bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of health education based on self-determination theory on hemodialysis knowledge, self-management and negative emotions in maintenance hemodialysis patients
Authors: Zhang Jiquan , Xu Fan , Zhuang Peimin , Xu Xingying , Zou Zhaohua , Qing Wei
Published: October 2024

To explore the application effect of health education based on self-determination theory on hemodialysis knowledge, self-management and negative emotions in maintenance hemodialysis patients. The research is a quasi-randomized control trial, a total of 86 maintenance hemodialysis patients who met the exclusion criteria were included (43 patients each in the intervention group and the control group). The control group received routine care, and the intervention group implemented health education guided by self-determination theory on the basis of the control group. Three months after the intervention, the two groups were compared in terms of hemodialysis knowledge, self-management, interdialytic weight gain value and anxiety and depression. Before the intervention, there was no statistical difference in the comparison of hemodialysis knowledge scores, self-management scores, interdialytic weight gain value and anxiety and depression scores (P > 0.05). After 3 months of intervention, the hemodialysis knowledge scores of the intervention group was higher than that of the control group and baseline; the scores of the intervention group in problem solving, partnership, emotional processing, executive self-care dimensions and the total self-management scores were higher than that of the control group and baseline; the interdialytic weight gain value of the intervention group was lower than that of the control group and baseline; the anxiety and depression scores of the intervention group were lower than that of the control group and baseline. All these differences were statistically significant (P < 0.05). Health education based on self-determination theory can improve the hemodialysis knowledge level and self-management ability of maintenance hemodialysis patients, and reduce the interdialytic weight gain value and anxiety and depression level, which is worthy of clinical promotion.
Distortion Analysis of BS L168 Aeronautical Aluminum Alloy Thin-Walled Parts during High-Speed Milling
Authors: Rajagopal Balaji , Rajagopal Balaji , Narayanaperumal Arunachalam , Chettu Kanna Babu
Published: October 2024

In the modern aviation industry, the use of thin-walled monolithic integrated parts made of aluminum alloys has significantly increased due to their high strength-to-weight ratio which reduces the overall weight of the aircraft, shortens assembly build cycle times, lower fuel consumption and improved performance. When slender, thin-walled components with varying contours are machined from BS L168 aluminum alloy bars commonly used in combat aircraft, distortion ranging from 5 to 12 mm along the wall thickness are often observed prior to lug removal. This is due to high milling forces, increased temperatures at the cutter-component interface zone, plastic deformation, low rigidity and the redistribution of internal stresses. Thin-walled components, which inherently lacking stiffness, are more prone to deformation, adversely affecting surface finish and often preventing parts from being properly aligned for subsequent operations. As a result, post-machining rework is frequently required, or, in some cases, parts are rejected due ti tight tolerance. This research analyses how cutting forces, thermal loads, surface finish, high material removal rates, residual stresses, cutter wear, and chip generation influence the distortion behaviour of thin-walled parts made from BS L168 Al alloy bars during high-speed milling (HSM) operations, aiming to identify factors contributing to distortion in real industrial scenarios and to develop strategies to minimize them, ensuring the production of high-precision parts with optimal structural integrity. Thin-walled, monolithic integrated parts of varying thickness and contour are milled into complex aircraft components using optimized cutting parameters under both dry and wet machining conditions. This is achieved with improved clamping, increased rigidity, the introduction of wax filling into pockets to add firmness to the workpiece, and intermittent stress-relieving operations after rough machining. The initial machining-induced residual stresses (MIRS) were studied using XRD, as high tensile stresses can cause micro-cracks and surface damage, impacting the part's structural integrity. Cutter wear and chip generation are also critical factors influencing stress and deformation in thin walls and were examined using a Scanning Electron Microscope (SEM) to analyse the impact of distortion across the wall thickness. Distortions in wall thickness were quantified with a coordinate measuring machine (CMM). The results indicated that HSM under wet machining of aircraft monolithic thin-walled parts, with optimized cutting parameters, improved clamping, and enhanced processes, had a substantial impact on reducing distortions. This technique led to a 30.56–48.93% reduction in distortion along the wall thickness of thin-walled components compared to dry machining.
Benzodiazepine agonist treatment for patients with benzodiazepine dependence undergoing opioid agonist treatment: a study protocol for the randomized controlled trial BMX-BAR
Authors: Chalabianloo Fatemeh , Fadnes Lars Thore , Assmus Jörg , Mordal Jon , Solli Kristin K , Dale Kjetil S , Andersen Christina D , Ohldieck Christian , Løberg Else-Marie , Johansson Kjell Arne
Published: October 2024

Background
There is a lack of knowledge on effective treatment methods for comorbid benzodiazepine dependence in populations undergoing opioid agonist treatment (OAT). Tapering and discontinuation of benzodiazepines has long been considered the standard treatment, even though there is limited evidence for this practice. There is also limited research on benzodiazepine agonist treatment, however, peer and clinical experiences indicate that such approaches may be beneficial for a subgroup of the patients with long-lasting benzodiazepine dependence not responding to other treatment approaches. A randomized controlled trial will be conducted to compare the efficacy and safety of stabilizing agonist treatment using prescribed benzodiazepines with standard treatment in reducing illicit benzodiazepine use.
Methods
The target sample is 108 participants at outpatient OAT clinics in five Norwegian cities/counties (Bergen/Vestland, Tønsberg/Vestfold, Skien/Telemark, Fredrikstad/Østfold and Tromsø/Troms). The main inclusion criteria are benzodiazepine dependence of ≥5 years, using ≥5 days a week during the last month, and previous attempts at tapering. Participants will be randomly assigned to receive either a 26-week benzodiazepine stabilizing treatment (15-30 mg diazepam or 50-100 mg oxazepam daily), or a 20-week tapering using the same medications and equivalent initial dosages. All participants will be given access to consultations from OAT therapists with psychosocial follow-up in accordance with current clinical practice.
The primary outcome is the use of illicit benzodiazepines assessed by observed urinary tests at week 24. Secondary outcomes include mental health symptoms, quality of life, cognitive performance, violence risk, other substance use, treatment retention, and life satisfaction. Additionally, the study will assess treatment-related adverse events as well as the cost-effectiveness of the intervention.
Discussion
This is the first randomized controlled trial of benzodiazepine agonist treatment for benzodiazepine dependence. The research project will assess efficacy and safety of stabilizing treatment with prescribed benzodiazepines compared to benzodiazepine tapering and discontinuation regarding use of illicit benzodiazepines and accordingly well-being of patients with concurrent benzodiazepine and opioid dependence undergoing OAT. If the intervention is found to be efficacious and safe, it will be considered one of the options to standard treatment for this patient group.
Trial registration
EU trial number: EudraCT: 2021-004981-37. Registered on December 13, 2021
Long-Term Functional Outcomes After Surgical Treatment of Displaced Midshaft Clavicle Fractures: A Retrospective Cohort Study
Authors: Lopiz Yaiza , Rodriguez-Zamorano Patricia , Díaz Macarena Diz , García-Fernandez Carlos , Marco Fernando
Published: October 2024

Introduction:
Long-term studies on clavicle fractures are scarce, making new data in this field particularly valuable. This study aimed to assess long-term clinical and radiographic outcomes, as well as the quality of life in patients treated with pre-contoured plates for midshaft clavicle fractures, while identifying potential outcome-associated risk factors.
Methods:
Between 2010 and 2020, 91 patients with displaced midshaft clavicle fractures treated by open reduction and internal fixation with pre-contoured plates were identified from 987 cases. Seventy-six of these patients were prospectively reviewed to assess clinical status (using DASH, Constant score, and EQ-5D/EQ-VAS for quality of life) and hardware-related outcomes at the most recent follow-up.
Results:
At an average follow-up of 64 months (range: 39–179), patients reported excellent outcomes: a mean Constant score of 91, a QuickDASH of 0.3, an EQ-5D of 0.94, and an EQ-VAS of 81.5. Active forward flexion, abduction, and external rotation were 177º, 175º, and 60º, respectively. Hardware removal was required in 11% of patients, with 30.7% reporting discomfort. Complications were minimal (5.5%), including 2 cases of non-union, 2 superficial wound infections, and 1 partial wound dehiscence. No refractures were observed. There was no significant association between fracture pattern (AO classification) or vertical displacement and functional outcomes (p = .578; p = .137). However, postoperative lengthening showed a significant correlation with QuickDASH scores (p = .019). Patient characteristics (BMI, age, gender, sports participation, or occupation) were not significantly associated with functional outcomes, complications, or hardware removal (p > .05).
Conclusion:
Although preoperative fracture displacement and hardware removal were not linked to poorer functional outcomes, up to 30% of patients reported discomfort post-surgery. Despite this, their perceived quality of life remained high. These findings provide valuable insights into long-term outcomes for patients treated with pre-contoured plates, underscoring the need for ongoing follow-up in this population.
Level of evidence
Level III, Retrospective Cohort Design, Treatment Study.
Sleep and wake intrusions: A continuous approach to explain insomnia and sleep state misperception.
Authors: Herzog Ruben , Crosbie Flynn , Aloulou Anis , Hanif Umaer , Chennaoui Mounir , Léger Damien , Andrillon Thomas
Published: October 2024

Understanding insomnia is crucial for improving its diagnosis and treatment. However, many subjective complaints about insomnia do not align with objective measures of sleep quality, as is the case in sleep state misperception (SSM). We addressed this discrepancy by measuring sleep intrusions and stability in polysomnographic (PSG) recordings from a large clinical database. Using advanced machine learning techniques, we inferred hypnodensities—a continuous and probabilistic measure of sleep dynamics—, and analyzed them via information theory to measure intrusions and stability in a principled way. We found that insomnia with SSM is associated with sleep intrusions during intra-sleep wakefulness, while insomnia without SSM is characterized by wake intrusions during sleep, suggesting a specific etiology for SSM. By mapping these metrics to micro and macrostructural sleep features, we provided a continuous and interpretable framework for measuring sleep quality. This integrative approach values subjective insomnia complaints and aligns them with physiological data, offering a more accurate and comprehensive understanding of sleep quality and its disorders.
Enhancing Proliferation and Osteogenesis of Single-cell hBMSCs Encapsulated in Alginate Microgels by Single-Layer Graphene Oxide Nanosheets: In-vitro Droplet Microfluidics Study
Authors: Soleymani Hossein , Moghaddam Mehrdad Moosazadeh , Naderi-Manesh Hossein , Taheri Ramezan Ali
Published: October 2024

Microfluidics cell encapsulation into the alginate droplets offers a way to mimic a three-dimensional (3D) microenvironment that supports cell growth and proliferation, while also protecting cells from environmental stress. This technique has found extensive applications in tissue engineering and cell therapies. Microcapsules offer a new method for creating injectable tissue transplants that are minimally invasive. Several studies have demonstrated the advantages of graphene oxide (GO) in the field of bone tissue engineering. GO has been recently reported as an osteogenic inducer; however, the significance of GO on stem cell fate in the single-cell state is still unclear. Here, a microfluidics-based approach is developed for continuous encapsulation of mesenchymal stem cells (MSCs) at the single-cell level using alginate microgels. So, single-layer graphene oxide (slGO) nanosheet is used to be encapsulated inside the alginate droplets. The results of AFM and SEM show that slGO can increase the roughness and reduce the stiffness of alginate hydrogels. The Young's modulus of the alginate and alginate-slGO was obtained as 985.9 kPa and 1414 kPa, respectively. Live/dead assay reveals that slGO maintains hBMSCs viability. Also, fluorescence microscopy images illustrate that slGO can enhance the viability and proliferation of microencapsulated hBMSCs. The obtained results show that slGO increases the mineralization of the microgel matrix, so that microgels containing hBMSCs gradually become opaque during 21 days of culture. RT-qPCR results indicate that the expression of OCN, Runx2, and ALP in the alginate-slGO microgels is significantly higher than in the alginate microgels. The expression of OCN and Runx2 in the alginate-slGO microgels is 4.27 and 5.87-fold higher than in the alginate microgels, respectively. It can be concluded that low doses of slGO nanosheets have the potential to be utilized in the development of tissue engineering and bone regeneration.
Burnout and anxiety among Chinese nurses: The mediating roles of positive coping strategies and interpersonal problems: A cross-sectional study
Authors: Wang△ Ya , Li Nan , Huang Xia , Wang Jingjun , Huang Junqiang , Huang Yalin , Feng Yan , Qin Liu , Huang Hao
Published: October 2024

Background Burnout among nurses is a global problem that results in increased turnover as well as decreased career satisfaction and poor nursing service. Previous researchers have suggested that anxiety is associated with burnout. However, the internal mechanism by which anxiety affects burnout remains unclear. Furthermore, the question of how the demographic characteristics of nurses predict burnout remains unanswered. Aims This study aimed to explore the mechanisms by which anxiety affects burnout, to verify the mediating roles of interpersonal relationship problems and positive coping in the relationship between anxiety and burnout, and to explore the factors that can predict burnout among nurses. Methods A total of 4,856 nurses were enrolled in this study. The ability of anxiety, positive coping, interpersonal relationship problems, and demographic factors to predict burnout were explored via linear regression models. The relationships among anxiety, positive coping, interpersonal relationship problems, and burnout were also explored by developing a parallel mediation model with the assistance of SPSS PROCESS 3.3 software. Results The following factors can predict burnout among nurses: internal medicine ward (β = 0.075 P < 0.01), surgery ward (β = 0.054 P < 0.01), operating room (β = 0.022 P = 0.037), a number of night shifts worked per month higher than 10 (β = 0.046 P < 0.01), and possession of a master's degree or higher level of education (β = 0.03 P < 0.01). Positive coping (β = 0.029, 95% CI: 0.022 to 0.036) and interpersonal problems (β = 0.134, 95% CI: 0.118 to 0.151) mediate the relationship between anxiety and burnout. Conclusion The results of this study reveal that nurses’ department, level of education, and number of night shifts worked per month are effective predictors of burnout. Positive coping and interpersonal relationships mediate the relationship between anxiety and burnout.
Diabetes, metabolic health, and the development of frozen shoulder: a cohort study in UK electronic health records
Authors: Dyer Brett , Burton Claire , Rathod-Mistry Trishna , Blagojevic-Bucknall Miliça , Windt Danielle van der
Published: October 2024

Objective
Estimate the effect of type 2 diabetes on the development of frozen shoulder and investigate whether the effect is mediated by other metabolic factors.
Methods
Primary care medical record-based cohort study containing 43,977 patients newly diagnosed with type 2 diabetes and 43,977 without diabetes. Variables were identified using established Read codes. A weighting approach with Cox regression was used to decompose the total effect into the direct effect and indirect effect, mediated by metabolic health (which was defined as the number of metabolic factors developed during follow-up). Estimates were expressed as hazard ratios (HR). Confounders were identified using a DAG. Sensitivity to unmeasured confounding, extreme weights, and missing data were tested.
Results
The total effect of type 2 diabetes on the development of frozen shoulder was HR = 4.38 (95% CI: 3.70–5.21), the natural indirect effect (mediated through metabolic health) was HR = 0.98 (95% CI: 0.93–1.03) and the natural direct effect was HR = 4.46 (95% CI: 3.68–5.41). Results were robust to unmeasured confounding, extreme weights, and missing data.
Conclusions
This study suggests that type 2 diabetes may be a cause of frozen shoulder but does not support the hypothesis that the effect is mediated by metabolic health. Clinicians should remain alert that shoulder pain in patients with diabetes could be indicative of a frozen shoulder. This study should raise awareness that, despite often being overlooked, musculoskeletal conditions can be complications of diabetes and should be considered during clinical conversations with patients.
Novel GSIP: GAN-based Sperm-Inspired Pixel Imputation for Robust Energy Image Reconstruction
Authors: Mahmoud Gamal M. , Said Wael , Fadel Magdy M. , Elbaz Mostafa
Published: October 2024

Missing pixel imputation is a critical task in image processing, where the presence of high percentages of missing pixels can significantly degrade the performance of downstream tasks such as image segmentation and object detection. This paper introduces a novel approach for missing pixel imputation based on Generative Adversarial Networks (GANs). We propose a new GAN architecture incorporating an identity module and a sperm motility-inspired heuristic during the filtration process to optimize the selection of pixels used in reconstructing missing data. The intelligent sperm motility heuristic navigates the image's pixel space, identifying the most influential neighboring pixels for accurate imputation. Our approach includes three key modifications: (1) integration of an identity module within the GAN architecture to mitigate the vanishing gradient problem; (2) introduction of a metaheuristic algorithm based on sperm motility to select the top 10 pixels that most effectively contribute to the generation of the missing pixel; and (3) the implementation of an adaptive interval mechanism between the discriminator's real value and the weighted average of the selected pixels, enhancing the generator's efficiency and ensuring the coherence of the imputed pixels with the surrounding image context. We evaluate the proposed method on three distinct datasets (Energy Images, NREL Solar Images and NREL Wind Turbine Dataset), demonstrating its superior performance in maintaining pixel integrity during the imputation process. Our experiments also confirm the approach's effectiveness in addressing common challenges in GANs, such as mode collapse and vanishing gradients, across various GAN architectures.
Intrauterine inflammation Exposure may increase the risk of late-onset sepsis in premature infants:a retrospective cohort study
Authors: Chen Xiafang , Zhang XinYu , Xue Ru , Mi Lanlan , Ye Liu , Zhang Guoqing , Bu Jun , Bei Fei
Published: October 2024

Background: Preterm birth associated with intrauterine inflammation (IUI) has been linked to alterations in postnatal immunity and severe inflammatory complications during infancy. However, the impact of IUI on late-onset sepsis (LOS), a leading cause of mortality and morbidity in preterm infants, remains unclear. This study aims to elucidate the effect of IUI on the incidence of LOS in preterm infants by analyzing cytokine levels and white blood cell differential counts in cord blood within 24 hours after birth.
Methods: This retrospective cohort study was conducted at a single tertiary neonatal center. Infants born before 37 weeks of gestation between July 2020 and June 2022 were included. Late-onset sepsis (LOS) was defined as sepsis occurring after 72 hours of life during the birth hospitalization. Levels of 12 cytokines, including interleukin-1β (IL-1β), IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17, tumor necrosis factor-α (TNF-α), interferon-α (IFN-α), and IFN-γ, were measured in cord blood using multiplex bead-based flow immunoassays. Clinical data were extracted from hospital databases. Peripheral white blood cell counts within 24 hours after birth were routinely recorded for preterm infants. Logistic regression analysis was used to assess the impact of cytokines and white blood cell counts on the incidence of LOS.
Results: A total of 628 preterm infants were included in this study. The mean gestational age was 33.17 ± 2.25 weeks, and the mean birth weight was 1929.50 ± 516.77 grams. Of these, 42 infants (6.7%) developed late-onset sepsis (LOS). Compared to the non-LOS group, cord blood levels of IL-6 [127.81 (399.86) vs. 31.02 (127.48), p = 0.004] and IL-8 [130.37 (202.53) vs. 52.91 (101.43), p = 0.001] were significantly higher in the LOS group. No significant differences were observed in the levels of other cytokines between the groups. Peripheral neutrophil and monocyte counts were significantly lower in the LOS group [5.08 ± 3.46 vs. 8.14 ± 4.90, p < 0.001; 0.98 ± 0.56 vs. 1.37 ± 0.72, p = 0.001, respectively]. Multivariable logistic regression analysis revealed that elevated cord blood IL-6 levels and reduced peripheral neutrophil counts were associated with an increased risk of LOS, after adjusting for gestational age, gestational hypertension, and antenatal steroid use (aOR = 3.113, 95% CI: 1.239–7.819, p = 0.016; aOR = 0.340, 95% CI: 0.818–0.994, p = 0.038, respectively).
Conclusions: Elevated cord blood IL-6 levels and low peripheral neutrophil counts on the first day after birth are associated with an increased risk of LOS in preterm infants. These findings suggest that intrauterine inflammation may have a lasting impact on immune system responses, potentially influencing susceptibility to infections later in life.
Phylodynamic Structure in the Botswana HIV Epidemic
Authors: Kotokwe Kenanao , Nascimento Fabrícia F. , Moyo Sikhulile , Gaseitsiwe Simani , Holme Molly Pretorius , Makhema Joseph , Essex Max , Novitsky Vlad , Volz Erik , Ragonnet-Cronin Manon , Consortium PANGEA
Published: October 2024

Background
Studying viral sequences can provide insights into the structure of host contact networks through which the virus is transmitted. Uncovering the population structure of the HIV-1 epidemic in Botswana will help optimise public health interventions and may identify hidden sub-epidemics. We sought to determine the phylodynamic structure of the Botswana HIV-1 epidemic from viral sequence genetic data.
Methods
The Botswana Combination Prevention Project (BCPP) randomly sampled 20% of households in 30 villages in Botswana between 2013–2018 and tested for HIV-1. Extensive demographic data were collected from all participants and next-generation full-genome HIV-1 sequences were generated from HIV-1 positive participants (n = 4,164), 78% of whom were on antiretroviral treatment (ART). We inferred the stage of infection (< or > 1 year) among HIV-1 cases based on nucleotide diversity and clinical data using a previously trained machine learning model. We then reconstructed time-resolved gag and pol phylogenies from sequences, other Botswana cohorts and publicly available sequences that were genetically close to those from Botswana. We statistically explored phylogenies for partitions with diverging patterns of coalescence, indicating sub-epidemics, and estimated viral effective population size through time, a measure of viral incidence, for each partition. Finally, we compared the demographic makeup, clinical and geographic characteristics across partitions using χ2, ANOVA tests and Tukey analysis.
Results
We identified three partitions of time-resolved gag and pol phylogenies, revealing divergent patterns of coalescence and HIV-1 transmission. In both gag and pol phylogenies, partitions with persistent growth and transmission were characterised by lower treatment coverage and more recent infections when compared to other partitions. The Southern and South East regions of Botswana were over-represented in the fast-growing partitions.
Conclusion
Our findings suggest that transmission is slowing in segments of the population that have high ART coverage. However, recent infections are over-represented in ongoing sub-epidemics. The phylodynamic structure suggests that there are districts with higher growth and prioritising these in the deployment of public health interventions might curb new infections. Nonetheless the high mobility of Botswana residents should be taken into consideration in implementing effective interventions to combat HIV-1.
Layout of multi-type firebreak network for transboundary fires—the Greater Khingan Mountains of China case
Authors: Xu Yue , Sun Shufa , Yu Miao , Zhou Yuan , Zhang Xuekai , Chu Jiangwei , Li Xingdong
Published: October 2024

The Yimuhe Forest Farm, located in the northern Greater Khingan Mountains of China, has been plagued by Russian transboundary fires. However, this area lacked an effective forest firebreak network, and the road network density is only 0.84m/ha. This paper aims to improve the density of forest firebreaks and the ability to resist fires in Yimuhe Forest Farm, and provide a reference for other forest areas to build multi-type firebreaks. By summarizing historical data on transboundary fires in this area, we used FARSITE to determine the planning scope of firebreaks and Geographic Information System (GIS)-Analytic Hierarchy Process (AHP) to obtain the layout of the regional emergency firebreak network of transboundary fires. The planned firebreak network had a length density of 13.11m/ha, with the engineered firebreaks contributing a length density of 4.31 m/ha. Under fire simulation, the firebreak network significantly reduced the spread of transboundary fire, confirming its fire-blocking effectiveness. The planned firebreak network met standard requirements for length density, making it a valuable tool for slowing the spread of transboundary fires. The firebreak network effectively curtails the spread of transboundary fires along the Greater Khingan Mountains, offering guidance for forestry departments to implement measures for emergency firebreak planning and layout.
Postoperative Wound Microbiota in Diabetic Patients with Perianal Abscess: A 16s rRNA GeneSequencing Study
Authors: Meng Fanyu , Yu Ting , Xie Minning , Chen Ming , Chen Xinghua
Published: October 2024

Background
Perianal abscesses are common in colorectal surgery, requiring surgical drainage and wound care. Diabetic patients often experience delayed wound healing and increased infection risk due to systemic factors and altered microbiota. This study investigated the postoperative wound microbiota in diabetic patients with perianal abscesses using 16s rRNA sequencing, aiming to identify potential microbial contributions to wound healing outcomes.
Results
The study compared wound microbiota between 22 diabetic patients and 22 non-diabetic patients undergoing perianal abscess surgery. Diabetic patients exhibited significantly lower microbial diversity and richness compared to non-diabetic patients. Specific bacterial taxa were enriched in the diabetic group, including Enterobacteriaceae, Streptococcus, and Lactobacillales, while beneficial bacteria like Bacteroides and Ruminococcaceae were reduced. Functional prediction analysis revealed significant differences in metabolic pathways, with diabetic wounds showing increased carbohydrate metabolism and chitin biosynthesis, and decreased energy metabolism and endocrine system function.
Conclusions
This study highlights the distinct wound microbiota characteristics of diabetic patients with perianal abscesses, suggesting potential microbial contributions to delayed wound healing. The findings underscore the importance of considering the wound microbiome in managing postoperative wound care for diabetic patients. Strategies to modulate the wound microbiota, such as probiotics or antibiotics, may be beneficial in improving healing outcomes. Further research is needed to understand the specific mechanisms driving the observed microbial dysbiosis and its impact on wound healing in diabetic patients.
Sex Differences in the Association Between Dietary Inflammatory Index and Chronic Kidney Disease in U.S. Adults: Insights from NHANES 2011–2018”
Authors: Xiao Xifeng , He Huabin , Yang Junjun , Lei Meixian
Published: October 2024

Background
studies on the association between dietary inflammatory index (DII) and chronic kidney disease (CKD) are limited. We aimed to examine the association between DII and CKD among U.S. adults with particular attention paid to sex differences.
Methods
A total of 19317participants were included in this study. The exposure variable was DII, which was calculated based on overall inflammatory effect scores. The outcome was CKD, defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 or urinary albumin/creatinine (uACR) ≥ 30mg/g.
Results
The mean (SD) of age our study participants was 47.84 (18.35); and the mean (SD) of DII was 1.50 (1.91) (median 1.74). In multivariate logistic regression analysis, we observed that the OR value (95%CI) of CKD is 1.19 (1.14, 1.23), 1.12 (1.06, 1.19), and 1.16 (1.06, 1.27) in models 1, 2 and 3 for Per SD increment of DII. Compared with Participants with Q1(DII < 0.15), the adjusted ORs for participants in Q2 (0.15 ≤ DII < 1.74), Q3 (1.74 ≤ DII < 3.02) and Q4 (≥ 3.02)were 1.46 (95% CI: 1.14–1.88), 1.55 (95% CI: 1.20–1.99) and 1.52 (95% CI: 1.17, 1.98) ( p for trend < 0.05), respectively. However, this study observed that the independent positive correlation between DII and CKD appeared in women rather than men.
Conclusions
A higher level of DII is significantly associated with the increased prevalence of CKD, and sex can modify the relationship between them.
Antimicrobial and antibiofilm activities of supernatants of Lactiplantibacillus plantarum A2 and Lactiplantibacillus plantarum 2.1 against Escherichia coli ATCC 25922
Authors: Almeida Milena Evangelista , Sodré Maisah Meyhr D’Carmo , Oliveira Samuel Santana , de Carvalho Luciana Debortoli , Apolônio Ana Carolina Morais , Rocha Vinícius Novaes , Rezende Rachel Passos , Romano Carla Cristina
Published: October 2024

Background
Urinary tract infections are the most common infections in humans. Furthermore, they are relevant for public health for being closely related to the phenomenon of dispersion of multi-resistant strains of bacteria. Most cases are caused by Escherichia coli, a commensal microorganism that colonizes the urinary tract by translocating from the gastrointestinal tract. In this context, the present work was dedicated to finding alternatives for controlling the dispersion of its multidrug-resistant strains by studying the inhibitory effect of the cell-free supernatants of Lactiplantibacillus plantarum A2 (LPA2) and Lactiplantibacillus Plantarum 2.1 (LP2.1). Among a group of eight strains isolated from cocoa fermentation, these two stood out in terms of their probiotic potential and possible applications in the health sector. This study conducted the in vitro investigation of the antimicrobial and antibiofilm activities of both supernatants and the preliminary analysis of their composition.
Results
Both supernatants evaluated showed antimicrobial and antibiofilm activity against E.coli ATCC 25922. In the semi-solid agar diffusion assay, LPA2 formed a 17 mm inhibition halo and LP2.1 formed a 12 mm one. In the 96-well microplate assay, LPA2 showed 89.22% inhibition and LP2.1 showed 91.22%. Regarding antibiofilm activity, LPA2 showed 80.96% inhibition and LP2.1 showed 81%. Preliminary analysis of the metabolites indicated that thermostable substances dependent on acidic pH may be responsible for the anti-E.coli action observed in the experiments.
Conclusions
LPA2 and LP2.1 supernatants are capable of antagonizing E.coli ATCC 25922 in vitro and can be used to control its proliferation in cases of asymptomatic bacteriuria, maintain the balance of the microbiota, and reestablish the microbiota after antimicrobial therapy.
Neurocritical Care Support of Endovascular Mechanical Thrombectomy
Authors: Tahsili-Fahadan Pouya , Wang Jing , Yi Seajin , Fang Yun , Tulloch Crystal , Leutbecker Jackie , Greenberg Edward , Dinescu Dan , Altaweel Laith
Published: October 2024

Background
Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality, where timely intervention with mechanical thrombectomy (MT) is crucial for restoring cerebral blood flow and improving patient outcomes. This study evaluates the impact of a dedicated Neurocritical Care Rapid Response Team (NCC-RRT) on MT workflow efficiency and patient outcomes.
Methods
We conducted a prospective analysis of AIS patients undergoing MT at a Comprehensive Stroke Center between January 2021 and December 2023. The study compared two periods: Era 1 (pre-NCC-RRT, January-October 2021) and Era 2 (post-NCC-RRT, December 2021-December 2023). The NCC-RRT was responsible for the expedited transfer, airway management, procedural analgosedation, and hemodynamic support. Key metrics, including door-to-groin-puncture (DTGP) and door-to-recanalization (DTR) times, were analyzed.
Results
A total of 395 patients were included in the study. The implementation of the NCC-RRT significantly reduced DTGP and DTR times, particularly in patients receiving general anesthesia (GA). The NCC-RRT was associated with a 14.3% reduction in groin-puncture-to-recanalization time and a 26.6% increase in GA utilization. Additionally, significant time reductions were observed in both direct ED presentations and transferred patients.
Conclusions
The introduction of a dedicated NCC-RRT led to substantial improvements in MT process efficiency, highlighting the critical role of neurocritical care in optimizing stroke treatment and enhancing patient outcomes. This model offers an effective alternative for centers where dedicated neuroanesthesia teams are unavailable.
Outcome Prediction, Quality of Life, and Life Expectancy in Metastatic Spine Tumors: WFNS Spine Committee Recommendation
Authors: Sharif Salman , Afsar Afifa , Zileli Mehmet , Vaishya Sandeep , Gokaslan Ziya
Published: October 2024

Objectives: This review aimed to formulate the most current, evidence-based recommendations for the prediction of outcome, life expectancy, and quality of life in patients with metastatic vertebral tumors.
Methods: A systematic literature search on PubMed and Google Scholar from 2012-2022 using the keywords “metastatic vertebral tumors + outcome prediction + prognosis,” “quality of life + spine metastases,” and “spine metastases + life expectancy” were done. Our PubMed search yielded 402 articles for outcome prediction, whereas 40 articles were identified for life expectancy in spine metastases. These were carefully screened, resulting in 61 and 11 final articles analyzed for this study.Our PubMed search for quality of life yielded 137 articles, of which 63 were analyzed for this study. This up-to-date information was reviewed and presented at two separate consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. Two rounds of the Delphi method were utilized to vote on the statements and arrive at a positive or negative consensus.
Results and Conclusion: The WFNS Spine Committee finalized seven recommendation guidelines on the prediction of outcome, life expectancy, and quality of life in metastatic vertebral tumors. Irrespective of the primary tumor, surgical decompression in appropriately selected patients potentially improves the quality of life. Pre-operative ambulatory status, overall performance, and age are independent predictors of outcome and overall survival. Prognostic scoring systems have evolved to principle-based algorithms, amongst which NOMS is the most widely used. The best tools to measure the quality of life are EUQOL5-D and SOSGOQ in patients with metastatic spine disease.
Placental Pouch Closure (PPC) technique as a uterus sparing technique for management of placenta accreta spectrum, does Bilateral uterine artery ligation as an added step really add?
Authors: Zahran Kamal M. , Shahat Mohamed A. , Abouzeid Mostafa H. , Kamal Mohamed Zahran.
Published: October 2024

Background
Placental pouch closure (Zahran’s) technique looks to be an attractive and effective surgical procedure for conservative management of placenta accreta. The major blood supply of the uterus comes from the uterine artery, so bilateral uterine artery ligation (UAL) before delivering of the placenta greatly decreases the blood loss. this study aimed to evaluate the effect of bilateral uterine artery ligation in decreasing the blood loss in placental pouch closure (PPC) technique and subsequently decreasing the associated maternal morbidity and mortality in women underwent PPC as a conservative surgery.
Methods
One-hundred thirty women attended women’s health hospital, Assiut University, Egypt with placenta accreta were randomly assigned into 2 groups. Group A included 65 women underwent the original PPC (Zahran’s) technique while group B included women underwent PPC and bilateral uterine artery ligation (modified technique). At 35 weeks, the management plan was discussed and determined by antepartum findings. The intra-operative blood loss was assessed by number of soaked towels and amount of blood at suction device.
Results
Intraoperative blood loss was significantly higher among women underwent original PPC in comparison to those women who underwent the modified PPC technique (1546.62 ± 212.51 vs. 1149.85 ± 130.54 (cc); p < 0.001). Women who underwent original PPC had significantly higher transfused packed red blood corpuscles (3.23 ± 0.67 vs. 1.77 ± 0.45 (cc); p < 0.001) and fresh frozen plasma (2.50 ± 0.55 vs. 1.50 ± 0.50 (cc); p < 0.001) in comparison to the other group.
Conclusions
the present study confirm that bilateral uterine artery ligation as an added step for PPC technique resulted in satisfactory decrease in the amount of intra-operative blood loss and subsequently the need for blood transfusion while still allowing for uterine preservation.
Trail Registration Number:
NCT05314595, submission date: March 11, 2022
Personal traits, lifestyle decisions, and geography shape our dietary intake and consequently our bacterial and fungal gut microbiome
Authors: Soler Zaida , Serrano-Gómez Gerard , Pons-Tarin Marc , Vega-Abellaneda Sara , Xie Zixuan , Manjon Isaac , Cognard Chloe , Varela Encarna , Yañez Francisca , Noguera-Segura Arnau , Roca-Bosch Melina , Manichanh Chaysavanh
Published: October 2024

Background
The Global Burden of Disease 2017 (GBD-2017) study identified high sodium intake, low whole grain intake, and low fruit consumption as key dietary risk factors for non-communicable diseases (NCDs). We hypothesize that individual characteristics and lifestyle factors influence these dietary risks, thereby modulating the composition of the gut bacterial and fungal communities.
Results
From 2020 to 2024, we enrolled 1001 participants from four Spanish regions. Participants completed a short Food Frequency Questionnaire (sFFQ) at baseline, month six, and month 12 (n = 2475). Age, gender, geography, and seasonal factors significantly shaped dietary patterns, with older age and healthier diets, especially those rich in fruits and vegetables, linked to increased gut microbiome diversity. Participants generally consumed less legumes, whole grains, and nuts but exceeded recommended red meat and sugar intake levels, with men showing poorer dietary habits and faster gut transit times correlating with distinct microbiome profiles and lower diversity. Using machine learning techniques, dietary intake can be predicted by the gut microbiome composition. Participants can learn about the study, their diet and their microbiome here
(https://manichanh.vhir.org/POP/;username:reviewers;password:reviewers)
Conclusion
Adherence to national dietary guidelines, particularly the Mediterranean diet, enhances gut microbial diversity. Personal, lifestyle, and geographic factors significantly influence dietary quality, highlighting the need for targeted interventions. The study suggests that improving dietary patterns positively impacts the gut microbiome and overall health in Spain.
Evaluating parental perception and confidence managing obesity-related behaviors among children with severe early-onset obesity
Authors: Sisley Stephanie , Morales Julia , Gonzalez Mayver , Elatrash Citrine , Alfonso Claudia Soler
Published: October 2024

Background
Severe early-onset obesity, defined as a BMI exceeding 120% of the 95th percentile before age 5, often involves hyperphagia, characterized by insatiable hunger and shortened satiety duration. Treatment generally requires caregivers to adjust their child's diet and exercise, but research on caregiver confidence in managing these changes is limited. This study aims to assess: 1) caregivers' confidence in addressing obesity-related behaviors in children with severe early-onset obesity and 2) differences in lifestyle behaviors between children with and without impaired satiety at a specialized clinic.
Methods
Caregivers from a specialized pediatric obesity clinic completed the Lifestyle Behavior Checklist (LBC), a 25-question tool evaluating their perceptions and confidence in managing obesity-related behaviors. Diagnoses of hyperphagia or impaired satiety were based on clinical ascertainment of at least three abnormal eating behaviors across multiple settings. Data were analyzed using averages, standard deviations, and non-parametric Mann-Whitney tests to compare responses between caregivers of children with and without impaired satiety.
Results
Caregivers felt least confident managing four of the five most problematic behaviors. They identified excessive eating, requesting extra portions, and unhealthy snacking as the top 3 problematic behaviors. Conversely, the least problematic behaviors included complaints about appearance, lack of friends, and food hiding. Parents were most confident addressing food-related yelling, excessive screen time, and food hiding. However, they exhibited the least confidence in managing excessive eating, eating quickly, and unhealthy snacking. Parents rated 16 behaviors as more problematic in children with impaired satiety compared to those without, and their caregivers reported significantly lower overall confidence.
Conclusion
Participants showed reduced confidence in managing the most challenging behaviors related to severe early-onset obesity. These challenging behaviors often involve controlling food intake. Therefore, alongside providing information on lifestyle changes, there is a need to enhance caregivers' ability to manage food-related behaviors, especially for children with impaired satiety.
Heterogeneous subtypes of intrinsic capacity in middle-aged and older patients after percutaneous coronary intervention: a latent class analysis
Authors: Zhao Yuan , Jiang Yueying , Xu Qunyan , Chen Dandan , Tang Panpan , Wang Xueqing , Guo Yunyu , Liu Chang , Feng Xiuqin , Tang Leiwen
Published: October 2024

We aims to explore the associated factors of intrinsic capacity (IC) levels and subtypes in middle-aged and older patients after percutaneous coronary intervention (PCI). The patient health questionnaire-9 (PHQ-9), the mini-mental state examination (MMSE), the short physical performance battery test (SPPB), and the mini-nutritional assessment short form (MNA-SF) were utilized for assessing IC domains. Both aural and visual were self-reported. The study employed latent class analysis (LCA) to investigate the diverse IC subtypes. Logistic regression analyses were used to identify the impact factors of IC levels as well as IC subtypes. We found that 318 middle-aged and older patients who had undergone PCI completed the assessments. Logistic regression results indicated that age, gender, occupation, comorbidity index (CCI), chronic disease resource utilization, multiple coronary artery lesions, and hs-CRP are implicit factors of IC levels. The findings of LCA suggested that three heterogeneous IC subtypes were identified: 47.8% poor audition-vision group (class 1), 38% high cognition-psychology group (class 2), 14.2% low locomotion-vitality group (class 3). Education, exercise frequency, cardiac function, drinking, NT proBNP, and cTnI could affect the IC subtype classification. In conclusion, the determinants of IC levels in middle-aged and older adults after PCI still require more empirical investigation. For targeted intervention, the examination of IC subtypes may bring benefits.
Distinct microbiome composition and reduced interactions in patients with pancreatic cancer
Authors: Kim Bomi , Oh Sujin , Yang Soomin , Ahn Jinwoo , Jung Kwangrok , Lee Jong-Chan , Hwang Jin-Hyeok , Shin Cheol Min , Lee Hyo-Jung , Lee Hye Seung , Kim Jaihwan , Park Kyoung Un
Published: October 2024

Background
The results of microbiome composition in patients with malignancy have been inconsistent across studies and are affected by various factors. This study aimed to identify microbiome composition of saliva, feces, and blood in patients with pancreatic cancer.
Results
Overall, 31 patients with pancreatic cancer and 24 healthy controls were sex- and age-matched. Microbiome analysis of saliva, fecal, and blood samples was conducted using 16S rRNA amplicon sequencing. Baseline characteristics were comparable between patients and controls. Saliva showed insignificant difference in alpha diversity (p = 0.42), whereas feces and blood exhibited a significant difference in Shannon’s index (feces: 6.19 vs. 6.52, p = 0.013; blood: 8.00 vs. 7.49, p < 0.001) between patients and controls. Beta diversity analysis revealed significant differences between saliva, fecal, and blood samples (p = 0.014, 0.001, and 0.001, respectively). Distinct microbiome compositions were identified in patients, with higher abundance of Lactobacillus, Enterobacter, and Prevotella in saliva, fecal, and blood samples, respectively. Based on microbial network analysis, patients with pancreatic cancer showed lower clustering coefficient (71% vs. 99%) and higher average path length (1.67 vs. 0.68) than healthy controls, suggesting a more compact network and stronger microbial interactions in healthy controls.
Conclusions
This study identified a distinctive microbiome in patients with pancreatic cancer, indicating the presence of Lactobacillus, Enterobacter, and Prevotella. A less condensed and robust microbial interaction network was observed in blood samples of patients with pancreatic cancer. These findings provide a basis for research on the connection between the microbiome and pancreatic cancer.