bluuebunny/crossref_metadata_2025 huggingface dataset:
Cochlear Implant Revisions Over Three Decades of Experience
Authors: Andresen Nicholas S. , Shneyderman Matthew , Bowditch Stephen P. , Wang Nae-Yuh , Della Santina Charles C. , Sun Daniel Q. , Creighton Francis X.
Published: May 2023

Importance

The indications, technology, and surgical technique for cochlear implantation have evolved over the last three decades. Understanding the risk of cochlear implant revision (CIR) is important for patient counseling.

Objective

The objective of this study was to analyze the rates, indications, and audiologic outcomes for CIR over three decades of experience at a single academic medical center.

Design

A retrospective chart review was performed at a single academic medical center for individuals who underwent cochlear implantation between 1985 and 2022.

Setting

Single academic medical center.

Participants

Three thousand twenty-five individuals who underwent 3,934 cochlear implant operations from 1985 to 2022.

Exposure

Cochlear implantation.

Main Outcomes and Measures

Rates, indications, risk factors, and audiologic outcomes for CIR.

Results

There were 276 cases of CIR after primary implantation and an overall revision rate of 7.6% (95% confidence interval, 6.8–8.5%) over 37 years of follow-up with many cases of CIR secondary to Advanced Bionics vendor B and field action failure groups. CIR rates increased sharply through the early and mid-2000s and have since remained stable. Hard or soft device failure was the most common indication for CIR, accounting for 73% of cases. Pediatric patient status and previous CIR were associated with an increased risk of CIR. Audiologic outcomes after CIR were similar to those before device failure.

Conclusions and Relevance

CIR remains a common procedure most often performed for device failure. Pediatric patients and those who have undergone previous CIR are at the highest risk for future CIR. Audiologic outcomes remain stable after CIR, and these data will help providers counsel patients at the risk of future CIR and understand the risk factors associated with CIR.
Obesity and physical exercise in hemophilia
Authors: Nieva Natalia Rodríguez
Published: May 2023

The new coagulation factors have made possible to increase the life expectancy of patients with hemophilia to around 70 years of age.

However, there are some comorbidities to take into account such as obesity, hypertension, cardiovascular or metabolic diseases.

Improving dietary habits and promoting physical exercise are the two ways of preventing this. But, less than 50% of people with haemophilia actually do something in this sense, even though to practice physical activity or sport is save if you under treatment.
Follow-up of Military Blood Donors Who Test Positive for Syphilis
Authors: Hojnoski Cara E. , Kieffer John W. , Casey Theresa M. , Osuna Angela B. , Casleton Brian G. , Okulicz Jason F. , Marcus Joseph E.
Published: May 2023

Background

Several large studies have demonstrated that syphilis, carries a risk of future sexually transmitted infections (STI), such as human immunodeficiency virus. There is limited data on outcomes of syphilis infections that occur in populations that undergo universal syphilis screening, such as blood donors. Military trainees who donate blood can be followed through their military career to determine future risk of STIs.

Methods

Blood donor data was gathered from the Armed Services Blood Bank Center-San Antonio for those with positive Treponema pallidum antibodies between 2014-2021. The medical chart of each case was compared to 6 sex- and military accession date-matched controls with negative T. pallidum antibodies to determine risk of STI in the three years following donation.

Results

63,375 individuals donated blood during the study period. A total of 23 military trainees (0.36 per 1,000 donors) had positive T. pallidum antibodies. A minority (n = 7, 30%) of cases were treated for early syphilis. Only 6 (26%) cases received a follow-up nontreponemal test within one year. Donors who tested positive had a significantly higher risk of developing an STI within three years after blood donation compared to blood donors who tested negative (RR 3.8, 95% CI 1.3-10.5; p = 0.01) including gonorrhea (9% vs. 0%, p = 0.02) and syphilis (9% vs. 0%, p = 0.02).

Conclusion

This study shows the presence of T. pallidum antibodies in blood donors was associated with increased risk of future STIs. These cases support the need for close follow-up and broad STI testing in blood donors with positive T. pallidum antibodies.
Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study*
Authors: Emeriaud Guillaume , Pons-Òdena Marti , Bhalla Anoopindar K. , Shein Steven L. , Killien Elizabeth Y. , Modesto i Alapont Vicent , Rowan Courtney , Baudin Florent , Lin John C. , Grégoire Gabrielle , Napolitano Natalie , Mayordomo-Colunga Juan , Diaz Franco , Cruces Pablo , Medina Alberto , Smith Lincoln , Khemani Robinder G. ,   Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: May 2023

OBJECTIVES:

The worldwide practice and impact of noninvasive ventilation (NIV) in pediatric acute respiratory distress syndrome (PARDS) is unknown. We sought to describe NIV use and associated clinical outcomes in PARDS.

DESIGN:

Planned ancillary study to the 2016/2017 prospective Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study.

SETTING:

One hundred five international PICUs.

PATIENTS:

Patients with newly diagnosed PARDS admitted during 10 study weeks.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Children were categorized by their respiratory support at PARDS diagnosis into NIV or invasive mechanical ventilation (IMV) groups. Of 708 subjects with PARDS, 160 patients (23%) received NIV at PARDS diagnosis (NIV group). NIV failure rate (defined as tracheal intubation or death) was 84 of 160 patients (53%). Higher nonrespiratory pediatric logistic organ dysfunction (PELOD-2) score, Pao2/Fio2was less than 100 at PARDS diagnosis, immunosuppression, and male sex were independently associated with NIV failure. NIV failure was 100% among patients with nonrespiratory PELOD-2 score greater than 2, Pao2/Fio2less than 100, and immunosuppression all present. Among patients with Pao2/Fio2greater than 100, children in the NIV group had shorter total duration of NIV and IMV, than the IMV at initial diagnosis group. We failed to identify associations between NIV use and PICU survival in a multivariable Cox regression analysis (hazard ratio 1.04 [95% CI, 0.61–1.80]) or mortality in a propensity score matched analysis (p= 0.369).

CONCLUSIONS:

Use of NIV at PARDS diagnosis was associated with shorter exposure to IMV in children with mild to moderate hypoxemia. Even though risk of NIV failure was high in some children, we failed to identify greater hazard of mortality in these patients.
FOXL2 Mutation Status in Sex Cord-stromal Tumors Cannot be Predicted by Morphology
Authors: Wessman Sandra , Fuentes Beatriz Bohorquez , Severin-Karlsson Josefin , Westbom-Fremer Sofia , Nistér Monica , Kokaraki Georgia , Petta Tirzah Braz , Haglund Felix , Carlson Joseph W.
Published: May 2023

Granulosa-cell tumors (GCTs) are the most common type of malignant ovarian sex cord-stromal tumor (SCST). The histopathologic diagnosis of these tumors can be challenging. A recurrent somatic mutation of the forkhead box L2 (FOXL2) gene has been identified in adult GCT. In this retrospective single-center study of 44 SCST, a morphologic review together with analysis of FOXL2 C134W was evaluated in relation to tumor morphology. In addition, TERT promoter mutation testing was performed. Twelve of 36 cases got an altered diagnosis based on morphology alone. The overarching architectural growth pattern in 32/44 (72.7%) tumors was diffuse/solid with several tumors showing markedly heterogeneous architecture. In correlation to FOXL2 C134W mutation status, cytoplasmic color, and nuclear shape, differed between the FOXL2 C134W positive and FOXL2 C134 W negative groups, but these differences were not significant when comparing them separately. Nineteen of 44 cases underwent TERT promoter sequencing with a positive result in 3 cases; 2 adult GCTs and 1 cellular fibroma. Three patients developed a recurrence of which 2 were FOXL2 C134W positive adult GCTs and the third was an unclassified SCST. In conclusion, the morphologic and immunohistochemical diagnosis of different SCSTs is challenging and one cannot reliably identify FOXL2 mutation-positive tumors solely by morphologic features. Therefore, broad use of molecular analysis of the FOXL2 C134W mutation is suggested for SCSTs, and further studies are needed to evaluate the clinical outcome of these tumors as well as the diagnostic and prognostic implications of TERT promoter mutations.
Immunohistochemical Analysis of the Tissue Factor Pathway Inhibitor-2 in Endometrial Clear Cell Carcinoma: A Single-center Retrospective Study
Authors: Kawaguchi Ryuji , Maehana Tomoka , Sugimoto Sumire , Kawahara Naoki , Iwai Kana , Yamada Yuki , Kimura Fuminori
Published: May 2023

The tissue factor pathway inhibitor-2 (TFPI2) was recently identified as a diagnostic serum marker for ovarian clear cell carcinoma. Moreover, the immunohistochemical expression of TFPI2 in ovarian clear cell carcinoma was recently reported. This single-center retrospective study aimed to evaluate whether TFPI2 can be a specific biomarker for immunohistological diagnosis of endometrial clear cell carcinoma (ECCC). Immunohistochemical staining of TFPI2 in 55 endometrial carcinomas was evaluated at Nara Medical University Hospital. Thirteen ECCC samples were included as cases and 42 samples were included as a control (endometrioid carcinoma grade 1, 11 cases; grade 2, 11 cases; grade 3, 10 cases; serous carcinoma, 10 cases). The mean ± SD TFPI2 histoscore for diagnosing ECCC was 115.4 ± 87.9, which was significantly higher than that of non-ECCC (21.3 ± 45.9, P = 0.002). The best TFPI2 histoscore value obtained from the analyses of receiver operating characteristic curves for immunohistochemical diagnosis of ECCC was 15. With TFPI2 histoscores ≥15.0 as positive and <15.0 as negative, all 13 ECCC cases (100%) were positive for TFPI2, whereas 11 (26.2%) non-ECCC cases were positive for TFPI2. The sensitivity and specificity of TFPI2 for diagnosing ECCC were 100% and 73.8%, respectively. TFPI2 is expressed in ECCC and is useful for histopathological diagnosis.
Subjective and Objective Differences in Patients with Unilateral and Bilateral Carpal Tunnel Syndrome and the Role of Obesity in Syndrome Severity
Authors: Vernick Robert C , Beckwitt Colin H , Fowler John R
Published: May 2023

Background:

It remains unclear if physiologic differences exist in musculoskeletal ultrasound nerve measurements when comparing bilateral and unilateral carpal tunnel syndrome (CTS) patients. Similarly, the influence of body mass index (BMI) on CTS severity is not well characterized.

Methods:

Unilateral and bilateral CTS patients were seen from October 2014-February 2021. Obese and non-obese CTS patients were compared. Median nerve cross-sectional area (CSA), Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and CTS-6 measures were obtained. NCS recorded distal motor latency (DML) and distal sensory latency (DSL). Statistical analysis used the Wilcoxon signed-rank testing for paired continuous variables, Mann-Whitney U testing for non-paired continuous variables, and chi-squared for continuous variables with a significance level of p < 0.05.

Results:

109 (218 nerves) bilateral and 112 (112 nerves) unilateral CTS patients were reviewed. Bilateral patients had larger median nerve CSAs on their more symptomatic side, when defined by BCTSQ score (p < 0.0001), CTS-6 score (p < 0.0001), DML (p < 0.0001), and DSL (p < 0.01). Bilateral patients also had higher symptom severity scale (p < 0.01) and DSL (p < 0.001) outcomes compared to unilateral. Obese patients had higher median nerve CSA (p < 0.01), prolonged DML, and DSL (p < 0.0001) values despite similar CTS severity (BCTSQ, CTS-6).

Conclusions:

Ultrasound identifies the more symptomatic side in bilateral patients, which correlates with increasing severity (NCS, BCTSQ). Obesity increases median nerve CSA and prolongs NCS without influencing CTS severity. This information can be utilized when considering which diagnostic testing to order for CTS.

Level of Evidence:

Level 3 Diagnostic
A Logistic Regression Analysis of Factors Associated with Guarded Outcome After Carpal Tunnel Release in Symptomatic Carpal Tunnel Syndrome
Authors: Chow Ian , Kaufmann Robert A. , Goitz Robert J. , Fowler John R.
Published: May 2023

Background:

The Boston Carpal Tunnel Questionnaire (BCTQ) is a validated measurement tool for the severity of carpal tunnel syndrome (CTS) and improvements in the BCTQ following carpal tunnel release (CTR) have been demonstrated to influence patient satisfaction. We hypothesized that patient-related factors influence response in BCTQ subscales including the symptom severity scale (SSS) and the functional status scale (FSS) following CTR.

Methods:

Patients who underwent surgery with follow-up BCTQ were identified from a prospectively maintained database. Paired t-tests were used to compare BCTQ sub-scales at each follow-up time point. Minimal clinically important differences (MCID) were set. Patients below these thresholds were deemed as failures to improve following CTR. Univariate analysis was used to identify risk factors for failure to improve following CTR. Multi-variate logistic regression was used to identify independent predictors for failure to improve following CTR.

Results:

106 patients met inclusion criteria. Patients demonstrated significant improvements at all follow-up time points. The factor most associated with improvement beyond the MCID was a more severe score in the respective domain assessed. Other independent factors that influenced outcome following CTR included ethnicity, concomitant cubital tunnel release, gender, and age.

Conclusions:

CTR results in significant improvements in BCTQ and its subscales with improvements stabilizing after six weeks. A select cohort of patients fails to improve following CTR with factors independently associated with a lower degree of improvement. Identification of patients with these risk factors will provide a basis for counseling and increased monitoring of patients at risk for a guarded prognosis.
Localization of Brown Tumors With 18F-Fluorocholine PET/CT Imaging in Severe Primary Hyperparathyroidism
Authors: Werner Jonas , Grünig Hannes , Loher Hannah , Fischli Stefan , Strobel Klaus , Wicke Corinna
Published: May 2023

We present the case of a 68-year-old woman with a painful tibial tumor and fatigue. Histology and laboratory studies were consistent with a brown tumor secondary to initially unrecognized, severe primary hyperparathyroidism. 18F-fluorocholine PET/CT revealed a large hypermetabolic parathyroid mass and multiple bone foci considered as brown tumors. Unilateral neck exploration confirmed a large parathyroid adenoma. Serum calcium and parathyroid hormone levels normalized quickly, and symptoms subsided gradually after parathyroidectomy. Brown tumors are a rare complication of severe hyperparathyroidism. 18F-fluorocholine PET/CT allows the localization of parathyroid adenomas and brown tumors, and can be used as a single imaging modality.
Reconstruction of Hemifacial Congenital Giant Nevus with Pre-expanded Scalp Flaps and Deltopectoral Skin Flaps
Authors: Ding Jianke , Chu Feifei , Dong Liwei , Zhang Yu , Liu Wei , Yu Zhou , Tang Yinke , Ma Xianjie
Published: May 2023

Background:

The hemifacial congenital giant nevus impacts both physical and mental health of the patients. Excision is typically the most suitable option in these situations, but reconstructing the subsequent surgical defects is always a serious challenge.

Methods:

Between February 2012 and January 2021, a retrospective review of 4 patients who suffered from hemifacial congenital giant nevus was conducted, and they were treated by pre-expanded scalp flap and deltopectoral flap simultaneously. All patients receive tissue expansion, nevus resection, expanded skin flap transfer, and pedicle division.

Results:

Four patients with hemifacial congenital giant nevi were successfully treated with no major complications. One patient with a transferred deltopectoral flap experienced distal necrosis of the flap, and healed after dressing changes. No recurrence of the nevus was found during the follow-up period, and the transferred skin flaps match well with facial skin in contour and color.

Conclusion:

This modified pre-expanded scalp flap combined with a deltopectoral flap provides an easy and reliable way for hemifacial reconstruction in patients with a congenital giant nevus.
Interprofessional Simulation as an Educational Tool to Assess Cultural Competence Among Health Professions Students
Authors: Paris Donna Marie , Slaymaker Rachel Renee , Guest Heather Ann , Kalb Amy Christine
Published: May 2023

Background

The concept of collaborative practice within health professions is viewed as “best practice.” Poor collaboration can adversely affect patient safety. Interprofessional (IP) teamwork skills can be developed and nurtured through the health professionals' education; however, many barriers exist, which deter this from occurring. A lack of cultural diversity exposure within the healthcare setting can result in treatment disparities and place the patient at risk. One healthcare area that has gained considerable interest is the practitioners' understanding of multiculturalism and how cultural competence subsequently influences health disparities.

Objectives

This study examined the application of culturally complex clinical simulation scenarios that intentionally integrated IP teamwork and hypothesized that participants' understanding of cultural competence would improve.

Methods

Participants were junior-level nursing, bachelor-level social work, graduate-level occupational therapy, and PharmD students (N = 180) who participated in an IP simulation exercise composed of culturally complex clinical scenarios performed by trained standardized patients designed to demonstrate underrepresented populations with diverse religious/spiritual, sexual orientation, racial/ethnic, socioeconomic, psychosocial, and geographic characteristics. Survey tools included an adapted Multicultural Awareness, Knowledge, and Skills Survey (MAKSS) and the Cultural Awareness Assessment Tool (CAAT). Descriptive statistical analyses were conducted to describe the sample population with the use of inferential statistics to analyze the MAKSS and CAAT scores using a statistical significance level of 0.05. Data were analyzed using SPSS v25 using paired t tests to compare pretest-posttest results.

Results

Results showed that there was a statistically significant increase in MAKSS and CAAT scores from presimulation to postsimulation. The findings also suggest that participation in this type of exercise may have increased self-assessment of cultural awareness and multicultural awareness, knowledge, and skills among health professions students.

Conclusions

This study described the planning and execution of a large multiple scenario simulation event that involved 180 students spanning 5 healthcare disciplines. Findings demonstrated that the IP simulation event improved the students' self-assessment of multicultural awareness, knowledge, and skills as well as their own cultural awareness. The exploration of cultural competence and humility should be a priority for simulation-based learning.
Study of Risk Factors for Readmission After Pancreatectomy for Cancer
Authors: Marchese Ugo , Desbiens Jean-François , Lenne Xavier , Naveendran Gaanan , Tzedakis Stylianos , Gaillard Martin , Bruandet Amelie , Theis Didier , Boyer Laurent , Truant Stephanie , Fuks David , El Amrani Mehdi
Published: May 2023

Objective:

To identify the factors associated with readmission after pancreatectomy for cancer and to assess their impact on the 1-year mortality in a French multicentric population.

Summary Background Data:

Pancreatectomy is a complex procedure with high morbidity that increases the length of hospital stay and jeopardizes survival. Hospital readmissions lead to increased health system costs, making this a topic of great interest.

Methods:

Data collected from patients who underwent pancreatectomy for cancer between 2011 and 2019 were extracted from a French national medico-administrative database. A descriptive analysis was conducted to evaluate the association of baseline variables, including age, sex, liver-related comorbidities, Charlson Comorbidity Index, tumor localization, and use of neoadjuvant therapy, along with hospital type and volume, with readmission status. Centers were divided into low and high volume according to the cut-off of 26 cases/year. Logistic regression models were developed to determine whether the identified bivariate associations persisted after adjusting for the patient characteristics. The mortality rates during readmission and at 1 year postoperatively were also determined.

Results:

Of 22,935 patients who underwent pancreatectomy, 9,129 (39.3%) were readmitted within 6 months. Readmission rates by year did not vary over the study period, and mean readmissions occurred within 20 days after discharge. Multivariate analysis showed that male sex (odds ratio [OR]=1.12), age >70 years (OR=1.16), comorbidities (OR=1.21), distal pancreatectomy (OR=1.11), and major postoperative complications (OR=1.37) were predictors of readmission. Interestingly, readmission and surgery in low volume centers increased the risk of death at 1 year by a factor of 2.15 ([2.01-2.31], P<0.001) and 1.31 ([1.17-1.47], P<0.001), respectively.

Conclusions:

Readmission after pancreatectomy for cancer is high with an increased rate of 1-year mortality.
Cambrian origin but no early burst in functional disparity for Class Bivalvia
Authors: Zhou Sharon , Edie Stewart M. , Collins Katie S. , Crouch Nicholas M. A. , Jablonski David
Published: May 2023

Both the Cambrian explosion, more than half a billion years ago, and its Ordovician aftermath some 35 Myr later, are often framed as episodes of widespread ecological opportunity, but not all clades originating during this interval showed prolific rises in morphological or functional disparity. In a direct analysis of functional disparity, instead of the more commonly used proxy of morphological disparity, we find that ecological functions of Class Bivalvia arose concordantly with and even lagged behind taxonomic diversification, rather than the early-burst pattern expected for clades originating in supposedly open ecological landscapes. Unlike several other clades originating in the Cambrian explosion, the bivalves' belated acquisition of key anatomical novelties imposed a macroevolutionary lag, and even when those novelties evolved in the Early Ordovician, functional disparity never surpassed taxonomic diversity. Beyond this early period of animal evolution, the founding and subsequent diversification of new major clades and their functions might be expected to follow the pattern of the early bivalves—one where interactions between highly dynamic environmental and biotic landscapes and evolutionary contingencies need not promote prolific functional innovation.
The three-dimensional coarse-graining formulation of interacting elastohydrodynamic filaments and multi-body microhydrodynamics
Authors: Fuchter Paul , Bloomfield-Gadêlha Hermes
Published: May 2023

Elastic filaments are vital to biological, physical and engineering systems, from cilia driving fluid in the lungs to artificial swimmers and micro-robotics. Simulating slender structures requires intricate balance of elastic, body, active and hydrodynamic moments, all in three dimensions. Here, we present a generalized three-dimensional (3D) coarse-graining formulation that is efficient, simple-to-implement, readily extendable and usable for a wide array of applications. Our method allows for simulation of collections of 3D elastic filaments, capable of full flexural and torsional deformations, coupled non-locally via hydrodynamic interactions, and including multi-body microhydrodynamics of structures with arbitrary geometry. The method exploits the exponential mapping of quaternions for tracking 3D rotations of each interacting element in the system, allowing for computation times up to 150 times faster than a direct quaternion implementation. Spheres are used as a ‘building block’ of both filaments and solid microstructures for straightforward and intuitive construction of arbitrary three-dimensional geometries present in the environment. We highlight the strengths of the method in a series of non-trivial applications including bi-flagellated swimming, sperm–egg scattering and particle transport by cilia arrays. Applications to lab-on-a-chip devices, multi-filaments, mono-to-multi flagellated microorganisms, Brownian polymers, and micro-robotics are straightforward. A Matlab code is provided for further customization and generalizations.
Expansion of hantavirus infection during the SARS-CoV-2 pandemic in Bosnia and Herzegovina, 2021
Authors: Salimović-Bešić Irma , Hrvo Semir , Zahirović Edina , Đulić El-Jesah , Baljić Rusmir , Dedeić-Ljubović Amela
Published: May 2023

Introduction. Bosnia and Herzegovina (B and H) has been recognized for decades as a country with a high risk of diseases caused by hantaviruses.

Gap statement. The severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) pandemic has diverted attention from many pathogens, including hantavirus.

Aim. To provide a socio-demographic, temporal, geographical and clinical laboratory overview of the expansion of hantavirus infection cases during the SARS-CoV-2 pandemic in B and H in 2021.

Methodology. The RecomLine HantaPlus IgG, IgM immuno-line assay (Mikrogen, Germany) was used to detect IgG and IgM antibodies to hantavirus serotypes in human sera from clinically suspected cases.

Results. In 2021 (January–October), the number of confirmed cases of hantavirus infection and tested persons (92/140; 65,71 %) was higher than in the previous 2 years, 2020 (2/20; 10.00 %) and 2019 (10/61; 16.39 %). Most of the infected persons were men (84/92; 91.30 %). Hantavirus infections were recorded from January to October 2021, and the peak was reached in July (25/92; 27.17 %). Six out of 10 cantons in the Federation of Bosnia and Herzegovina (FB and H) were affected, namely Sarajevo Canton, Central Bosnia Canton, Neretva Canton, Zenica-Doboj Canton, Posavina Canton and Bosnian-Podrinje Canton Goražde, in descending order. Of the 38/92 (41.30 %) infected patients with characteristic clinical manifestations of haemorrhagic fever, including renal (mainly) or pulmonary syndrome, 32/92 (34.78 %) were hospitalized in the Clinical Center of the University of Sarajevo. Two cases were detected with dual infection, hantavirus (Puumala) with

Leptospira

in one and SARS-CoV-2 in another case. The largest number of infections was related to Puumala (PUUV) (83/92; 90.22 %), while the rest of the infections were caused by the hantavirus Dobrava serotype (DOBV).

Conclusion. The reported infections were probably caused by exposure of individuals to at-risk areas inhabited by contaminated rodents as natural reservoirs of hantavirus. As a highly endemic area, B and H requires continuous monitoring and increased awareness of this problem.
The Effects of Maternal Obesity on Some Obstetric Features: A Comparative and Descriptive Study
Authors: Ekiz Merve , Durmaz Aysegul
Published: May 2023

Background

The worldwide increase in obesity triggers the increase in the incidence of obesity during pregnancy. In this study, it was aimed to examine the effects of maternal obesity on some obstetric features.

Methods

This study was conducted in a tertiary hospital with a comparative group, crosssectional and descriptive design. The data of the study were collected with a Data Collection Form created by the researchers. Descriptive statistics, Pearson’s chi-squared test, independentsamples t-test, and multinomial regression analysis were used to analyze the data.

Results

In this study, women were divided into two groups, namely the obese group (BMI>29.9 kg/m2) and the normal weight group (BMI 18.5-24.9 kg/m2). There was no significant difference between the groups in terms of their height, education level, employment status, income level, and place of residence (p>0.05). It was determined that the obese group had higher rates of multiparity, postmature deliveries, and fetal distress developing in their babies on labor (p<0.05). There was no significant difference between the groups in terms of their modes of delivery, onset of labor, and the requirement of interventions during the second stage of the labor (p>0.05). In the logistic regression analysis, maternal obesity was found to increase the rates of multiparity by 1.758 times (1.038-2.978 CI, p=0.036), post-maturity by 5.902 times (1.283-27.164 CI, p=0.023), and moderate postpartum hemorrhage by 2.286 times (1.433-3.646 CI, p=0.001).

Conclusion

It is important that women who have obesity problems in the preconception period are counseled to help them reach a normal BMI. Health care professionals should advise women on healthy nutrition and weight control during both the pregnancy and postpartum periods.
The Neural Correlates of Autonomic Interoception in a Clinical Sample: Implications for Anxiety
Authors: Grimes Poppy Z , Kampoureli Christina N , Rae Charlotte L , Harrison Neil A , Garfinkel Sarah N , Critchley Hugo D , Eccles Jessica A
Published: May 2023

Interoceptive mismatch is a perceptual discrepancy between ascending bodily signals and higher-order representation of anticipated physiological state. Inspired by predictive coding models, we presentautonomic perceptual mismatchas a measure of this discrepancy for clinical application to brain-body interactions. Joint hypermobility is disproportionately found in individuals with anxiety disorders. Previous work has shown atypical autonomic reactivity represents a likely mediating mechanism consequent of altered connective tissue in the vasculature and nervous system.

This fMRI study investigates the neural substrates of autonomic perceptual mismatch on affective processing in the hypermobility-anxiety interaction. We compared regional brain activity during emotional face processing in participants with and without hypermobility and generalized anxiety disorder diagnosis, then tested association with perceptual mismatch.

In the brain, autonomic perceptual mismatch correlated with enhanced activation in emotion processing and autonomic control regions, notably anterior cingulate cortex. Anxious individuals exhibited increased mid-insula cortex activity in relation to perceptual mismatch. Activity was decreased within the inferior frontal gyrus, a region implicated in cognitive control. Dysautonomia mediated the link between hypermobility and anxiety.

Together, these findings support a neural basis of an autonomic perceptual mismatch model in a clinical sample. This is supported by the engagement of neural systems for emotion-cognition and interoception. This work highlights convergent aspects of neurodiversity, mental health, connective tissue disorders and brain-body interactions relevant to precision healthcare.
Understanding quantity and intensity of hospital rehabilitation using electronic health record data
Authors: Georgiev Konstantin , Doudesis Dimitrios , McPeake Joanne , Mills Nicholas L , Fleuriot Jacques , Shenkin Susan D , Anand Atul
Published: May 2023

Background

Many hospitalised patients require rehabilitation during recovery from acute illness. We use routine data from electronic health records (EHR) to report the quantity and intensity of rehabilitation and compared this in patients with and without COVID-19.

Methods

We performed a retrospective cohort study of consecutive adults in whom COVID-19 testing was undertaken between March 2020 and August 2021 across three acute hospitals in Scotland. We defined rehabilitation contacts (physiotherapy, occupational therapy, dietetics and speech and language therapy) from timestamped EHR data and determined contact time from a linked workforce planning dataset. We included survivors to hospital discharge who received at least two rehabilitation contacts. The primary outcome was total rehabilitation time. Secondary outcomes included the number of contacts, time to first contact, and rehabilitation minutes per day. A multivariate regression analysis for predictors of rehabilitation time included age, sex, comorbidities, and socioeconomic status.

Findings

We included 11,591 consecutive unique patient admissions (76 [63,85] years, 56% female), of which 651 (6%) were with COVID-19, and 10,940 (94%) were admissions with negative testing. There were 128,646 rehabilitation contacts. Patients with COVID-19 received more than double the rehabilitation time compared to those without (365 [165,772]vs170 [95,350] mins, p<0.001), and this was delivered over more specialist contacts (12 [6,25]vs6 [3,11], p<0.001). Time to first rehabilitation contact was later in patients with COVID-19 (3 [1,5]vs2 [1,4] days from admission). Overall, patients with COVID-19 received fewer minutes of rehabilitation per day of admission (14.1 [9.8,18.7]vs15.6 [10.6,21.3], p<0.001). In our regression analyses, older age and COVID-19 were the most important predictors of increased rehabilitation time.

Interpretation

Patients with COVID received more rehabilitation contact time than those without COVID, but this was delivered less intensively. Rehabilitation data derived from the EHR represents a novel measure of delivered hospital care.
Carriage of antimicrobial-resistant Enterobacterales among pregnant women and newborns in Amhara, Ethiopia
Authors: Amsalu Getnet , Wen Christine Tedijanto , Perovic Olga , Gebru Addisalem , Hunegnaw Bezawit M. , Tadesse Fisseha , Smith Marshagne , Fikre Addisalem , Bekele Delayehu , Taddesse Lisanu , Chan Grace
Published: May 2023

Background

Infections are one of the most common causes of neonatal mortality, and maternal colonization has been associated with neonatal infection. Data on carriage of bacterial pathogens and mother-child transmission patterns in low- and middle-income countries is sparse.

Methods

We sought to quantify carriage prevalence of extended-spectrum-beta-lactamase (ESBL) - producing and carbapenem-resistant Enterobacterales (CRE) among pregnant women and their neonates and to characterize risk factors for carriage in a rural area of Amhara, Ethiopia. We sampled 211 pregnant women in their third trimester and/or labor/delivery and 159 of their neonates in the first week of life.

Results

We found that carriage of ESBL-producing organisms was fairly common (women: 22.3%, 95% CI: 16.8-28.5; neonates: 24.5%, 95% CI: 18.1-32.0), while carriage of CRE (women: 0.9%, 95% CI: 0.1-3.4; neonates: 2.5%, 95% CI: 0.7-6.3) was rare. Neonates whose mothers tested positive for ESBL-producing organisms were nearly twice as likely to also test positive for ESBL-producing organisms (38.7% vs. 21.1%, p-value: 0.06). Carriage of ESBL-producing organisms was also associated with woreda (district) of sample collection (Fisher exact test maternal p-value: <0.01; neonatal p-value: <0.01) and recent antibiotic use (maternal p-value: 0.55; neonatal p-value: 0.011).

Conclusions

Understanding carriage patterns of potential pathogens and antibiotic susceptibility among pregnant women and newborns in this region will help to inform local, data-driven recommendations to prevent and treat neonatal infections.

Main point

Carriage prevalence of ESBL-producing Enterobacterales was high among pregnant women and neonates in a rural area of Ethiopia, and neonates were more likely to test positive if their mother tested positive. This work informs prevention and treatment of neonatal infections.
Deciphering deep-sea chemosynthetic symbiosis by single-nucleus RNA-sequencing
Authors: Wang Hao , He Kai , Zhang Huan , Zhang Quanyong , Cao Lei , Li Jing , Zhong Zhaoshan , Chen Hao , Zhou Li , Lian Chao , Wang Minxiao , Chen Kai , Qian Pei-Yuan , Li Chaolun
Published: May 2023

Bathymodioline mussels dominate deep-sea methane seep and hydrothermal vent habitats and obtain nutrients and energy primarily through chemosynthetic endosymbiotic bacteria in the bacteriocytes of their gill. However, the molecular mechanisms that orchestrate mussel host-symbiont interactions remain unclear. Here, we constructed a comprehensive cell atlas of the gill in the musselGigantidas platifronsfrom the South China Sea methane seeps (1100m depth) using single-nucleus RNA sequencing (snRNA-seq) and whole-mountin situhybridisation. We identified 13 types of cells, including three previously unknown ones, and uncovered unknown tissue heterogeneity. Every cell type has a designated function in supporting the gill’s structure and function, creating an optimal environment for chemosynthesis, and effectively acquiring nutrients from the endosymbiotic bacteria. Analysis of snRNA-seq ofin situtransplanted mussels clearly showed the shifts in cell state in response to environmental oscillations. Our findings provide insight into principles of host-symbiont interaction and the bivalves’ environmental adaption mechanisms.
Unique interactions and functions of the mitochondrial small Tims inTrypanosoma brucei
Authors: Quiñones Guillén Linda S. , Gonzalez Fidel Soto , Darden Chauncey , Khan Muhammad , Tripathi Anuj , Smith Joseph T. , Cooley Ayorinde , Paromov Victor , Davis Jamaine , Misra Smita , Chaudhuri Minu
Published: May 2023

Trypanosoma bruceiis an early divergent parasitic protozoan that causes a fatal disease, African trypanosomiasis.T. bruceipossesses a unique and essential translocase of the mitochondrial inner membrane, the TbTIM17 complex. TbTim17 associates with 6 small TbTims, (TbTim9, TbTim10, TbTim11, TbTim12, TbTim13, and TbTim8/13). However, the interaction pattern of the small TbTims with each other and TbTim17 are not clear. Here, we demonstrated by yeast two-hybrid (Y2H) analysis that all six small TbTims interact with each other, but stronger interactions were found among TbTim8/13, TbTim9, and TbTim10. Each of the small TbTims also interact directly with the C-terminal region of TbTim17. RNAi studies indicated that among all small TbTims, TbTim13 is most crucial to maintain the steady-state levels of the TbTIM17 complex. Co-immunoprecipitation analyses fromT. bruceimitochondrial extracts also showed that TbTim10 has a stronger association with TbTim9 and TbTim8/13, but a weaker association with TbTim13, whereas TbTim13 has a stronger connection with TbTim17. Analysis of the small TbTim complexes by size exclusion chromatography revealed that each small TbTim, except TbTim13, is present in ∼70 kDa complexes, which could be heterohexameric forms of the small TbTims. However, TbTim13 is primarily present in the larger complex (>800 kDa) and co-fractionated with TbTim17. Altogether, our results demonstrated that TbTim13 is a part of the TbTIM complex and the smaller complexes of the small TbTims likely interact with the larger complex dynamically. Therefore, relative to other eukaryotes, the architecture and function of the small TbTim complexes are specific inT. brucei.
Restored somatosensation in individuals with lower limb loss improves gait, speed perception, and motor adaptation
Authors: Kim Daekyoo , Triolo Ronald , Charkhkar Hamid
Published: May 2023

Lower limb loss is a significant insult to the body’s nervous and musculoskeletal systems. Despite technological advances in prosthesis design, artificial limbs are not yet integrated into the body’s physiological systems. Therefore, lower limb amputees (LLAs) experience lower balance confidence, higher fear of falls, and impaired gait mechanics compared to their able-bodied peers (ABs). Restoring sensations perceived as originating directly from the missing limb via implanted neural interfaces were shown to improve balance and performance in certain ambulatory tasks; however, the effects of such evoked sensations on neural circuitries involved in the locomotor activity are not well understood. In this work, we investigated the effects of plantar sensation elicited by peripheral nerve stimulation delivered by multi-contact nerve cuff electrodes on gait symmetry and stability, speed perception, and motor adaptation during walking. We found that restored plantar sensation increased stance time and propulsive force on the prosthetic side, improved gait symmetry, and yielded an enhanced perception of prosthetic limb movement. Most importantly, our results show the locomotor adaptation among LLAs with plantar sensation became similar to ABs. These findings suggest that our peripheral nerve-based approach to elicit plantar sensation directly affects central nervous pathways involved in locomotion and motor adaptation during walking. Our neuroprosthesis provided a unique model to investigate the role of somatosensation in the lower limb during walking and its effects on perceptual recalibration following a locomotor adaptation task. Furthermore, we demonstrated how plantar sensation in LLAs could effectively increase mobility, improve walking dynamics, and possibly reduce fall risks.

One-Sentence Summary

Neuroprosthesis stabilizes gait and improves speed perception and locomotor adaptation in individuals with lower limb loss.
A wearable EEG device: LANMAO Sleep Recorder compared to polysomnography in terms of EEG recording and sleep analysis
Authors: Zheng Xin , Xi Guannan , Lei Huijie , Lyu Dongbin , Zhang Yu , Yuan Chengmei , Gao Anchen , Huang Siyang , Jiang Jian
Published: May 2023

Background

Polysomnography (PSG) is the gold standard for sleep monitoring and diagnosis, yet it is difficult to use in home environments. This study evaluated the performance of a wearable electroencephalographic (EEG) device, LANMAO Sleep Recorder in EEG recording and sleep staging algorithm by comparing with PSG.

Method

Sleep of 7 Chinese adults were recorded concurrently with PSG and LANMAO devices. First, we validated the consistency of the raw signals with relative spectral power and Pearson correlation coefficient. Second, we evaluated the performance of the automated sleep staging algorithm integrated in the LANMAO device by comparing with the staging by experts.

Results

The Pearson correlation coefficient between the relative spectral power of multiple frequency bands during the sleep stages ranged from 0.7613 to 0.8816, with the strongest correlation observed for delta waves (r=0.8816). The overall F1-Score of the automated sleep staging algorithm was 84.03%, with individual F1-Scores for each class as follows: Wake: 93.67%, REM: 87.23%, Light Sleep: 72.10%, and Deep Sleep: 82.82%.

Conclusion

The results suggest that the EEG recorded by the LANMAO Sleep Recorder is precise and valid, and its automated sleep staging algorithm can accurately perform sleep staging with high accuracy. Therefore, in specific scenarios such as the home environment, LANMAO devices can work as a promising PSG alternative for sleep monitoring.
Staphylococcus aureusplanktonic but not biofilm environment induces an IFN-β macrophage immune response via the STING/IRF3 pathway
Authors: Seebach Elisabeth , Sonnenmoser Gabriele , Kubatzky Katharina F.
Published: May 2023

Chronic implant-related bone infections are a severe complication in orthopedic surgery. Biofilm formation on the implant surface impairs an effective immune response leading to bacterial persistence. In a previous study, we found thatStaphylococcus aureus(SA) induced IRF3 activation andIfnbgene expression only in its planktonic form but not in the biofilm. The aim of this study was to clarify the role of the stimulator of interferon genes (STING) in this process.

We treated murine RAW 264.7 macrophages with conditioned media (CM) generated from planktonic or biofilm cultured SA in combination with agonists or inhibitors of the cGAS/STING pathway. We further evaluated bacterial gene expression of planktonic and biofilm SA to find potential mediators. STING inhibition resulted in a loss of IRF3 activation andIfnbinduction in SA planktonic CM, whereas STING activation induced an IRF3 dependent IFN-β response in SA biofilm CM. Expression levels of genes associated with virulence decreased with biofilm formation while those associated with cyclic dinucleotide (CDN) synthesis did not correlate withIfnbinduction. We further observed that cGAS contributed to theIfnbinduction by SA planktonic CM although cGAS activation was not sufficient to induceIfnbgene expression in SA biofilm CM.

Our data indicate that the different degrees of virulence associated with planktonic and biofilm SA environments result in an altered induction of an IRF3 mediated IFN-β response via the STING pathway. This finding suggests that the STING/IRF3/IFN-β axis is a potential candidate for further investigation as immunotherapeutic target in implant-related bone infections.
HUWE1 Amplifies Ubiquitin Modifications to Broadly Stimulate Clearance of Proteins and Aggregates
Authors: Zhou Mengying , Fang Rui , Colson Louis , Donovan Katherine A. , Hunkeler Moritz , Song Yuyu , Zhang Can , Chen Siyi , Lee Dong-hoon , Bradshaw Gary A. , Eisert Robyn , Ye Yihong , Kalocsay Marian , Goldberg Alfred , Fischer Eric S. , Lu Ying
Published: May 2023

Selective breakdown of proteins and aggregates is crucial for maintaining normal cellular activities and is involved in the pathogenesis of diverse diseases. How the cell recognizes and tags these targets in different structural states for degradation by the proteasome and autophagy pathways has not been well understood. Here, we discovered that a HECT-family ubiquitin ligase HUWE1 is broadly required for the efficient degradation of soluble factors and for the clearance of protein aggregates/condensates. Underlying this capacity of HUWE1 is a novel Ubiquitin-Directed ubiquitin Ligase (UDL) activity which recognizes both soluble substrates and aggregates that carry a high density of ubiquitin chains and rapidly expand the ubiquitin modifications on these targets. Ubiquitin signal amplification by HUWE1 recruits the ubiquitin-dependent segregase p97/VCP to process these targets for subsequent degradation or clearance. HUWE1 controls the cytotoxicity of protein aggregates, mediates Targeted Protein Degradation and regulates cell-cycle transitions with its UDL activity.