bluuebunny/crossref_metadata_2025 huggingface dataset:
In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study
Authors: Vanoverschelde Anna , Van Hoey Chloë , Buyle Franky , Den Blauwen Nadia , Depuydt Pieter , Van Braeckel Eva , Lahousse Lies
Published: April 2023

Background

The use of antibiotics in mild to severe acute exacerbations of chronic obstructive pulmonary disease (COPD) remains controversial.

Aim

To explore in-hospital antibiotic use in severe acute exacerbations of COPD (AECOPD), to analyze determinants of in-hospital antibiotic use, and to investigate its association with hospital length of stay (LOS) and in-hospital mortality.

Methods

A retrospective, observational study was conducted in Ghent University Hospital. Severe AECOPD were defined as hospitalizations for AECOPD (ICD-10 J44.0 and J44.1) discharged between 2016 and 2021. Patients with a concomitant diagnosis of pneumonia or ‘pure’ asthma were excluded. An alluvial plot was used to describe antibiotic treatment patterns. Logistic regression analyses identified determinants of in-hospital antibiotic use. Cox proportional hazards regression analyses were used to compare time to discharge alive and time to in-hospital death between antibiotic-treated and non-antibiotic-treated AECOPD patients.

Results

In total, 431 AECOPD patients (mean age 70 years, 63% males) were included. More than two-thirds (68%) of patients were treated with antibiotics, mainly amoxicillin-clavulanic acid. In multivariable analysis, several patient-related variables (age, body mass index (BMI), cancer), treatment-related variables (maintenance azithromycin, theophylline), clinical variables (sputum volume and body temperature) and laboratory results (C-reactive protein (CRP) levels) were associated with in-hospital antibiotic use independent of sputum purulence, neutrophil counts, inhaled corticosteroids and intensive care unit of which CRP level was the strongest determinant. The median hospital LOS was significantly longer in antibiotic-treated patients (6 days [4–10]) compared to non-antibiotic-treated patients (4 days [2–7]) (p < 0.001, Log rank test). This was indicated by a reduced probability of hospital discharge even after adjustment for age, sputum purulence, BMI, in-hospital systemic corticosteroid use and forced expiratory volume in one second (FEV1) (adjusted hazard ratio 0.60; 95% CI 0.43; 0.84). In-hospital antibiotic use was not significantly associated with in-hospital mortality.

Conclusions

In this observational study in a Belgian tertiary hospital, in-hospital antibiotic use among patients with severe AECOPD was determined by the symptom severity of the exacerbation and the underlying COPD severity as recommended by the guidelines, but also by patient-related variables. Moreover, in-hospital antibiotic use was associated with a longer hospital stay, which may be linked to their disease severity, slower response to treatment or 'harm' due to antibiotics.

Trial registration

Number: B670201939030; date of registration: March 5, 2019.
Development of the clinical reasoning competency scale for nurses
Authors: Bae Juyeon , Lee JuHee , Choi Mona , Jang Yeonsoo , Park Chang Gi , Lee Young Joo
Published: April 2023

Background

Clinical reasoning is emphasized as an important component of nursing education, since nurses’ lack of clinical reasoning leads to incorrect clinical decision-making. Therefore, a tool for measuring clinical reasoning competency needs to be developed.

Methods

This methodological study was conducted to develop the Clinical Reasoning Competency Scale (CRCS) and examine its psychometric properties. The attributes and preliminary items of the CRCS were developed based on a systematic literature review and in-depth interviews. The validity and reliability of the scale were evaluated among nurses.

Results

The exploratory factor analysis was conducted for the construct validation. The total explained variance of the CRCS was 52.62%. The CRCS consists of 8 items for plan setting, 11 items for intervention strategy regulation, and 3 items for self-instruction. The Cronbach’s α of the CRCS was 0.92. Criterion validity was verified with the Nurse Clinical Reasoning Competence (NCRC). The correlation between the total NCRC and CRCS scores was 0.78, all of which were significant correlations.

Conclusion

The CRCS is expected to provide raw scientific and empirical data for various intervention programs to develop and improve nurses’ clinical reasoning competency.
Production and optimization of novel Sphorolipids from Candida parapsilosis grown on potato peel and frying oil wastes and their adverse effect on Mucorales fungal strains
Authors: Al-kashef Amr S. , Nooman Mohamed U. , Rashad Mona M. , Hashem Amr H. , Abdelraof Mohamed
Published: April 2023

Brief introduction

Mucormycosis disease, which has recently expanded with the Covid 19 pandemic in many countries, endangers patients' lives, and treatment with common drugs is fraught with unfavorable side effects.

Aim and objectives

This study deals with the economic production of sophorolipids (SLs) from different eight fungal isolates strains utilizing potato peels waste (PPW) and frying oil waste (FOW). Then investigate their effect against mucormycetes fungi.

Results

The screening of the isolates for SLs production revealed the highest yield (39 g/100 g substrate) with most efficiency was related to a yeast that have been identified genetically as Candida parapsilosis. Moreover, the characterizations studies of the produced SLs by FTIR, 1H NMR and LC–MS/MS proved the existence of both acidic and lactonic forms, while their surface activity was confirmed by the surface tension (ST) assessment. The SLs production was optimized utilizing Box-Behnken design resulting in the amelioration of yield by 30% (55.3 g/100 g substrate) and ST by 20.8% (38mN/m) with constant level of the critical micelle concentration (CMC) at 125 mg/L. The studies also revealed the high affinity toward soybean oil (E24 = 50%), in addition to maintaining the emulsions stability against broad range of pH (4–10) and temperature (10–100℃). Furthermore, the antifungal activity against Mucor racemosus, Rhizopus microsporus, and Syncephalastrum racemosum proved a high inhibition efficiency of the produced SLs.

Conclusion

The findings demonstrated the potential application of the SLs produced economically from agricultural waste as an effective and safer alternative for the treatment of infection caused by black fungus.
Dental health status, dentist visiting, and dental insurance of Asian immigrants in Canada
Authors: Li Qianqian , Wang Yu , Knight John C. , Yi Yanqing , Ozbek Sara , Shariati Matin , Wang Peizhong Peter , Zhu Yun
Published: April 2023

Objective

This study examined the dental care utilization and self-preserved dental health of Asian immigrants relative to non-immigrants in Canada. Factors associated with oral health-related disparities between Asian immigrants and other Canadians were further examined.

Methods

We analyzed 37,935 Canadian residents aged 12 years and older in the Canadian Community Health Survey 2012–2014 microdata file. Factors (e.g., demographics, socioeconomic status, lifestyles, dental insurance coverage, and year of immigration) associated with disparities in dental health (e.g., self-perceived teeth health, dental symptoms during past one month, and teeth removed due to decay in past one year) and service utilization (e.g., visiting dentist within the last three years, visiting dentist more than once per year) between Asian immigrants and other Canadians were examined using multi-variable logistic regression models.

Results

The frequency of dental care utilization was significantly lower in Asian immigrants than their non-immigrant counterparts. Asian immigrants had lower self-perceived dental health, were less likely to be aware of recent dental symptoms, and more likely to report tooth extractions due to tooth decay. Low education (OR = 0.42), male gender(OR = 1.51), low household income(OR = 1.60), non-diabetes(OR = 1.87), no dental insurance(OR = 0.24), short immigration length (OR = 1.75) may discourage Asian immigrants from dental care utilization. Additionally, a perceived lack of necessity to dentist-visiting was a crucial factor accounting for the disparities in dental care uptake between Asian immigrants and non-immigrants.

Conclusion

Asian immigrants showed lower dental care utilization and oral health than native-born Canadians.
Letter to editor – observation on the article titled “Vaccine-Induced Thrombotic Thrombocytopenia (VITT): first report from India”
Authors: Kotwal Jyoti , Balraam K. V. Vinu
Published: April 2023

The first case of Vaccine-Induced Thrombotic Thrombocytopenia (VITT) was reported in the letter-to-editor submission in the journal of Indian Journal of Hematology and Blood Transfusion which was published online on 29th Sep 2021. Whereas, an article published in your journal on 04th Mar 2022 has been titled as first report of VITT from India which is a very conflicting statistic. The former article under reference has been diagnosed by a confirmatory functional assay as per the recommended guidelines and is thus genuinely the first case reported in this country.
How to select interventions for promoting physical activity in schools? Combining preferences of stakeholders and scientists
Authors: Brandes Mirko , Brandes Berit , Sell Louisa , Sacheck Jennifer M. , Chinapaw Mai , Lubans David R. , Woll Alexander , Schipperijn Jasper , Jago Russell , Busse Heide
Published: April 2023

Background

The failure to scale-up and implement physical activity (PA) interventions in real world contexts, which were previously successful under controlled conditions, may be attributed to the different criteria of stakeholders and scientists in the selection process of available interventions. Therefore, the aim of our study was to investigate and compare the criteria applied by local stakeholders and scientists for selecting amongst suitable school-based PA interventions for implementation.

Methods

We conducted a three-round repeated survey Delphi study with local stakeholders (n = 7; Bremen, Germany) and international scientific PA experts (n = 6). Independently for both panels, two rounds were utilized to develop a list of criteria and the definitions of criteria, followed by a prioritization of the criteria in the third round. For each panel, a narrative analysis was used to rank-order unique criteria, list the number of scorers for the unique criteria and synthesize criteria into overarching categories.

Results

The stakeholders developed a list of 53 unique criteria, synthesized into 11 categories with top-ranked criteria being ‘free of costs’, ‘longevity’ and ‘integration into everyday school life’. The scientists listed 35 unique criteria, synthesized into 7 categories with the top-ranked criteria being ‘efficacy’, ‘potential for reach’ and ‘feasibility’. The top ranked unique criteria in the stakeholder panel were distributed over many categories, whereas four out of the top six criteria in the scientist panel were related to ‘evidence’.

Conclusions

Although stakeholders and scientists identified similar criteria, major differences were disclosed in the prioritization of the criteria. We recommend an early collaboration of stakeholders and scientists in the design, implementation, and evaluation of PA interventions.
Electrical stimulation methods and protocols for the treatment of traumatic brain injury: a critical review of preclinical research
Authors: Ziesel D. , Nowakowska M. , Scheruebel S. , Kornmueller K. , Schäfer U. , Schindl R. , Baumgartner C. , Üçal M. , Rienmüller T.
Published: April 2023

Background

Traumatic brain injury (TBI) is a leading cause of disabilities resulting from cognitive and neurological deficits, as well as psychological disorders. Only recently, preclinical research on electrical stimulation methods as a potential treatment of TBI sequelae has gained more traction. However, the underlying mechanisms of the anticipated improvements induced by these methods are still not fully understood. It remains unclear in which stage after TBI they are best applied to optimize the therapeutic outcome, preferably with persisting effects. Studies with animal models address these questions and investigate beneficial long- and short-term changes mediated by these novel modalities.

Methods

In this review, we present the state-of-the-art in preclinical research on electrical stimulation methods used to treat TBI sequelae. We analyze publications on the most commonly used electrical stimulation methods, namely transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS) and vagus nerve stimulation (VNS), that aim to treat disabilities caused by TBI. We discuss applied stimulation parameters, such as the amplitude, frequency, and length of stimulation, as well as stimulation time frames, specifically the onset of stimulation, how often stimulation sessions were repeated and the total length of the treatment. These parameters are then analyzed in the context of injury severity, the disability under investigation and the stimulated location, and the resulting therapeutic effects are compared. We provide a comprehensive and critical review and discuss directions for future research.

Results and conclusion

We find that the parameters used in studies on each of these stimulation methods vary widely, making it difficult to draw direct comparisons between stimulation protocols and therapeutic outcome. Persisting beneficial effects and adverse consequences of electrical simulation are rarely investigated, leaving many questions about their suitability for clinical applications. Nevertheless, we conclude that the stimulation methods discussed here show promising results that could be further supported by additional research in this field.
Breast implant associated EBV-positive Diffuse Large B-cell lymphoma: an underrecognized entity?
Authors: Vets Johanna , Marcelis Lukas , Schepers Charlotte , Dorreman Yaliva , Verbeek Sanne , Vanwalleghem Lieve , Gieraerts Katrien , Meylaerts Liesbeth , Lesaffer Jan , Devos Helena , Put Natalie , Snauwaert Sylvia , De Paepe Pascale , Tousseyn Thomas
Published: April 2023

Breast-implant associated (BIA) lymphoma is an infrequent type of cancer occurring in the fluid and fibrous capsule around a textured breast implant. Recently, both the 2022 WHO 5th edition classification of Haematological tumours (WHO HAEM5) and 2022 International Consensus Classification of Mature Lymphoid Neoplasms (22ICC), recognized breast implant-associated Anaplastic Large Cell Lymphoma (BIA-ALCL) as a definitive entity, defined as a mature CD30-positive T-cell lymphoma, confined by a fibrous capsule, in a breast implant setting. Only few B-cell lymphomas have been reported in the literature to be associated with breast implants. Here we report two EBV-positive Diffuse Large B-cell lymphomas (EBV + DLBCL) in relation to a breast implant, both expressing CD30 as well as EBV latency type 3. Both lesions were considered as DLBCL associated with chronic inflammation (CI-DLBCL), but one presented as a 7 cm solid mass, while the other presented as a fibrin-associated DLBCL (FA-DLBCL) in an HIV patient. Clinically, both are in complete remission 6 months or longer after capsulectomy and graft removal, without additional chemotherapy.

Such cases, characterized by large CD30-positive cells, can easily be misdiagnosed as BIA-ALCL if the cell of origin is not further established. Therefore, a diagnostic panel including lineage-specific B-and T-cell markers and EBER in situ hybridization is essential to recognize this rare entity, to understand lymphomagenesis, to predict outcome and to define clinical approach.
LncRNA ZFAS1 protects chondrocytes from IL-1β-induced apoptosis and extracellular matrix degradation via regulating miR-7-5p/FLRT2 axis
Authors: Han Jicheng , Luo Zongjian , Wang Yifei , Liang Yantao
Published: April 2023

Background

Increasing evidence suggested that long non-coding RNAs (lncRNAs) played vital roles in osteoarthritis (OA) progression. In this study, we aimed to reveal the protective roles of lncRNA ZFAS1 in osteoarthritis (OA) and further investigated its underlying mechanism.

Methods

The chondrocytes were stimulated by IL-1β to establish an in vitro OA model. Then, the expression of ZFAS1, miR-7-5p, and FLRT2 in chondrocytes was determined by qRT-PCR. Gain- and loss-of-function assays of ZFAS1, miR-7-5p and FLRT2 were conducted. CCK-8 assay and flow cytometry analysis were performed to detect cell viability and apoptosis rate. The expression levels of cartilage-related proteins, including MMP13, ADAMTS5, Collagen II, and Aggrecan, were measured by western blot analysis. The interaction between ZFAS1 and miR-7-5p, as well as miR-7-5p and FLRT2, was confirmed by dual-luciferase reporter assay and RNA immunoprecipitation assay.

Results

The expression of ZFAS1 and FLRT2 was down-regulated, while the expression of miR-7-5p was up-regulated in chondrocytes exposed to IL-1β. ZFAS1 overexpression promoted cell viability and suppressed apoptosis in IL-1β-treated chondrocytes. Besides, ZFAS1 overexpression suppressed the expression of MMP13 and ADAMTS5, but promoted the expression of Collagen II and Aggrecan to suppress ECM degradation. The mechanistic study showed that ZFAS1 sponged miR-7-5p to regulate FLRT2 expression. Furthermore, the overexpression of miR-7-5p could neutralize the effect of ZFAS1 in IL-1β-treated chondrocytes, and suppression of FLRT2 counteracted the miR-7-5p down-regulation role in IL-1β-treated chondrocytes.

Conclusions

ZFAS1 could promote cell viability of IL-1β-treated chondrocytes via regulating miR-7-5p/FLRT2 axis.

Trial registration Not applicable.
A self-inspected adaptive SMOTE algorithm (SASMOTE) for highly imbalanced data classification in healthcare
Authors: Kosolwattana Tanapol , Liu Chenang , Hu Renjie , Han Shizhong , Chen Hua , Lin Ying
Published: April 2023

In many healthcare applications, datasets for classification may be highly imbalanced due to the rare occurrence of target events such as disease onset. The SMOTE (Synthetic Minority Over-sampling Technique) algorithm has been developed as an effective resampling method for imbalanced data classification by oversampling samples from the minority class. However, samples generated by SMOTE may be ambiguous, low-quality and non-separable with the majority class. To enhance the quality of generated samples, we proposed a novel self-inspected adaptive SMOTE (SASMOTE) model that leverages an adaptive nearest neighborhood selection algorithm to identify the “visible” nearest neighbors, which are used to generate samples likely to fall into the minority class. To further enhance the quality of the generated samples, an uncertainty elimination via self-inspection approach is introduced in the proposed SASMOTE model. Its objective is to filter out the generated samples that are highly uncertain and inseparable with the majority class. The effectiveness of the proposed algorithm is compared with existing SMOTE-based algorithms and demonstrated through two real-world case studies in healthcare, including risk gene discovery and fatal congenital heart disease prediction. By generating the higher quality synthetic samples, the proposed algorithm is able to help achieve better prediction performance (in terms of F1 score) on average compared to the other methods, which is promising to enhance the usability of machine learning models on highly imbalanced healthcare data.
Identifying yield-related genes in maize based on ear trait plasticity
Authors: Liu Minguo , Zhang Shuaisong , Li Wei , Zhao Xiaoming , Wang Xi-Qing
Published: April 2023

Background

Phenotypic plasticity is defined as the phenotypic variation of a trait when an organism is exposed to different environments, and it is closely related to genotype. Exploring the genetic basis behind the phenotypic plasticity of ear traits in maize is critical to achieve climate-stable yields, particularly given the unpredictable effects of climate change. Performing genetic field studies in maize requires development of a fast, reliable, and automated system for phenotyping large numbers of samples.

Results

Here, we develop MAIZTRO as an automated maize ear phenotyping platform for high-throughput measurements in the field. Using this platform, we analyze 15 common ear phenotypes and their phenotypic plasticity variation in 3819 transgenic maize inbred lines targeting 717 genes, along with the wild type lines of the same genetic background, in multiple field environments in two consecutive years. Kernel number is chosen as the primary target phenotype because it is a key trait for improving the grain yield and ensuring yield stability. We analyze the phenotypic plasticity of the transgenic lines in different environments and identify 34 candidate genes that may regulate the phenotypic plasticity of kernel number.

Conclusions

Our results suggest that as an integrated and efficient phenotyping platform for measuring maize ear traits, MAIZTRO can help to explore new traits that are important for improving and stabilizing the yield. This study indicates that genes and alleles related with ear trait plasticity can be identified using transgenic maize inbred populations.
Surgical trial design for incorporating the effects of learning: what is the current methodological guidance, and is it sufficient?
Authors: Corrigan Neil , Brown Julia M. , Emsley Richard , Jayne David G. , Walwyn Rebecca E. A.
Published: April 2023

Background

Surgical interventions are complex. Key elements of this complexity are the surgeon and their learning curve. They pose methodological challenges in the design, analysis and interpretation of surgical RCTs.

We identify, summarise, and critically examine current guidance about how to incorporate learning curves in the design and analysis of RCTs in surgery.

Examining current guidance

Current guidance presumes that randomisation must be between levels of just one treatment component, and that the evaluation of comparative effectiveness will be made via the average treatment effect (ATE). It considers how learning effects affect the ATE, and suggests solutions which seek to define the target population such that the ATE is a meaningful quantity to guide practice. We argue that these are solutions to a flawed formulation of the problem, and are inadequate for policymaking in this setting.

Reformulating the problem

The premise that surgical RCTs are limited to single-component comparisons, evaluated via the ATE, has skewed the methodological discussion. Forcing a multi-component intervention, such as surgery, into the framework of the conventional RCT design ignores its factorial nature.

We briefly discuss the multiphase optimisation strategy (MOST), which for a Stage 3 trial would endorse a factorial design. This would provide a wealth of information to inform nuanced policy but would likely be infeasible in this setting.

We discuss in more depth the benefits of targeting the ATE conditional on operating surgeon experience (CATE). The value of estimating the CATE for exploring learning effects has been previously recognised, but with discussion limited to analysis methods only. The robustness and precision of such analyses can be ensured via the trial design, and we argue that trial designs targeting CATE represent a clear gap in current guidance.

Conclusion

Trial designs that facilitate robust, precise estimation of the CATE would allow for more nuanced policymaking, leading to patient benefit. No such designs are currently forthcoming. Further research in trial design to facilitate the estimation of the CATE is needed.
Leveraging IgG N-glycosylation to infer the causality between T2D and hypertension
Authors: Wang Haotian , Li Yuan , Cao Weijie , Zhang Jie , Cao Mingyang , Meng Xiaoni , Liu Di , Wang Youxin
Published: April 2023

Background

Observational studies demonstrated a bidirectional association between type 2 diabetes (T2D) and hypertension, whereas Mendelian randomization (MR) analyses supported the causality from T2D to hypertension but not causal from hypertension to T2D. We previously found that IgG N-glycosylation is associated with both T2D and hypertension, and thus IgG N-glycosylation might link the causality between them.

Methods

We carried out a genome-wide association study (GWAS) to identify IgG N-glycosylation-quantitative-trait loci (QTLs) integrating GWAS for T2D and hypertension and then performed bidirectional univariable and multivariable MR analyses to infer the causal association among them. The inverse-variance-weighted (IVW) analysis was performed as the primary analysis, followed by some sensitivity analyses to explore the stability of the results.

Results

Six putatively causal IgG N-glycans for T2D and four for hypertension were identified in the IVW method. Genetically predicted T2D increased the risk of hypertension (odds ratio [OR] = 1.177, 95% confidence interval (95% CI) = 1.037–1.338, P = 0.012) and vice versa (OR = 1.391, 95% CI = 1.081–1.790, P = 0.010). Multivariable MR showed that T2D remained at risk effect with hypertension ([OR] = 1.229, 95% CI = 1.140–1.325, P = 7.817 × 10–8) after conditioning on T2D-related IgG-glycans. Conversely, hypertension was associated with higher T2D risk (OR = 1.287, 95% CI = 1.107–1.497, P = 0.001) after adjusting for related IgG-glycans. No evidence of horizontal pleiotropy was observed, as MR‒Egger regression provided P values for intercept > 0.05.

Conclusion

Our study validated the mutual causality between T2D and hypertension from the perspective of IgG N-glycosylation, further validating the “common soil” hypothesis underlying the pathogenesis of T2D and hypertension.
Primary health care coverage in Brazil: a dataset from 1998 to 2020
Authors: Alves Ronaldo Fernandes Santos , Boccolini Cristiano Siqueira , Baroni Lais Ribeiro , Boccolini Patricia de Moraes Mello
Published: April 2023

Objectives

Primary health care builds the backbone of an effective healthcare system and can improve population health, reduce cost growth, and lessen inequality. We offer a machine-readable and open-access dataset on primary health care coverage in Brazil from 1998 to 2020. This dataset is interoperable with epidemiological data from two major studies and reusable by the research community worldwide for other purposes, such as monitoring progress toward universal health coverage and studying the association between primary health care and health outcomes.

Data description

The dataset gathers official and public information from the “e-Gestor AB” platform of the Ministry of Health of Brazil and restricted data obtained by the Brazilian Access to Information Law. It includes 1,509,870 observations and 35 attributes aggregated by months/years and policy-relevant geographic units (country, macroregions, states, municipalities, and capitals) on primary health care team count and their absolute and relative population coverage estimates, information on the More Doctors Program implementation and physician counts, and spatial, demographic, and socioeconomic characteristics. We automated all data processing and curation in the free and open software R. The codes can be audited, replicated, and reused to produce alternative analyses.
The role of DNA hydroxymethylation and TET enzymes in placental development and pregnancy outcome
Authors: Vasconcelos Sara , Caniçais Carla , Chuva de Sousa Lopes Susana M. , Marques C. Joana , Dória Sofia
Published: April 2023

The placenta is a temporary organ that is essential for supporting mammalian embryo and fetal development. Understanding the molecular mechanisms underlying trophoblast differentiation and placental function may contribute to improving the diagnosis and treatment of obstetric complications. Epigenetics plays a significant role in the regulation of gene expression, particularly at imprinted genes, which are fundamental in the control of placental development. The Ten-Eleven-Translocation enzymes are part of the epigenetic machinery, converting 5-methylcytosine (5mC) into 5-hydroxymethylcytosine (5hmC). DNA hydroxymethylation is thought to act as an intermediate in the DNA demethylation mechanism and potentially be a stable and functionally relevant epigenetic mark on its own. The role of DNA hydroxymethylation during differentiation and development of the placenta is not fully understood but increasing knowledge in this field will help to evaluate its potential role in pregnancy complications. This review focuses on DNA hydroxymethylation and its epigenetic regulators in human and mouse placental development and function. Additionally, we address 5hmC in the context of genomic imprinting mechanism and in pregnancy complications, such as intrauterine growth restriction, preeclampsia and pregnancy loss. The cumulative findings show that DNA hydroxymethylation might be important for the control of gene expression in the placenta and suggest a dynamic role in the differentiation of trophoblast cell types during gestation.
Food protein-induced enterocolitis syndrome in an infant triggered by prunes
Authors: Kovaltchouk Uliana , Gerstner Thomas
Published: April 2023

Background

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE mediated food allergy that has a cumulative incidence of 0.015 to 0.7% in infants [1]. The most common allergens causing FPIES reactions include cow’s milk, followed by soy, grains, and rice [1, 3]. Increasing clinical awareness of FPIES has resulted in the expansion of emerging triggers of FPIES, including fruit antigens.

Case presentation

We describe an infant diagnosed with FPIES to prune.

Conclusion

Fruit allergens are an emerging group of triggers for FPIES, both in their fresh and dried forms. To our knowledge, this case is the first presentation of FPIES to prunes (dehydrated plum). This case highlights that careful history taking can avoid unnecessary investigations and delay in diagnosing FPIES.
Acute obstructive pyelonephritis due to pyosalpinx: a case report
Authors: Chaker Kays , Ouanes Yassine , Azouz Eya , Trigui Mohamed , Madani Anouar , Mosbahi Boutheina , Elabed Wiem , Chbeb Oumayma , Bibi Mokhtar , Dali Kheireddine Mrad , Ammous Adel , Nouira Yassine
Published: April 2023

Background

A pyosalpinx is the acute inflammation of the fallopian tube, which fills up and swells with pus. It commonly results from inadequate or delayed treatment of pelvic inflammatory disease.

Case presentation

We report the case of a 54-year-old Africain female patient, who presented with sustained high-grade fever, right flank pain, and severe acute storage low-urinary-tract symptoms. Computed tomography showed signs of acute obstructive pyelonephritis with a right tubular juxtauterine mass with complex internal fluid and thick enhancing walls exerting a mass effect on the right ureter. A drainage of the right excretory cavities by a JJ stent was performed. An ultrasound-guided aspiration of the collection was also performed.

Conclusion

A pyosalpinx can then exert a mass effect on the excretory cavities, thus causing an acute obstructive pyelonephritis. A double drainage coupled with an effective antibiotic therapy is then necessary.
Prospective paired crossover evaluation of potential impact of investigator gender on perceived pain intensity early after acute or scheduled surgery
Authors: Engskov Anna Sellgren , Ydrefors Andreas , el-Jaleb Karolin , Åkeson Jonas
Published: April 2023

Background

Postoperative pain is common but often difficult to assess, and there are many potential confounders. Over the last decades, the gender of investigator as well as participant has been found to influence pain perception in both preclinical and clinical studies. However, to our knowledge this has not been studied in various postoperative patients. Objectives of this study were to test the hypotheses that pain intensity levels early after acute or scheduled in- or out-hospital surgery are lower when evaluated by a female investigator, and higher when reported by a female patient.

Methods

In this prospective observational paired crossover study, two investigators of opposite genders independently obtained individually reported pain intensity levels with a visual analogue scale in a mixed cohort of adult postoperative study patients at Skåne University Hospital in Malmö, Sweden.

Results

In total, 245 (129 female) study patients were included and then one female excluded. The study patients rated their intensity of postoperative pain lower when evaluated by a female than by a male investigator (P = 0.006), where the male patients constituted the significant difference (P < 0.001). Pain intensity levels did not differ between female and male study patients (P = 0.210).

Conclusions

Main findings of lower pain intensity reported by males to a female than to a male investigator early after surgery in this paired crossover study in mixed postoperative patients, indicate that potential impact of investigator gender on pain perception should be considered and further evaluated in clinical bedside practice.

Trial registration Retrospectively registered in the ClinicalTrials.gov research database on 24th June 2019 with TRN number NCT03968497.
The oldest Gondwanan record of the extinct durophagous hybodontiform chondrichthyan, Strophodus from the Bajocian of Morocco
Authors: Stumpf Sebastian , Kettler Christoph , Kindlimann René , Cuny Gilles , Kriwet Jürgen
Published: April 2023

Strophodusis a speciose and geographically widespread taxon of large durophagous hybodontiform chondrichthyan, with a stratigraphic range extending from Middle Triassic to the Early Cretaceous. Here, we describe a new species ofStrophodus,S.atlasensissp. nov., based on an incomplete articulated dentition recovered from marine Bajocian deposits of the eastern High Atlas Mountains in Morocco. The new species is diagnosed by a unique combination of dental characters that includes, among others, the presence of triangular first lateral teeth, mesio-distally wide and bulbous second lateral teeth without an occlusal crest or dome and uniquely shaped first posterior teeth that are shorter mesio-distally than being labio-lingually long, as well as small second posterior teeth whose roots protrude below the crowns to meet each other in an efficient interlocking manner. The holotype and only specimen ofStrophodus atlasensissp. nov. represents the hitherto oldest known record ofStrophodusfrom Gondwana and the first record of that genus from the Bajocian, thus adding valuable novel information to our incomplete understanding of the evolutionary history of extinct hybodontiform chondrichthyans.
Risk factors for severe COVID-19 in the young—before and after ICU admission
Authors: Kämpe Johanna , Bohlin Olof , Jonsson Martin , Hofmann Robin , Hollenberg Jacob , Wahlin Rebecka Rubenson , Svensson Per , Nordberg Per
Published: April 2023

Background

Factors associated with severe COVID-19 and death among young adults are not fully understood, including differences between the sexes. The aim of this study was to identify factors associated with severe COVID-19 requiring intensive care and 90-day mortality among women and men below 50 years of age.

Methods

A register-based study using data from mandatory national registers, where patients with severe COVID-19 admitted to the ICU with need for mechanical ventilation (cases) between March 2020 and June 2021 were matched regarding age, sex, and district of residence with 10 population-based controls. Both the study population and the controls were divided into groups based on age (< 50 years, 50–64, and ≥ 65 years) and sex. Multivariate logistic regression models including socioeconomic factors were used to calculate odds ratios (OR) with 95% confidence intervals (CIs) for associations between severe COVID-19 in the population to compare the magnitude of the risk associations for co-morbidities in the different age categories, and subsequently factors associated with 90-day mortality among patients admitted to ICU.

Results

In total, 4921 cases and 49,210 controls (median age 63 years, 71% men) were included.

The co-morbidities with the strongest associations with severe COVID-19 for the young population compared to older patients were chronic kidney disease (OR 6.80 [3.61–12.83]), type 2 diabetes (OR 6.31 [4.48–8.88]), hypertension (OR 5.09 [3.79–6.84]), rheumatoid arthritis (OR 4.76 [2.29–9.89]), obesity (OR 3.76 [2.88–4.92]), heart failure (OR 3.06 [1.36–6.89]), and asthma (OR 3.04 [2.22–4.16]).

When comparing women vs. men < 50 years of age, stronger associations were seen for women regarding type 2 diabetes (OR 11.25 [6.00–21.08] vs OR 4.97 [3.25–7.60]) and hypertension (OR 8.76 [5.10–15.01] vs OR 4.09 [2.86–5.86]).

The factors associated with 90-day mortality in the young were previous venous thromboembolism (OR 5.50 [2.13–14.22]), chronic kidney disease (OR 4.40 [1.64–11.78]) and type 2 diabetes (OR 2.71 [1.39–5.29]). These associations with 90-day mortality were foremost driven by the female population.

Conclusion

Chronic kidney failure, type 2 diabetes, hypertension, rheumatoid arthritis, obesity, heart failure, and asthma were the strongest risk factors associated with severe COVID-19 requiring ICU-care in individuals < 50 years compared to the older population. However, after ICU admission, previous thromboembolism, chronic kidney failure, and type 2 diabetes were associated with increased 90-day mortality. The risk associations for co-morbidities were generally stronger among younger individuals compared to older and in women compared to men.
Comparing the incidence of SARS-CoV-2 across age groups considering sampling biases - use of testing data of autumn 2021 in Belgium
Authors: Lajot Adrien , Cornelissen Laura , Van Cauteren Dieter , Meurisse Marjan , Brondeel Ruben , Dupont-Gillain Christine
Published: April 2023

Background

To design efficient mitigation measures against COVID-19, understanding the transmission dynamics between different age groups was crucial. The role of children in the pandemic has been intensely debated and involves both scientific and ethical questions. To design efficient age-targeted non-pharmaceutical interventions (NPI), a good view of the incidence of the different age groups was needed. However, using Belgian testing data to infer real incidence (RI) from observed incidence (OI) or positivity ratio (PR) was not trivial.

Methods

Based on Belgian testing data collected during the Delta wave of Autumn 2021, we compared the use of different estimators of RI and analyzed their effect on comparisons between age groups.

Results

We found that the RI estimator’s choice strongly influences the comparison between age groups.

Conclusion

The widespread implementation of testing campaigns using representative population samples could help to avoid pitfalls related to the current testing strategy in Belgium and worldwide. This approach would also allow a better comparison of the data from different countries while reducing biases arising from the specificities of each surveillance system.
A meta-analysis on the prevalence of resistance of Staphylococcus aureus to different antibiotics in Nigeria
Authors: Ezeh Christian Kelechi , Eze Chibuzor Nwadibe , Dibua Marie Esther Uju , Emencheta Stephen Chijioke
Published: April 2023

Background

Rapid emergence of multidrug resistant Staphylococcus aureus has resulted to difficulty in treatment of infections caused by such strains. The aim of this meta-analysis study was to determine the pooled prevalence of resistance of S. aureus to different antibiotics in Nigeria.

Methods

Literature search for studies was done using Google scholar, PubMed, Science direct, and African Journal Online. The prevalence of S. aureus resistance to different antibiotics was evaluated using the meta-analysis proportion command in MedCalc software version 20.0 adopting a rand effect model. I2 statistic and Egger test in MedCalc was used to evaluate the heterogeneity and the presence of publication bias among studies respectively.

Results

A total of 40, 682 studies were retrieved through the database search of which 98 studies met the study inclusion criteria. Prevalence of resistance of S. aureus to different antibiotics ranges from 13 to 82%. Results showed a very high degree of resistance to penicillin G (82% [95% confidence interval (CI) 61%, 0.96%]), cloxacillin (77% [95% CI 64%, 88%]), amoxacillin (74% [95% CI 66%, 81%]), cefuroxime (69% [95% CI 51%, 85%]), ampicillin (68% [95% CI 53%, 81%]). Moderately resistance to erythromycin (47% [95% CI 40%, 53%]), chloramphenicol (47% [95% CI 37%, 56%]), methicillin (46% [95% CI 37%, 56%]), ofloxacin (24% [95% CI 18%, 31%]) and rifampicin 24% [95% CI 6%, 48%]). Low resistance was observed in vancomycin 13% (95% CI 7%, 21%). For each individual meta-analysis, high heterogeneity was observed with I2 range (79.36–98.60%) at p-values ≤ 0.01). Egger’s tests for regression intercept in funnel plots indicated no evidence of publication bias.

Conclusion

This meta-analysis study established that S. aureus in Nigeria has developed resistance to commonly used antibiotics such as the beta-lactam class antibiotics, sulphonamides, tetracyclines, chloramphenicol, and vancomycin. Hence it is imperative to develop programs to promote rational use of antimicrobial agents, infection prevention and control to reduce the incidence of antimicrobial resistance.
Qualitative assessment of the national initiative to implement antimicrobial stewardship centres in French administrative regions
Authors: Conlin Michèle , Leroy Anne-Gaëlle , Asquier-Khati Antoine , Boutoille David , Birgand Gabriel
Published: April 2023

Background

In May 2020, the French Ministry of Health funded the creation of regional antimicrobial stewardship (AMS) coordination centres (CRAtb) in preparation for the new national framework for the prevention of antimicrobial resistance. This study aimed to assess through qualitative methods the implementation process, the activities carried out, and the interactions with other regional stakeholders of the newly created CRAtb.

Methods

We conducted a mixed-method study based on a cross-sectional survey and semi-structured interviews by French regions among implemented CRAtb. Of the eight eligible French regions with an existing CRAtb, seven participated to the online survey. Regional partners involved in AMS from the eight regions were interviewed between September 2021 and April 2022. The survey questionnaire addressed, through closed questions, the organization of the CRAtb, articulation with other regional actors involved in AMS and infection prevention and control (IPC), and AMS activities. The semi-structured interviews approached the implementation and the role of CRAtb, and the collaboration of other AMS and IPC stakeholders. Interview transcripts were analysed using thematic content analysis methodology.

Results

AMS activities carried out by CRAtb were mainly focusing on hospitals (n = 3), primary care (n = 2) and nursing homes (n = 1). Education mostly relied on training days and AMS help lines, communication on websites and newsletters. CRAtb members reported still being more engaged in providing advice to professionals for individual antibiotic treatments rather than collective-level AMS activities. Interactions were frequent between CRAtb, IPC regional centres and health authorities, but rarely involved other stakeholders. Interviews were performed with 28 professionals involved in AMS from eight regions. Pre-existing networks and working relationships in AMS and more broadly facilitated the implementation of CRAtb. Streamlining and decompartmentalizing IPC and AMS regional activities were considered a way to optimise the prevention of antimicrobial resistance across sectors. The engagement with liberal health professionals was identified as a significant obstacle for CRAtb.

Conclusions

Two years after the launch of a new national framework, the implementation of CRAtb appeared complex in most regions. An integrative model joining IPC and AMS efforts, relying on existing networks, with engagement from liberal health profession organisations may be the next pivotal step.
Mediating effect of anxiety and depression between family function and hope in patients receiving maintenance hemodialysis: a cross-sectional study
Authors: Wang Xuefen , Xia Fuhai , Wang Guoqing
Published: April 2023

Objectives

This study aimed to explore the levels of hope in patients receiving maintenance hemodialysis (MHD), and whether anxiety and depression mediate the relationship between family function and hope.

Methods

The family APGAR index, hospital anxiety and depression scale, and Herth hope index were recorded using the self-reported questionnaires completed by 227 MHD patients.

Results

The family function can directly predict hope, positively predict hope through depression (β = 0.052, p = 0.001), and positively predict hope through the chain mediating of anxiety and depression (β = 0.087, p = 0.001), according to chain mediation analysis. The total effect size was 28.31%. The total indirect effect value was 0.139, and the total effect value was 0.491.

Conclusions

Our findings suggest that family function had a direct impact on MHD patients’ hope, and that lowering anxiety and depression can help to feel more hopeful.
Lupeol alleviates atopic dermatitis-like skin inflammation in 2,4-dinitrochlorobenzene/Dermatophagoides farinae extract-induced mice
Authors: Bae Sojung , Jeong Na-Hee , Choi Young-Ae , Lee Byungheon , Jang Yong Hyun , Lee Soyoung , Kim Sang-Hyun
Published: April 2023

Background

Atopic dermatitis (AD) is a chronic inflammatory skin disease that affects from children to adults widely, presenting symptoms such as pruritus, erythema, scaling, and dryness. Lupeol, a pentacyclic triterpenoid, has anti-inflammatory and antimicrobial activities. Based on these properties, the therapeutic effects of lupeol on skin disorders have been actively studied. In the present study, we aimed to determine the effectiveness of lupeol on AD.

Methods

We utilized tumor necrosis factor (TNF)-α/interferon (IFN)-γ-stimulated keratinocytes and 2, 4-dinitrochlorobenzene/Dermatophagoides farinae extract (DFE)-induced AD mice to confirm the action.

Results

Lupeol inhibited TNF-α/IFN-γ-stimulated keratinocytes activation by reducing the expressions of pro-inflammatory cytokines and chemokines which are mediated by the activation of signaling molecules such as signal transducer and activator of transcription 1, mitogen-activated protein kinases (p38 and ERK), and nuclear factor-κB. Oral administration of lupeol suppressed epidermal and dermal thickening and immune cell infiltration in ear tissue. Immunoglobulin (Ig) E (total and DFE-specific) and IgG2a levels in serum were also reduced by lupeol. The gene expression and protein secretion of T helper (Th) 2 cytokines, Th1 cytokines, and pro-inflammatory cytokine in ear tissue were decreased by lupeol.

Conclusions

These results suggest that lupeol has inhibitory effects on AD-related responses. Therefore, lupeol could be a promising therapeutic agent for AD.