bluuebunny/crossref_metadata_2025 huggingface dataset:
Genomic analysis reveals the population structure and antimicrobial resistance of avian Pasteurella multocida in China
Authors: Jiang Nansong , Chen Hongmei , Cheng Longfei , Fu Qiuling , Liu Rongchang , Liang Qizhang , Fu Guanghua , Wan Chunhe , Huang Yu
Published: November 2023

Objectives

To investigate the population structure and antimicrobial resistance (AMR) of avian Pasteurella multocida in China.

Methods

Utilizing WGS analysis, we explored the phylogeny using a dataset of 546 genomes, comprising avian P. multocida isolates from China (n = 121), the USA (n = 165), Australia(n = 153), Bangladesh (n = 3) and isolates of other hosts from China (n = 104). We examined the integrative and conjugative element (ICE) structures and the distribution of their components carrying resistance genes, and reconstructed the evolutionary history of A:L1:ST129 (n = 110).

Results

The population structure of avian P. multocida in China was dominated by the A:L1:ST129 clone with limited genetic diversity. A:L1:ST129 isolates possessed a broader spectrum of resistance genes at comparatively higher frequencies than those from other hosts and countries. The novel putative ICEs harboured complex resistant clusters that were prevalent in A:L1:ST129. Bayesian analysis predicted that the A:L1:ST129 clone emerged around 1923, and evolved slowly.

Conclusions

A:L1:ST129 appears to possess a host predilection towards avian species in China, posing a potential health threat to other animals. The complex AMR determinants coupled with high frequencies may strengthen the population dominance of A:L1:ST129. The extensive antimicrobial utilization in poultry farming and the mixed rearing practices could have accelerated AMR accumulation in A:L1:ST129. ICEs, together with their resistant clusters, significantly contribute to resistance gene transfer and facilitate the adaptation of A:L1:ST129 to ecological niches. Despite the genetic stability and slow evolution rate, A:L1:ST129 deserves continued monitoring due to its propensity to retain resistance genes, warranting global attention to preclude substantial economic losses.
Exploring zinc deficiency using serum Zn levels: consequences and potential solutions in suckling pigs
Authors: Blavi Laia , Villagómez-Estrada Sandra , Solà-Oriol David , Pérez José F
Published: November 2023

Three trials were undertaken to provide an answer to different questions: 1) Are suckling pigs able to maintain physiological serum Zn levels throughout lactation and do these levels vary between high and low body weight (BW) pigs?, 2) Are serum Zn levels in pigs soon after weaning a predisposing factor for diarrhea?, and 3) Is it possible to increase serum Zn levels at weaning by supplementing Zn during lactation. In trial 1, blood samples were taken from pigs during lactation. Eight pigs (one piglet per litter) had blood drawn on days 0 (farrowing), 7, 14, 21, and 28 (weaning), and 60 pigs (selected from the whole farrowing batch with 35 sows), categorized as either heavy (8.63 kg) or light (5.50 kg) had blood drawn on day 28. Serum Zn levels at birth were 1.2 mg/L and decreased (P < 0.01) to 0.67 mg/L on day 28. Heavier pigs showed greater (P < 0.01) serum Zn levels (0.98 mg/L) than light BW pigs (0.79 mg/L). In trial 2, blood samples were obtained from 240 pigs at weaning (26.2 ± 2.5 d) with an average initial BW of 6.94 ± 1.87 kg and were distributed into 24 pens (10 pigs/pen) by BW. Diarrhea incidence was recorded daily from days 0 to 35 post-weaning. From the 240 pigs, a group of 110 pigs with uniform BW (6.5 ± 1.9 kg) was selected and separated into two groups based on serum Zn levels at weaning with 55 pigs with low serum Zn (LZn: <0.71 mg/L) and 55 pigs with high serum Zn (HZn: >0.9 mg/L). Pigs with LZn were 2.49 times as likely to have diarrhea as pigs with HZn (P < 0.02). In trial 3, a total of 96 suckling pigs were allotted four treatments that consisted of the daily administration of 0, 6, 18, or 30 mg of Zn as Zn citrate in capsule form during the last 7 d of lactation. Pigs were individually weighed, and blood samples were obtained on days 14, 21 (weaning), and 7 after weaning. Serum Zn levels linearly increased by day as Zn citrate supplementation increased (interaction, P < 0.001). However, only light pigs supplemented with 18 and 30 mg/L of Zn experienced an increase in serum Zn levels during lactation. In conclusion, a decrease in serum Zn levels occurs during lactation and is more severe in low BW pigs. Low Zn status (< 0.7 mg/L) at weaning may be a predisposing factor for diarrhea. However, Zn supplementation during lactation can mitigate this decrease in light pigs.
Supercomplex formation of mitochondrial respiratory chain complexes in leukocytes from patients with neurodegenerative diseases
Authors: Hara Tsukasa , Amagai Ryosuke , Sakakibara Ryuji , Okado-Matsumoto Ayako
Published: November 2023

With population aging, cognitive impairments and movement disorders due to neurodegenerative diseases, such as Alzheimer’s disease (AD), Parkinson’s disease (PD) and dementia with Lewy bodies (DLB), are increasingly considered as key social issues. Clinically, it has remained challenging to diagnose them before the onset of symptoms because of difficulty to observe the progressive loss of neurons in the brain. Therefore, with exploratory research into biomarkers, a number of candidates have previously been proposed, such as activities of mitochondrial respiratory chain complexes in blood in AD and PD. In this study, we focused on the formation of mitochondrial respiratory chain supercomplexes (SCs) because the formation of SC itself modulates the activity of each complex. Here we investigated the SC formation in leukocytes from patients with AD, PD and DLB. Our results showed that SCs were well formed in AD and PD compared with controls, while poorly formed in DLB. We highlighted that the disruption of the SC formation correlated with the progression of PD and DLB. Taking our findings together, we propose that pronounced SC formation would already have occurred before the onset of AD, PD and DLB and, with the progression of neurodegeneration, the SC formation would gradually be disrupted.
A reflection on the teacher education curriculum and the decolonizing agenda in England
Authors: Byrd Jo , Stothard Jack Bryne
Published: November 2023

This paper is a reflective piece on the thought processes individuals and teams have when engaging in decoloniality work in Teacher Training/Education. We argue that until the self is decolonized, the process of decolonialization becomes rhetoric. We also question how much we can decolonize whilst working in the academy whose very culture, symbols and practices are borne out of colonialism and the period of enlightenment; whose very raison d’être is to elevate some knowledge over others and to claim cultural and academic superiority. The current political landscape in England approaches anti-racism as a political ideology that must be avoided in schools and education and this ideological battlefield is evident in teacher education. We aim to recognize the tensions and resistance to decolonialize, which demonstrates the messy and contingent process of moving between shifting positions and subjectivities. It confronts the challenge of the teacher–practitioner who must balance their own moral and philosophical grounding whilst attending the political imperatives of the work. This can take the form of according with the policies and procedures of the institutions in which they are situated which can often be balkanizing and debilitating.
Community pharmacists’ perception and role in early diagnosis and health promotion of celiac disease
Authors: Al-Suhaimat Rawan , Al-Halaseh Lidia K , Al-Samydai Ali
Published: November 2023

Objectives

The study aims to measure pharmacists’ knowledge and perception of celiac disease.

Methods

A Google form was used to collect data randomly from 283 pharmacists. The effects of each of the following hypotheses towards early diagnosis of celiac disease and patient compliance were studied: pharmacist’s experience in community pharmacies (H1), pharmacist’s knowledge (H2), pharmacist’s participation in continuing learning programmes (H3), and pharmacist’s attitude and practice (H4).

Key findings

A robust relationship between the variables was confirmed and was expressed by the moderate mean effect of H1, H2, H3, and H4 (2.3332, 2.3386, 2.1731, and 2.5717, respectively, and the correlation coefficient [r] of 0.797). Findings suggest that H1 is moderately correlated with H2 and H3 but weakly correlated with H4 (0.568 and 0.518, 0.183, respectively). Around a third of the participants (33.9%) admit their lack of knowledge regarding the symptoms. A third of the participants would refer the patients with recurrent symptoms to the physician. Three-quarters of the participants (78.4%) have not attended any educational programme, but they show a high desire (84.1%) to participate in such events either in person (50.2%) or through distance learning applications (36.4%).

Conclusion

Pharmacists have crucial roles in early diagnosis, monitoring patient compliance, and providing counselling regarding celiac disease. Updating their knowledge should contribute to improving the overall health status of the patients and cutting off the expenses for the health sector.
Optimization of limonin invertase production by scaling up Aspergillus tubingensis UA13 fermentation to a 5-l scale
Authors: Chen Yuting , Yang Dandan , Ouyang Nongfei , Lei Shengjiao , Liu Haiyan , Huang Yiwei , Wu Junqian
Published: November 2023

The enzymatic approach is a highly effective and the major scientific method to eliminating bitter components in citrus-derived products nowadays. Microbial production of limonin invertase stands out due to its pivotal role in the removal of the bitter substance, limonin. The optimization of fermentation parameters and the study of scale-up fermentation are imperative for product commercialization. In this study, we focused on optimizing stirring speed, fermentation temperature, and initial pH to enhance the growth and limonin invertase production by the Aspergillus tabin strain UA13 in a 5-l stirred-tank bioreactor. Our results revealed the following optimal parameters are: a stirring speed of 300 rpm, a fermentation temperature of 35°C and a pH 5.0. Under these optimized conditions, the limonin invertase activity reached its peak at 63.38 U ml−1, representing a 1.67-fold increase compared to the unoptimized conditions (38.10 U ml−1), while also reducing the fermentation duration by 12 h. Furthermore, our research demonstrated that limonin invertase effectively hydrolyze limonin in grapefruit juice, reducing its content from 13.28 to 2.14 μg ml−1, as determined by HPLC, resulting in a 6.21-fold reduction of the bitter substance.
Follicular lymphoma with secondary central nervous system relapse: a case report and literature review
Authors: Tsuboi Yuri , Shimizu Misayo , Kuroda Akihiro , Suyama Takuya , Seki Masanori , Shinagawa Atsushi
Published: November 2023

Secondary central nervous system (CNS) relapse by aggressive non-Hodgkin’s lymphoma is a well-known complication portending a very poor prognosis. Conversely, patients with indolent lymphoma-like follicular lymphoma (FL) rarely present with CNS involvement and, thus, limited information is currently available. We herein describe a patient with FL who developed CNS involvement during chemotherapy. Treatment including high-dose methotrexate and radiation therapy was ineffective and the patient died 5 months after CNS relapse. In a literature review, there were 8 case reports of the secondary CNS relapse of FL. The findings obtained suggest that bone marrow infiltration is a risk factor for CNS relapse. Moreover, 5 out of 9 patients died within 2.5 years, indicating a poorer prognosis than that of FL. Therefore, it is important to promptly perform detailed examinations as soon as neurological findings appear.
VZV Encephalitis with Brucella coinfection—case report
Authors: Allahyari Fakhri , Halabian Raheleh , Nejad Javad Hosseini
Published: November 2023

Encephalitis occasionally occurs due to the central nervous system (CNS) infection by Varicella-zoster virus (VZV). The coincidence of herpes Encephalitis-brain infection and brucellosis occurs rarely. In this case, a 56-year-old woman was described with low consciousness, seizures, fever, and mood disorders. The brain CT revealed no pathological lesions, but MR showed non-specific plaques in the periventricular white matter. VZV was detected in molecular tests for the panel of viral Encephalitis in cerebrospinal fluid (CSF). The blood culture and the Wright test revealed the presence of Brucella spp. The antiviral treatment of choice was Acyclovir, Levetiracetam to control seizures, and Ampicillin/Sulbactam as prophylaxis antibiotics. Coinfections common poor prognoses makes it crucial to administer antiviral medications immediately. Many clinical challenges require a multidisciplinary team, including involvement of the CNS, resistance to viral strains, reactivation of diseases, and drug toxicity. The early detection of Encephalitis and treatment can promptly prevent exacerbation and complications.
Autophagy Promotes Cell Death Induced by Hydrogen Peroxide in Physcomitrium patens
Authors: Sakil Md Arif , Mukae Kyosuke , Bao Junyu , Sadhu Abhishek , Roni Md. Shyduzzaman , Inoue-Aono Yuko , Moriyasu Yuji
Published: November 2023

The autophagy-defective mutants (atg5 and atg7) of Physcomitrium patens exhibit strong desiccation tolerance. Here, we examined the effects of H2O2 on wild-type (WT) and autophagy-defective mutants of P. patens, considering that desiccation induces reactive oxygen species (ROS). We found that atg mutants can survive a 30-min treatment with 100 mM H2O2, whereas WT cannot, implying that autophagy promotes cell death induced by H2O2. Concomitant with cell death, vacuole collapse occurred. Intracellular H2O2 levels in both WT and atg5 increased immediately after H2O2 treatment and subsequently reached plateaus, which were higher in WT than in atg5. The ROS scavenger N-acetylcysteine lowered the plateau levels in WT and blocked cell death, suggesting that higher H2O2 plateau caused cell death. The uncoupler of electron transport chain (ETC) carbonyl cyanide m-chlorophenylhydrazone also lowered the H2O2 plateaus, showing that ROS produced in the ETC in mitochondria and/or chloroplasts elevated the H2O2 plateau. The autophagy inhibitor 3-methyladenine lowered the H2O2 plateau and the cell death rate in WT, suggesting that autophagy occurring after H2O2 treatment is involved in the production of ROS. Conversely, the addition of bovine serum albumin, which is endocytosed and supplies amino acids instead of autophagy, elevated the H2O2 plateau in atg5 cells, suggesting that amino acids produced through autophagy promote H2O2 generation. These results clearly show that autophagy causes cell death under certain stress conditions. We propose that autophagy-derived amino acids are catabolized using ETCs in mitochondria and/or chloroplasts and produce H2O2, which in turn promotes the cell death accompanying vacuole collapse.
Garnet–Quartz Inclusion Thermobarometry and Lu–Hf Chronology Detail the Pre-Ultra-High Pressure Metamorphic History of the Grapesvare Nappe, Scandinavian Caledonides
Authors: Barnes Christopher J , Gilio Mattia , Bukała Michał , Włodek Adam , Majka Jarosław , Smit Matthijs , Alvaro Matteo
Published: November 2023

The subduction–exhumation history of the Grapesvare nappe in the northern Seve Nappe Complex (Scandinavian Caledonides) is recorded by late Cambrian/Early Ordovician ultra-high pressure (UHP) and subsequent amphibolite facies metamorphic events. Records of these events obscured earlier metamorphic episodes that are important for understanding the tectonics of the orogen. To extract the pre–UHP metamorphic records, garnet Lu–Hf geochronology, Titanium-in-Quartz thermobarometry, and Quartz-in-Garnet elastic thermobarometry were applied to garnet porphyroblasts in metasedimentary rocks and eclogite. Metasedimentary rocks contain chemically homogeneous garnet (Grt-M1) with shape-matured quartz inclusions. In some rocks, these garnets are overgrown by garnet with bell-shaped Mn-zoning (Grt-M2) containing irregularly-shaped quartz inclusions. This evolution is interpreted as partial dissolution of Grt-M1 and subsequent growth of Grt-M2. Garnet in the eclogite is volumetrically dominated by eclogite-facies garnet (Grt-E1) that envelope remnants of an older, chemically distinct generation (Grt-E0) with highly irregular and diffuse boundaries. Shape-matured quartz inclusions are present within both garnet generations and define a zoning pattern that is not reflective of the chemical zoning. Collectively, these characteristics are interpreted as replacement of Grt-E0 by Grt-E1 via interface-coupled dissolution–reprecipitation, with the latter inheriting the shape-matured quartz inclusions of the former. Pressure–temperature (P–T) conditions extracted from the quartz inclusions in Grt-M1 and Grt-E0/E1 are 1.08 to 1.21 GPa at 645°C to 695°C and 0.94 to 1.03 GPa at 605°C to 640°C, respectively. These conditions are interpreted as cooling of the rocks from a high temperature metamorphic history, altogether preceding subduction of the Grapesvare nappe. The quartz inclusions in Grt-M2 record 1.04 to 1.21 GPa at 620°C to 675°C, interpreted as prograde metamorphic growth of Grt-M2 during subduction at 495.7 ± 3.2 Ma. Subsequent eclogite-facies metamorphism was responsible for the formation of Grt-E1 at the expense of Grt-E0. The collective results indicate a prolonged polymetamorphic history of the Grapesvare nappe prior to UHP metamorphism that has not been recognized previously.
Venture Capital Investments, Merger Activity, and Competition Laws around the World
Authors: Phillips Gordon M , Zhdanov Alexei
Published: November 2023

We examine the relation between venture capital (VC) investments, M&A activity, and merger competition laws in 45 countries around the world. We find evidence of a strong positive association between VC investments and lagged M&A activity, consistent with an active M&A market providing viable exit opportunities for VC companies and therefore incentives for venture capitalists to invest. We also explore the effects of country-level merger competition laws and pro-takeover legislation passed internationally on VC activity. We find significant reductions in VC activity in countries with stricter competition laws and find that VC activity intensifies after the enactment of country-level takeover-friendly legislation. (JEL G15, G24, D43, K21, L26)
Colchicine: the good, the bad, the ugly and how to minimize the risks
Authors: Stamp Lisa K , Horsley Carl , Te Karu Leanne , Dalbeth Nicola , Barclay Murray
Published: November 2023

Colchicine has an important role in managing various conditions, including gout, familial Mediterranean fever, amyloidosis, Behçet’s syndrome, recurrent pericarditis and calcium pyrophosphate deposition disease. The adverse effect profile of colchicine is well understood. However, due to its narrow therapeutic index, colchicine has been associated with overdose and fatalities. When ingested in toxic amounts, the mainstay of management is supportive care. Strategies to minimize the risk of colchicine poisoning can focus on three broad causes: unauthorized access, intentional overdose and inappropriate dosing. Culturally safe and appropriate education about storage and appropriate use of colchicine is essential to minimize the risk of overdose.
Assessment of organ doses, peak skin doses and effective doses in patients undergoing anterior cervical discectomy and fusion utilising VirtualDose-IR software
Authors: Metaxas Vasileios , Dimitroukas Christos , Efthymiou Fotios , Delis Harry , Gatzounis George , Tzortzidis Fotios , Zampakis Petros , Theofanopoulos Andreas , Constantoyannis Constantine , Panayiotakis George
Published: November 2023

In this study, the effect of patient- and procedure-related parameters on organ doses (ODs), peak skin dose (PSD) and effective dose (E) during anterior cervical discectomy and fusion (ACDF) was evaluated. Patient- and procedure-related parameters, as well as fluoroscopy time, kerma-area product (KAP), cumulative air-kerma (Kair) and incident Kair, were analysed for 50 ACDF procedures performed with a mobile C-arm. These parameters were inserted in VirtualDose-IR software implementing sex-specific and body mass index (BMI)-adjustable anthropomorphic phantoms to calculate OD, PSD and E. The BMI, gender and type of implants did not significantly affect KAP, incident Kair, PSD and E. However, the type of fusion significantly affected the E. The single fusions in C5/C6 resulted in significantly higher KAP, incident Kair and E than C4/C5 levels, while those performed in C6/C7 resulted in significantly higher E and PSD than C4/C5 levels. The thyroid, oesophagus and salivary glands received the largest doses in all groups studied. The BMI did not significantly affect ODs. The salivary glands absorbed significantly higher doses in males than females, while the extrathoracic region’s dose significantly increased for multi- than single-level fusions. The fusions in C6/C7 resulted in significantly higher oesophagus and thyroid doses than C3/C4 and C4/C5 levels, as well as fusions performed in C5/C6 compared with C4/C5 levels. The data presented here could be used by the neurosurgeons as a comparator for future studies in optimising radiation protection during ACDF procedures in the operating theatre by keeping the ODs, PSD and E as low as reasonably practicable.
Childhood Adversity Determines the Syndemic Effects of Violence, Substance Misuse, and Sexual Behavior on Psychotic Spectrum Disorder Among Men
Authors: Zhang Yamin , Coid Jeremy
Published: November 2023

Background and hypothesis

Childhood adversity (CA) increases the risk for several adult psychiatric conditions. It is unclear why some exposed individuals experience psychotic symptoms and others do not. We investigated whether a syndemic explained a psychotic outcome determined by CA.

Study design

We used self-reported cross-sectional data from 7461 British men surveyed in different population subgroups. Latent class analysis (LCA) identified categorical psychopathological outcomes. LCs were tested by interaction analysis between syndemic factors derived from confirmatory factor analysis according to CA experiences. Pathway analysis using partial least squares path modeling.

Results

A 4-class model with excellent fit identified an LC characterized by both psychotic and anxiety symptoms (class 4). A syndemic model of joint effects, adducing a 3-component latent variable of substance misuse (SM), high-risk sexual behavior (SH), violence and criminality (VC) showed synergy between components and explained the psychotic outcome (class 4). We found significant interactions between factor scores on the multiplicative scale, specific only to class 4 (psychosis), including SM × SH, SH × VC, and SM × VC (OR > 1, P < .05); and on the additive scale SM × SH (relative excess risk due to interaction >0, P < .05), but only for men who experienced CA.

Conclusion

Multiplicative synergistic interactions between SM, SH, and VC constituted a mechanism determining a psychotic outcome, but not for anxiety disorder, mixed anxiety disorder/depression, or depressive disorder. This was specific to men who had experienced CA along direct and syndemic pathways. Population interventions should target SM and VC in adulthood but prioritize primary prevention strategies for CA.
Patient and Hospital Characteristics Associated With the Interhospital Transfer of Adult Patients With Sepsis
Authors: Ofoma Uchenna R. , Lanter Tierney J. , Deych Elena , Kollef Marin , Wan Fei , Joynt Maddox Karen E.
Published: November 2023

IMPORTANCE:

The interhospital transfer (IHT) of patients with sepsis to higher-capability hospitals may improve outcomes. Little is known about patient and hospital factors associated with sepsis IHT.

OBJECTIVES:

We evaluated patterns of hospitalization and IHT and determined patient and hospital factors associated with the IHT of adult patients with sepsis.

DESIGN:

Retrospective cohort study.

SETTING AND PARTICIPANTS:

A total of 349,938 adult patients with sepsis at 329 nonfederal hospitals in California, 2018–2019.

MAIN OUTCOMES AND MEASURES:

We evaluated patterns of admission and outward IHT between low sepsis-, intermediate sepsis-, and high sepsis-capability hospitals. We estimated odds of IHT using generalized estimating equations logistic regression with bootstrap stepwise variable selection.

RESULTS:

Among the cohort, 223,202 (66.4%) were initially hospitalized at high-capability hospitals and 10,870 (3.1%) underwent IHT. Nearly all transfers (98.2%) from low-capability hospitals were received at higher-capability hospitals. Younger age (< 65 yr) (adjusted odds ratio [aOR] 1.54; 95% CI, 1.40–1.69) and increasing organ dysfunction (aOR 1.22; 95% CI, 1.19–1.25) were associated with higher IHT odds, as were admission to low-capability (aOR 2.79; 95% CI, 2.33–3.35) or public hospitals (aOR 1.35; 95% CI, 1.09–1.66). Female sex (aOR 0.88; 95% CI, 0.84–0.91), Medicaid insurance (aOR 0.59; 95% CI, 0.53–0.66), home to admitting hospital distance less than or equal to 10 miles (aOR 0.92; 95% CI, 0.87–0.97) and do-not-resuscitate orders (aOR 0.48; 95% CI, 0.45–0.52) were associated with lower IHT odds, as was admission to a teaching hospital (aOR 0.83; 95% CI, 0.72–0.96).

CONCLUSIONS AND RELEVANCE:

Most patients with sepsis are initially hospitalized at high-capability hospitals. The IHT rate for sepsis is low and more likely to originate from low-capability and public hospitals than from high-capability and for-profit hospitals. Transferred patients with sepsis are more likely to be younger, male, sicker, with private medical insurance, and less likely to have care limitation orders. Future studies should evaluate the comparative benefits of IHT from low-capability hospitals.
Summary of the 2022 Report on Cardiovascular Health and Diseases in China
Authors: Wang Zengwu , Ma Liyuan , Liu Mingbo , Fan Jing , Hu Shengshou
Published: November 2023

Recent decades have seen the remarkable development of China in medical accessibility and quality index, and the application of a number of new advanced cardiovascular technologies benefits more patients. However, according to the Annual Report on Cardiovascular Health and Diseases in China published in this article, which was organized and summarized by National Center for Cardiovascular Diseases, there is still a huge population living with risk factors of cardiovascular diseases (CVD), and the morbidity and mortality of CVD are increasing. It is estimated that there are around 330 million patients suffering from CVD currently, including 245 million of hypertension, 13 million of stroke, 45.3 million of peripheral artery disease, 11.39 million of coronary heart disease (CHD), 8.9 million of heart failure, 5 million of pulmonary heart disease, 4.87 million of atrial fibrillation, 2.5 million of rheumatic heart disease, and 2 million of congenital heart disease. Tobacco use, diet and nutrition factors, physical activity, overweight and obesity, and psychological factors are what affect cardiovascular health, while hypertension, dyslipidemia, diabetes, chronic kidney disease, metabolic syndrome, and air pollution are the risk factors for CVD. In this article, in addition to risk factors for CVD, we also report the epidemiological trends of CVD, including CHD, cerebrovascular disease, arrhythmias, valvular heart disease, congenital heart disease, cardiomyopathy, heart failure, pulmonary vascular disease and venous thromboembolism, and aortic and peripheral artery diseases, as well as the basic research and medical device development in CVD. In a word, China has entered a new stage of transforming from high-speed development focusing on scale growth to high-quality development emphasizing on strategic and key technological development to curb the trend of increasing incidence and mortality of CVD.
Implementation Strategies Addressing Stakeholder-Perceived Barriers and Enablers to the Establishment of a Beta-Lactam Antibiotic Therapeutic Drug Monitoring Program: A Qualitative Analysis
Authors: Pai Mangalore Rekha , Udy Andrew Alexander , Peel Trisha Nicole , Peleg Anton Yariv , Ayton Darshini
Published: November 2023

Background:

Therapeutic drug monitoring (TDM) of beta-lactam antibiotics (beta-lactams) is increasingly recommended for optimizing antibiotic exposure in intensive care patients with sepsis. However, limited data are available on the implementation of beta-lactam TDM in complex health care settings. Theory-based approaches were used to systematically explore barriers and enablers perceived by key stakeholders in the implementation of beta-lactam TDM in the intensive care unit.

Methods:

In this qualitative descriptive study, the authors interviewed key stakeholders (n = 40): infectious disease physicians, intensive care unit physicians, pharmacists, clinical leaders, scientists, and nurses. The data were thematically analyzed and coded using the theoretical domains framework, and the codes and themes were mapped to the relevant domains of the capability, opportunity, and motivation behavior-change wheel model.

Results:

Barriers included a lack of knowledge, experience, evidence, and confidence, which led to concerns about capability, lack of resources, and harm in straying from standard practice. Access to education and guidelines, on-site assays with short turnaround times, communication among teams, and workflow integration were identified as enablers. A focus on patient care, trust in colleagues, and endorsement by hospital leaders were strong motivators. Pharmacist and nursing stakeholder groups emerged as key targets in the implementation of strategies.

Conclusions:

Using theory-based approaches, the authors identified the key barriers and enablers to establishing beta-lactam TDM. These data were used to identify strategies, policies, and key target groups for the implementation of interventions.
Artificial intelligence for glaucoma: state of the art and future perspectives
Authors: Correia Barão Rafael , Hemelings Ruben , Abegão Pinto Luís , Pazos Marta , Stalmans Ingeborg
Published: November 2023

Purpose of review

To address the current role of artificial intelligence (AI) in the field of glaucoma.

Recent findings

Current deep learning (DL) models concerning glaucoma diagnosis have shown consistently improving diagnostic capabilities, primarily based on color fundus photography and optical coherence tomography, but also with multimodal strategies. Recent models have also suggested that AI may be helpful in detecting and estimating visual field progression from different input data. Moreover, with the emergence of newer DL architectures and synthetic data, challenges such as model generalizability and explainability have begun to be tackled.

While some challenges remain before AI is routinely employed in clinical practice, new research has expanded the range in which it can be used in the context of glaucoma management and underlined the relevance of this research avenue.
Enhancing Campus Safety
Authors: Anderson Jocelyn C. , Nguyen Meghan U. , Huynh Wendy , Sharif Khadeeja , Draughon Moret Jessica E.
Published: November 2023

Background

Alcohol-related sexual violence, including sexual coercion, nonconsensual contact, and rape, is prevalent on college campuses.

Aim

The purpose of the study was to investigate college students' feedback and recommendations regarding content for a text-message-delivered harm reduction intervention to jointly address alcohol use and alcohol's role in sexual violence risk.

Methods

This qualitative thematic study used focus groups and individual interviews to collect feedback from 61 college students between February 2019 and July 2020.

Results

Targeted recruitment resulted in a sample that was nearly half queer/ lesbian, gay, bisexual (46.2%) or trans* (9.8%) identified students. Participants endorsed text messaging as an effective way to reach college students but diverged in specific content they felt was relevant and appropriate for a universal education intervention. Students preferred content describing individual strategies versus those requiring collaboration from friends or potential sex partners. Students also preferred content phrased as suggestions or questions versus declarative statements. Although most participants recognized the value of content related to consent, sexual violence, sexual health, and resources, a few male-identifying participants failed to recognize that content as important to their experience. Maintaining brevity while discussing consent in the overlapping settings of drinking and interpersonal relationships was described as a particular challenge.

Impact of This Work on Campus Sexual Assault and Forensic Nursing

Students in our sample highlighted the challenges of sharing sexual violence and alcohol-related harm reduction text messaging because of the complexities of rape culture, consent, and interpersonal dynamics during college student drinking events.
Comparing EUS-directed Transgastric ERCP (EDGE) Versus Laparoscopic-Assisted ERCP Versus Enteroscopic ERCP
Authors: Gangwani Manesh K. , Aziz Muhammad , Haghbin Hossein , Iqbal Amna , Dillard Julia , Dahiya Dushyant S. , Ali Hassam , Hayat Umar , Khuder Sadik , Lee-Smith Wade , Nawras Yusuf , Kamal Faisal , Inamdar Sumant , Alastal Yaseen , Thosani Nirav , Adler Douglas
Published: November 2023

Background:

Management of choledocholithiasis in patients with Roux-en-Y gastric bypass surgery is challenging. This study aims to compare technical success rates, adverse events, and procedural time between 3 current approaches: endoscopic ultrasound-directed transgastric Endoscopic retrograde cholangiopancreatography (ERCP) (EDGE), enteroscopy-assisted ERCP (E-ERCP), and laparoscopic-assisted ERCP (LA-ERCP).

Methods:

A systematic search of 5 databases was conducted. Direct and network meta-analyses were performed to compare interventions using the random effects model. A significance threshold of P < 0.05 was applied.

Results:

Sixteen studies were included. On direct meta-analysis, technical success rates were comparable between EDGE and LA-ERCP (odds ratio: 0.768, CI: 0.196-3.006, P = 0.704, I
2 = 14.13%). However, EDGE and LA-ERCP showed significantly higher success rates than E-ERCP. No significant differences in adverse events were found between EDGE versus LA-ERCP, EDGE versus E-ERCP, and LA-ERCP versus E-ERCP on direct meta-analysis. In terms of procedural time, EDGE was significantly shorter than E-ERCP [mean difference (MD): −31 minutes, 95% CI: −40.748 to −21.217, P < 0.001, I
2 = 19.89%), and E-ERCP was shorter than LA-ERCP (MD: −44.567 minutes, 95% CI: −76.018 to −13.116, P = 0.005, I
2 = 0%). EDGE also demonstrated a significant time advantage over LA-ERCP (MD: −78.145 minutes, 95% CI: −104.882 to −51.407, P < 0.001, I
2 = 0%). All findings were consistent with network meta-analysis on random effects model. The heterogeneity of the model was low.

Conclusions:

EDGE and LA-ERCP showed superior technical success rates compared with E-ERCP. Adverse events did not significantly differ among the three approaches. Furthermore, EDGE demonstrated the shortest procedural duration. We recommend considering EDGE as a first-choice procedure.
Evaluation of a Novel Easy Loop-Forming Guidewire to Reduce Post–Endoscopic Retrograde Cholangiopancreatography Pancreatitis for Serial Pancreatic Juice Aspiration Cytologic Examination
Authors: Mandai Koichiro , Inoue Takato , Yoshimoto Takaaki , Ogawa Tomoya , Uno Koji , Yasuda Kenjiro
Published: November 2023

Objective

This study aimed to investigate whether a novel, easy loop-forming guidewire could reduce post–endoscopic retrograde cholangiopancreatography pancreatitis (PEP) in patients undergoing endoscopic nasopancreatic drainage tube placement for serial pancreatic juice aspiration cytologic examination (SPACE).

Methods

We evaluated patients with suspected pancreatic cancer who underwent SPACE at our institution between January 2015 and April 2023 retrospectively. The patients were divided into 2 groups based on the type of guidewire used, namely, easy loop-forming and control groups. Propensity score matching was used to compare the incidence of PEP between the groups.

Results

We included 101 patients, with 51 and 50 in the easy loop-forming and control groups, respectively. After propensity score matching, 29 pairs of patients were selected from each group. Intraductal ultrasonography of the pancreas was performed more frequently in the easy loop-forming group than in the control group (27.6% vs 0%; P = 0.004); however, PEP incidence was significantly lower in the easy loop-forming group than in the control group (3.4% vs 27.6%; odds ratio, 0.097; 95% confidence interval, 0.002–0.82; P = 0.025).

Conclusions

The use of the novel easy loop-forming guidewire decreased PEP occurrence in patients who underwent endoscopic nasopancreatic drainage tube placement for SPACE.
Elucidating the Role of miRNA-326 Modulating Hedgehog Signaling in Pancreatic Carcinoma
Authors: Rashid Safoora , Rashid Sumaira , Das Prasenjit , Malik Nargis , Dash Nihar Ranjan , Singh Nidhi , Pandey R. M. , Kumar Lalit , Chauhan Shyam Singh , Chosdol Kunzang , Gupta Surabhi , Saraya Anoop
Published: November 2023

Background and Aim

Pancreatic ductal adenocarcinoma (PDAC) is one of the lethal malignancies worldwide characterized by poor prognosis. MicroRNAs (miRNAs) function as the key regulators in carcinogenesis and may act as noninvasive biomarkers in various malignancies including PDAC. The present study aimed to elucidate the role of miR-326, a known modulator of hedgehog (Hh) pathway in PDAC.

Materials and Methods

miR-326 circulating levels were assessed in 105 PDAC patients, 31 with chronic pancreatitis (CP) and 36 healthy controls by quantitative Polymerase chain reaction. The expression of miR-326 and smoothened (SMO) was checked in surgical PDAC tissue. SMO protein expression was analyzed by immunohistochemistry in different groups. Finally, the role of miR-326 as a modulator of Hh pathway was assessed in vitro.

Results

Our results demonstrate that miR-326 is downregulated in both blood and tissue of PDAC patients as compared with controls. In contrast, the target gene/protein expression of SMO is upregulated in PDAC. Moreover, the tumor stromal expression of SMO was found to be clinically associated with lymph-node metastasis and vascular encasement in PDAC. Overexpression of miR-326 in Panc1 cell line was found to induce downregulation of SMO suggesting the tumor suppressor role of miR-326 in PDAC.

Conclusions

Taken together, miR-326 acts as a tumor suppressor in PDAC by modulating Hh pathway. It may be a promising target for the development of efficient drug therapies for the treatment of PDAC
Combination of Serum CA 19-9 and Endoscopic Ultrasound Findings Can Predict Malignancy Risk in Patients With Chronic Pancreatitis Presenting With Pancreatic Head Mass
Authors: Agarwal Samagra , Gunjan Deepak , Gopi Srikanth , Saraya Anoop
Published: November 2023

Background and Aims

Inflammatory head mass of pancreas (IMP) developing in background of chronic pancreatitis (CP) is difficult to distinguish from carcinoma pancreas. We aimed to delineate natural course of IMP and predict their malignancy risk, avoiding unnecessary biopsies.

Materials and Methods

In this retrospective single-center study, clinical records of patients with CP with diagnosed pancreatic head mass were reviewed. Clinical, laboratory, imaging, endoscopic findings, and follow-up details were retrieved from prospectively maintained database. A diagnostic nomogram was developed combining serum cancer antigen 19-9 and endoscopic ultrasound (EUS) findings to predict the risk of malignancy.

Results

We identified 107 patients with pancreatic head mass with CP of whom 87 (81.3%) were IMP and 20 (18.7%) were malignant. Patients with IMP were more frequently young males with alcohol-related CP and low CA 19-9 in comparison with those with malignancy (age IMP: 41.3 ± 11.3 vs carcinoma: 49.3 ± 14.5 years [P = 0.009]; males 89.7% vs 65% [P = 0.011]; alcoholic etiology: 71.3% vs 20% [P < 0.001]; median CA 19-9: 25.78 [interquartile range, 7.20–120.60] vs 1034.50 [106.65–7808.25] [P < 0.001]). A diagnostic nomogram combining CA 19-9 and EUS findings could identify malignancy with an optimism-corrected c-statistic of 0.905, which was better than both CA 19-9 (0.80) and EUS alone (0.826). Patients with IMP had relatively benign disease course with 40.2% biliary obstruction, 20.7% portal venous thrombosis, 14.9% gastric outlet obstruction, and 1-, 3-, and 5-year survival being 97.3%, 92.7%, and 92.0%, respectively. Surgery was required in only 12 patients (13.8%) with IMP.

Conclusions

Combination of CA 19-9 and EUS best identifies malignancy risk in patients with IMP, who have otherwise benign course.
A Shift Toward Early Oral Feeding in Acute Pancreatitis
Authors: Nammour Tarek , Lee Alice A. , McNabb-Baltar Julia , Banks Peter A. , Jin David X.
Published: November 2023

Objectives

The 2018 American Gastroenterological Association (AGA) guidelines strongly recommended early oral feeding as tolerated in patients with acute pancreatitis (AP). We compare early oral feeding rates in AP patients hospitalized in the periods before (2013–2016, Period A) and after (2019–2020, Period B) publication of the AGA guidelines, hypothesizing increased adherence in Period B.

Methods

We performed a retrospective cohort study of AP patients presenting to the emergency department during each period. Early oral feeding was defined as diet initiation within the first 48 hours of presentation.

Results

The cohort included 276 AP cases in period A and 104 in period B. A higher percentage of patients were offered early oral feeding during period B as compared to period A (70.2% vs. 43.5%). Similarly, more patients in period B were started on solid diet as compared to period A (34.6% vs. 20.3%). On multivariable regression analysis, the independent predictors of delayed oral feeding included early opioid analgesics use (OR 0.37), presence of pancreatic necrosis (OR 0.14), and organ failure (OR 0.33).

Conclusions

More AP patients were initiated on early oral feeding in the period following the publication of the AGA guidelines. Opioid analgesics use, pancreatic necrosis, and organ failure were associated with delayed oral feeding.
BRAT1-Associated Leukodystrophy Exacerbated by Classic Hodgkin Lymphoma–Directed Therapy
Authors: Hooshmand Sara J. , Chohan Karan L. , Raghunathan Aditya , Renaud Deborah L. , Ruff Michael W.
Published: November 2023

Introduction:

BRCA1-associated ataxia-telangiectasia–mutated activator-1 (BRAT1) is responsible for cell cycle surveillance and mitochondrial function. The implications of adult-onset BRAT1-variant and the resulting phenotypic neurocognitive and imaging features have not been previously described.

Case Report:

A 66-year-old man with a recent diagnosis of classic Hodgkin lymphoma was referred to neuro-oncology for cognitive and motor decline, and progressive cerebral white matter changes noted on magnetic resonance imaging (MRI). A neurological examination revealed global weakness, broad-based gait, and bilateral extensor plantar responses. Brain MRI demonstrated periventricular, deep, and subcortical white matter T2/FLAIR hyperintensities without contrast enhancement. Cerebral spinal fluid studies were unremarkable. A GeneDX genetic leukodystrophy panel conduction revealed a pathogenic variant (c.294dupA; p.L99TfsX92) resulting in a truncated protein of BRAT1, along with a variant of uncertain significance (c.746A>G;p.E249G). A presumptive diagnosis of late-onset leukoencephalopathy secondary to the BRAT1 variant was made. In an attempt to combat his mitochondrial dysfunction, he was initiated on a mitochondrial cocktail, including B-100 complex and coenzyme Q10. He began lymphoma-directed combination chemotherapy and developed precipitous functional decline after 2 cycles of therapy. Compared with prechemotherapy imaging, repeat positron emission tomography/computed tomography metabolic imaging showed a response after 3 cycles of chemotherapy; however, repeat brain MRI showed worsening diffuse white matter hyperintensities and cerebral atrophy.

Conclusion:

Given the variability in phenotypes and clinical onset, leukodystrophies can be a diagnostic challenge. This case demonstrated progressive BRAT1-associated leukodystrophy exacerbated by chemotherapy-induced toxic leukoencephalopathy. Mitochondrial energy deficiency in the context of multiple metabolic insults was likely underlying the progressive neurological decline observed in this case of genetic leukodystrophy.
The Eicosapentaenoic Acid and Docosahexaenoic Acid Content Reported in the Nutrition Panel of Fish Oil Supplements and Formula Milks Promoted for Young Children in Selected Markets
Authors: AbuKhader Majed , Al-Ghazali Mohammad , Ali Salma Khamis , Merie Ismael , Bouazza Aya
Published: November 2023

The aim of this study was to investigate the eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) content found in fish oil supplements and formula milks for young children sold in Europe, the Middle East, and North Africa's local markets and online stores. To allow comparison of fish oil supplements and formula milks, information about the EPA and DHA content was collected from the nutrition panel of each product. A total of 79 fish oil supplements and 70 formula milks were studied. Out of the 32 fish oil supplements in local markets 12 products (37.5%) and of the 47 fish oil supplements in Amazon online stores 12 products (25.5%) contained more EPA than DHA. The highest DHA:EPA ratio for fish oil supplements was 4.6. The percentage of Recommended Dietary Intake for DHA, based on 250 mg daily, ranged from 3.2% to 558% for the fish oil supplements, and the range of 0.4% to 25.2% was found for the formula milks. Fish oil supplements provided high daily dose of DHA, which was significantly higher than that provided by the formula milks.
Presentation of Eating Disorders in Clinical Practice and the Role of Nutrition Therapy
Authors: Borton Kelley A. , Sonneville Kendrin R.
Published: November 2023

Eating disorders are serious mental health disorders characterized by persistent disturbances in eating that impair physical health and/or psychosocial functioning. Widespread screening for eating disorders can help reduce disparities in diagnosis and may prevent the physical, psychological, and social consequences associated with delayed treatment. Evidence-based recommendations involve intervention by specialized mental healthcare providers; however, dietitians are pivotal in the prevention, identification, and treatment of eating disorders, leading to improved outcomes for the patient. Developing skills aimed at identification of disordered eating and basic treatment guidelines is of critical importance due to the ubiquity of these behaviors and symptoms.