craniosynostosis (SC) restricts craniofacial growth perpendicular to the sagittal plane resulting in scaphocephaly. The cranium grows in the anterior-posterior dimension causing disproportionate changes, which can be corrected with either cranial vault reconstruction (CVR) or endoscopic strip craniectomy (ESC) combined with post-operative helmet therapy. ESC is performed at an earlier age, and studies demonstrate benefits in risk profile and morbidity compared to CVR, with comparable results if the post-operative banding protocol is strictly upheld. We aim to identify predictors of successful outcome and, using three-dimensional (3D) imaging, assess cranial changes following ESC with post-banding therapy.

Materials and Methods:

A single institution retrospective review was performed from 2015–19 for patients with SC who underwent ESC. Patients received immediate post-operative 3D photogrammetry for helmet therapy planning and implementation as well as post-therapy 3D imaging. Using these 3D images, the cephalic index (CI) for study patients was calculated before and after helmet therapy. In addition, Deformetrica™ was used to measure volume and shape changes of pre-defined anatomic skull regions (frontal, parietal, temporal, & occipital) based on the pre- and post-therapy 3D imaging results. Fourteen institutional raters evaluated the pre- and post-therapy 3D imaging in order to determine the success of the helmeting therapy.

Results:

Twenty-one SC patients met our inclusion criteria. Using 3D photogrammetry, 14 raters at our institution rated 16 of the 21 patients to have had successful helmet therapy. There was a significant difference in CI following helmet therapy with both groups, but there was no significant difference in CI between the “successful” and “unsuccessful” groups. Furthermore, the comparative analysis demonstrated that the parietal region had a significantly higher change in mean RMS distance when compared to the frontal or occipital regions.

Conclusion:

For patients with SC, 3D photogrammetry may be able to objectively recognize nuanced findings not readily detectable when using CI alone. The greatest changes in volume were observed in the parietal region, which falls in line with treatment goals for SC. Patients deemed to have unsuccessful outcomes were found to be older at time of surgery and initiation of helmet therapy. This suggests that early diagnosis and management for SC may increase the likelihood of success.
Meta-Analysis of Randomized Clinical Trials on Long-Term Outcomes of Surgical Treatment of Perforated Diverticulitis
Authors: Horesh Nir , Emile Sameh Hany , Khan Sualeh Muslim , Freund Michael R , Garoufalia Zoe , Silva-Alvarenga Emanuela , Gefen Rachel , Wexner Steven D
Published: May 2023

Objective:

Assess long-term outcomes of patients with perforated diverticulitis treated with resection or laparoscopic lavage (LL).

Summary Background Data:

Surgical treatment of perforated diverticulitis changed in the last few decades. LL and increasing evidence that primary anastomosis (PRA) is feasible in certain patients have broadened surgical options. However, debate for the optimal surgical strategy lingers.

Methods:

PubMed, Scopus, and Web of Science were searched for randomized clinical trials (RCT) on surgical treatment of perforated diverticulitis from inception to October 2022. Long-term reports of RCT comparing surgical interventions for treatment of perforated diverticulitis were selected. Main outcomes measures were long-term ostomy, long term complications, recurrence, and re-intervention rates.

Results:

After screening 2431 studies, 5 long-term follow-up studies of RCT comprising 499 patients were included. Three studies, excluding patients with fecal peritonitis, compared LL and colonic resection, two compared PRA and Hartmann’s procedure. LL had lower odds of long-term ostomy (OR= 0.133, 95%CI: 0.278- 0.579;P<0.001) and re-operation (OR= 0.585, 95%CI: 0.365- 0.937;P=0.02) compared to colonic resection but higher odds of diverticular disease recurrence (OR= 5.8, 95%CI: 2.33- 14.42;P<0.001). Colonic resection with PRA had lower odds of long-term ostomy (OR= 0.02, 95%CI: 0.003-0.195;P<0.001), long-term complications (OR= 0.195, 95%CI: 0.113-0.335;P<0.001), reoperation (OR= 0.2, 95%CI: 0.108- 0.384;P<0.001) and incisional hernia (OR= 0.184, 95%CI: 0.102-0.333;P<0.001). There was no significant difference in odds of mortality among the procedures.

Conclusions:

Long-term follow-up of patients who underwent emergency surgery for perforated diverticulitis showed that LL had lower odds of long-term ostomy and re-operation, but more risk for disease recurrence when compared to resection in purulent peritonitis. Colonic resection with PRA had better long-term outcomes than Hartmann’s procedure for fecal peritonitis.
Structural insights into a regulatory mechanism of FIR RRM1–FUSE interaction
Authors: Ni Xiaomin , Joerger Andreas C. , Chaikuad Apirat , Knapp Stefan
Published: May 2023

FUBP-interacting repressor (FIR) is a suppressor of transcription of the proto-oncogene MYC. FIR binds to the far upstream element (FUSE) of the MYC promoter. Competition of FIR with FUSE-binding protein 1 (FUBP1) is a key mechanism of MYC transcriptional regulation. To gain insights into the structural mechanisms regulating FIR DNA interaction, we determined the crystal structure of two FIR RRM domains (RRM1-2) with single-stranded FUSE DNA sequences. These structures revealed an ability of the RRM domain to recognize diverse FUSE regions through distinct intermolecular interactions and binding modes. Comparative structural analyses against available RRM-ssDNA/RNA complexes showed that the nucleotide configurations in FIR were similar to those in other RRMs that harbour a tyrosine at the conserved aromatic position in the RNP2 motif (Y-type RRM), but not those with a phenylalanine (F-type RRM). Site-directed mutagenesis experiments demonstrated that a single substitution, Y115F, altered the binding affinities of oligonucleotides to FIR RRM, suggesting an important role of this conserved aromatic residue in ssDNA/RNA interactions. Our study provides the structural basis for further mechanistic studies on this important protein–DNA interaction.
Leeia speluncae sp. nov., isolated from Stegodon Sea Cave in Thailand
Authors: Charoenyingcharoen Piyanat , Kim Ji-Sun , Lee Jung-Sook , Yukphan Pattaraporn
Published: May 2023

A novel Gram-stain-negative, obligately aerobic, short rod-shaped and motile bacterium, designated strain BC00092T, was isolated from brackish ground water collected in Stegodon Sea Cave located at Satun UNESCO Global Geopark, Satun Province, Thailand. The phylogenetic analysis of BC00092T based on 16S rRNA gene sequences revealed that the strain represented a member of the genus

Leeia

and was closely related to

Leeia oryzae

DSM 17879T (96.68 %) and

Leeia aquatica

IMCC25680T (94.89 %). The average nucleotide identity and digital DNA–DNA hybridization values calculated from the whole-genome sequences between BC00092T and closely related type strains of species within the family

Leeiaceae

were lower than the species demarcation threshold values of 95 and 70 %, respectively. Moreover, five conserved signature indels of members of the family

Leeiaceae

were found in the protein sequences from the annotated assembled genome of BC00092T. According to the results of the polyphasic taxonomic study, strain BC00092T represents a novel species within the genus

Leeia

, for which the name Leeia speluncae sp. nov. is proposed. The type strain is BC00092T (TBRC 13508T = KCTC 92111T).
Barriers and enablers to participation in a proposed online lifestyle intervention for older adults with age-related macular degeneration
Authors: Kha Richard , Wen Qingyun , Bender Nicholas , Jones Charlotte , Gopinath Bamini , Macniven Rona , Tang Diana
Published: May 2023

Age-related macular degeneration (AMD) is a blinding condition associated with depression and loneliness. This facilitates unhealthy lifestyle behaviours which drives AMD progression. We developed the first online lifestyle intervention for AMD, called Movement, Interaction and Nutrition for Greater Lifestyles in the Elderly (MINGLE) to promote positive lifestyle changes, reduce loneliness and depression. This qualitative study explored enablers and barriers to participation in MINGLE for older Australians with AMD. Thirty-one participants with AMD were interviewed using a semi-structured in-depth approach. Thematic analysis revealed nine themes. Enablers to participation were: socialising and learning about AMD, motivation to improve health, program accessibility and structure. Barriers were: lack of time, unfamiliarity with technology, limited knowledge regarding holistic interventions, vision-related issues, mobility and negative perception of group interactions. Multiple factors influence the participation of AMD patients in MINGLE and these must be considered when developing and implementing the MINGLE program to maximise participation.
Estimating post-treatment recurrence after multidrug-resistant tuberculosis treatment among patients with and without HIV: the impact of assumptions about death and missing follow-up
Authors: Sauer Sara M. , Mitnick Carole D. , Khan Uzma , Hewison Catherine , Bastard Mathieu , Holtzman David , Law Stephanie , Khan Munira , Padayachee Shrivani , Ahmed Saman , Isani Afshan K. , Krisnanda Aga , Vilbrun Stalz Charles , Bektasov Sagit , Kumsa Andargachew , Docteur Wisney , Tintaya Karen , McNicol Mark , Atshemyan Hakob , Voynilo Tatiana , Thwe Thin Thin , Seung Kwonjune , Rich Michael , Huerga Helena , Khan Palwasha , Franke Molly
Published: May 2023

Background

Quantification of recurrence risk following successful treatment is crucial to evaluating regimens for multidrug- or rifampicin-resistant (MDR/RR) tuberculosis (TB). However, such analyses are complicated when some patients die or become lost during post-treatment-follow-up.

Methods

We analyzed data on 1,991 patients who successfully completed a longer MDR/RR-TB regimen containing bedaquiline and/or delamanid between 2015 and 2018 in 16 countries. Using five approaches for handling post-treatment deaths, we estimated the six-month post-treatment TB recurrence risk overall, and by HIV status. We used inverse-probability-weighting to account for patients with missing follow-up and investigated the impact of potential bias from excluding these patients without applying inverse-probability weights.

Results

The estimated TB recurrence risk was 6.6 per 1000 (95% confidence interval (CI):3.2,11.2) when deaths were handled as non-recurrences, and 6.7 per 1000 (95% CI:2.8,12.2) when deaths were censored and inverse-probability weights were applied to account for the excluded deaths. The estimated risk of composite recurrence outcomes were 24.2 (95% CI:14.1,37.0), 10.5 (95% CI:5.6,16.6), and 7.8 (95% CI:3.9,13.2) per 1000 for recurrence or 1) any death, 2) death with unknown or TB-related cause, 3) TB-related death, respectively. Corresponding relative risks for HIV status varied in direction and magnitude. Exclusion of patients with missing follow-up without inverse-probability-weighting had a small but apparent impact on estimates.

Conclusion

The estimated six-month TB recurrence risk was low, and the association with HIV status was inconclusive due to few recurrence events. Estimation of post-treatment recurrence will be enhanced by explicit assumptions about deaths and appropriate adjustment for missing follow-up data.
Circulating Metabolites May Illustrate Relationship of Alcohol Consumption with Cardiovascular Disease
Authors: Li Yi , Wang Mengyao , Liu Xue , Rong Jian , Miller Patricia Emogene , Joehanes Roby , Huan Tianxiao , Guo Xiuqing , Rotter Jerome , Smith Jennifer , Yu Bing , Nayor Matthew , Levy Daniel , Liu Chunyu , Ma Jiantao
Published: May 2023

Background

Metabolite signatures of long-term alcohol consumption are lacking. To better understand the molecular basis linking alcohol drinking and cardiovascular disease (CVD), we investigated circulating metabolites associated with long-term alcohol consumption and examined whether these metabolites were associated with incident CVD.

Methods

Cumulative average alcohol consumption (g/day) was derived from the total consumption of beer, wine and liquor on average of 19 years in 2,428 Framingham Heart Study Offspring participants (mean age 56 years, 52% women). We used linear mixed models to investigate the associations of alcohol consumption with 211 log-transformed plasma metabolites, adjusting for age, sex, batch, smoking, diet, physical activity, BMI, and familial relationship. Cox models were used to test the association of alcohol-related metabolite scores with fatal and nonfatal incident CVD (myocardial infarction, coronary heart disease, stroke, and heart failure).

Results

We identified 60 metabolites associated with cumulative average alcohol consumption (p<0.05/211≈0.00024). For example, one g/day increase of alcohol consumption was associated with higher levels of cholesteryl esters (e.g., CE 16:1, beta=0.023±0.002, p=6.3e-45) and phosphatidylcholine (e.g., PC 32:1, beta=0.021±0.002, p=3.1e-38). Survival analysis identified that 10 alcohol-associated metabolites were also associated with a differential CVD risk after adjusting for age, sex, and batch. Further, we built two alcohol consumption weighted metabolite scores using these 10 metabolites and showed that, with adjustment age, sex, batch, and common CVD risk factors, the two scores had comparable but opposite associations with incident CVD, hazard ratio 1.11(95% CI=[1.02, 1.21],p=0.02) vs 0.88 (95% CI=[0.78, 0.98], p=0.02).

We identified 60 long-term alcohol consumption-associated metabolites. The association analysis with incident CVD suggests a complex metabolic basis between alcohol consumption and CVD.
Distinct and synergistic immunological responses to SARS-CoV-2 andMycobacterium tuberculosisduring co-infection identified by single-cell-RNA-seq
Authors: Sheerin Dylan , Phan Thanh Kha , Eriksson Emily M. ,   COVID PROFILE Consortium, Coussens Anna K.
Published: May 2023

COVID-19 and tuberculosis (TB) exhibit similar symptomatic presentation, clinical parameters and co-diagnosis increases COVID-19 mortality yet there is limited understanding of the mechanisms underlying their immunopathogenic interactions. Here we show by single-cell RNA-sequencing of 18,990 cells from whole blood uninfected or infected withMycobacterium tuberculosis(Mtb), SARS-CoV-2, or both pathogens, their shared, distinct, and synergistic immunological interactions. The greatest transcriptional divergence occurred within monocytes and two neutrophil subsets at early timepoints of infection. Co-infection had the greatest synergistic effect 24 hours post-infection including enrichment of IFN-γ and TNF production, whilst 96 hours post-infectionMtb, SARS-CoV-2 and co-infection shared considerable pathway overlap. SARS-CoV-2 infection alone resulted in widespread cell death 96 hours post-infection, whilstMtband co-infection had enhanced cell survival at 96 hrs, sharing negative regulation of extrinsic apoptosis. Our findings elucidate potential pathways for targeted host-directed therapies, which is particularly crucial for settings where these pathogens are now endemic.
Prediction of Overall Patient Characteristics that Incorporate Multiple Outcomes in Acute Stroke: Latent Class Analysis
Authors: Uchida Junya , Yamada Moeka , Nagayama Hirofumi , Tomori Kounosuke , Ikeda Kohei , Yamauchi Keita
Published: May 2023

Background

Previous prediction models have predicted a single outcome (e.g. gait) from several patient characteristics at one point (e.g. on admission). However, in clinical practice, it is important to predict an overall patient characteristic by incorporating multiple outcomes. This study aimed to develop a prediction model of overall patient characteristics in acute stroke patients using latent class analysis.

Methods

This retrospective observational study analyzed stroke patients admitted to acute care hospitals (37 hospitals, N=10,270) between January 2005 and March 2016 from the Japan Association of Rehabilitation Database. Overall, 6,881 patients were classified into latent classes based on their outcomes. The prediction model was developed based on patient characteristics and functional ability at admission. We selected the following outcome variables at discharge for classification using latent class analysis: Functional Independence Measure (functional abilities and cognitive functions), subscales of the National Institutes of Health Stroke Scale (upper extremity function), length of hospital stay, and discharge destination. The predictor variables were age, Functional Independence Measure (functional abilities and comprehension), subscales of the National Institutes of Health Stroke Scale (upper extremity function), stroke type, and amount of rehabilitation (physical, occupational, and speech therapies) per day during hospitalization.

Results

Patients (N=6,881) were classified into nine classes based on latent class analysis regarding patient characteristics at discharge (class size: 4–29%). Class 1 was the mildest (shorter stay and highest possibility of home discharge), and Class 2 was the most severe (longer stay and the highest possibility of transfers including deaths). Different gradations characterized Classes 3–9; these patient characteristics were clinically acceptable. Predictor variables at admission that predicted class membership were significant (odds ratio: 0.0– 107.9,P<.001).

Conclusions

Based on these findings, the model developed in this study could predict an overall patient characteristic combining multiple outcomes, helping determine the appropriate rehabilitation intensity. In actual clinical practice, internal and external validation is required.
Regional Variation in Antenatal Late Preterm Steroid Use following the ALPS Trial
Authors: Freret Taylor S. , Cohen Jessica L. , Gyamfi-Bannerman Cynthia , Kaimal Anjali J. , Lorch Scott A , Wright Jason D. , Melamed Alexander , Clapp Mark A.
Published: May 2023

Objective

To assess regional variation in the use of late preterm steroids use after the publication of the Antenatal Late Preterm Steroids (ALPS) Trial and to understand factors associated with a region’s pace of adoption.

Methods

This was a repeated cross-sectional study using US natality data across hospital referral regions (HRRs) within the US from February 2015 to October 2017. Inclusion criteria included live-born, non-anomalous, singleton, late preterm (34-36 completed weeks of gestation) neonates born to individuals without pregestational diabetes. HRRs were categorized as either a “slower” or “faster” adopter of antenatal late preterm steroids based on the observed versus expected pace of antenatal steroid adoption in a 1-year period after the trial’s dissemination compared to a 1-year pre-dissemination period. Patient and regional factors hypothesizeda priorito be associated with the uptake of late preterm steroids were compared between faster and slower adopters.

Results

There were 666,097 late preterm births in 282 HRRs during the study period. Of the included HRRs, 136 (48.2%) were considered faster adopters and 146 (51.8%) slower adopters. Faster adopters increased their steroid use by 12.1-percentage points (5.9% to 18.0%) compared to a 5.5-point increase (3.7% to 9.2%) among slower adopters (p<0.001). Most examined patient and regional factors were not associated with a region’s pace of adoption. The only factor associated with being a faster adopter was the regional prevalence of prior preterm birth (adjusted odds ratio 2.04, 95% confidence interval 1.48-2.82).

Conclusion

There was widespread geographic variation in the adoption of antenatal steroid administration for late preterm births that largely remained unexplained by population factors. Future research should focus on patient, provider, and system-level factors that may be influencing the adoption of late preterm steroids. Namely, this work can provide insights to barriers to timely or equitable access to new evidence-based practices and can guide future dissemination strategies with the goal of more uniform adoption.