bluuebunny/crossref_metadata_2025 huggingface dataset:
Resting-State Functional Connectivity Predicts Cochlear-Implant Speech Outcomes
Authors: Esmaelpoor Jamal , Peng Tommy , Jelfs Beth , Mao Darren , Shader Maureen J. , McKay Colette M.
Published: July 2024

Objectives:

Cochlear implants (CIs) have revolutionized hearing restoration for individuals with severe or profound hearing loss. However, a substantial and unexplained variability persists in CI outcomes, even when considering subject-specific factors such as age and the duration of deafness. In a pioneering study, we use resting-state functional near-infrared spectroscopy to predict speech-understanding outcomes before and after CI implantation. Our hypothesis centers on resting-state functional connectivity (FC) reflecting brain plasticity post-hearing loss and implantation, specifically targeting the average clustering coefficient in resting FC networks to capture variation among CI users.

Design:

Twenty-three CI candidates participated in this study. Resting-state functional near-infrared spectroscopy data were collected preimplantation and at 1 month, 3 months, and 1 year postimplantation. Speech understanding performance was assessed using consonant-nucleus-consonant words in quiet and Bamford-Kowal-Bench sentences in noise 1-year postimplantation. Resting-state FC networks were constructed using regularized partial correlation, and the average clustering coefficient was measured in the signed weighted networks as a predictive measure for implantation outcomes.

Results:

Our findings demonstrate a significant correlation between the average clustering coefficient in resting-state functional networks and speech understanding outcomes, both pre- and postimplantation.

Conclusions:

This approach uses an easily deployable resting-state functional brain imaging metric to predict speech-understanding outcomes in implant recipients. The results indicate that the average clustering coefficient, both pre- and postimplantation, correlates with speech understanding outcomes.
Real-world use and outcomes of targeted therapy and immunotherapy for adjuvant treatment of BRAF-mutated melanoma patients in the United States
Authors: Chandrasekaran Sanjay , Ling You-Li , Tang Jackson
Published: July 2024

Using a customized, harmonized US electronic health record database, real-world prescription patterns of first-line adjuvant immunotherapy and targeted therapy were retrospectively assessed for BRAFV600-mutated melanoma. Adults with BRAFV600 mutation-positive stage IIIA-D cutaneous melanoma who received first-line adjuvant immunotherapy (nivolumab or pembrolizumab) or targeted therapy (dabrafenib plus trametinib) between 1 January 2014 and 30 August 2020 in the NOBLE database were included. Patients were followed from first-line adjuvant therapy initiation for at least 6 months, until death, progression, follow-up loss, or data cutoff. Primary endpoints were proportion of patients receiving either therapy in first-line and second-line, treatment switching, treatment timing, and status at the end of first-line therapy. Secondary endpoints included discontinuation rates, recurrence-free survival (RFS), and overall survival (OS). Of 318 patients evaluated, 67.6% received nivolumab, 14.2% pembrolizumab, and 18.2% targeted therapy as first-line adjuvant therapy. Median treatment duration was longest for nivolumab (292 days) and shortest for targeted therapy (115 days). Reason for discontinuation was recorded for 195 of 274 patients who discontinued first-line therapy; most common reasons were treatment completion and treatment-related toxicity [87/158 (55.0%) and 29/158 (18.4%), respectively, in immunotherapy-treated patients; 9/37 (24.3%) and 21/37 (56.8%) in targeted therapy-treated patients]. Median RFS and OS for targeted therapy and nivolumab were not reached and were 34.6 and 38.1 months, respectively, for pembrolizumab. These results inform on prescription preferences and clinical outcomes for BRAFV600-mutated melanoma patients in the first-line adjuvant setting.
Concurrent Use of Trastuzumab Deruxtecan and Radiation Therapy in HER2-positive and HER2-low Metastatic Breast Cancer
Authors: Bouziane Jihane , Loap Pierre , Cao Kim , Allali Sofiane , Gounane Yacine , Loganadane Gokoulakrichenane , Escalup Laurence , Pierga Jean-Yves , Kirova Youlia
Published: July 2024

Objectives:

Recent DESTINY-Breast trials have demonstrated trastuzumab deruxtecan’s effectiveness in HER2-positive and HER2-low metastatic breast cancer. However, safety concerns remain regarding its combination with radiation therapy (RT). The purpose of this work is to assess the toxicity profile of combining trastuzumab deruxtecan and RT in patients with HER2-positive and HER2-low metastatic breast cancer to address these concerns.

Methods:

We conducted a retrospective study which included patients treated at Institut Curie Paris between November 2020 and January 2024. Patients with HER2-positive and HER2-low metastatic breast cancer who received concurrent trastuzumab deruxtecan and RT were identified. Data on patient demographics, treatment regimens, radiation doses, toxicity profiles, and treatment discontinuations were collected. Follow-up was conducted from the last day of radiotherapy until death or the last examination and toxicities were graded using the CTCAE V5.0.

Results:

The studied population includes all 33 patients with HER2-positive and HER2-low metastatic breast cancer who underwent concurrent treatment with trastuzumab deruxtecan and radiotherapy. The median follow-up was 11 months. The most common acute grade 1 toxicity was nausea. Grade 2 toxicities affected 21.2% of patients, including asthenia, mucositis, cardiac decompensation, and diarrhea. Trastuzumab deruxtecan discontinuation occurred in 5 patients due to systemic treatment-related toxicities, including nausea, thrombocytopenia, neutropenia, and cardiac decompensation. There were 21.2% reported with late toxicities, with nausea being the most prevalent.

Conclusions:

Our series of patients who received concurrent treatment of radiotherapy and trastuzumab deruxtecan are showing acceptable toxicity. Larger prospective studies are needed to evaluate the toxicity and efficacy of this combination.
Evolving Trends in the Diagnosis and Management of Keratoconus Over 3 Decades
Authors: Deshmukh Rashmi S. , Das Anthony Vipin , Vaddavalli Pravin Krishna
Published: July 2024

Purpose:

To report the trends in the clinical presentation, diagnosis, and management of keratoconus (KC) in patients presenting to a multitier hospital network over 33 years.

Methods:

This retrospective study included patients with KC presenting from 1987 to 2020. Patients with KC in at least 1 eye were included. The data of 20,576 patients included in this study were retrieved from the electronic medical record database. Data on patient demographics, ocular diagnosis, contact lens usage, and surgical history were collected and exported for analysis. Descriptive statistics and chi square test were used for statistical analysis.

Results:

A total of 20,576 KC cases were seen from 1987 to 2020. Mean age at diagnosis reduced from 29.3 years (1987–1991) to 22.2 years (2016–2020). Adults (76.64%) were commonly affected with a majority being male (61.25%). Use of contact lenses increased from 4.34% (2002–2006) to 11.23% (2016–2020). Of the total number of surgical interventions, collagen crosslinking (CXL) constituted more than 1/5th (22.28%) between 2007 and 2011, which increased to more than half between 2012 and 2016 (53.61%) and almost 3/4th (72.53%) between 2017 and 2020. Advances in lamellar surgery have led to more patients undergoing deep anterior lamellar keratoplasty (DALK) as compared with penetrating keratoplasty. In the last 8 years, 17.2% patients underwent surgery and the most common was CXL (14.77%) followed by DALK (1.72%) and penetrating keratoplasty (1.04%).

Conclusions:

We report the trends in the clinical presentation and management of KC over 3 decades. In the last 33 years, advances in diagnostics have helped diagnose KC earlier. Contact lenses and advances in CXL have reduced the number of keratoplasties in KC, DALK being more common.
Relationships of Psychosocial Factors to Diabetes Self-efficacy
Authors: Heo Seongkum , Kang JungHee , Barbé Tammy , Kim JinShil , Slocumb Rhonda H. , Haley Brandy , Wright Nina
Published: July 2024

Background

Self-care in people with diabetes is poor, which could be influenced by positive and negative psychosocial factors. Self-efficacy is an important factor affecting self-care, and depressive symptoms and diabetes distress may directly and indirectly affect self-efficacy.

Objective

The aim of this study was to examine the relationships of depressive symptoms, diabetes distress, age, sex, self-compassion, resilience, self-esteem, and social support to diabetes self-efficacy and the mediating roles of diabetes distress and depressive symptoms in the relationships among people with diabetes.

Methods

In this cross-sectional, correlational study, data on all the psychosocial and demographic factors were collected (N = 148; 57.6 years old) through Research Electronic Data Capture in 2023. The PROCESS macro for SPSS was used to address the purpose.

Results

The mean score of diabetes self-efficacy was 28.6 (range, 8–40). In 1 model, depressive symptoms were directly and indirectly associated with diabetes self-efficacy through diabetes distress (direct effect, −3.524; t = −3.020, P = .003; indirect effect, −2.089; 95% bootstrap confidence interval, −3.494 to −0.911). In another model, diabetes distress was directly and indirectly associated with diabetes self-efficacy through depressive symptoms (direct effect, −3.778; t = −3.638, P < .001; indirect effect, −0.785; 95% bootstrap confidence interval, −1.868 to −0.089). In addition, self-esteem was associated with both depressive symptoms and diabetes distress. Resilience was associated with diabetes self-efficacy in 1 model.

Conclusions

Negative psychological factors were directly and indirectly associated with diabetes self-efficacy. Depressive symptoms, diabetes distress, self-esteem, and resilience can be important targets of interventions to improve diabetes self-efficacy.
The Lived Experience of Cardiac Arrest Survivors
Authors: El Hussein Mohamed Toufic , Dhaliwal Simreen , Hakkola Jonah
Published: July 2024

Background

Survival rates after cardiac arrest have steadily increased over the past few decades because of the adoption of cardiopulmonary resuscitation, public access to automated external defibrillators, and an increase in public education on how to perform cardiopulmonary resuscitation. The lived experiences of post–cardiac arrest survival have been underexplored. The themes that resulted from the analysis in this scoping review can inform clinical practice and propose strategies to improve the patients' quality of life.

Objective

The objective of this scoping review was to map out qualitative literature that explores the lived experience of individuals who have survived cardiac arrest.

Method

In this scoping review, the authors examined peer-reviewed qualitative studies identified in the PubMed, CINAHL, and MEDLINE databases. Arksey and O'Malley's methodological framework for conducting a scoping study was followed.

Results

The search yielded 174 articles, with 16 meeting inclusion criteria for this scoping review. Initially, 14 articles were selected, and 2 additional articles were identified through references. Themes extracted from these 16 articles include the need for support and information, emotional challenges, and acceptance of a new reality.

Conclusion

Cardiac arrest survivors often experience loss of control, vulnerability, and insecurity. These emotional changes can be significant and may include physical challenges, cognitive impairments, and psychological distress, which can cause individuals to reevaluate their perspectives on life and accept a new reality, potentially leading to changes in their future outlook.
The Effects of Conservative Treatment on Geometric Morphology of the Spine and Thoracic Cage in Patients with Adolescent Idiopathic Scoliosis: A 1-Year Follow-up
Authors: Yağci Gözde , Apaydın Zilan Bazancir , Erbahceci Fatih
Published: July 2024

Introduction

The thoracic cage has a direct relation with the spine and thereby scoliosis affects spinal morphology. The aim of the study is to investigate the effects of a 1-year conservative treatment on the geometric morphology of the spine and thoracic cage in patients with adolescent idiopathic scoliosis (AIS).

Methods

Thirty-six patients with AIS were assessed retrospectively for the initiation of conservative treatment and at 1-year follow-up. Patients were divided into two groups based on the intervention method: exercises-only group (ExG) and brace plus exercises group (BrG). The posteroanterior and lateral radiograph of each patient were measured in terms of spinal morphology including coronal, sagittal, transverse spinal, and thoracic cage parameters. Besides, the success rate of the conservative treatment was recorded by the sum of the stabilization and correction of each patient.

Results

No significant difference was found in the thoracic dimensions, thoracic geometry, and coronal and transverse plane parameters in ExG group (P > 0.05). The spine height increased (P = 0.006), whereas other parameters did not change (P > 0.05) in BrG. Lumbar lordosis decreased in ExG group (P = 0.025). The total success rate of the conservative treatment in AIS patients was 75%. The success rate of ExG and BrG was 68.4% and 82.4%, respectively.

Conclusions

The conservative treatment including both bracing and exercise seems to provide an additional elongation over the spine height without causing a negative effect in the spine and thoracic cage geometry in AIS.

Clinical Relevance

Bracing and exercise treatment do not have a negative impact on thoracic cage geometry in AIS.
The Effects of Cycle Ergometer Versus Treadmill Exercise Stress Testing on QTc Interval Prolongation in Patients With Long QT Syndrome: A Systematic Review and Meta-analysis
Authors: Harvey Audrey , Curnier Daniel , Dodin Philippe , Jacquemet Vincent , Caru Maxime
Published: July 2024

Objective:

The safest and most effective exercise stress tests (EST) modalities for long QT syndrome (LQTS) are currently unknown. The main objective was to explore the effects of EST on the corrected QT interval (QTc) in patients with LQTS, and to compare the effects of different EST modalities (cycle ergometer vs treadmill).

Data Sources:

Systematic searches were performed in September 2022 in accordance with the PRISMA statement through PubMed, Medline, EBM Reviews, Embase, and Web of Science.

Main Results:

A total of 1728 patients with LQTS, whether congenital or acquired, without any age restrictions (pediatric age ≤18 years and adult age >19 years), and 2437 control subjects were included in the 49 studies. The QT interval data were available for 15 studies. Our analyses showed that the QT interval prolonged in a similar manner using either a cycle ergometer or a treadmill (standardized mean difference [SMD] = 1.89 [95% CI, 1.07-2.71] vs SMD = 1.46 [95% CI, 0.78-2.14], respectively). Therefore, it seems that either modality may be used to evaluate patients with LQTS.

Conclusions:

The methodology for the measurement of the QT interval was very heterogeneous between studies, which inevitably influenced the quality of the analyses. Hence, researchers should proceed with caution when exploring and interpreting data in the field of exercise and LQTS.
Assessment of knowledge, attitude, and practice regarding medical waste management among operation room personnel in a tertiary hospital
Authors: Bizuneh Yosef Belay , Ferede Yonas Admasu , Berhe Yophtahe Woldegerima , Alemu Wudie Mekonnen , Zeleke Tadael Gudayu
Published: July 2024

Introduction:

Medical waste management (MWM) is of concern to the medical and surgical communities in the hospital. Adequate knowledge, attitude, and practice regarding the management of healthcare waste are important for the proper handling and disposal by physicians and healthcare workers.

Objective:

The aim of this study was an assessment of knowledge, attitude, and practices regarding medical waste management among operation room personnel in a tertiary hospital.

Methods:

This study was a descriptive cross-sectional survey conducted at a single-center government Comprehensive Specialized Hospital operation room from 1–30 September 2022. All specialty operation room healthcare personnel consenting to cooperate and participate were included in the study. The data were collected using a self-administered questionnaire. The collected data were analyzed using SPSS. The results were presented in texts, tables and graphs.

Results:

From 130 operation room personnel, the results revealed that the majority of the total respondents were male (83.1%). Only 30 (23.1%) of the respondents were involved in training, whereas 100 (76.9%) of the study participants have not participated in training. It was found that 86 (66.2%) of the respondents had good knowledge, 113 (86.9%) of the respondents had a good attitude, and 27 (20.8%) of the respondents had good practice.

Conclusion and recommendation:

The authors’ study reveals that the majority of study participants have a moderate level of knowledge, a good level of attitude, and poor levels of practice, according to Bloom’s cut-off point. The institution should more fully implement the training for operation room personnel to improve their level of knowledge and practice of medical waste management.
Efficacy and outcomes of BCG re-vaccination in COVID-19: a systematic review, meta-analysis, and meta-regression of randomized controlled trials
Authors: Jain Hritvik , Odat Ramez M. , Hussein Ayham Mohammad , Dey Debankur , Ahmed Mushood , Jain Jyoti , Goyal Aman , Ratnani Tanya , Idrees Muhammad , Prajjwal Priyadarshi , Passey Siddhant , Yadav Rukesh
Published: July 2024

Introduction:

The Bacillus Calmette-Guerin (BCG) vaccine has a beneficial “off-target” effect that offers heterologous protection against respiratory tract infections by inducing trained immunity. The need for producing antigen-specific COVID-19 vaccines leads to delays in vaccine administration. Current randomized controlled trials (RCTs) report conflicting data on BCG’s efficacy in COVID-19 infection.

Methods:

A comprehensive literature search was conducted using major bibliographic databases to identify RCTs evaluating the outcomes of BCG re-vaccination in COVID-19. For dichotomous outcomes, odds ratios (ORs) with 95% CIs were pooled using the DerSimonian-Laird random-effects model. Statistical significance was set at P less than 0.05.

Results:

Thirteen RCTs with 13 939 participants (7004 in the BCG re-vaccination group and 6935 in the placebo group) were included. BCG re-vaccination did not lead to a statistically significant difference in the incidence of COVID-19 infection [OR: 1.04; 95% CI: 0.91, 1.19; P=0.56], COVID-19-related hospitalizations [OR: 0.81; 95% CI: 0.38, 1.72; P=0.58), ICU admissions [OR: 0.43; 95% CI: 0.13, 1.46; P=0.18], or mortality [OR: 0.67; 95% CI 0.15, 3.04; P=0.60]. For safety outcomes, BCG re-vaccination led to a significant increase in the local injection site complications [OR: 99.79; 95% CI: 31.04, 320.80; P<0.00001], however, the risk of serious adverse events was similar [OR: 1.19; 95% CI: 0.84, 1.67; P=0.33].

Conclusions:

BCG re-vaccination does not decrease the incidence of COVID-19 infection, COVID-19-related hospitalizations, ICU admissions, COVID-19-related mortality, and serious adverse events; however, it leads to a rise in local injection site complications. Caution should be exercised when overstating BCG’s efficacy in COVID-19 prevention.
COVID-19: vaccination, therapeutics and a review of the science and public health
Authors: Shah Sanjit Kumar , Bhandari Kritick , Shah Avish , Chaurasiya Gopal
Published: July 2024

COVID-19, stemming from the SARS-CoV-2 virus, has initiated a worldwide respiratory pandemic. Remarkable headway has been made in the realm of vaccination, as nearly every nation has initiated COVID-19 vaccine deployment. However, a mere 32.6% of individuals in low-income countries have received only a single vaccine dose. Unprecedented research and development endeavors have yielded over 170 COVID-19 vaccines, several of which are now in practical use. These vaccines have demonstrated remarkable efficacy in averting severe illness, hospitalization, and fatalities from COVID-19, even against emerging variants. Research pursuits persist, concentrating on novel vaccine technologies, oral and nasal vaccines, broader coronavirus protection, and vaccine combinations. In the realm of therapeutics, there have been significant strides in developing oral antiviral medications and monoclonal antibodies. Nonetheless, challenges in COVID-19 vaccination persist, encompassing issues of hesitancy, accessibility, financial barriers, knowledge gaps, and logistical hindrances. Robust monitoring via global agencies and reporting systems remains pivotal. Strategies for enhancing vaccination efficacy are rooted in fostering trust, countering misinformation, and expanding access. As for therapeutics, the approach involves dedicated research, clinical trials, regulatory streamlining, stockpiling, and international collaboration. Telemedicine and public awareness campaigns play integral roles in this effort, with coordination being the linchpin for preserving lives and mitigating the disease’s impact. The global campaign against COVID-19 has witnessed substantial advancements, with an ongoing research focus on developing vaccines and therapeutics that are not only more accessible and affordable but also more effective, particularly for populations in low-income countries and vulnerable communities.
Suicide by an Electric Power Drill and Spade Drill Bit
Authors: Watkins Trevor , Milne Nathan , Ong Beng Beng
Published: July 2024

Self-inflicted penetrating brain injuries with drills have been reported but are uncommon and typically involve the use of conventional drill bits. We report an unusual case of a 56-year-old man with a history of psychiatric illness who completed suicide using an electric drill and spade-type drill bit. Multiple superficial scalp and deeper bony injuries were sustained, although without breach of the dura, and death was not from brain injury, but secondary to venous air embolism related to entrainment of air into diploic vessels.
Deep Learning Reconstruction of Accelerated MRI: False-Positive Cartilage Delamination Inserted in MRI Arthrography Under Traction
Authors: Bosbach Wolfram A. , Merdes Kim Carolin , Jung Bernd , Montazeri Elham , Anderson Suzanne , Mitrakovic Milena , Daneshvar Keivan
Published: July 2024

Objectives:

The radiological imaging industry is developing and starting to offer a range of novel artificial intelligence software solutions for clinical radiology. Deep learning reconstruction of magnetic resonance imaging data seems to allow for the acceleration and undersampling of imaging data. Resulting reduced acquisition times would lead to greater machine utility and to greater cost-efficiency of machine operations.

Materials and Methods:

Our case shows images from magnetic resonance arthrography under traction of the right hip joint from a 30-year-old, otherwise healthy, male patient.

Results:

The undersampled image data when reconstructed by a deep learning tool can contain false-positive cartilage delamination and false-positive diffuse cartilage defects.

Conclusions:

In the future, precision of this novel technology will have to be put to thorough testing. Bias of systems, in particular created by the choice of training data, will have to be part of those assessments.
Surgery for Craniosynostosis: Developing a Psychosocial Booklet for Families
Authors: Stock Nicola M. , Pearse Lucy , Murfett Lucy , Pearse Kris , Kearney Anna , Horton Jo , Hilton Caroline , Wilkinson-Bell Karen
Published: July 2024

Parents of children with craniosynostosis may experience psychological distress, particularly during intensive periods of treatment. Yet, recent research indicates parents may not be accessing the support they need to cope with common challenges. The aim was to develop an evidence-based booklet to promote psychological health in families undergoing surgery and to assess the acceptability of the booklet among the craniosynostosis community. Researchers collaborated with UK charity Headlines Craniofacial Support, 5 parent representatives, and 2 specialist clinical psychologists to develop the booklet based on data obtained from online focus groups, individual interviews, and written accounts. The draft booklet was attached to an online acceptability survey and distributed to a broader group of parents and multidisciplinary craniofacial specialists for feedback. A total of 52 complete responses to the online acceptability survey were received, and acceptability (measured by the number of respondents who would recommend the booklet) was 100%. All respondents supported the UK-wide distribution of the booklet. Evidence for psychological intervention in the craniofacial field remains scarce, and specialist teams may be under-resourced to effectively screen and support families. It is hoped this booklet can begin to address the gap in psychological support for families affected by craniosynostosis.
METABOLIC AND BIOENERGETIC ALTERATIONS ARE ASSOCIATED WITH INFECTION SUSCEPTIBILITY IN SURVIVORS OF SEVERE TRAUMA: AN EXPLORATORY STUDY
Authors: Smith Samuel R. , Becker Eugene J. , Bone Nathaniel B. , Kerby Jeffrey D. , Nowak Joanna I. , Tadié Jean-Marc , Darley-Usmar Victor M. , Pittet Jean-Francois , Zmijewski Jaroslaw W.
Published: July 2024

Background: Trauma and blood loss are frequently associated with organ failure, immune dysfunction, and a high risk of secondary bacterial lung infections. We aim to test if plasma metabolomic flux and monocyte bioenergetics are altered in association with trauma and related secondary infections. Methods: Plasma samples were collected from trauma patients at three time points: days 0, 3, and 7 postadmission. Metabolites (140) were measured in plasma from trauma survivors (n = 24) and healthy control individuals (HC, n = 10). Further analysis within the trauma cohort included subsets of trauma/infection-negative (TIneg, n = 12) and trauma/infection-positive patients (TIpos, n = 12). The bioenergetic profile in monocytes was determined using mitochondrial and glycolytic stress tests. Results: In the trauma cohort, significant alterations were observed in 29 metabolites directly affecting 11 major metabolic pathways, while 34 metabolite alterations affected 8 pathways in 9, versus TIneg patients. The most altered metabolic pathways included protein synthesis, the urea cycle/arginine metabolism, phenylalanine, tyrosine, tryptophan biosynthesis, and carnitine compound family. In monocytes from trauma patients, reduced mitochondrial indices and loss of glycolytic plasticity were consistent with an altered profile of plasma metabolites in the tricarboxylic acid cycle and glycolysis. Conclusions: Our study highlights that the metabolic profile is significantly and persistently affected by trauma and related infections. Among trauma survivors, metabolic alterations in plasma were associated with reduced monocyte bioenergetics. These exploratory findings establish a groundwork for future clinical studies aimed at enhancing our understanding of the interplay between metabolic/bioenergetic alterations associated with trauma and secondary bacterial infections.
PREDICTION OF TIME TO HEMODYNAMIC STABILIZATION OF UNSTABLE INJURED PATIENT ENCOUNTERS USING ELECTRONIC MEDICAL RECORD DATA
Authors: Carroll Allison , Garg Ravi , Furmanchuk Alona , Lundberg Alexander , Silver Casey M. , Adams James , Moklyak Yuriy , Tomasik Thomas , Slocum John , Holl Jane , Shapiro Michael , Kong Nan , Andrei Adin-Cristian , Kho Abel , Stey Anne M.
Published: July 2024

Background: This study sought to predict time to patient hemodynamic stabilization during trauma resuscitations of hypotensive patient encounters using electronic medical record (EMR) data. Methods: This observational cohort study leveraged EMR data from a nine-hospital academic system composed of Level I, Level II, and nontrauma centers. Injured, hemodynamically unstable (initial systolic blood pressure, <90 mm Hg) emergency encounters from 2015 to 2020 were identified. Stabilization was defined as documented subsequent systolic blood pressure of >90 mm Hg. We predicted time to stabilization testing random forests, gradient boosting, and ensembles using patient, injury, treatment, EPIC Trauma Narrator, and hospital features from the first 4 hours of care. Results: Of 177,127 encounters, 1,347 (0.8%) arrived hemodynamically unstable; 168 (12.5%) presented to Level I trauma centers, 853 (63.3%) to Level II, and 326 (24.2%) to nontrauma centers. Of those, 747 (55.5%) were stabilized with a median of 50 min (interquartile range, 21–101 min). Stabilization was documented in 94.6% of unstable patient encounters at Level I, 57.6% at Level II, and 29.8% at nontrauma centers (P < 0.001). Time to stabilization was predicted with a C-index of 0.80. The most predictive features were EPIC Trauma Narrator measures, documented patient arrival, provider examination, and disposition decision. In-hospital mortality was highest at Level I, 3.0% vs. 1.2% at Level II, and 0.3% at nontrauma centers (P < 0.001). Importantly, nontrauma centers had the highest retriage rate to another acute care hospital (12.0%) compared to Level II centers (4.0%, P < 0.001). Conclusion: Time to stabilization of unstable injured patients can be predicted with EMR data.
Assessment and management of post-surgical pain in adult patients undergoing thoracic surgery: a best practice implementation project
Authors: González de la Cuesta Delia , González María Esther , López Ibort Nieves , Lahuerta Martínez Ana Carmen , de la Torre Arrieta Isabel , Martínez Mompel Ana Sofía , Martín Ramo M Pilar , Belsue Cortés Eva , Monge Nieto Mariana , Cayón Geli Cristina , Ferrando Margeli Mercedes Nuria
Published: July 2024

Introduction and objectives:

Effectiv. e management of post-operative pain improves the condition of patients and reduces their hospital stay. This, in turn, has an impact on caregivers, professionals, and institutions and, as such, is considered a primary indicator of quality. The aim of this project was to improve the assessment and management of post-surgical pain in thoracic surgery patients.

Methods:

This implementation project was conducted in a thoracic surgery unit of a tertiary hospital in Spain. The project was guided by the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit strategy. A baseline audit was conducted with 44 patients, and barriers to best practice were identified. Strategies were then implemented to improve the assessment and management of post-operative pain. Three follow-up audits were performed using nine audit criteria with 34, 40, and 46 patients, respectively.

Results:

The baseline audit revealed poor compliance with best practices. After implementing strategies to address areas of non-compliance, health education for patients and caregivers improved up to 80%, while the measurement of pain upon admission and post-surgery rose to 91%. However, patients undergoing pre-operative assessment to guide their post-operative pain management at hospital discharge remained below 50%.

Conclusions:

Using a methodology to implement best practices, together with clinical audits, improved compliance with the use of validated scales to assess and manage pain. A multidisciplinary approach improves the quality of care received by patients and contributes to their recovery.

Spanish abstract:

http://links.lww.com/IJEBH/A240
Evolution of threat response-related polymorphisms at the
SLC6A4
locus in callitrichid primates
Authors: Twyman Hanlu , Heywood India , Barros Marília , Zeredo Jorge , Mundy Nicholas I. , Santangelo Andrea M.
Published: July 2024

Variation in an upstream repetitive region at the
SLC6A4
locus, which encodes the serotonin transporter, is associated with anxiety-related behaviour in a few primate species, including humans and rhesus macaques, and has been suggested to be related to ecological adaptability among macaques. In this study, we investigate evolution of
SLC6A4
polymorphisms associated with anxiety-related behaviour in common marmosets (
Callithrix jacchus
). Assaying variation in the
SLC6A4
repeat region across 14 species in eight genera of callitrichid primates (marmosets and tamarins), we find large interspecific variation in the number of repeats present (24–43). The black tufted-ear marmoset (
C. penicillata
) has sequence polymorphisms similar to those found in the common marmoset, which is its sister species, and no other species has intraspecific variation at these sites. We conclude that, similar to humans and macaques, the functional polymorphism at
SLC6A4
in common marmosets has a recent evolutionary origin, and that the anxiety-related allele is evolutionarily derived. Common/black tufted-ear marmosets and rhesus/bonnet macaques share high ecological adaptability and behavioural flexibility that we propose may be related to the maintenance of the polymorphism.
Understanding the roles of economy and society in the relative risks of zoonosis emergence from livestock
Authors: Hinchliffe Stephen , Blanchette Alex , Chan Kin Wing (Ray) , Degeling Chris , Emel Jody , Leach Melissa , Scoones Ian , Winter Michael
Published: July 2024

The emergence of zoonotic infections that can develop into pathogens of pandemic potential is a major concern for public health. The risks of emergence and transmission relate to multiple factors that range from land use to human–non-human animal contacts. Livestock agriculture plays a potentially significant role in those risks, shaping landscapes and providing hosts that can act as the source or amplifiers of emergent pathogens. The relative risks will be contingent upon the nature of those systems, with comparisons often made between intensive, indoor, biosecure systems and more extensive, outdoor, insecure systems. Microbiological, ecological and veterinary sciences provide useful entry points in specifying and modelling some of the relative risks. Yet, they often do so with little regard for social science inputs and by making assumptions about social and economic conditions. In this article, we respond to recent analyses of relative risks by raising the importance of social and economic drivers of risk. We chart social science insights and research that materially alter the zoonotic risks associated with livestock production. Our purpose is to emphasize the requirement for full appreciation of the social, economic and political components of zoonotic and pandemic risk.
Three-dimensional geometric morphometric shape analysis of chest wall kinematics in different breathing conditions
Authors: Gómez-Recio Marta , Bastir Markus , LoMauro Antonella , Aliverti Andrea , Beyer Benoit
Published: July 2024

Breathing motion is based on the differential activity of the thoracic, diaphragmatic and abdominal muscles. Muscle contributions differ between rest and exercise conditions and depend on posture and other factors. Traditionally, these changes are investigated on volumetric data using optoelectronic plethysmography (OEP). OEP offers insight into size variations of different chest wall (CW) compartments but does not provide three-dimensional visualization methods of CW breathing kinematics. Here we explore the use of three-dimensional geometric morphometrics to analyse size and shape changes caused by spontaneous breathing motion during quiet (QB), and recovery breathing (REC, immediately after heavy exercise) in two different postures (SIT, sitting on cycle ergometer; STA, standing position). Our findings show that size and shape differ significantly between inspiration and expiration and that differences are greater in REC than in QB. However, this is achieved by stronger expiration in SIT but by greater expiratory and inspiratory movements in STA. Shape analysis suggests that these differences may be attributed to constrained mobility of the shoulder girdle and a minor thoracic spine extension during inspiration owing to position on the ergometer. Breathing motion in STA seems biomechanically less constrained. Geometric morphometrics analyses can provide additional insights into data obtained by OEP.
Lacrimispora brassicae sp. nov. isolated from fermented cabbage, and proposal of Clostridium indicum Gundawar et al. 2019 and Clostridium methoxybenzovorans Mechichi et al. 1999 as heterotypic synonyms of Lacrimispora amygdalina (Parshina et al. 2003) Haas and Blanchard 2020 and Lacrimispora indolis (McClung and McCoy 1957) Haas and Blanchard 2020, respectively
Authors: Kobayashi Hisami , Tanizawa Yasuhiro , Sakamoto Mitsuo , Ohkuma Moriya , Tohno Masanori
Published: July 2024

A Gram-stain-negative, endospore-forming, rod-shaped, indole-producing bacterial strain, designated YZC6T, was isolated from fermented cabbage. Strain YZC6T grew at 10–37  °C, pH 5.5–8.5, and with up to 2  % (w/v) NaCl. The major cellular fatty acids were C16 : 0 and C18 : 1
cis 11 dimethyl acetal. Phylogenetic analysis of the 16S rRNA gene revealed that strain YZC6T belonged to the genus Lacrimispora and was closely related to Lacrimispora aerotolerans DSM 5434T (98.3  % sequence similarity), Lacrimispora saccharolytica WM1T (98.1  %), and Lacrimispora algidixylanolytica SPL73T (98.1  %). The average nucleotide identity based on blast (below 87.8  %) and digital DNA–DNA hybridization (below 36.1 %) values between the novel isolate and its corresponding relatives showed that strain YZC6T could be readily distinguished from its closely related species. Based on genotypic, phenotypic, and chemotaxonomic data, a novel Lacrimispora species, Lacrimispora brassicae sp. nov., was proposed, with YZC6T as the type strain (=MAFF 212518T=JCM 32810T=DSM 112100T). This study also proposed Clostridium indicum Gundawar et al. 2019 as a later heterotypic synonym of Lacrimispora amygdalina (Parshina et al. 2003) Haas and Blanchard 2020 and Clostridium methoxybenzovorans Mechichi et al. 1999 as a later heterotypic synonym of Lacrimispora indolis (McClung and McCpy 1957) Haas and Blanchard 2020.
Building an antimicrobial stewardship model for a public-sector hospital: a pre-implementation study
Authors: Cassim Jowhara , Essack Sabiha Yusuf , Chetty Sarentha
Published: July 2024

Introduction. Antimicrobial resistance (AMR) is recognized as an important global health risk, associated with increased mortality, morbidity and healthcare costs. Antimicrobial stewardship (AMS) involves a coherent set of processes that promote the rational use of antimicrobials.

Gap statement. An AMS programme should be adapted and developed according to the available resources of a facility. This requires an analysis of the core AMS elements that are already in place and the resources available.

Aim. This study aimed to assess the readiness of a tertiary healthcare facility and staff towards implementing an antimicrobial stewardship programme (ASP).

Methodology. This study focused on two aspects during an AMS pre-implementation phase. A situational or strengths, weaknesses, opportunities, and threats analysis was conducted based on (1) a questionnaire on attitudes and perceptions of pharmacists, clinicians and nurses towards AMR and AMS and (2) a situational analysis on the readiness of the facility.

Results. The questionnaire, which was available for completion between September 2021 and December 2021, was sent to a total of 3100 healthcare professionals (HCPs). Thirty-two (1.0 %) HCPs comprising 2 pharmacists, 16 clinicians and 14 nurses completed the questionnaire. Of the total participants, 31 (96.9 %) viewed AMR as a problem in South African hospitals and 29 (90.6 %) perceived AMR as a problem at their facility. The majority (n = 29, 90.6 %) of the participants were familiar with the term AMS, and 26 (81.3 %) participants agreed to willingly participate in any initiatives involving antimicrobial use at the facility. The situational analysis depicted existing strengths in terms of AMS structures such as the formation of an AMS committee and information and technology systems at the HCP’s disposal. Weaknesses included the limited number of AMS activities being carried out and poor participation from HCPs within the AMS team.

Conclusion. A pre-implementation phase in the building of an ASP can greatly assist in finding gaps for improvement, which can then be addressed in the implementation phase. Furthermore, the pre-implementation phase provides a baseline to measure improvements once the implementation phase has been instituted.
Mild neonatal hypoxia disrupts adult hippocampal learning and memory and is associated with CK2-mediated dysregulation of synaptic calcium-activated potassium channel KCNN2
Authors: Riddle Art , Srivastava Taasin , Wang Kang , Tellez Eduardo , O’Neill Hanna , Gong Xi , O’Niel Abigail , Bell Jaden A , Raber Jacob , Lattal Matthew , Maylie James , Back Stephen A.
Published: July 2024

Objective

Although nearly half of preterm survivors display persistent neurobehavioral dysfunction including memory impairment without overt gray matter injury, the underlying mechanisms of neuronal or glial dysfunction, and their relationship to commonly observed cerebral white matter injury are unclear. We developed a mouse model to test the hypothesis that mild hypoxia during preterm equivalence is sufficient to persistently disrupt hippocampal neuronal maturation related to adult cellular mechanisms of learning and memory.

Methods: Neonatal (P2) mice were exposed to mild hypoxia (8%O2) for 30 min and evaluated for acute injury responses or survived until adulthood for assessment of learning and memory and hippocampal neurodevelopment.

Results

Neonatal mild hypoxia resulted in clinically relevant oxygen desaturation and tachycardia without bradycardia and was not accompanied by cerebral gray or white matter injury. Neonatal hypoxia exposure was sufficient to cause hippocampal learning and memory deficits and abnormal maturation of CA1 neurons that persisted into adulthood. This was accompanied by reduced hippocampal CA3-CA1 synaptic strength and LTP and reduced synaptic activity of calcium-sensitive SK2 channels, key regulators of spike timing dependent neuroplasticity, including LTP. Structural illumination microscopy revealed reduced synaptic density, but intact SK2 localization at the synapse. Persistent loss of SK2 activity was mediated by altered casein kinase 2 (CK2) signaling.

Interpretation

Clinically relevant mild hypoxic exposure in the neonatal mouse is sufficient to produce morphometric and functional disturbances in hippocampal neuronal maturation independently of white matter injury. Additionally, we describe a novel persistent mechanism of potassium channel dysregulation after neonatal hypoxia. Collectively our findings suggest an unexplored explanation for the broad spectrum of neurobehavioral, cognitive and learning disabilities that paradoxically persist into adulthood without overt gray matter injury after preterm birth.
BOOST: a robust ten-fold expansion method on hour-scale
Authors: Guo Jinyu , Yang Hui , Lu Chixiang , Cui Di , Zhao Murong , Li Cun , Chen Weihua , Yang Qian , Li Zhijie , Chen Mingkun , Zhao Shanchao , Zhou Jie , He Jiaye , Jiang Haibo
Published: July 2024

Expansion microscopy (ExM) enhances the microscopy resolution by physically expanding biological specimens and improves the visualization of structural and molecular details. Numerous ExM techniques and labeling methods have been developed and refined over the past decade to cater to specific research needs. Nonetheless, a shared limitation among current protocols is the extensive time required for sample processing, particularly for challenging-to-expand biological specimens (e.g., formalin-fixed paraffin-embedded (FFPE) sections and large three-dimensional specimens). Here, we have developed a rapid and robust ExM workflow named BOOST, which leverages a series of novel microwave (MW)-accelerated ExM chemistry, resulting in a single-step linear expansion of ∼10×. Specifically, BOOST facilitates a ∼10-fold expansion of cultured cells, tissue sections, and even the challenging-to-expand FFPE sections under merely 90 minutes with heat and surfactant-based protein denaturation. Furthermore, BOOST employs microwave-assisted proteomic staining and immunostaining to facilitate high-resolution visualization of structural and molecular details with significantly enhanced throughput. Noteworthily, BOOST has pioneered a ∼10-fold expansion of large millimeter-sized three-dimensional specimens in approximately three hours. BOOST offers an easily adaptable workflow based on stable and common reagents, thus boosting the potential adoption of ExM methods in biological investigations.
Mapping the genetic landscape establishing a tumor immune microenvironment favorable for anti-PD-1 response in mice and humans
Authors: Skelly Daniel A. , Graham John P. , Cheng Mingshan , Furuta Mayuko , Walter Andrew , Stoklasek Thomas A. , Yang Hongyuan , Stearns Timothy M. , Poirion Olivier , Zhang Ji-Gang , Grassmann Jessica D. S. , Luo Diane , Flynn William F. , Courtois Elise T. , Chang Chih-Hao , Serreze David V. , Menghi Francesca , Reinholdt Laura G. , Liu Edison T.
Published: July 2024

Identifying host genetic factors modulating immune checkpoint inhibitor (ICI) efficacy has been experimentally challenging because of variations in both host and tumor genomes, differences in the microbiome, and patient life exposures. Utilizing the Collaborative Cross (CC) multi-parent mouse genetic resource population, we developed an approach that fixes the tumor genomic configuration while varying host genetics. With this approach, we discovered that response to anti-PD-1 (aPD1) immunotherapy was significantly heritable in four distinct murine tumor models (H2between 0.18-0.40). For the MC38 colorectal carcinoma system (H2= 0.40), we mapped four significant ICI response quantitative trait loci (QTL) localized to mouse chromosomes (mChr) 5, 9, 15 and 17, and identified significant epistatic interactions between specific QTL pairs. Differentially expressed genes within these QTL were highly enriched for immune genes and pathways mediating allograft rejection and graft vs host disease. Using a cross species analytical approach, we found a core network of 48 genes within the four QTLs that showed significant prognostic value for overall survival in aPD1 treated human cohorts that outperformed all other existing validated immunotherapy biomarkers, especially in human tumors of the previously defined immune subtype 4. Functional blockade of two top candidate immune targets within the 48 gene network, GM-CSF and high affinity IL-2/IL-15 signaling, completely abrogated the MC38 tumor transcriptional response to aPD1 therapyin vivo. Thus, we have established a powerful cross speciesin vivoplatform capable of uncovering host genetic factors that establish the tumor immune microenvironment configuration propitious for ICI response.