bluuebunny/crossref_metadata_2025 huggingface dataset:
Unraveling antibiotic resistance in
Achromobacter mucicolens
IA strain: genomic insights, structural analysis, and prospects for targeted therapeutics
Authors: Al-Asadi Sura Ali , Abdul Wahhab Batool Hazim , Bootwala Jamila , Alwatar Wifaq M. Ali , Al-Kahachi Rusul Emaduldeen S.
Published: October 2024

The mortality rate of infectious diseases caused by
Achromobacter mucicolens
is increasing. The enhanced antibiotic resistance among bacterial species through genetic transfer and mutations in the efflux mediating genes has made the treatment quite challenging.
A. mucicolens
is an aerobic, gram-negative, and non-fermenting opportunistic pathogen found in immunocompromised patients.
A. mucicolens
shows resistance against beta-lactams and other antibiotics through intrinsic resistance mechanisms, including multi-drug efflux pumps and beta-lactamases. In this study, the clinical isolate whole genome sequencing of
A. mucicolens
data was analyzed to identify the genes and mutations responsible for antimicrobial resistance. The identified genes and their mutants were then subjected to structural analysis to better understand the impact of mutations on the protein structure, and domain analysis was performed to investigate the role of domains in antibiotic resistance. A total of 4 genes,
acrR, macB, msbA,
and
tolC
, were identified with significant mutations, whereas
macB
was shortlisted for further analysis based on the conserved regions, sequence alignment, and the maximum number of mutations. All the mutants of the
macB
gene contain the two common domains, the ABC transporter-like ATP-binding domain and the AAA + ATPase domain. These domains are crucial in efflux mediating drug transport and can be targeted to design novel drugs for treating infections caused by
A. mucicolens
.

IMPORTANCE

Achromobacter
species represent a significant threat as opportunistic pathogens, particularly in healthcare settings. Their resilience to antibiotics, demonstrated by strains like A.
mucicolens
, poses a serious challenge in treating infections, especially in immunocompromised patients. This study emphasizes the critical need for heightened vigilance among healthcare professionals regarding
Achromobacter
infections. By analyzing the whole genome sequencing data of
A. mucicolens
, the study sheds light on the genetic basis of antimicrobial resistance, aiding in more targeted treatment strategies. Furthermore, structural and domain analyses offer insights into how mutations impact protein structure and function, crucial for developing effective interventions. Ultimately, implementing rigorous sanitation measures and antibiotic stewardship protocols is needed to mitigate the spread of
Achromobacter
and safeguard vulnerable patient populations.
Influence of reactivated basement structures on evolving orogens: Along-strike diachronous Himalayan metamorphism in far west Nepal
Authors: Morrell Taylor Rae I. , Godin Laurent , La Roche Renaud Soucy , Cottle John M.
Published: October 2024

Determining the geometry and evolution of a basal detachment and its influence on orogenesis is a challenging, but important, aspect to understanding orogenic evolution. The basal detachment of the Himalayan orogen in far west Nepal is presently segmented by a documented tear fault. New pressure-temperature-time-deformation paths from the Himalayan metamorphic core along the Seti Khola river transect were integrated to compare the tectonometamorphic evolution on either side of the basal detachment tear fault to outline its history. Peak metamorphic conditions of 645–745 °C and 0.85–1.1 GPa were reached in the Seti Khola Himalayan metamorphic core rocks during the Oligocene to earliest Miocene, 10–14 m.y. prior to equivalent along-strike rocks in the adjacent Karnali valley, which indicates segmentation of the Himalayan metamorphic core across the tear fault. We interpret the segmentation of the orogen to have been caused by the development of the tear fault in the basal detachment of the Himalayan orogen and differing ramp-flat geometries on either side. The segmentation and change in basal detachment geometry is consistent with the reactivation of an underthrusted Indian plate inherited basement structure, the Great Boundary Fault, during the Oligocene to earliest Miocene. The comparison of tectonometamorphic histories along-strike in far west Nepal highlights the basal detachment geometry through time and the need to consider the pre-orogenic structural features of the plates involved in orogenesis. This study reinforces the importance of combining tectonometamorphic studies with geophysical and geomorphological data to fully understand the causes of along-strike segmentation of orogenic systems through time.
Substantial in situ Ti isotope variations in rutile record source and fluid evolution of porphyry copper mineralization systems
Authors: Jiang Xiaojia , Chen Xin , Hoare Liam , Schertl Hans-Peter , Palmer Martin R. , Zhang Wen , Cai Pengjie , Liu Hong , Zheng Youye , Gao Shunbao
Published: October 2024

Titanium (Ti) and its stable isotopes have been widely used as tracers for magmatic processes. However, our understanding of Ti isotope behavior in magmatic-hydrothermal systems remains limited. Hence, the in situ Ti isotope composition (δ49Ti) of magmatic titanite and hydrothermal rutile associated with magnetite and chalcopyrite mineralization was determined for the first time in four well-characterized porphyry copper deposits in southern Tibet. The rutile formed through the alteration of primary Ti-rich minerals during fluid-rock interaction in the early high-temperature magnetite and later moderate-temperature chalcopyrite stages of mineralization. Hydrothermal rutile, altered from magmatic titanite, exhibits δ49Ti values similar to those of residual magmatic titanite. This suggests that hydrothermal rutile inherited the Ti isotope composition of magmatic titanite. The average δ49Ti values of rutile are negatively correlated with whole-rock εNd(t) and zircon εHf(t) data, and positively correlated with whole-rock (87Sr/86Sr)i values, which suggests that the initial Ti isotope compositions of hydrothermal rutile in porphyry copper deposits primarily reflect their source. Rutile from the Qulong deposit sometimes exhibits fractionation of δ49Ti at levels exceeding 0.5‰, displaying a negative correlation with Zr and FeO, which may be attributed to the formation of magnetite and rutile at an early potassic alteration stage. Isotopically light Ti is preferentially incorporated into magnetite and rutile. Thus, the rutile associated with sulfide mineralization that formed from the remaining fluids during a later stage of phyllic alteration is enriched in heavy δ49Ti. These findings contribute to the understanding of how rutile fractionates Ti isotopes in hydrothermal systems related to porphyry copper deposits. In local contexts, the substantial crystallization of magnetite, along with the preferential incorporation of isotopically light Ti during the early stages, leads to a decrease in oxygen fugacity within the ore-bearing fluid. This, in turn, facilitates the formation of sulfides during later stages. The results of this study demonstrate the efficacy of in situ Ti isotope analysis as a powerful tool for tracking fluid and metal sources, and can be used to help interpret ore precipitation throughout different stages of magmatic-to-hydrothermal ore-forming processes.
Hospital-recorded chronic health conditions in children with and without Down syndrome in England: a national cohort of births from 2003 to 2019
Authors: Shumway Julia , Ellis Jill , Stephens Alice , De Stavola Bianca Lucia , Gilbert Ruth , Zylbersztejn Ania
Published: October 2024

Objective

The objective is to describe age-specific cumulative incidence for hospital-recorded indicators of chronic health conditions (CHCs) in children with Down syndrome (DS) compared with children without DS.

Design

National birth cohort using hospital admission and death records.

Setting

National Health Service (NHS)-funded hospitals in England.

Population

Liveborn, singleton infants born in NHS-funded hospitals between 2003 and 2019.

Main outcome measures

Cumulative incidence of nine categories of hospital-recorded CHCs, multimorbidity and mortality.

Results

We identified 10 621 infants with DS among 9 631 646 liveborn, singleton infants (0.11%). Among children with DS, the cumulative incidence for any indicated CHC was 90.1% by age 16, as compared with 21.2% of children without DS. By age 16, a third of children (33.1%) with DS had CHCs affecting four or more body systems; only 6.0% of children without DS had CHCs indicated in more than one body system. The most common CHCs in children with DS were severe congenital heart defects, indicated in 57.2% (0.8% in children without DS). The estimated HR for mortality up to age 16 comparing children with versus without DS was 15.26 (95% CI: 14.15, 16.45).

Conclusions

Children with DS had a higher cumulative incidence for CHCs in each body system category and subcategory, at all ages, than children without DS. Multimorbidity and mortality were higher among children with DS. Administrative data can be used to examine the health needs and healthcare use of children with DS throughout childhood and adolescence.
Chronic myelomonocytic leukaemia causing orbital inflammation
Authors: McGrath Robert , Fay Michael , McAnena Lisa
Published: October 2024

We present a case of acute-onset orbital inflammation with rapidly progressive proptosis, episcleral venous stasis with raised intraocular pressure and loss of vision in a patient with a recent diagnosis of chronic myelomonocytic leukaemia (CMML). The patient’s orbital inflammation and ocular hypertension showed no response to topical and systemic pressure-lowering agents and non-steroidal anti-inflammatory agents but resolved rapidly after the commencement of intravenous steroids. The patient was subsequently treated with the hypomethylating agent azacitidine with good systemic control of CMML with no further orbital inflammation. CMML is strongly associated with systemic inflammatory disease, possibly due to the upregulation of inflammatory pathways in the abnormal monocytes. CMML is a rare cause of orbital or ocular inflammation but should be considered in patients with persistent monocytosis.
Endotracheal hamartoma causing persistent dyspnoea after coronary artery bypass grafting
Authors: Kamisetty Sujay R , Mathavan Akshay , Thomas Joshua , Mathavan Akash
Published: October 2024

Pulmonary hamartomas are abnormal growths of mature cell or tissue types, including cartilage, epithelium, fat or muscle. Although most cases are benign, asymptomatic and often incidentally discovered, these masses may provoke significant complications via predisposition to obstruction, ischaemia or infection. Pulmonary hamartomas located within the tracheal lumen are exceedingly rare clinical entities which produce symptoms of dyspnoea, cough, stridor, wheezing or angina. Significant clinical consequences include airway obstruction and cardiovascular collapse. Most cases of tracheal hamartoma are initially diagnosed as obstructive pulmonary disease. We present a structured case report of a tracheal hamartoma identified in a patient with recent coronary artery bypass grafting who was initially evaluated for persistent ischaemic pathology, resulting in delay of diagnosis. By review of limited literature of this disorder, we emphasise the need for clinicians to be aware of this indolent and rare entity.
Neonatal respiratory distress syndrome in E292V homozygous ABCA3
Authors: Stone Anne , Huynh Trang
Published: October 2024

We describe a late preterm neonate presenting with respiratory distress syndrome (RDS), homozygous for the E292V missense mutation in the ATP-binding cassette subfamily A, member 3 gene. The neonate improved with supportive care. The E292V variant is the most common mutation in ABCA3, which is essential in surfactant synthesis. This variant has variable penetrance and is associated with increased prevalence of RDS and childhood interstitial lung disease and adult-onset interstitial lung disease. Homozygous E292V mutations have been associated with fatal neonatal lung disease and lung fibrosis in adulthood. This case highlights the association of homozygous E292V with non-fatal RDS that is more severe than predicted based on gestational age. Early genetic diagnosis permits the implementation of preventative health strategies and screening for lung disease throughout life and furthers knowledge of genetic risks for RDS and interstitial lung disease.
Managing the diagnostic challenge: chronic inflammatory demyelinating polyneuropathy during pregnancy
Authors: Tholu Chandana , Choudhary Amruta , Yadav Anita , Babtiwale Smruti
Published: October 2024

Chronic inflammatory demyelinating polyneuropathy (CIDP) during pregnancy presents diagnostic and management challenges. We report a case of a primigravida in her 30s, exhibiting progressive quadriparesis starting in the second trimester. Initially, her symptoms of weakness, numbness and progressive quadriparesis were attributed to vitamin B12 deficiency, leading to the administration of intramuscular methylcobalamin injection. After referral to our tertiary care centre at 37 weeks of pregnancy and after further evaluation, neurological examination revealed findings characteristic of CIDP, which were confirmed by nerve conduction studies showing typical features of the condition. Treatment included intravenous methylprednisolone followed by intravenous immunoglobulin. An elective caesarean section was carried out because the patient was unable to effectively participate in labour due to her condition. The patient exhibited improved limb power postoperatively after immunoglobulin therapy. Challenges include delayed diagnosis, treatment initiation and management decisions. Multidisciplinary collaboration is crucial for optimal outcomes in CIDP during pregnancy.
Tongue carcinoma in Plummer-Vinson syndrome: a modern rarity
Authors: Jogigowda Sanjay Chikkarasinakere , Patil Karthikeya , Kaggare Puttaraju Mahesh
Published: October 2024

Plummer-Vinson syndrome (PVS), formerly known as Paterson-Brown-Kelly syndrome or sideropenic dysphagia, is a sporadic condition defined by the typical triad of symptoms, which are iron deficiency anaemia, oesophageal strictures and dysphagia. PVS predominantly affects women between the ages of 40 and 70. PVS, if left untreated or undiagnosed, may be associated with an increased risk of developing squamous cell carcinoma of the upper gastrointestinal tract or oral cavity, even in the absence of other risk factors. This case study describes a woman who is in her 50s who developed carcinoma of the tongue as a result of chronic dysphagia and untreated iron deficiency anaemia. This article emphasises the need for dental surgeons to be aware of the oral aspects of anaemia and be able to detect PVS to aid in early diagnosis and treatment.
Transfusion-associated graft-versus-host disease in an immunocompetent individual
Authors: Ullah Midrar , hassan Syed Muhammad Hassan , riaz Muhammad Mehmood , Ali Syed Ahsan
Published: October 2024

Transfusion-associated graft-versus-host disease (TA-GVHD) is a fatal complication that occurs in both immunocompromised and immunocompetent individuals following blood transfusion. It is characterised by donor lymphocyte attacks on recipient tissues. We present a case of TA-GVHD in an immunocompetent man in his 70s who developed fever, diarrhoea, rash and pancytopenia after non-irradiated blood transfusion from an unrelated donor. Despite aggressive treatment, the patient’s condition deteriorated leading to his death, highlighting the challenges in recognising and managing TA-GVHD. This case emphasises considering TA-GVHD as a differential diagnosis in patients exhibiting symptoms post-transfusion, particularly in populations with high rates of consanguinity. This raises the likelihood that a population will have a high prevalence of a certain human leucocyte antigen. Prevention strategies, such as irradiation of blood products, are essential in reducing the risk of TA-GVHD. In this case, TA-GVHD affected an immunocompetent individual after receiving blood from unrelated donors, highlighting the importance of vigilance.
Adipsic arginine vasopressin deficiency: challenges in managing the intricate interplay of adipsia with polyuria
Authors: Malik Aayush , Singh Rekha , Goyal Alpesh , Gupta Rahul
Published: October 2024

Adipsic arginine vasopressin deficiency (AAVP-D) is caused by hypothalamic dysfunction (HD) due to varied aetiologies, including craniopharyngiomas. Its management is extremely challenging because two of the three regulatory mechanisms (thirst, arginine vasopressin, and renal medullary tonicity) for maintaining plasma osmolality are impaired (thirst, arginine vasopressin). These individuals develop severe dehydration and hypernatraemia, necessitating multiple emergency visits despite the administration of arginine vasopressin analogue (desmopressin). Here, we describe a case with HD secondary to craniopharyngioma treatment manifesting as AAVP-D, short stature, central hypothyroidism, hypoadrenalism and probable hypogonadism. AAVP-D was managed by fixing the renal water losses (using desmopressin) and water intake in a predetermined range. The treatment monitoring was done using total body weight and weekly to fortnightly serum sodium. Using this approach, the serum sodium was maintained in the range of 140–150 mmol/L, and there were no emergency visits for hypernatraemia or hyponatraemia (dysnatraemia) at 3 months.
An unusually encountered folliculosebaceous cystic hamartoma clinically resembling an epidermal inclusion cyst
Authors: Neman Sophia , Said Jordan T , Trinidad John , Pouli Dimitra
Published: October 2024

Folliculosebaceous cystic hamartoma (FSCH) is a rare cutaneous hamartoma comprising epithelial and mesenchymal components. It typically appears as slow-growing, skin-coloured nodules on the face and scalp. We report a case of a mid-forties male with a 4 mm nodule on his left temple, initially thought to clinically represent an epidermal inclusion cyst (EIC). Excisional biopsy results identified the lesion as FSCH, characterised by its unique dilated infundibulocystic configuration with radiating sebaceous lobules and associated mesenchymal elements. FSCH can be misdiagnosed for EIC due to similar clinical presentations but has distinct histological features. Surgical excision is the standard treatment, and the patient has remained recurrence-free since the procedure. This case underscores the importance of considering FSCH in the differential diagnosis of particularly facial and scalp nodules.
Acute torrential mitral regurgitation secondary to iatrogenic papillary muscle rupture
Authors: Marsalisi Christopher Bernard , Lam Loruanma , Feghaly Julien , Kadariya Dinesh
Published: October 2024

Papillary Muscle rupture is a rare and potentially life-threatening complication that is typically observed in the days following acute myocardial infarction. Less commonly, rupture of a papillary muscle may arise as an iatrogenic complication of cardiac procedures. We present a case of cardiogenic shock in the setting of torrential mitral regurgitation secondary to iatrogenic papillary muscle rupture during a left ventricular angiogram. The patient was placed on percutaneous mechanical circulatory support with Impella CP and transferred for emergent mitral valve replacement. This case highlights the potential complications of minimally invasive cardiac procedures and reviews the management of acute severe mitral regurgitation.
Uncommon presentation: monozygotic twins with Turner syndrome
Authors: Rehman Bushra , Shariff Yumna , Arif Muzna , Memon Fozia
Published: October 2024

Turner syndrome (TS) affects approximately 1 in 2500 female live births globally, making it the most common sex chromosomal abnormality in females. It results from a partially or completely missing X chromosome, often occurring in mosaic karyotypes. TS is associated with various health issues, including short stature, delayed puberty, ovarian dysgenesis, hypergonadotropic hypogonadism, infertility, congenital heart defects, endocrine disorders and autoimmune disorders. TS is less prevalent among twins. Since the first case report in 1938, the association between TS and twinning has been noted in only 30 cases worldwide. However, only six reports exist of monozygotic non-mosaic twins with TS, all 45,XO. Although TS affects individuals worldwide, the literature on TS in Asian twins is sparse, with no reported cases from Asia. This scarcity underscores the need for further research to understand this region’s epidemiology and challenges. This case report highlights the importance of evaluating both twins if one is diagnosed with TS.
Patients and clinicians have different priorities when discussing pain in the IBD clinic
Authors: Huisman Danielle , Andrews Esther , Williams Amanda C de C , Parkes Miles , Norton Christine
Published: October 2024

Objective

Pain in inflammatory bowel disease (IBD) is frequently neglected/overlooked, particularly in ulcerative colitis, and communication about pain can be suboptimal. The current study juxtaposes clinicians’ conceptualisations of patients’ pain with patient narratives. The aim was to inform the development of a pain reporting tool and provide guidance for better communication about IBD pain.

Methods

In-depth semistructured interviews with 13 IBD clinicians in the UK: gastroenterologists (n=5), colorectal surgeons (n=2), specialist nurses (n=4) and psychologists (n=2). Primary analysis of these data and secondary analysis of earlier interviews about pain in IBD with clinicians (n=12) and patients (n=71) followed principles of reflexive thematic analysis. Themes were compared across participant groups.

Results

Clinicians state that they regularly ask about pain in Crohn’s disease, but not ulcerative colitis. Patients, however, report inconsistent attention to pain in either condition, with power dynamics constraining their pain report. Some clinicians acknowledged that they assume that patients manage their pain independently, leading to insufficient follow-up (Theme 1: Contradictions and ambiguities when discussing pain in IBD). Inadequate acknowledgement of pain by clinicians was attributed to time constraints and systemic issues. Where inflammatory or structural causes were lacking, some clinicians default to attributing pain to irritable bowel syndrome, contributing to patients feeling uncared for (Theme 2: Consequences of limited tools and time for pain). Addressing pain was further complicated by the reluctance of some patients to express discomfort or pain and others who avoided activities that might lead to pain (Theme 3: Addressing pain in patients who do not complain).

Conclusion

The study emphasises the importance of consistent pain evaluation and management, advocating for more open dialogues between clinicians and patients.
Mechanisms of impact of web-based support and self-monitoring to augment and maintain physical activity levels: a qualitative study exploring participants’ interactions with the e-coachER, a web-based support programme for people attending exercise referral schemes
Authors: Lambert Jeffrey D , Dean Sarah Gerard , Terry Rohini H , Charles Nigel , Greaves Colin , Campbell John L , Taylor Adrian
Published: October 2024

Objectives

e-coachER was a web-based intervention designed to support uptake and maintenance of physical activity for people attending exercise referral schemes (ERS) for weight loss, diabetes, hypertension, osteoarthritis or a history of depression/low mood. The aim of this study was to explore the mechanisms of impact of the e-coachER intervention, specifically how participants interacted with e-coachER and the key mediators of increased physical activity.

Design

This was a qualitative one-on-one interview study. Interviews were audio-recorded and transcribed and analysed using thematic analysis.

Setting

UK primary care ERS.

Participants

A purposive sample of adult patients randomised to the intervention arm of the e-coachER randomised controlled trial.

Results

Twenty-six participants (20 female), who had logged on to e-coachER at least once were recruited, resulting in a total of 38 interviews (mean duration 48 min). Four broad, inter-related themes were generated from the data (1) catalyst for change, (2) goals and aspirations, (3) support and (4) engagement with the e-coachER programme. Most participants who took part in e-coachER were already motivated to improve their health and perceived e-coachER as an additional source of motivation and accountability. Many felt that the opportunity to set goals and self-monitor supported participant’s competence and autonomy by enabling them to progress at their own pace. Many participants reported on how e-coachER helped them to foster a sense of relatedness by encouraging them to seek support from others. Finally, e-coachER was regarded as being generally accessible and engaging. Despite this, some found it too simplistic, and others found it hard to maintain engagement over time.

Conclusions

The e-coachER intervention seemed to be generally motivating in the early stages of initiating behaviour change, but engagement waned over time. Our findings highlight how important an online package might be in supporting behaviour change while also highlighting the challenges of achieving sustained physical activity changes.

Trial registration number

ISRCTN15644451.
Associations between health literacy proficiencies and health-related quality of life and GP visits among young people in Norway: a population-based cross-sectional study
Authors: Le Christopher , Guttersrud Øystein , Joranger Pål , Okan Orkan , Finbråten Hanne Søberg
Published: October 2024

Objectives

Despite globally increased attention from policymakers and being recognised as a critical determinant of health, health literacy (HL) research in young people (YP) remains limited. This study aims to describe HL in YP across person factors and explore the associations between HL and health-related quality of life (HRQoL) and the number of visits to general practitioners (GP visits).

Design

Cross-sectional study.

Setting

Population-based data collection applying country representative strata in Norway.

Participants

890 participants aged 16–25 years.

Primary and secondary measures

Rasch modelling and Wright’s method were used to identify statistically distinct levels of HL proficiency. Multiple linear regression and negative binomial regression models were applied to explore the associations between HL and HRQoL, and between HL and GP visits, respectively.

Results

Among YP, HL was statistically significantly associated with HRQoL and the number of GP visits, when adjusting for age, gender, education, self-perceived social status and financial deprivation. For every logit increase in HL, the number of GP visits decreased by 22%. Four statistically distinct levels of HL proficiency were identified for the 12-item HLS19-YP12 scale, started from a cut-point of 23, 30, 37 and 44 out of 48. Relatedly, 70% of respondents were observed at or below level 2 (30–36 points), indicating a varying lack of central skills. The span from lowest (1) to highest (4) HL level was associated with a decrease of 2.1 GP visits per year and an increase of .12 on the EQ-5D index.

Conclusions

This study provides new empirical insights into the impact of HL in YP. Identified cut-points for the HLS19-YP12 may contribute to simplifying the process of adapting information and communication for various HL skills. The study also suggests the need for more efforts in HL policy and structural intervention development to enhance YP health and well-being.
Factors affecting community pharmacists’ capacity to deliver pharmacy services in Zhengzhou, China: a cross-sectional study
Authors: Meng Wenxin , Wang Yanan , Shen Jian , Yan Mingxun , Hu Yuanjia , Jiang Rong
Published: October 2024

Objective

To assess the factors that affect the capacity of community pharmacists to deliver pharmacy services (PSs) in Zhengzhou, China.

Design

An online, cross-sectional survey was conducted.

Setting and participants

A stratified sampling method was used to select community pharmacists for questionnaires. A total of 124 community pharmacists from various districts of Zhengzhou were included in this study.

Results

Principal component regression analysis showed that cumulative hours of continuing education (CE), job satisfaction, career prospects, awareness of the need for CE and income had a positive impact on pharmacists’ capacity to deliver PS, with a gradually decreasing degree of influence.

Conclusions

Most pharmacists felt that their capacity to provide PS met the basic public requirements. Cumulative CE hours had the most significant effect on pharmacists’ capacity to provide PS, while income had the least effect. The government, grassroots community pharmacies, pharmacists and the public should formulate timely and targeted measures to enhance the PS capacity of community pharmacists.
Assessing the relative efficacy of components of opioid-free anaesthesia in adult surgical patients: protocol for a systematic review and component network meta-analysis
Authors: Belltall Amparo , Mazzinari Guido , Ní Eochagáin Aisling , Wall Tom , Serpa Neto Ary , Diaz-Cambronero Oscar , Sessler Daniel , Buggy Donal J , Cata Juan , Hollmann Markus W
Published: October 2024

Introduction

The rise of opioid-free anaesthesia (OFA) aims to reduce postoperative pain while reducing opioid-related side effects during surgery. However, the various adjuvant agents used in OFA complicate the evaluation of their effectiveness and risks. Recent reviews question the clinical benefits of OFA, highlighting the need for thorough evaluation. This protocol describes a network meta-analysis to compare the effectiveness of OFA with opioid-based anaesthesia and will identify key components for optimal postoperative outcomes.

Methods and analysis

We will perform a systematic search of literature published in English without time restriction in Embase, The Cochrane Library, MEDLINE (via PubMed) and CINAHL, along with Google Scholar for grey literature. The final search will be performed on 1 October 2024. We will include randomised controlled trials with adult patients undergoing surgery with general anaesthesia, excluding preclinical, observational, regional anaesthesia-only and prolonged anaesthesia outside the operating room studies. The primary outcome is postsurgical pain scores, with secondary outcomes including quality of recovery, opioid consumption, adverse effects and long-term events. We will assess bias using the Cochrane risk of bias 2 tool and conduct Bayesian network meta-analyses for pooled estimates. We will report effect estimates as ORs and standardised mean differences with 95% credible intervals and assess certainty using GRADE methodology.

Ethics and dissemination

Ethics approval is not required for this systematic review. Results will be published in a peer-reviewed journal and presented at national and international anaesthesia and pain management conferences.

PROSPERO registration number

CRD42024505853.
Implementing a multisite shared haemodialysis care programme
Authors: Green David , Pietrafesa Angela , Reyes Marianne , Donnini Giada , Gicana Evelyn , Nadurata Evelyn , John Juniya , Ponting Jessica , Srinivasan Raji , Udayaraj Udaya Prabhakar
Published: October 2024

Adults receiving centre-based haemodialysis (HD) have low levels of patient activation which are associated with poorer outcomes. Shared haemodialysis care (SHC) describes an intervention whereby individuals are supported to undertake elements of their treatment to improve their activation levels and promote better self-care. This project aimed to increase the proportion of those performing SHC in seven HD centres within the Oxford Kidney Unit’s catchment area. Sequential Plan-Do-Study-Act (PDSA) cycles effected change first in two central HD centres, in cycles 1 and 2, before rolling out to five satellite HD centres, in cycles 3 and 4. Cycle 1 explored and transformed staff perceptions regarding SHC using a questionnaire and teaching sessions while in cycle 2, staff partnered with patients to develop leaflets and noticeboards to improve awareness and participation. These interventions were then rolled out to the remaining HD centres in PDSA cycles 3 and 4. Other interventions included: Enrolling staff and patients in virtual training courses; designating SHC ‘Champions’; engagement with a national SHC forum; and changes to the electronic patient record to enable the monitoring of patient SHC opportunity and to promote sustainable change. Outcome measurement data on the number of patients performing SHC and the number at different defined stages of SHC competency were captured monthly. In April 2022, only 4% (19/483) of those receiving centre-based HD performed any aspect of SHC. By the end of the project in December 2023, this had increased to 43% (220/511). There was a significant and sustained growth in the stage of patient SHC competency as well as the number of patients performing SHC in each HD centre. The project demonstrated that it is possible to implement, scale-up and maintain a multisite SHC programme even with little baseline staff and patient SHC experience.
Adjunct polymeric exclusive enteral nutrition helps achieve biochemical remission in active Crohn’s disease in adults irrespective of disease location and concomitant corticosteroid use
Authors: Kuo Hellen , Tognolini Katrina , Mutsekwa Rumbidzai , Shukla Dheeraj , Willmann Laura , Moattar Hadi , Dorrington Alexander , Ishaq Naveed , Bhullar Maneesha , Edwards John , Mohsen Waled , Kakkadasam Ramaswamy Pradeep
Published: October 2024

Background and aim

Data on the effectiveness of polymeric exclusive enteral nutrition (EEN) in inducing biochemical remission in adults with active Crohn’s Disease (CD) is scarce. We aimed to assess the effectiveness of polymeric EEN in inducing biochemical remission in adults with active CD.

Methods

Single-centre retrospective study, from January 2018 to September 2022, of patients with active CD who received therapy with EEN, along with standard of care. Active CD was defined as C-Reactive Protein (CRP) ≥10 mg/L and/or faecal calprotectin (FC) ≥250 µg/g. Primary endpoint (PE) was biochemical remission at 8 weeks. Biochemical remission was defined as CRP <6 mg/L in patients with CRP ≥10 mg/L at baseline and/or FC <150 µg/g in patients with an FC ≥250 µg/g at baseline.

Results

61 patients were included, 32 (52.4%) female. PE was achieved in 35 (57.4%) patients; 20 (58.8%) with concurrent corticosteroid (CS) and 15 (55.6%) without CS use at baseline, p=1. 43.7% (7/16) of patients with ileal, 50% (4/8) with colonic and 64.9% (24/37) with ileocolonic (p=0.33) disease phenotype achieved PE. Fewer patients with baseline concurrent biological achieved PE (12/29 (41.38%) vs 23/32 (71.9%), p=0.021). On univariable analysis, the absence of biological therapy at baseline was a predictor for achieving PE (OR 3.6 (95% CI 1.23 to 10.6), p=0.019).

Conclusion

Polymeric EEN is effective in inducing biochemical remission in adults with active CD irrespective of disease location or concurrent CS use. Significantly fewer patients on concurrent biologics at baseline achieved biochemical remission.
Type I MET inhibitors cooperate with PD-1 blockade to promote rejection of hepatocellular carcinoma
Authors: DeAzevedo Ricardo , Steiner Madeline , Turner Broderick X , Liu Arthur , Newton Sherwin , Schmidt Joanna , Fleming Rachel , Tolentino Angelica , Kaseb Ahmed O , Curran Michael A
Published: October 2024

Blockade of the immune checkpoints programmed death-1 (PD-1) and cytotoxic lymphocyte antigen 4 has improved outcomes for patients with hepatocellular carcinoma (HCC), yet most still fail to achieve objective clinical benefit. MET plays key roles in both HCC tumorigenesis and immunosuppressive conditioning; however, inhibition of MET causes upregulation of PD-ligand 1 (PD-L1) suggesting the use of these inhibitors in the context of PD-1 blockade. We sought to investigate across the Hepa1-6, HCA-1 and diethylnitrosamine (DEN) models of HCC whether the combination of more specific type I versus more pleiotropic type II MET inhibitors would confer superior outcomes in combination with PD-1 blockade. While MET inhibition demonstrated cooperativity with αPD-1 across all three models, the type I MET inhibitor capmatinib showed optimal activity in combination and statistically significantly outperformed the combination with the type II inhibitor cabozantinib in the αPD-1 refractory DEN model. In both HCA-1 and DEN HCC, the capmatinib and αPD-1 combination enhanced CD8 T cell frequency and activation state while limiting intratumoral myeloid immune suppression. In vitro studies of antigen-specific T cell activation reveal significantly less inhibition of effector cytokine production and proliferation by capmatinib versus by type II or type III MET inhibitors. These findings suggest significant potential for clinical HCC combination studies of type I MET inhibitors and PD-1 blockade where prior trials using type II inhibitors have yielded limited benefit.
Cardiac remodelling in patients with atrial fibrillation and obstructive sleep apnoea
Authors: Hunt Tove Elizabeth Frances , Traaen Gunn Marit , Aakerøy Lars , Massey Richard John , Bendz Christina , Øverland Britt , Akre Harriet , Steinshamn Sigurd , Loennechen Jan Pål , Broch Kaspar , Helle-Valle Thomas , Lie Øyvind Haugen , Anstensrud Anne Kristine , Haugaa Kristina H , Gullestad Lars , Anfinsen Ole-Gunnar , Aakhus Svend
Published: October 2024

Background

Obstructive sleep apnoea (OSA) can cause left atrial (LA) and left ventricular (LV) remodelling, which is linked to atrial fibrillation (AF). Whether continuous positive airway pressure (CPAP) can reverse LA and LV remodelling in patients with OSA and paroxysmal AF (PAF) has yet to be studied. We assessed the impact of CPAP treatment on LA and LV size and function in patients with OSA and PAF before and after catheter ablation.

Methods

In a randomised controlled trial, we screened patients with PAF for OSA. We enrolled patients with an Apnoea–Hypopnoea Index ≥15/hour. The burden of AF was monitored by an implantable loop recorder in all patients. Patients were then randomised to CPAP treatment or standard care. Transthoracic echocardiography was performed at baseline and after 6 and 12 months to assess LV and LA function and remodelling with advanced echocardiographic imaging techniques.

Results

We enrolled 109 patients (63±7 years, body mass index 29.6±4.3, 76% men). 83 patients were scheduled for pulmonary vein isolation (PVI) and 26 for clinical follow-up only. 55 patients were randomised to CPAP and 54 to standard care. The burden of AF decreased significantly in patients who underwent PVI irrespective of treatment with CPAP (p for difference ≤0.001). Patients in the study group had LV ejection fraction (LVEF) and LV global longitudinal strain (GLS) within the normal range, increased LA Volume Index (LAVI), LA volume (by speckle tracking) and decreased LA reservoir strain at baseline. We did not observe any improvement in LVEF, GLS, LAVI, LA volume or LA reservoir strain in either group during the 12 months of follow-up.

Conclusions

In patients with PAF and OSA, treatment with CPAP was not associated with reverse LA remodelling within 12 months of follow-up.
The ground states of hidden-charm tetraquarks and their radial excitations
Authors: Yu Guo-Liang , Li Zhen-Yu , Wang Zhi-Gang , Wu Bin , Zhou Ze , Lu Jie
Published: October 2024

Inspired by the great progress in the observations of charmonium-like states in recent years, we perform a systematic analysis about the ground states and the first radially excited states of $$qc\bar{q}\bar{c}$$

q
c

q

¯

c

¯

(q = u/d and s) tetraquark systems. Their mass spectra, root mean square (r.m.s.) radii and radial density distributions are predicted within the framework of relativized quark model. By comparing with experimental data, some potential candidates for hidden-charm tetraquark states are suggested. For $$qc\bar{q}\bar{c}$$

q
c

q

¯

c

¯

(q = u/d) system, if $$Z_{c}(3900)$$

Z
c

(
3900
)

is supposed to be a compact tetraquark state with $$J^{PC}=1^{+-}$$

J

PC

=

1

+
-

, Z(4430) can be interpreted as the first radially excited states of $$Z_{c}(3900)$$

Z
c

(
3900
)

. Another broad structure $$Z_{c}(4200)$$

Z
c

(
4200
)

can also be explained as a partner of $$Z_{c}(3900)$$

Z
c

(
3900
)

, and it arise from a higher state with $$J^{PC}=1^{+-}$$

J

PC

=

1

+
-

. In addition, theoretical predictions indicate that the possible assignments for X(3930), X(4050) and X(4250) are low lying $$0^{++}$$

0

+
+

tetraquark states. As for the $$sc\bar{s}\bar{c}$$

s
c

s

¯

c

¯

system, X(4140) and X(4274) structures can be interpreted as this type of tetraquark states with $$J^{PC}=1^{++}$$

J

PC

=

1

+
+

, and X(4350) can be described as a $$sc\bar{s}\bar{c}$$

s
c

s

¯

c

¯

tetraquark with $$J^{PC}=0^{++}$$

J

PC

=

0

+
+

. With regard to $$qc\bar{s}\bar{c}$$

q
c

s

¯

c

¯

(q = u/d) system, we find two potential candidates for this type of tetraquark, which are $$Z_{cs}(4000)$$

Z

cs

(
4000
)

and $$Z_{cs}(4220)$$

Z

cs

(
4220
)

structures. The measured masses of these two structures are in agreement with theoretical predictions for the $$1^{+}$$

1
+

state.
A gentle introduction to Drinfel’d associators
Authors: Bordemann Martin , Rivezzi Andrea , Weigel Thomas
Published: October 2024

In this paper, we give an introduction to Drinfel’d’s associator coming from the Knizhnik–Zamolodchikov connections and a self-contained proof of the hexagon and pentagon equations by means of minimal amounts of analysis or differential geometry: we rather use limits of concrete parallel transports.
Unexpected planetary relationships as the new signature in Astro-particle physics
Authors: Zioutas K. , Anastassopoulos V. , Argiriou A. , Cantatore G. , Cetin S. , Gardikiotis A. , Haralambous H. , Karuza M. , Kryemadhi A. , Maroudas M. , Mastronikolis A. , Oikonomou C. , Ozbozduman K. , Semertzidis Y. K. , Tsagri M. , Tsagris I.
Published: October 2024

Dunkle Materie (DM) came from unexpected cosmological observations. Nowadays within our solar system, diverse observations also defy conventional explanations, like the main physical process(es) underlying the heating of the different solar atmospheric layers. Streaming DM offers a viable common scenario following gravitational focusing by the solar system bodies. This fits as the underlying process behind the solar cycle, which was the first signature suggesting a planetary dependency. The challenge, since 1859, is to find a remote planetary impact, beyond the extremely feeble planetary tidal force. We stress the possible involvement of an external impact by some overlooked “streaming invisible matter”, which reconciles all investigated mysterious observations mimicking a not extant remote planetary force. Unexpected planetary relationships exist for both the dynamic Sun and Earth, reflecting multiple signatures for streaming DM. The local reasoning à la Zwicky is also suggestive for searches including puzzling biomedical phenomena. Favorite DM candidates are anti-quark-nuggets, magnetic monopoles, dark photons, or the composite “pearls”. Then, anomalies within the solar system are the manifestation of the dark Universe. The tentative streaming DM scenario enhances spatiotemporally the DM flux favouring conditions for direct DM detection or extracting energy from the not-so-invisible as anticipated dark sector.
Bound states of the Dunkl–Schrödinger equation for the spiked inverted oscillator potential
Authors: Schulze-Halberg Axel
Published: October 2024

We construct closed-form solutions to the one-dimensional, stationary Dunkl–Schrödinger equation for the inverted oscillator potential with an inverse quadratic singularity at the origin. Conditions are derived for our solutions to represent bound states, and an example is given.
A Sentiment Analysis and Semantic Comprehension-Integrated Automatic Abstraction Model for English Texts
Authors: Huang Cuiying , Li Qingyuan
Published: October 2024

Automatic abstraction has been a more prevalent technical demand in text analysis. However, due to the complex relationship between sentence structure and semantics, current automatic abstraction models in English texts still suffer from some challenges. Therefore, this paper explores a new type of English text automatic abstraction model that combines sentiment analysis and semantic perception technology. First, it is supposed to make serialization and extraction of English texts, resulting in multi-level sequential text. Then, a hierarchical multihead attention mechanism is introduced to achieve dynamic word vectorization. Finally, it is input into a multi-angle convolutional network, in which each token-level vector in the sentence is input for multiangle sentiment analysis and double-layer semantic perception. Hence, the automatic abstract result for long texts can be achieved. After that, experiments are conducted on multiple English text datasets to compare the proposal with other benchmark methods. The results show that the model has achieved significant improvement in the generation of text summaries, which can more effectively generate text summaries with rich emotions and accurate semantics.
AI-Driven Optimization of Renewable Energy Storage Systems in Smart Cities Using Improved Binary Genetic Algorithm
Authors: Yan Yuping , Liang Yingwei
Published: October 2024

Today, the utilization and management of renewable energy have become integral to the development of smart cities. This paper explores the application of Artificial Intelligence (AI) in analyzing energy storage and renewable energy systems within smart city contexts. We introduce a joint optimization method that combines two-stage input feature selection and parameter training in traditional prediction models. This method integrates physical, statistical, and AI modeling techniques. Additionally, we conduct comprehensive experiments on feature input selection using a Binary Genetic Algorithm (BGA) and two-stage model parameter optimization based on a Natural Evolution Strategies (NES). The experimental results provide strong support for the conclusions of this study. Finally, we simulate the full charge process of energy storage in a smart city and predict the full charge data for batteries B0005, B0006, B0007, and B0029. The results indicate that the NES-BGA-ELM approach outperforms the BGA-ELM method in terms of error reduction.
On the atomicity of power monoids of Puiseux monoids
Authors: Gonzalez Victor , Li Eddy , Rabinovitz Henrick , Rodriguez Pedro , Tirador Marcos
Published: October 2024

A submonoid of the additive group [Formula: see text] is called a Puiseux monoid if it consists of non-negative rationals. Given a monoid [Formula: see text], the set consisting of all non-empty finite subsets of [Formula: see text] is also a monoid under the Minkowski sum, and it is called the (finitary) power monoid of [Formula: see text]. In this paper, we study atomicity and factorization properties in the setting of power monoids of Puiseux monoids. We specifically focus on the ascent of atomicity and the finite factorization property (although we also consider the ascending chain condition on principal ideals and the length-finite factorization property). We prove that the finite factorization property ascends from any Puiseux monoid to its power monoid. On the other hand, we construct an atomic Puiseux monoid whose power monoid is not atomic. We also prove that the existence of maximal common divisors for non-empty finite subsets is a sufficient condition for the property of being atomic to ascend from a Puiseux monoid to its power monoid.