bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and User Experience of a Novel X-Ray Shield on Operator Radiation Exposure During Cardiac Catheterization: A Randomized Controlled Trial
Authors: Davidsen Cedric , Ytre-Hauge Kristian , Samnøy Andreas Tefre , Vikenes Kjell , Lancellotti Patrizio , Tuseth Vegard
Published: November 2023

BACKGROUND:

Radiation shielding is mandatory during cardiac catheterization, but there is a need to improve efficacy and ease of use.

METHODS:

The aim of the study was to assess the shielding effect and user feedback for a novel flexible multiconfiguration x-ray shield (FMX). The 0.5-mm Pb equivalent FMX can be selectively configured to accommodate for variations in patient morphology, access site, and type of procedure with maintained visualization, vascular access, and shielding. To evaluate efficacy, relative operator dose (operator dose indexed for given dose) was measured during 103 consecutive procedures randomized in a 1:1 proportion to the current routine setup or FMX+routine. User feedback was collected on function, relevance, and likelihood of adoption into clinical practice.

RESULTS:

Median relative operator dose was 3.63 μSv/µGy·m
2
×10
–3
(IQR, 2.62–6.37) with routine setup and 0.57 μSv/µGy·m
2
×10
–3
(IQR, 0.27–1.06) with FMX+routine, which amounts to an 84.4% reduction (
P
<0.001). For 500 procedures/year, this corresponds to an estimated yearly dose reduction from 3.6 to 0.7 mSv. User feedback regarding size, functionality, ease of use, likely to use, critical issues, shielding, draping, procedure time, vascular access, patient discomfort, and risk was 99% positive. No critical issues were identified. There was no significant difference in patient radiation exposure.

CONCLUSIONS:

The FMX reduces radiation exposure considerably. The FMX represents an effective and attractive solution for radiation protection that can easily be implemented in existing workflow. FMX has potential for general use with maintained visualization, vascular access, and shielding in routine cardiac catheterization.
Factors Associated With Transition From Community to Permanent Residential Aged Care Following Stroke: A Linked Registry Data Study
Authors: Westworth Sarah E. , Ung David , Dalli Lachlan L. , Barnden Rebecca , Kilkenny Monique F. , Srikanth Velandai , Lannin Natasha A. , Lodge Margot E. , Cadilhac Dominique A. , Olaiya Muideen T. , Andrew Nadine E. ,   on behalf of the PRECISE Investigators
Published: November 2023

BACKGROUND:

Understanding factors that influence the transition to permanent residential aged care following a stroke or transient ischemic attack may inform strategies to support people to live at home longer. We aimed to identify the demographic, clinical, and system factors that may influence the transition from living in the community to permanent residential care in the 6 to 18 months following stroke/transient ischemic attack.

METHODS:

Linked data cohort analysis of adults from Queensland and Victoria aged ≥65 years and registered in the Australian Stroke Clinical Registry (2012–2016) with a clinical diagnosis of stroke/transient ischemic attack and living in the community in the first 6 months post-hospital discharge. Participant data were linked with primary care, pharmaceutical, aged care, death, and hospital data. Multivariable survival analysis was performed to determine demographic, clinical, and system factors associated with the transition to permanent residential care in the 6 to 18 months following stroke, with death modeled as a competing risk.

RESULTS:

Of 11 176 included registrants (median age, 77.2 years; 44% female), 520 (5%) transitioned to permanent residential care between 6 and 18 months. Factors most associated with transition included the history of urinary tract infections (subhazard ratio [SHR], 1.41 [95% CI, 1.16–1.71]), dementia (SHR, 1.66 [95% CI, 1.14–2.42]), increasing age (65–74 versus 85+ years; SHR, 1.75 [95% CI, 1.31–2.34]), living in regional Australia (SHR, 31 [95% CI, 1.08–1.60]), and aged care service approvals: respite (SHR, 4.54 [95% CI, 3.51–5.85]) and high-level home support (SHR, 1.80 [95% CI, 1.30–2.48]). Protective factors included being dispensed antihypertensive medications (SHR, 0.68 [95% CI, 0.53–0.87]), seeing a cardiologist (SHR, 0.72 [95% CI, 0.57–0.91]) following stroke, and less severe stroke (SHR, 0.71 [95% CI, 0.58–0.88]).

CONCLUSIONS:

Our findings provide an improved understanding of factors that influence the transition from community to permanent residential care following stroke and can inform future strategies designed to delay this transition.
The Meddler's Trap: McKinley, the Philippines, and the Difficulty of Letting Go
Authors: Mukharji Aroop
Published: November 2023

From Vietnam to Afghanistan, U.S. leaders have had great difficulty disentangling the United States from faraway military interventions. William McKinley's 1898 decision to annex the Philippines reveals why, through a phenomenon called the “meddler's trap.” The meddler's trap denotes a situation of self-entanglement, whereby a leader inadvertently creates a problem through military intervention, feels they can solve it, and values solving the new problem more because of the initial intervention. The inflated valuation is driven by a cognitive bias called the endowment effect, according to which individuals tend to overvalue goods they feel they own. A military intervention causes a feeling of ownership of the foreign territory, triggering the endowment effect. Following the U.S. victory in Manila during the War of 1898, McKinley doubted Filipino civilizational capacity to self-govern, believed that a U.S. departure from the Philippines would cause chaos and great power war, and believed that U.S. governance could forestall that outcome. Because he had already deployed troops to the Philippines, McKinley also felt ownership over them, and this endowment effect inflated his valuation of the archipelago. Together, these mutually reinforcing beliefs produced the meddler's trap and the United States’ largest annexation outside its hemisphere.
The Architectonicidae and Mathildidae (Gastropoda, Heterobranchia) of the Miocene Paratethys Sea—victims of the Miocene Climatic Transition
Authors: HARZHAUSER MATHIAS , LANDAU BERNARD
Published: November 2023

The Architectonicidae of the Miocene of the Central Paratethys Sea comprise 18 species placed in eight genera. The coeval Mathildidae are documented by nine species, placed into three genera. We present descriptions of these species and illustrate type material wherever possible. Several species suggest relationships with Late Miocene to Holocene species of the Mediterranean Sea, although none of the species is known from modern faunas. Both families attained their maximum diversity during the early Middle Miocene (Langhian), and both families experienced a dramatic loss in species richness at the Langhian/Serravallian boundary. This Architectonicidae/Mathildidae turnover evidently coincided with the Miocene Climatic Transition, suggesting climate as the driving force. As members of both families feed on coelenterates, we assume that the climatic cooling of that phase caused a retreat of cnidarians, which is reflected in a decline in their predators.
Ammotectonica nov. gen., Simplexollata nov. gen. and Pseudotuba nov. gen. are introduced as new genera. Ammotectonica gregorovae nov. sp., Simplexollata anticollata nov. sp., Nipteraxis deformatus nov. sp., Solatisonax? transversa nov. sp., Heliacus globosus nov. sp., Solatisonax tavianii nov. sp., and Pseudotorinia grasemanni nov. sp. are described as new species. Solarium (Torinia) criticum Boettger, 1907 and Discohelix quinquangularis Boettger, 1902 are treated as subjective junior synonyms of Heliacus berthae (Boettger, 1902) and Spirolaxis cornicula (Boettger, 1902).
A new mineral cuprodobrovolskyite Na4Cu(SO4)3 from the Tolbachik volcano (Kamchatka, Russia) and relationships in the family of natural anhydrous Na–Cu sulfates
Authors: Shchipalkina Nadezhda V. , Pekov Igor V. , Koshlyakova Natalia N. , Belakovskiy Dmitry I. , Zubkova Natalia V. , Agakhanov Atali A. , Britvin Sergey N. , Nazarova Maria A.
Published: November 2023

A new mineral cuprodobrovolskyite, ideally Na4Cu(SO4)3, was found in sublimates of the Arsenatnaya fumarole at the Second scoria cone of the Northern Breakthrough of the Great Tolbachik Fissure Eruption, Tolbachik volcano, Kamchatka, Russia. It is associated with petrovite, saranchinaite, euchlorine, krasheninnikovite, langbeinite, calciolangbeinite, anhydrite, sanidine, tenorite and hematite. Cuprodobrovolskyite occurs as coarse hexagonal tabular or equant, typically skeletal crystals up to 1 mm and their clusters or crusts up to 1.5 cm × 2.5 cm in area. The mineral is transparent, light blue or greenish-bluish to almost colourless with vitreous lustre. Cuprodobrovolskyite is optically uniaxial (+) with ω = 1.509(3) and ε = 1.528(3). The empirical formula calculated on the basis of 12 O apfu is (Na3.64K0.09Pb0.03)Σ3.76(Cu0.51Ca0.22Mg0.16Zn0.07Al0.01Mn0.01)Σ0.98S3.04O12. The unit-cell parameters of cuprodobrovolskyite calculated from the powder X-ray diffraction data are: a = 15.702(2), c = 22.017(5) Å, V = 4701.0(2) Å3, space group R3 and Z = 18. The crystal structure was studied using the Rietveld method, Rp = 0.0246, Rwp = 0.0325, R1 = 0.0521 and wR2 = 0.0770. Cuprodobrovolskyite is an isostructural analogue of dobrovolskyite Na4Ca(SO4)3 with Cu prevailing over Ca. One of the main features of cuprodobrovolskyite is Cu2+ in 7-fold coordination. On the basis of relationships with saranchinaite Na2Cu(SO4)2 and petrovite Na12Cu2(SO4)8 in the Arsenatnaya fumarole and the results of heating experiments, cuprodobrovolskyite is considered as the highest-temperature phase among anhydrous Na–Cu sulfate minerals.
Exosomal miR-155-5p drives widespread macrophage M1 polarization in hypervirulent Klebsiella pneumoniae-induced acute lung injury via the MSK1/p38-MAPK axis
Authors: Xu Yihan , Zhang Chunying , Cai Danni , Zhu Rongping , Cao Yingping
Published: November 2023

Background

HypervirulentKlebsiella pneumoniae(hvKp) infection-induced sepsis-associated acute lung injury (ALI) has emerged as a significant clinical challenge. Increasing evidence suggests that activated inflammatory macrophages contribute to tissue damage in sepsis. However, the underlying causes of widespread macrophage activation remain unclear.

Methods

BALB/c mice were intravenously injected with inactivated hvKp (iHvKp) to observe lung tissue damage, inflammation, and M1 macrophage polarization. In vitro, activated RAW264.7 macrophage-derived exosomes (iHvKp-exo) were isolated and their role in ALI formation was investigated. RT-PCR was conducted to identify changes in exosomal miRNA. Bioinformatics analysis and dual-luciferase reporter assays were performed to validate MSK1 as a direct target of miR-155-5p. Further in vivo and in vitro experiments were conducted to explore the specific mechanisms involved.

Results

iHvKp successfully induced ALI in vivo and upregulated the expression of miR-155-5p. In vivo, injection of iHvKp-exo induced inflammatory tissue damage and macrophage M1 polarization. In vitro, iHvKp-exo was found to promote macrophage inflammatory response and M1 polarization through the activation of the p38-MAPK pathway. RT-PCR revealed exposure time-dependent increased levels of miR-155-5p in iHvKp-exo. Dual-luciferase reporter assays confirmed the functional role of miR-155-5p in mediating iHvKp-exo effects by targeting MSK1. Additionally, inhibition of miR-155-5p reduced M1 polarization of lung macrophages in vivo, resulting in decreased lung injury and inflammation induced by iHvKp-exo or iHvKp.

Conclusions

The aforementioned results indicate that exosomal miR-155-5p drives widespread macrophage inflammation and M1 polarization in hvKp-induced ALI through the MSK1/p38-MAPK Axis.

Graphical Abstract
Phenotypic and genetic characterization of hypervirulent Klebsiella pneumoniae in patients with liver abscess and ventilator-associated pneumonia
Authors: Guo Mingquan , Gao Bo , Su Jun , Zeng Yigang , Cui Zelin , Liu Haodong , Guo XiaoKui , Zhu Yongzhang , Wei Beiwen , Zhao Yanan , Qin Juanxiu , Lu Xiaoye , Li Qingtian
Published: November 2023

Ventilator-associated pneumonia (VAP) and pyogenic liver abscess (PLA) due to Klebsiella pneumoniae infection can trigger life-threatening malignant consequences, however, there are few studies on the strain-associated clinical pathogenic mechanisms between VAP and PLA. A total of 266 patients consist of 129 VAP and 137 PLA were included for analysis in this study. We conducted a comprehensive survey for the two groups of K. pneumoniae isolates, including phenotypic experiments, clinical epidemiology, genomic analysis, and instrumental analysis, i.e., to obtain the genomic differential profile of K. pneumoniae strains responsible for two distinct infection outcomes. We found that PLA group had a propensity for specific underlying diseases, especially diabetes and cholelithiasis. The resistance level of VAP was significantly higher than that of PLA (78.57% vs. 36%, P < 0.001), while the virulence results were opposite. There were also some differences in key signaling pathways of biochemical processes between the two groups. The combination of iucA, rmpA, hypermucoviscous phenotype, and ST23 presented in K. pneumoniae infection is more important and highly prudent for timely treatment. The present study may contribute a benchmark for the K. pneumoniae clinical screening, epidemiological surveillance, and effective therapeutic strategies.
Device-related infection and mortality in patients with chronic kidney disease receiving cardiac implantable electronic devices: a propensity score-matched cohort study
Authors: Wu Po-Jui , Chen Huang-Chung , Fang Yen-Nan , Chong Shaur-Zheng , Chen Yung-Lung , Chen Mien-Cheng
Published: November 2023

Background

Chronic kidney disease (CKD) was reported to be a risk factor of cardiac implantable electronic device (CIED) infection. The application of bundled skin antiseptic preparation before CIED implantation decreased the risk of CIED infection, even in patients undergoing complex procedures. However, the effect of bundled skin antiseptic preparation to prevent CIED infection in patients with CKD was not tested.

Methods

Between July 2012 and December 2019, 1668 patients receiving CIEDs comprised this retrospective cohort study and were categorized into two groups by the diagnosis of CKD: group with CKD (n = 750, 45%) and group without CKD (n = 918, 55%). The primary outcome was clinical CIED infection, including major and minor infection, and the secondary outcomes were cardiovascular mortality and all-cause mortality. Propensity score matching (PSM) was applied to reduce selection bias between the study groups.

Results

During a 4-year follow-up period, 30 patients (1.8%) had a CIED infection. After PSM, the incidence of CIED infection was similar between the patients with CKD and without CKD (1.0% vs. 1.8%). The incidences of cardiovascular mortality and all-cause mortality were higher in patients with CKD compared to patients without CKD (6.5% vs. 3.0%, P = 0.009; 22.8% vs. 11.8%, P < 0.001, respectively).

Conclusion

The incidence of clinical CIED infection in patients with CKD was as lower as in patients without CKD after applying the bundled skin antiseptic preparation strategy. The cumulative incidences of cardiovascular mortality and all-cause mortality were significantly higher in the matched CIED recipients with CKD compared to the matched cohort without CKD.
Prevalence of chronic kidney disease in the Netherlands and its cardiovascular and renal complications
Authors: Vervloet Marc G. , de Jong Hilda JI , Pander Jan , Overbeek Jetty A.
Published: November 2023

Background

Knowledge on prevalence, comorbidities and consequences of chronic kidney disease (CKD) is mandatory to estimate the potential of cardiovascular risk management on a population level. We studied the prevalence of CKD with or without type 2 diabetes mellitus (T2D) and/or heart failure and its cardiorenal complications in The Netherlands.

Methods

A descriptive cross-sectional and longitudinal cohort study was performed, using data from the Dutch PHARMO Data Network. Prevalence of CKD at a single time point was determined by a recorded diagnosis or by ≥ 2 estimated glomerular filtration rate (eGFR) measurements and urine albumin/creatinine ratio (UACR) that define CKD. A representative group of adults with CKD was included in a longitudinal analysis to study cardiorenal complications. Those were followed until first complication, end of study or death, whichever occurred first.

Results

The prevalence of CKD was 8.9% in a representative population of 2,187,962 adult Dutch individuals. The average age of persons with CKD was 72 years, 57% were female, 19.9% had T2D, 7.7% heart failure, and 3.0% both T2D and heart failure. In the longitudinal analysis, cerebrovascular events (11/1,000 person-years), hospitalizations for heart failure (10/1,000 person-years), myocardial infarction (5.5/1,000 person-years), and hospitalization for CKD (6.2/1,000 person-years) were the most common first cardiorenal complications. People with CKD with T2D and/or heart failure generally had higher rates of cardiovascular or renal complications or mortality than people with CKD without these comorbidities.

Conclusion

The prevalence of CKD in The Netherlands is 8.9%. People with T2D or heart failure, or both, in addition to CKD, had numerically higher mortality and cardiorenal complication rates than people without these comorbidities. Optimizing up-to-date cardiovascular risk management in these high-risk individuals may provide health benefits.
Immune thrombocytopenia secondary to primary cytomegalovirus infection after renal transplantation treated with a thrombopoietin receptor agonist: a case report
Authors: Takehara Tomohiro , Nishida Hayato , Ichikawa Kazunobu , Hosokawa Yuka , Nawano Takaaki , Takai Satoshi , Fukuhara Hiroki , Himuro Masahito , Tsuchiya Norihiko , Watanabe Masafumi
Published: November 2023

Background

Immune thrombocytopenia (ITP) is an acquired disorder characterised by a low platelet count due to immune-mediated destruction and impaired platelet production. Here we report a rare case of primary cytomegalovirus (CMV) infection followed by thrombocytopenia after renal transplantation (RT).

Case presentation

A 24-year-old male patient with end-stage kidney disease secondary to hereditary focal segmental glomerulosclerosis was treated with peritoneal dialysis and received ABO-compatible living-related RT from his aunt. Nine months after the RT, the patient was diagnosed with primary CMV infection. After initiating treatment for primary CMV infection, the patient developed thrombocytopenia. After excluding other diseases or drugs that may cause thrombocytopenia, the patient was finally diagnosed with ITP, administered prednisolone (PSL), and started on Helicobacter pylori eradication therapy. Tapering the PSL dose was difficult, but thrombopoietin receptor agonists (TPO-RAs) were effective.

Conclusions

In this case, the patient was diagnosed with ITP, and other causes of thrombocytopenia after RT were successfully ruled out. This case report demonstrates that RT recipients can develop ITP after CMV infection, and, in such cases, TPO-RAs may be an attractive option as a second-line therapy.
Construction of iron metabolism-related prognostic features of gastric cancer based on RNA sequencing and TCGA database
Authors: Liu Xihong , Ren Junyu , Zhou Ruize , Wen Zhengqi , Wen Zhengwei , Chen Zihao , He Shanshan , Zhang Hongbin
Published: November 2023

Background

Researches have manifested that the disorder of iron metabolism is participated in Gastric cancer (GC), but whether iron metabolism-relevant genes (IMRGs) is related to the survival outcome of GC remain unknown.

Methods

Eleven tumor as well as nine adjacent normal tissues from GC patients were underwent mRNA sequencing, and the The Cancer Genome Atlas Stomach Cancer (TCGA-STAD) datasets were acquired from the TCGA database. Cox analyses and least absolute shrinkage and selection operator (LASSO) regression were applied to build a IMRGs signature. The relationship between signature genes and the infiltration profiling of 24 immune cells were investigated using single-sample GSEA (ssGSEA). Meanwhile, the potential biological significance, genes that act synergistically with signature genes, and the upstream regulatory targets were predicted. Finally, the abundance of the signature genes were measured via the quantitative real-time PCR (qRT-PCR).

Results

A IMRGs signature was constructed according to the expression and corresponding coefficient of DOHH, P4HA3 and MMP1 (The Schoenfeld individual test showed risk score was not significant with P values = 0.83). The prognostic outcome of patients in the high-risk group was terrible (p < 0.05). Receiver operating characteristic (ROC) curves confirmed that the IMRGs signature presented good efficiency for predicting GC prognosis (AUC > 0.6). The nomogram was performed well for clinical utilize (C-index = 0.60), and the MMP1 expression significantly increased in the cohorts at age > 60 and Stage II-IV (p < 0.05). The positive correlation of P4HA3 and MMP1 expression as well as the negative correlation of DOHH expression with risk score (p < 0.0001) and worse prognosis (p < 0.05) were detected as well. Furthermore, 11 differential immune cells were associated with these signature genes (most p < 0.01). Finally, qRT-PCR revealed that the abundance of DOHH, P4HA3 and MMP1 were high in tumor cases, indicating the complex mechanism between the high expression of DOHH as a protective factor and the high expression of P4HA3 and MMP1 as the risk factors in the development of GC.

Conclusion

An iron metabolism-related signature was constructed and has significant values for foretelling the OS of GC.
Case series of ovarian neuroendocrine carcinoma: overview of clinicopathological features
Authors: Feng Bao-Jie , Li Tian-Hua , Li Yue-Hong , Feng Jing-Xuan , Zhang Jun , Ma Jun-Ying , Wang Yan-Wei , Lu Su-Shuang
Published: November 2023

Background

Ovarian neuroendocrine carcinoma (O-NEC) is a relatively uncommon neoplasm, and the current knowledge regarding its diagnosis and management is limited. In this series, our objective was to provide an overview of the clinicopathological characteristics of the disease by analyzing clinical case data to establish a theoretical foundation for the diagnosis and management of O-NEC.

Case presentation

We included three patients in the present case series, all of whom were diagnosed with primary O-NEC based on pathomorphological observation and immunohistochemistry. Patient 1 was a 62-year-old patient diagnosed with small cell carcinoma (SCC) of the pulmonary type. Post-surgery, the patient was diagnosed with stage II SCC of the ovary and underwent standardized chemotherapy; however, imaging examinations conducted at the 16-month follow-up revealed the existence of lymph node metastasis. Unfortunately, she passed away 21 months after the surgery. The other two patients were diagnosed with carcinoid tumors, one at age 39 and the other at age 71. Post-surgery, patient 2 was diagnosed with a carcinoid in the left ovary, whereas patient 3 was diagnosed with a carcinoid in her right ovary based on clinical evaluation. Neither of the cases received adjuvant therapy following surgery; however, they have both survived for 9 and 10 years, respectively, as of date.

Conclusion

Primary O-NECs are rare and of diverse histological types, each of which has its own unique biological features and prognosis. SCC is a neoplasm characterized by high malignancy and a poor prognosis, whereas carcinoid tumors are of lesser malignancy and have a more favorable prognosis.
Defining the landscape of patient harm after osteopathic manipulative treatment: synthesis of an adverse event model
Authors: Unger Mark D. , Barr Jackilyn N. , Brower Jacob A. , Kingston Joseph C. , Heller Gregory R. , Palmer Joy L.
Published: November 2023

Background

In the United States, osteopathic manipulative treatment (OMT), is a popular complementary physical health approach for the treatment of neuromusculoskeletal disorders. However, post-OMT adverse events (AEs) are poorly defined in terms of frequency, severity, and temporal evolution. To date, no benchmark for patient safety exists. To improve understanding in this field, we set out to model the landscape of patient harm after OMT.

Methods

We conducted a comprehensive search of all available primary clinical research studies reporting on the occurrence of post-OMT AEs in nonpregnant, adult outpatients treated by an osteopathic physician in the United States. The methodology of eligible studies was then reviewed to select those containing the minimum required dataset to model the post-OMT AEs. The minimum required dataset consisted of four model parameters: ‘post-OMT interval’, ‘OMT encounters with post-OMT interval assessment’, ‘AEs preceded by an OMT encounter’, and ‘AE severity.’ We used the dataset extracted from selected studies to calculate a patient safety benchmark defined as the incidence rate of AEs per 100 post-OMT interval-days.

Results

From 212 manuscripts that we identified, 118 primary clinical research studies were assessed for eligibility. A total of 23 studies met inclusion criteria for methodological review, of which 13 studies passed and were selected for modeling. Mild AEs were the most frequent, accounting for n = 161/165 (98%) of total AEs observed in the literature. The cumulative incidence of mild AEs was also significantly greater (P = 0.01) than both moderate and severe grades. The benchmark incidence rate was 1.0 AEs per 100 post-OMT interval-days.

Conclusions

The majority of post-OMT AEs observed in the primary clinical literature were of mild severity. Modeling of the combined dataset on post-OMT AEs allowed for the derivation of a patient safety benchmark that, to date, has not been established in the field of osteopathic manipulative medicine. Additional research is needed to improve model resolution during the post-OMT period. This work conceptualized a model for identifying and grading post-OMT AEs, which should facilitate future comparisons between institutions in order to continually improve patient safety standards in the field of osteopathic manipulative medicine.
Social support, empathy and compassion fatigue among clinical nurses: structural equation modeling
Authors: Zhang Jie , Wang Xiao , Chen Ouying , Li Juan , Li Yifei , Chen Yiping , Luo Yaoyue , Zhang Jingping
Published: November 2023

Background

Clinical nurses are at high risk for compassion fatigue. Empathy is a prerequisite for compassion fatigue, and social support is an important variable in the process of reducing individual stress. However, the role of social support in the relationship between empathy and compassion fatigue remains unclear. This study explored whether social support mediates the relationship between empathy and compassion fatigue among clinical nurses.

Methods

A total of 992 clinical nurses were recruited through convenience sampling for a cross-sectional study in Central China. They completed the General Information Questionnaire, Perceived Social Support Scale, Professional Quality of Life Scale, and Jefferson Scale of Empathy. SPSS was used to conduct descriptive statistical analyses. Pearson’s or Spearman’s correlation analyses and AMOS were employed to build a structural equation model (SEM) to verify the mediating effect of social support on the relationship between empathy and compassion fatigue.

Results

The results indicated that the standardized direct effect of empathy on compassion fatigue was 0.127, and the standardized indirect effect of empathy on compassion fatigue through social support was 0.136. The mediation effect ratio between empathy and compassion fatigue was 51.7%.

Conclusions

Our findings show that social support mediates the relationship between empathy and compassion fatigue among clinical nurses. This finding suggests that increasing nurses’ social support can decrease the prevalence of compassion fatigue. Nursing managers should provide training related to flexibly adjusting empathy and educating nurses to establish effective social networks with family, friends, and colleagues to prevent compassion fatigue.
Self-efficacy and well-being in the association between caregiver burden and sleep quality among caregivers of elderly patients having multiple chronic conditions in rural China: a serial multiple mediation analysis
Authors: Yang Ziyue , Sun Fengye , Zhao Lingrui , Hu Tingwei , Lin Xin , Guo Yufang
Published: November 2023

Background

Caregivers of elderly patients with multiple chronic conditions have heavy caregiver burden and poor sleep quality, which has an important impact on both caregivers and patients. This study aimed to examine among rural caregivers of elderly patients who have multiple chronic conditions in China, whether self-efficacy and well-being mediate the link between caregiver burden and sleep quality.

Methods

The study recruited 325 caregivers of elderly patients having multiple chronic conditions in rural China. Several measures including the Caregiver Burden Inventory (CBI), Athens Insomnia Scale (AIS), General Self-Efficacy Scale (GSES) and Index of Well-Being (IWB) were utilized to collect data. Structural equation modeling was employed to study the relationships among caregiver burden, sleep quality, self-efficacy, as well as well-being.

Results

Significant correlations were found between the measured variables (each p < 0.01). Self-efficacy and well-being acted as mediators in the link between caregiver burden and sleep quality, accounting for 10.94% and 15.63% of the total effect, respectively. In addition, self-efficacy and well-being had a serial multiple mediating effect in the association between caregiver burden and sleep quality, with this mediating pathway, explaining 9.93% of the total effect.

Conclusions

Caregivers of elderly patients having multiple chronic conditions in rural China experienced poor sleep quality due to the caregiver burden. Self-efficacy and well-being had serial mediating roles on the relationship between caregiver burden and sleep quality. Effective interventions should be developed to improve self-efficacy and well-being of caregivers, reduce their caregiver burden and, eventually, improve their sleep quality.
Expression profiles of the autism-related SHANK proteins in the human brain
Authors: Woelfle Sarah , Pedro Maria T. , Wagner Jan , Schön Michael , Boeckers Tobias M.
Published: November 2023

Background

SHANKs are major scaffolding proteins at postsynaptic densities (PSDs) in the central nervous system. Mutations in all three family members have been associated with neurodevelopmental disorders such as autism spectrum disorders (ASDs). Despite the pathophysiological importance of SHANK2 and SHANK3 mutations in humans, research on the expression of these proteins is mostly based on rodent model organisms.

Results

In the present study, cellular and neuropil SHANK2 expression was analyzed by immunofluorescence (IF) staining of post mortem human brain tissue from four male individuals (19 brain regions). Mouse brains were analyzed in comparison to evaluate the degree of phylogenetic conservation. Furthermore, SHANK2 and SHANK3 isoform patterns were compared in human and mouse brain lysates. While isoform expression and subcellular distribution were largely conserved, differences in neuropil levels of SHANK2 were found by IF staining: Maximum expression was concordantly measured in the cerebellum; however, higher SHANK2 expression was detected in the human brainstem and thalamus when compared to mice. One of the lowest SHANK2 levels was found in the human amygdala, a moderately expressing region in mouse. Quantification of SHANK3 IF in mouse brains unveiled a distribution comparable to humans.

Conclusions

In summary, these data show that the overall expression pattern of SHANK is largely conserved in defined brain regions; however, differences do exist, which need to be considered in the translation of rodent studies. The summarized expression patterns of SHANK2 and SHANK3 should serve as a reference for future studies.
Exosomal miR-146a-5p derived from human umbilical cord mesenchymal stem cells can alleviate antiphospholipid antibody-induced trophoblast injury and placental dysfunction by regulating the TRAF6/NF-κB axis
Authors: Lv Qingfeng , Wang Yuan , Tian Wei , Liu Yuqiu , Gu Mengqi , Jiang Xiaotong , Cai Yanjun , Huo Ruiheng , Li Yuchen , Li Lei , Wang Xietong
Published: November 2023

Exosomes originating from human umbilical cord mesenchymal stem cells (hucMSC-exos) have become a novel strategy for treating various diseases owing to their ability to regulate intercellular signal communication. However, the potential of hucMSC-exos to improve placental injury in obstetric antiphospholipid syndrome and its underlying mechanism remain unclear. Our objective was to explore the potential application of hucMSC-exos in the treatment of obstetric antiphospholipid syndrome and elucidate its underlying mechanism. In our study, hucMSC-exos ameliorated the functional impairment of trophoblasts caused by antiphospholipid antibodies in vitro and attenuated placental dysfunction in mice with obstetric antiphospholipid syndrome by delivering miR-146a-5p. Exosomal miR-146a-5p suppressed the expression of tumor necrosis factor receptor-associated factor 6 (TRAF6) and inhibited the activation of NF-κB signaling, leading to the down-regulation of IL-1β and IL-18 to rescue inflammation and modulation of Cleaved-CASP3, BAX, and BCL2 to inhibit apoptosis in HTR8/SVneo cells and mice placenta. This study identified the potential molecular basis of how hucMSC-exos improved antiphospholipid antibody-induced placental injury and highlighted the functional importance of the miR-146a-5p/TRAF6 axis in the progression of obstetric antiphospholipid syndrome. More importantly, this study provided a fresh outlook on the promising use of hucMSC-exos as a novel and effective treatment approach in obstetric antiphospholipid syndrome.

Graphical Abstract
The faces behind vaccination: unpacking the attitudes, knowledge, and practices of staff of Cameroon’s Expanded program on Immunization
Authors: Saidu Yauba , Gu Jessica , Ngenge Budzi Michael , Nchinjoh Sangwe Clovis , Adidja Amani , Nnang Nadege Edwidge , Muteh Nkwain Jude , Zambou Vouking Marius , Mbanga Clarence Mvalo , Agbor Valirie Ndip , Ousmane Diaby , Njoh Andreas Ateke , Flegere Junie , Diack Demba , Wiwa Owens , Montomoli Emanuele , Clemens Sue Ann Costa , Clemens Ralf
Published: November 2023

Background

Immunization is regarded as one of the most cost-effective public health interventions in global health. However, its cost-effectiveness depends greatly on the knowledge and skills of vaccinators. With the growing complexity of immunization programs, the need for a well-trained vaccination workforce cannot be overemphasized. In this study, we assessed the knowledge, attitudes, and practices among vaccination staff in Cameroon.

Methods

Through a descriptive cross-sectional design, we used structured questionnaires and observation guides to collect data from vaccination staff in health facilities that were selected by a multistage sampling method. Data were analyzed using STATA 13 software.

Results

Overall, we collected data from Expanded Program on Immunization focal staff in 265 health facilities across 68 health districts. Over half (53%) of the surveyed facilities were found in rural areas. Nearly two-thirds of health facilities had immunization focal staff with knowledge gaps for each of the four basic immunization indicators assessed. In other words, only 37% of staff knew how to estimate coverages, 36% knew how to inteprete the EPI monitoring curve, 35% knew how to prepare vaccine orders, and 37% knew how to estimate vaccine wastage. In terms of practices, staff waited for more than ten children to be present before opening a 20-dose vaccine vial in 63% of health facilities, and more than five children to be present before opening a 10-dose vaccine vial in 80% of surveyed facilities. Provision of vaccine-specific information (informing caregiver about vaccine received, explanation of benefits and potential side effects) during immunization sessions was suboptimal for the most part.

Conclusion

This study suggests marked deficits in immunization knowledge among vaccination staff and exposes common attitudes and practices that could contribute to missed opportunities for vaccination and hinder vaccination coverage and equity in Cameroon. Our findings highlight the urgent need to invest in comprehensive capacity building of vaccination staff in Cameroon, especially now that the immunization program is becoming increasingly complex.
Effects of a novel ANLN E841K mutation associated with SRNS on podocytes and its mechanism
Authors: Lin Li , Ye Yuhong , Fu Haidong , Gu Weizhong , Zhao Manli , Sun Jingmiao , Cao Zhongkai , Huang Guoping , Xie Yi , Liu Fei , Li Lu , Li Qiuyu , Mao Jianhua , Hu Lidan
Published: November 2023

Background

Steroid-resistant nephrotic syndrome (SRNS) is characterized by unrelieved proteinuria after an initial 4–8 weeks of glucocorticoid therapy. Genes in podocytes play an important role in causing SRNS.

Objective

This study aimed to report a pathogenic mutation in SRNS patients and investigate its effects on podocytes, as well as the pathogenic mechanism.

Methods

We screened out a novel mutation by using whole-exon sequencing in the SRNS cohort and verified it via Sanger sequencing. Conservative analysis and bioinformatic analysis were used to predict the pathogenicity of the mutation. In vitro, stable podocyte cell lines were constructed to detect the effect of the mutation on the function of the podocyte. Moreover, an in vivo mouse model of podocyte ANLN gene knockout (ANLNpodKO) was used to confirm clinical manifestations. Transcriptome analysis was performed to identify differential gene expression and related signaling pathways.

Results

ANLN E841K was screened from three unrelated families. ANLN E841K occurred in the functional domain and was predicted to be harmful. The pathological type of A-II-1 renal biopsy was minimal change disease, and the expression of ANLN was decreased. Cells in the mutation group showed disordered cytoskeleton, faster cell migration, decreased adhesion, increased endocytosis, slower proliferation, increased apoptosis, and weakened interaction with CD2 association protein. ANLNpodKO mice exhibited more obvious proteinuria, more severe mesangial proliferation, glomerular atrophy, foot process fusion, and increased tissue apoptosis levels than ANLNflox/flox mice after tail vein injection of adriamycin. Upregulated differentially expressed genes in cells of the mutation group were mainly enriched in the PI3K-AKT pathway.

Conclusion

The novel mutation known as ANLN E841K affected the function of the ANLN protein by activating the PI3K/AKT/mTOR/apoptosis pathway, thus resulting in structural and functional changes in podocytes. Our study indicated that ANLN played a vital role in maintaining the normal function of podocytes.
Spatial transcriptomics and neurofilament light chain reveal changes in lesion patterns in murine autoimmune neuroinflammation
Authors: Brummer Tobias , Schillner Miriam , Steffen Falk , Kneilmann Flores , Wasser Beatrice , Uphaus Timo , Zipp Frauke , Bittner Stefan
Published: November 2023

Objective

Ongoing neuroaxonal damage is a major contributor to disease progression and long-term disability in multiple sclerosis. However, spatio-temporal distribution and pathophysiological mechanisms of neuroaxonal damage during acute relapses and later chronic disease stages remain poorly understood.

Methods

Here, we applied immunohistochemistry, single-molecule array, spatial transcriptomics, and microglia/axon co-cultures to gain insight into spatio-temporal neuroaxonal damage in experimental autoimmune encephalomyelitis (EAE).

Results

Association of spinal cord white matter lesions and blood-based neurofilament light (sNfL) levels revealed a distinct, stage-dependent anatomical pattern of neuroaxonal damage: in chronic EAE, sNfL levels were predominately associated with anterolateral lumbar lesions, whereas in early EAE sNfL showed no correlation with lesions in any anatomical location. Furthermore, neuroaxonal damage in late EAE was largely confined to white matter lesions but showed a widespread distribution in early EAE. Following this pattern of neuroaxonal damage, spatial transcriptomics revealed a widespread cyto- and chemokine response at early disease stages, whereas late EAE was characterized by a prominent glial cell accumulation in white matter lesions. These findings were corroborated by immunohistochemistry and microglia/axon co-cultures, which further revealed a strong association between CNS myeloid cell activation and neuroaxonal damage both in vivo and in vitro.

Interpretation

Our findings indicate that CNS myeloid cells may play a crucial role in driving neuroaxonal damage in EAE. Moreover, neuroaxonal damage can progress in a stage-dependent centripetal manner, transitioning from normal-appearing white matter to focal white matter lesions. These insights may contribute to a better understanding of neurodegeneration and elevated sNfL levels observed in multiple sclerosis patients at different disease stages.

Graphical Abstract
‘Functional hyperthermia’: a historical overview
Authors: Ginier-Gillet Mathieu
Published: November 2023

The management of low-grade fever in adults has not been codified. This gap is related not only to the numerous possible aetiologies but also to the difficulty of escaping the monocausal model of diseases. This article explores the complex issue of positive signs in ‘psychogenic fever’ through Reimann’s 1930s series. The discussion emphasises Canguilhem’s positions regarding vital signs and proposes (1) a semantic clarification of ‘habitual hyperthermia’ and (2) an amendment of the Belgian diagnostic criteria based on the concept of functional disorder. This paper also suggests following Peirce’s pragmatism in the face of an uncommon clinical picture.
Critical Illness Weakness, Polyneuropathy and Myopathy: Diagnosis, treatment, and long-term outcomes
Authors: Latronico Nicola , Rasulo Frank A. , Eikermann Matthias , Piva Simone
Published: November 2023

Background

Severe weakness associated with critical illness (CIW) is common. This narrative review summarizes the latest scientific insights and proposes a guide for clinicians to optimize the diagnosis and management of the CIW during the various stages of the disease from the ICU to the community stage.

Main body

CIW arises as diffuse, symmetrical weakness after ICU admission, which is an important differentiating factor from other diseases causing non-symmetrical muscle weakness or paralysis. In patients with adequate cognitive function, CIW can be easily diagnosed at the bedside using manual muscle testing, which should be routinely conducted until ICU discharge. In patients with delirium or coma or those with prolonged, severe weakness, specific neurophysiological investigations and, in selected cases, muscle biopsy are recommended. With these exams, CIW can be differentiated into critical illness polyneuropathy or myopathy, which often coexist. On the general ward, CIW is seen in patients with prolonged previous ICU treatment, or in those developing a new sepsis. Respiratory muscle weakness can cause neuromuscular respiratory failure, which needs prompt recognition and rapid treatment to avoid life-threatening situations. Active rehabilitation should be reassessed and tailored to the new patient’s condition to reduce the risk of disease progression. CIW is associated with long-term physical, cognitive and mental impairments, which emphasizes the need for a multidisciplinary model of care. Follow-up clinics for patients surviving critical illness may serve this purpose by providing direct clinical support to patients, managing referrals to other specialists and general practitioners, and serving as a platform for research to describe the natural history of post-intensive care syndrome and to identify new therapeutic interventions. This surveillance should include an assessment of the activities of daily living, mood, and functional mobility. Finally, nutritional status should be longitudinally assessed in all ICU survivors and incorporated into a patient-centered nutritional approach guided by a dietician.

Conclusions

Early ICU mobilization combined with the best evidence-based ICU practices can effectively reduce short-term weakness. Multi-professional collaborations are needed to guarantee a multi-dimensional evaluation and unitary community care programs for survivors of critical illnesses.
Married women’s decision-making autonomy on modern contraceptive use and its associated factors in high fertile sub-Saharan Africa countries: a multi-level analysis of Demographic and Health Surveys
Authors: Belachew Tadele Biresaw , Asmamaw Desale Bihonegn , Belachew Ayele Biresaw , Bayafers Mulatu Wubu , Negash Wubshet Debebe
Published: November 2023

Background

For better maternal and child health, women’s independence on reproductive health issues is crucial; however, couples are restricted from discussing openly with their partner. Regarding this, information about women’s decision-making autonomy is low in the world, including Sub-Saharan Africa; therefore, this study was aimed to assess married women’s decision-making autonomy on modern contraceptive utilization in high fertility SSA countries.

Methods

Data for this study was obtained from the most recent (2010–2018) Demographic and Health Surveys. A total of weighted sample of 14,575 married reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of decision-making autonomy on modern contraceptive utilization. Finally, the Adjusted Odds Ratio (AOR) with 95% confidence interval was used to declare as statistical significance.

Results

Overall prevalence of married women decision-making autonomy on modern contraceptive utilization in the high fertile SSA countries is 25.28% (95% CI:18.32%, 32.24%). The factors significantly associated with the decision-making autonomy on modern contraceptive utilization were women’s age 25–34 years (AOR = 1.88, 95% CI = 1.84–1.93) and 35–49 years (AOR = 1.90, 95% CI = 1.82–1.92), had media exposure (AOR = 1.13, 95% CI = 1.00- 1.28), Number of alive children, 1–2 (AOR = 2.35, 95% CI = 1.38–4.01), 3–4 (AOR = 2.98, 95% CI = 1.74–5.10),$$\ge$$≥5 (AOR = 2. 82, 95% CI = 1.63–4.86), educational status; primary education (AOR = 1.93, 95% CI = 1.77–2.83), Secondary and higher (AOR = 2.11, 95% CI = 1.78–2.89), Community media exposure (AOR = 1.80, 95% CI = 1.38–2.34), Community level poverty, (AOR = 1.43, 95% CI = 1.09–1.86) and resides in rural (AOR = 0.67, 95% CI = 0.64–0.71).

Conclusion

Women’s decision-making autonomy on modern contraception utilization in this study was low. Therefore, the government should promote women’s autonomy on contraceptive use as an essential component of SRH rights through mass media, with particular attention for, women living in the poorest communities, and those residing in rural settings of the country. Moreover, health professionals should counsel the women about the benefits of using modern contraceptive to help them managing their number of children.