bluuebunny/crossref_metadata_2025 huggingface dataset:
Tocilizumab for faster and safer remission of Takayasu’s arteritis
Authors: Liao Hua , Du Juan , Li Taotao , Pan Lili
Published: October 2022

Purpose:

Takayasu’s arteritis (TAK) is a large-vessel vasculitis. Glucocorticoids (GCs) combined with cyclophosphamide (CTX) is a common treatment option, but their efficacy is limited. The aim of this retrospective study was to study the efficacy and safety of tocilizumab (TCZ) in the treatment of TAK.

Patients and methods:

A total of 63 patients with TAK were divided into two groups according to different treatment strategies: 31 patients in the TCZ group and 32 patients in the CTX group. After 6 months of treatment, disease activity and side effects were evaluated and were compared between the two groups.

Results:

After 3 months of treatment, the National Institutes of Health (NIH) score ( p = 0.005), Indian Takayasu Clinical Activity Score (ITAS) 2010 ( p = 0.043), and the Indian Takayasu Activity Score with the Acute-Phase Response (ITAS.A; p = 0.036) were lower in patients treated with TCZ compared with those treated with CTX. In the TCZ group, the proportion of patients with NIH scores ⩽1 reached 50% after 1 month, 90% after 3 months, and 96% after 6 months of treatment, whereas in the CTX group, these proportion were 36%, 30%, and 78%, respectively. Thus, TCZ treatment of TAK is accompanied with a faster remission rate than CTX treatment. Moreover, the total cumulative incidence of adverse events was lower in the TCZ group than in the CTX group ( p = 0.035).

Conclusion:

TCZ was faster and safer in alleviating TAK.
Examining the gender dimension in the non-medical use of over the counter and prescription only medication
Authors: Gittins Rosalind , Tay Wee Teck Joseph , Madill Anna
Published: October 2022

There is concern regarding gender differences in problematic non-medical over the counter (OTC) and/or prescription only medication (POM) use. This issue has traditionally been considered a predominantly male and/or younger persons’ problem, but more recent transnational evidence shows that women across their life-course are increasingly and often more severely affected. Nevertheless, the bulk of research, policy and treatment services continue to be focused on men. This suggests the need for increased awareness, a shift in research and policy agenda and improved treatment access and engagement approaches, informed by a robust examination of the gender dimension. We present here a summary of current evidence around the epidemiology of non-medical use of OTC and POM and highlight the gender differences across the domains of healthcare interactions, changes across the life-course, experiences of trauma and barriers to obtaining support. We conclude by proposing a re-gendering agenda to challenge the ‘male by default’ tendency when designing, delivering and evaluating treatment services. For example, utilising co-production with a strengths-based approach has been found to balance gender power with positive outcomes for participants. Such approaches can help to address stigma and marginalisation, by embedding the lived experiences and voices of women in designing and providing treatment services, safe spaces and gender-sensitive treatment programs. It also means promoting coordinated, holistic, multidisciplinary and multi-agency approaches, and establishing a research strategy to fill knowledge gaps around the experiences of women. These changes should improve engagement with treatment services and consequent outcomes, especially in relation to OTC/POM.
Spoken resilience: Documenting lived experience of neurodiversity and thriving despite disease
Authors: Naegeli Costa Christina
Published: October 2022

This speech details my lived experience and coping strategies of a psychologist and academic diagnosed with a brain tumor. As an educator and researcher studying well-being and resilience, I summarize my experience of living through adversity and draws on the research that helped me do so. I specifically reflect on the literature of gratitude and well-being to take oppose the “fight” narrative presented at the forefront of the diagnosis. This speech script offers insight into this lived experience and calls for written speech to be utilized as a method of inquiry. Insights for healthcare practitioners and providers in navigating patient experience are discussed.
A Model to Implement Standardized Virtual Care for Low Back Pain Amongst a Large Network of Providers in Urban and Rural Settings
Authors: Correale Marcia Rebecca , Soever Leslie Jayne , Rampersaud Yoga Raja
Published: October 2022

Prior to the COVID-19 pandemic, virtual care (VC) was not routinely offered for assessment of low back pain (LBP), a highly prevalent, disabling condition. COVID-19 related healthcare closures resulted in a rapid backlog of patients referred to a provincial interprofessional LBP program. Without management, these patients were at high risk of experiencing untoward outcomes. Virtual care became a logical option. However, many clinicians lacked experience and confidence with LBP virtual care (LBP-VC); and either were unfamiliar with, or did not have access to, requisite technology. Multi-stakeholder engagement was utilized to understand barriers, identify enablers, and ultimately promote VC for LBP. As a result of the multi-stakeholder engagement, the concept of a toolkit for LBP-VC, including clinical resources and guidelines, emerged. The toolkit contains preparatory steps for VC and a standardized approach to virtual LBP assessment. Key steps in the toolkit have potential applicability to other musculoskeletal populations.
Calling Your Aunt Bertha for Social Assets: Family Medicine and Social Determinants of Health
Authors: DeVetter Nick , Westfall John M. , Carrozza Mark , Westfall Erin
Published: October 2022

Purpose:

The sociopolitical determinants of health drive health outcomes and inequities in the United States. Primary care practices are, increasingly, expected by payers and policy makers to assess patients’ social needs. Resource referral platforms provide physicians with information and referral systems for community resources. One commonly used platform is Aunt Bertha/Find Help (AB/FH). The American Academy of Family Physicians (AAFP) Neighborhood Navigator (NN) tool allows physicians and laypeople to search for resources using AB/FH. We sought to describe what users were searching for and to identify patterns to inform resource allocation.

Methods:

This was a descriptive study of the AAFP’s NN tool. Searches of NN were analyzed to describe what users were searching for.

Results:

From 2018 to April 2022 there were 168 135 searches. The most common searches were for food and housing insecurity (22%, 21%) and health care referral (20.6%) with 22% more searches in the winter than the spring. There was a 119% increase in searches between 2018 and 2022, and a 47% increase in searches during the COVID-19 Pandemic. In the “Health” category the top 20 subcategories accounted for over 77% of searches.

Conclusions:

Family physicians and their patients use NN to search AB/FH for community resources to address adverse social determinants of health (SDOH). As expected, searches increased during the COVID-19 pandemic. This type of analysis may help individual clinicians, practices, and health systems prepare for the most common social needs of their patients. Social resource platforms might serve as a robust measure for primary care practice screening and referral for SDOH.
Midterm Outcomes After Surgical Management for Mitral Valve Regurgitation in Infancy
Authors: Maeda Toshi , Fujiwara Keiichi , Yoshizawa Kosuke , Mori Otohime , Wakami Tatsuto , Shimoji Akio , Fukunaga Naoto , Okada Tatsuji , Tamura Nobushige , Sakazaki Hisanori
Published: October 2022

Background

Mitral valve repair is preferred for pediatric mitral valve disease. However, it is technically difficult because of complex lesions, poor surgical exposure, and tissue fragility, especially in infants. We investigated the midterm outcomes of mitral valve surgery for mitral regurgitation in infancy.

Methods

We retrospectively reviewed 18 patients (aged <12 months old) undergoing mitral valve surgery for mitral regurgitation at our institution between October 2005 and March 2019. The patients had 10 acquired and 8 congenital valve lesions as follows: torn chordae ( n = 6), leaflet prolapse ( n = 4), posterior leaflet hypoplasia ( n = 3), anterior leaflet cleft ( n = 2), infective endocarditis ( n = 1), papillary muscle rupture ( n = 1), and hammock valve ( n = 1).

Results

All patients initially underwent mitral valve repair. There was no operative mortality, and 1 case of late death. The median follow-up period was 7 years and 9 months. Reoperation was performed in 3 patients, re-repair (twice) in 1 patient with a hammock valve, and mitral valve replacement in 2 patients. Fifteen patients had at most mild mitral regurgitation at the last follow-up. A transmitral mean pressure gradient of over 5 mm Hg was observed in 3 cases, including the patient with a hammock valve. Postoperative mitral annular diameter increased within the normal range in all patients. Survival and reoperation-free rates at 5 and 10 years were 94.4% and 83.0%, respectively.

Conclusions

Mitral valve repair for mitral regurgitation in infancy is safe and feasible with satisfactory midterm outcomes, even under serious preoperative conditions.
Surgical Repair of Truncus Arteriosus: A Long-Term Hemodynamic Assessment
Authors: Martín de Miguel Irene , Jain C. Charles , Egbe Alexander C. , Hagler Donald J. , Connolly Heidi M. , Miranda William R.
Published: October 2022

Background: Unrepaired truncus arteriosus (TA) carries poor prognosis due to complications of unrestricted pulmonary flow, truncal valve insufficiency, and pulmonary vascular disease. Currently, the hemodynamic profile of adults late after TA repair is unknown. We reviewed the hemodynamics, prevalence, and pathophysiology of pulmonary hypertension (PH) in this population. Methods: Eighteen adult patients with repaired TA who underwent cardiac catheterization at Mayo Clinic, MN, between 1997 and 2021 were identified. PH was defined as either precapillary (mean pulmonary artery pressure [mPAP] ≥25 mm Hg, pulmonary artery wedge pressure [PAWP] ≤15 mm Hg, and pulmonary vascular resistance [PVR] >3 Wood units), isolated postcapillary (mPAP ≥25, PAWP >15, PVR ≤3), or combined (mPAP ≥25, PAWP >15, and PVR >3). Diastolic pressure and transpulmonary gradients were used as ancillary data for classification. Results: Mean age at catheterization was 34 ± 10 years. Mean right ventricular (RV) systolic pressure was 82 ± 22.6 mm Hg, mean right and left mPAPs 28.1 ± 16.2 and 27.9 ± 11.9 mm Hg, respectively. Seven patients (41.2%) had PAWP >15 mm Hg and, among those undergoing arterial catheterization, 7 (53.8%) had a left ventricular (LV) end-diastolic pressure >15 mm Hg. PH was diagnosed in 13 patients (72.2%): 6 (33.3%) precapillary, 4 (22.2%) isolated postcapillary, and 3 (16.7%) combined. PAWP >15 mm Hg was associated with male sex ( P = .049), <moderate RV dysfunction ( P = .049), and lesser RV conduit mean systolic gradient ( P = .02). Patients with PH with precapillary component were older at catheterization ( P = .046). Conclusions: In adults with repaired TA, precapillary PH was only present in one-third of patients with mPAPs not significantly increased in most, whereas elevated PAWP and left-heart disease were common.
Growth Differentiation Factor 15: A Novel Growth Biomarker for Children With Congenital Heart Disease
Authors: Paneitz Dane C , Zhou Alice , Yanek Lisa , Golla Srujana , Avula Sravani , Kannankeril Prince J , Everett Allen D , Mettler Bret A , Gottlieb Sen Danielle
Published: October 2022

Background

Failure to thrive (FTT), defined as weight or height less than the lowest 2.5 percentile for age, is prevalent in up to 66% of children with congenital heart disease (CHD). Risk stratification methods to identify those who would benefit from early intervention are currently lacking. We aimed to identify a novel growth biomarker to aid clinical decision-making in children with CHD.

Methods

This is a cross-sectional study of patients 2 months to 10 years of age with any CHD undergoing cardiac surgery. Preoperative weight-for-age Z scores (WAZ) and height-for-age Z scores (HAZ) were calculated and assessed for association with preoperative plasma biomarkers: growth differentiation factor 15 (GDF-15), fibroblast growth factor 21, leptin, prealbumin, and C-reactive protein (CRP).

Results

Of the 238 patients included, approximately 70% of patients had WAZ/HAZ < 0 and 34% had FTT. There was a moderate correlation between GDF-15 and WAZ/HAZ. When stratified by age, the correlation of GDF-15 to WAZ and HAZ was strongest in children under 2 years of age and persisted in the setting of inflammation (CRP > 0.5 mg/dL). Diagnoses commonly associated with congestive heart failure had high proportions of FTT and median GDF-15 levels. Prealbumin was not correlated with WAZ or HAZ.

Conclusions

GDF-15 represents an important growth biomarker in children with CHD, especially those under 2 years of age who have diagnoses commonly associated with CHF. Our data do not support prealbumin as a long-term growth biomarker.
Ross Procedure in Neonate and Infant Populations: A Meta-Analysis Review
Authors: Tohme Scarlett , Jiang Shangqing , Farooqi Kanwal , Crystal Matthew A , Blitzer David , Ferrari Giovanni , Bacha Emile , Kalfa David
Published: October 2022

Objective

This study aims to perform a meta-analysis of early and late outcomes of the Ross/Ross-Konno procedures in neonates/infants.

Methods

A meta-analysis was performed in accordance with PRISMA guidelines. We used Ovid versions of MEDLINE/PubMed for relevant studies and included those that reported Ross/Ross-Konno operations in neonates/infants and at least one of the predetermined clinical outcomes. I2 and double arcsine methods assessed the heterogeneity between pooled estimates. We used a random-effect model to account for heterogeneity with MetaXL. We calculated point estimates of a pooled estimates along with its 95% CI.

Results

587 neonate/infant patients were included with median age of 87.5 days old. The follow-up range was five days to 23 years. Early mortality reported in 25 studies with pooled estimates of 18.3% (95% CI: 13.6%-23.5%). Estimates ranged from 0% to 50% with relatively substantial heterogeneity ( P = .01, I2 = 48.6%). Late mortality reported in 22 studies with pooled incidence of 9.7% (95% CI: 5.9%-14.3%). Estimates ranged from 0% to 53% with relatively substantial heterogeneity ( P = .01, I2 = 46.1%). Autograft reintervention reported in 18 studies with pooled estimate of 19.2% (95% CI: 7.3%-34.5%). Estimates ranged from 0% to 81.8% with high heterogeneity ( P < .001, I2 = 90.5%). Right ventricle-to-pulmonary artery conduit reintervention reported in 16 studies with pooled estimates of 32.0% (95% CI: 20.9%-44.12%). Estimates ranged from 0% to 92.3% with high heterogeneity ( P < .001, I2 = 75.9%).

Conclusions

The data suggest that the Ross/Ross-Konno procedure in neonates/infants still carries significant risk of early/late mortality and autograft/conduit reintervention. The high variability of results among centers confirms the need for surgical expertise and good patient selection. Prospective multicenter studies are warranted to investigate the rate of autograft reintervention and the impact on long-term survival in this specific population.
The Lugones Procedure for Scimitar Syndrome Repair Through Right Axillary Thoracotomy: Not Only a Cosmetically Superior Approach
Authors: Diliz-Nava Héctor S. , López Terrazas Javier H. , Palacios Macedo-Quenot Alexis J. , Zezular Idara , Laudani Verónica , Lugones Ignacio
Published: October 2022

Several surgical strategies to deal with scimitar syndrome have been described over the years. Among them, the technique described by Lugones and coworkers in 2014 has gained attention due to its simplicity, reproducibility and excellent results. Following the original report of the procedure, the defect is usually repaired through a midline sternotomy. Here, we describe an alternative approach using a right axillary thoracotomy, which not only exhibits superior cosmetic results but allows for an excellent view of all relevant anatomic structures.
How Does Social and Work Life Change for Fathers of Children With Cancer?
Authors: Yi Jaehee , Kim Min Ah , Sang Jina , Gonzalez-Pons Kwynn M.
Published: October 2022

Caring for a child with cancer greatly affects fathers’ social lives, with fathers experiencing conflicts between work demands and their desire to be with their sick child. To date, fathers’ unique experiences of caring for a child with cancer remain poorly understood. This study aimed to understand the impact of a child’s cancer diagnosis on the social and work relationships of their father through in-depth interviews with 20 Korean fathers of a child with cancer within 5 years of the diagnosis. Thematic analysis yielded five themes related to how a child’s cancer diagnosis affected the father’s relationships at work and in social situations: (a) shifting priorities, (b) changes in work, (c) support and struggles at work, (d) not being social out of guilt, and (e) pent-up stress. Overall, the findings highlight that fathers experienced conflicting roles and constraints in social relationships after their child’s cancer diagnosis. This should be considered when developing and implementing social services for families with children diagnosed with cancer.
Less air pollution did not explain the decline in admissions for AMI during the first wave of COVID-19 pandemic in Sardinia, Italy
Authors: Meloni Luigi , Ranieri Gaetano , Marchetti Maria Francesca , Aste Francesca , Piga Carlo , Casu Gavino , Pes Rosanna , Meloni Ivan , Loi Bruno , Montisci Roberta
Published: October 2022

During the COVID-19 pandemic, hospitalizations for acute myocardial infarction (AMI) decreased worldwide. We compared the admissions for AMI in the four regional 24/7 cath lab during the national lockdown, the 8 weeks before the lockdown, the 8 weeks after the e lockdown, and the corresponding time period in 2019 and we analyzed the average level of pollution in the studies areas. A marked decline in AMI admissions was observed during the lockdown period in comparison with the 8 weeks before the lockdown ( p < 0.0001) and a significant increase in the 8 weeks after the lockdown ( p < 0.00001). No significant change in air pollutants density were highlighted. Since air pollution did not change substantially in our region, the environment factor cannot explain the decline in the number of admissions for AMI we recorded during the lockdown. Fear of contagion is the most plausible reason for the drop of hospitalizations during the lockdown period.
Occurrence Rate of Cyclops Lesion After Anatomic Double-Bundle ACL Reconstruction: Comparison Between Remnant Tissue Preservation and Resection Methods
Authors: Hishimura Ryosuke , Kondo Eiji , Suzuki Yuki , Matsuoka Masatake , Iwasaki Koji , Onodera Tomohiro , Momma Daisuke , Yagi Tomonori , Yasuda Kazunori , Iwasaki Norimasa
Published: October 2022

Background:

The occurrence rate of cyclops lesion after anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with remnant tissue preservation remains unclear.

Hypothesis:

The study hypotheses were as follows: (1) the occurrence rate of cyclops lesion will be comparable between the remnant-preserving and remnant-resecting ACL reconstruction methods, and (2) there will be no significant differences in clinical outcomes between the remnant-preserving and remnant-resecting procedures.

Methods:

This retrospective comparative study involved 177 patients who underwent unilateral anatomic double-bundle ACL reconstruction using hamstring tendon autografts from 2014 to 2018 at our hospital. According to the Crain classification of ACL remnant tissue, 98 patients with remnant types I, II, or III underwent the remnant-preserving procedure (group A), and the remaining 79 patients with remnant type IV underwent the remnant-resecting procedure (group B). All patients underwent second-look arthroscopy. Patients were evaluated according to arthroscopic and clinical results at postoperative 15.2 ± 8.4 months (mean ± SD). Statistical comparisons between groups were made using the paired Student t test, chi-square test, and Fisher exact test.

Study Design:

Cohort study; Level of evidence, 3.

Results:

At second-look arthroscopy, the incidence of cyclops lesions was significantly higher in group B than in group A (29.1% vs 13.3%; P = .0139). Cyclops lesions were divided into 4 locations: femoral side (type 1), midsubstance (type 2), tibial side (type 3), and anterior (type 4) of the ACL graft. The ratio of the tibial-side cyclops lesion (type 3) was significantly higher in group B than in group A ( P = .0354). There were no significant differences in the clinical evaluation scores between the procedures. Side-to-side anterior laxity was significantly less in group A than in group B (0.7 vs 1.6 mm; P = .0035). Concerning postoperative laceration and synovium coverage of the grafts, group A was significantly better than group B ( P < .0001).

Conclusion:

In this cohort of patients undergoing double-bundle ACL reconstruction, resection of the ACL remnant was associated with a significantly higher rate of cyclops lesion formation when compared with preservation of the remnant.
Hearing aid Experiences of Adult Hearing aid Owners During and After Fitting: A Systematic Review of Qualitative Studies
Authors: Oosthuizen Ilze , Manchaiah Vinaya , Launer Stefan , Swanepoel De Wet
Published: October 2022

There has been an increasing number of qualitative studies exploring the experiences and perceptions of adult hearing aid owners throughout their hearing aid journey. As these studies and reported experiences vary greatly, a systematic review was conducted to identify and synthesize the key concepts in adult hearing aid owners’ experiences during and after fitting. A systematic search of three electronic databases was conducted, yielding 443 results. Articles were evaluated for inclusion based on pre-determined eligibility criteria, including conventional, smartphone-connected, and direct-to-consumer hearing devices. Twenty-five studies met the inclusion criteria. The quality of the included articles was evaluated using the Rating of Qualitative Research scale. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Synthesis Without Meta-Analysis (SWiM) were followed. A narrative synthesis was conducted, and studies were grouped into three main domains, namely experiences of owners related to a) hearing aid adoption and fitting (n = 3), b) hearing aid use (n = 20), and c) hearing aid sub-optimal use (n = 25). Hearing aid owners mainly reported on how their attitude towards hearing aids affected experiences during the fitting stage. Improved psychosocial functioning was the most prevalent perceived benefit of hearing aid use. Owners described sub-optimal use in terms of hearing device-related and non-device-related concepts. The COM-B (capability, opportunity, motivation-behavior) model is used to discuss specific service-delivery, hearing-device, and hearing-aid-owner related concepts and clinical implications, including behavior change techniques to enhance understanding of the concepts that hearing aid owners perceive as essential to improve hearing aid experiences.
Cloth Face Coverings: Effect of Decontamination Method on Fabric Performance
Authors: Goodge Katarina , Frey Margaret
Published: October 2022

Various textiles have previously been evaluated for use in cloth face masks as a reusable option to help control the spread of respiratory viruses, but only their initial performance was tested. In this study, a broad range of fabrics (3 knit, 7 woven, and 3 nonwoven) were characterized for filtration efficiency (FE) and air permeability (AP) before and after 40 decontamination cycles by home laundry, microwave-generated steam, or dishwasher sterilization. AP was quantified following ASTM D737, and FE was assessed using NaCl aerosol in a simulated breathing system. While most fabrics maintained or improved their FE after 40 decontamination cycles, the AP of many fabrics decreased due to detergent buildup, fiber breakage, and fabric shrinkage. Tightly woven cotton fabrics had unacceptably low AP and FE performance. Knit and nonwoven structures had the best balance of properties, and although they are not recommended for use in single-layer masks, they have potential use in multilayer masks.
Characterization of Water Repellent and Flame Retardant Finished Cotton Canvas Fabric for Bivouac T﻿ents
Authors: Naeem Farhana , Hussain Muhammad Dawood , Khan Danyal Rashid
Published: October 2022

Water repellency and flame retardancy have applications in many fields, such as automotive interiors, indoor decorations, upholstery, outdoor clothing and tents. Cotton, having superior qualities, is considered one of the best raw materials for tent manufacture. The study has undertaken the application of different water repellent and flame retardant chemicals on 100% cotton canvas fabric to be used as bivouac tents. The purpose was to find suitable water repellent and flame retardant chemicals that can be applied in a single bath or in a two-step process to give the desired repellency and retardancy effect. Initially, two screening sets were carried out, which aided in the identification of best-performed chemicals to be used in the combined application of water repellent and flame retardant. In the combined application, the fabric was finished using two approaches. In the first approach, both repellent and retardant chemicals were prepared in a single bath, and in the second approach, the fabric was first finished with flame retardant chemicals and then finished with water repellent chemicals. In both the approaches, the finished fabric was evaluated by a cone test, a hydrostatic pressure head test and a flammability test against locally set requirements. It is concluded that the procedure of single bath water repellent and flame retardant finishes (SBWRFR1b) showed reduced pickup percentage (60%) and resulted in better water repellency and flame retardancy properties, in comparison to other procedures and series of recipes.
Video‐Based Tracheostomy Care Education for Medical Students
Authors: Pu Serena F. , Boyle John V. , Rubinstein Benjamin J. , Bak Matthew J. , Brooke Hooper A. , Mark Jonathan R.
Published: October 2022

Objective

Tracheostomy is a common procedure that requires management by a multidisciplinary team of health care providers across a range of surgical and nonsurgical specialties. Nonsurgical health care providers have demonstrated a lack of knowledge and confidence in tracheostomy care, which improve with tracheostomy education programs. However, tracheostomy care is rarely included in preresidency medical education. The purpose of this study is to evaluate the effectiveness of a tracheostomy care video on third‐year medical students’ knowledge of and confidence in performing tracheostomy care.

Methods

Prior to beginning clinical rotations, third‐year medical students completed a 10‐question tracheostomy care knowledge test (100 points total) and 11‐question confidence survey (110 points total). After watching an 18‐minute teaching video on tracheostomy care, students repeated the knowledge test and confidence survey.

Results

An overall 147 medical students completed the educational module. After they watched the tracheostomy education video, their average score on the knowledge test improved from 57.8 to 88.9 out of 100 (P <. 0001), and their average rating in confidence improved from 12.7 to 49.1 out of 110 (P <. 0001). Students rated the helpfulness of the video a 7.4 out of 10.

Discussion

Medical students’ knowledge of tracheostomy care and confidence in caring for patients with tracheostomies improved after watching the video. Tracheostomy education should be included in early medical education so that future physicians of various specialties can better care for this patient population.

Implications for Practice

Internet‐published videos are an accessible educational resource with great potential application to various topics within otolaryngology, including tracheostomy care.
The ‘brother layer problem’: Routine killing, biotechnology and the pursuit of ‘ethical sustainability’ in industrial poultry
Authors: Rutt Rebecca Leigh , Jakobsen Jostein
Published: October 2022

The global poultry industry culls approximately seven billion day-old male layer chicks annually. Superfluous to both egg and meat, male ‘brother’ layers constitute a momentous problem, simultaneously economical and ethical, to the poultry industry. In this article, we scrutinize present and proposed alternatives to routine killing involving multiple biotechnological innovations, including novel methods for fetus sexing, genome editing technologies and re-sexing. We utilize a political ecological perspective that views attempts to solve the ‘brother layer problem’ as discursive and techno-scientific ‘fixes’ to problems of the capitalist poultry industry's own making and to rising demands for ethics and environmental-friendly animal agriculture. This context opens new avenues for profit-making by and for an expanding matrix of actors we view as an evolving ‘economy of repair’ that is built in part by public resources. Further, these fixes constitute an ostensible ‘ethical sustainability’ meant to signal both animal welfare and environmental improvements, which seem to work towards stabilizing agro-industry, thereby foreclosing alternatives to agro-industrial intensification.
Two Cases of Hepatoblastoma in Adults
Authors: Ihssan Elouarith , Hajar Elagouri , Salma Bekarsabein , Soumaya Ech-Charif , Youssef Mahdi , Mouna Khmou , Basma El Khannoussi
Published: October 2022

Adult hepatoblastoma is a rare tumor whose etiology and mechanisms of development are still incompletely understood. Imaging and biological tests such as AFP and liver enzymes are non-specific. Histologically, there are 2 histological variants: pure epithelial with 5 types (pure fetal, embryonal, small cell undifferentiated, cholangioblastic, and macrotrabecular), a mixed epithelial and a mesenchymal variant with or without a teratoid contingent. The main differential diagnosis concerns hepatocellular carcinoma. The treatment of hepatoblastoma in adults is not yet standardized and surgery remains the mainstay of treatment. In this report we aim to describe the clinical, pathological, and immunohistochemical features of this rare entity in adult patients and discuss the elements allowing its distinction from hepatocellular carcinoma (HCC).
Mucha-Habermann Disease: The Quandary Continues
Authors: Mezni Line , Elhadadi Farah , Meziane Mariame , Ismaili Nadia , Benzekri Laila , Senouci Karima
Published: October 2022

Pityriasis lichenoides et varioliformis acuta (PLEVA) is an uncommon skin disorder, clinically characterized by an acute onset of a polymorphic eruption. The disease has an unpredictable course, the pathogenesis is not fully understood, and many treatments have been proposed while self-resolution may occur. Hence, We report a puzzling case of PLEVA in its early stage of transition to a febrile ulceronecrotic Mucha-Habermann disease.
Inhibition of platelet activation suppresses reactive enteric glia and mitigates intestinal barrier dysfunction during sepsis
Authors: Cheng Bo , Du Mengyu , He Shuxuan , Yang Lan , Wang Xi , Gao Hui , Chang Haiqing , Gao Wei , Li Yan , Wang Qiang , Li Yansong
Published: October 2022

Background

Intestinal barrier dysfunction, which is associated with reactive enteric glia cells (EGCs), is not only a result of early sepsis but also a cause of multiple organ dysfunction syndrome. Inhibition of platelet activation has been proposed as a potential treatment for septic patients because of its efficacy in ameliorating the organ damage and barrier dysfunction. During platelet activation, CD40L is translocated from α granules to the platelet surface, serving as a biomarker of platelet activation a reliable predictor of sepsis prognosis. Given that more than 95% of the circulating CD40L originate from activated platelets, the present study aimed to investigate if inhibiting platelet activation mitigates intestinal barrier dysfunction is associated with suppressing reactive EGCs and its underlying mechanism.

Methods

Cecal ligation and puncture (CLP) was performed to establish the sepsis model. 24 h after CLP, the proportion of activated platelets, the level of sCD40L, the expression of tight-junction proteins, the intestinal barrier function and histological damage of septic mice were analyzed. In vitro, primary cultured EGCs were stimulated by CD40L and LPS for 24 h and EGCs-conditioned medium were collected for Caco-2 cells treatment. The expression of tight-junction proteins and transepithelial electrical resistance of Caco-2 cell were evaluated.

Results

In vivo, inhibiting platelet activation with cilostazol mitigated the intestinal barrier dysfunction, increased the expression of ZO-1 and occludin and improved the survival rate of septic mice. The efficacy was associated with reduced CD40L+platelets proportion, decreased sCD40L concentration, and suppressed the activation of EGCs. Comparable results were observed upon treatment with compound 6,877,002, a blocker of CD40L–CD40–TRAF6 signaling pathway. Also, S-nitrosoglutathione supplement reduced intestinal damage both in vivo and in vitro. In addition, CD40L increased release of TNF-α and IL-1β while suppressed the release of S-nitrosoglutathione from EGCs. These EGCs-conditioned medium reduced the expression of ZO-1 and occludin on Caco-2 cells and their transepithelial electrical resistance, which could be reversed by CD40-siRNA and TRAF6-siRNA transfection on EGCs.

Conclusions

The inhibition of platelet activation is related to the suppression of CD40L-CD40-TRAF6 signaling pathway and the reduction of EGCs activation, which promotes intestinal barrier function and survival in sepsis mice. These results might provide a potential therapeutic strategy and a promising target for sepsis.
Low-Consumption Synaptic Devices Based on Gate-All-Around InAs Nanowire Field-Effect Transistors
Authors: Zha Chaofei , Luo Wei , Zhang Xia , Yan Xin , Ren Xiaomin
Published: October 2022

In this work, an artificial electronic synaptic device based on gate-all-around InAs nanowire field-effect transistor is proposed and analyzed. The deposited oxide layer (In2O3) on the InAs nanowire surface serves as a charge trapping layer for information storage. The gate voltage pulse serves as stimuli of the presynaptic membrane, and the drain current and channel conductance are treated as post-synaptic current and weights of the postsynaptic membrane, respectively. At low gate voltages, the device simulates synaptic behaviors including short-term depression and long-term depression. By increasing the amplitude and quantity of gate voltage pulses, the transition from short-term depression to long-term potentiation can be achieved. The device exhibits a large memory window of over 1 V and a minimal energy consumption of 12.5 pJ per synaptic event. This work may pave the way for the development of miniaturized low-consumption synaptic devices and related neuromorphic systems.
Examining the factors influencing microtransit users’ next ride decisions using Bayesian networks
Authors: He Jiajing , Ma Tai-Yu
Published: October 2022

The progress of microtransit services across the world has been slower than expected due to institutional, operational, and financial barriers. However, how users' ride experiences and system attributes affects their future ride decisions remain an important issue for successful deployment. A Bayesian network approach is proposed to infer users’ next ride decisions on a microtransit service based on historical ride data from Kussbus, a pilot microtransit system operating in the Belgium–Luxembourg cross-border areas in 2018. The results indicate that the proposed Bayesian network approach could reveal a plausible causal relationship between different dependent factors compared to the classical multinomial logit modeling approach. By examining public transport coverage in the study area, we find that Kussbus complements the existing public transport and provides an effective alternative to personal car use.
Effectively predicting HIV-1 protease cleavage sites by using an ensemble learning approach
Authors: Hu Lun , Li Zhenfeng , Tang Zehai , Zhao Cheng , Zhou Xi , Hu Pengwei
Published: October 2022

Background

The site information of substrates that can be cleaved by human immunodeficiency virus 1 proteases (HIV-1 PRs) is of great significance for designing effective inhibitors against HIV-1 viruses. A variety of machine learning-based algorithms have been developed to predict HIV-1 PR cleavage sites by extracting relevant features from substrate sequences. However, only relying on the sequence information is not sufficient to ensure a promising performance due to the uncertainty in the way of separating the datasets used for training and testing. Moreover, the existence of noisy data, i.e., false positive and false negative cleavage sites, could negatively influence the accuracy performance.

Results

In this work, an ensemble learning algorithm for predicting HIV-1 PR cleavage sites, namely EM-HIV, is proposed by training a set of weak learners, i.e., biased support vector machine classifiers, with the asymmetric bagging strategy. By doing so, the impact of data imbalance and noisy data can thus be alleviated. Besides, in order to make full use of substrate sequences, the features used by EM-HIV are collected from three different coding schemes, including amino acid identities, chemical properties and variable-length coevolutionary patterns, for the purpose of constructing more relevant feature vectors of octamers. Experiment results on three independent benchmark datasets demonstrate that EM-HIV outperforms state-of-the-art prediction algorithm in terms of several evaluation metrics. Hence, EM-HIV can be regarded as a useful tool to accurately predict HIV-1 PR cleavage sites.
Genome sequence of the entomopathogenic Serratia entomophila isolate 626 and characterisation of the species specific itaconate degradation pathway
Authors: Vaughan Amy L. , Altermann Eric , Glare Travis R. , Hurst Mark R. H.
Published: October 2022

Background

Isolates of Serratia entomophila and S. proteamaculans (Yersiniaceae) cause disease specific to the endemic New Zealand pasture pest, Costelytra giveni (Coleoptera: Scarabaeidae). Previous genomic profiling has shown that S. entomophila isolates appear to have conserved genomes and, where present, conserved plasmids. In the absence of C. giveni larvae, S. entomophila prevalence reduces in the soil over time, suggesting that S. entomophila has formed a host-specific relationship with C. giveni. To help define potential genetic mechanisms driving retention of the chronic disease of S. entomophila, the genome of the isolate 626 was sequenced, enabling the identification of unique chromosomal properties, and defining the gain/loss of accessory virulence factors relevant to pathogenicity to C. giveni larvae.

Results

We report the complete sequence of S. entomophila isolate 626, a causal agent of amber disease in C. giveni larvae. The genome of S. entomophila 626 is 5,046,461 bp, with 59.1% G + C content and encoding 4,695 predicted CDS. Comparative analysis with five previously sequenced Serratia species, S. proteamaculans 336X, S. marcescens Db11, S. nematodiphila DH-S01, S. grimesii BXF1, and S. ficaria NBRC 102596, revealed a core of 1,165 genes shared. Further comparisons between S. entomophila 626 and S. proteamaculans 336X revealed fewer predicted phage-like regions and genomic islands in 626, suggesting less horizontally acquired genetic material.

Genomic analyses revealed the presence of a four-gene itaconate operon, sharing a similar gene order as the Yersinia pestis ripABC complex. Assessment of a constructed 626::RipC mutant revealed that the operon confer a possible metabolic advantage to S. entomophila in the initial stages of C. giveni infection.

Conclusions

Evidence is presented where, relative to S. proteamaculans 336X, S. entomophila 626 encodes fewer genomic islands and phages, alluding to limited horizontal gene transfer in S. entomophila.

Bioassay assessments of a S. entomophila-mutant with a targeted mutation of the itaconate degradation region unique to this species, found the mutant to have a reduced capacity to replicate post challenge of the C. giveni larval host, implicating the itaconate operon in establishment within the host.
VascuFit: vascular effects of non-linear periodized exercise training in sedentary adults with elevated cardiovascular risk – protocol for a randomized controlled trial
Authors: Königstein Karsten , Meier Jennifer , Angst Thomas , Maurer Debbie J. , Kröpfl Julia M. , Carrard Justin , Infanger Denis , Baumann Sandra , Bischofsberger Imerio , Harder Marc , Jäggi Yves , Wettach Sabrina , Hanssen Henner , Schmidt-Trucksäss Arno
Published: October 2022

Background

Early vascular aging (EVA) is increasingly prevalent in the general population. Exercise is important for primary cardiovascular prevention, but often insufficient due to ineffective training methods and a lack of biomarkers suitable to monitor its vascular effects. VascuFit will assess the effectiveness of non-linear periodized aerobic exercise (NLPE) in a non-athletic sedentary population to improve both established and promising biomarkers of EVA.

Methods

Forty-three sedentary adults, aged 40–60 years, with elevated cardiovascular risk will either engage in 8 weeks of ergometer-based NLPE (n = 28) or receive standard exercise recommendations (n = 15). The primary outcome will be the change of brachial-arterial flow-mediated dilation (baFMD) after versus before the intervention. Secondary outcomes will be the change in static vessel analysis (SVA; clinical biomarker of microvascular endothelial function), endomiRs (microRNAs regulating key molecular pathways of endothelial cell homeostasis) and circulating cellular markers of endothelial function (mature endothelial cells, endothelial progenitor cells). Tertiary outcomes will be the change in sphingolipidome, maximum oxygen capacity, and traditional cardiovascular risk factors (blood pressure, triglycerides, cholesterol, fasting glucose, high-sensitivity C-reactive protein).

Discussion

We expect an improvement of baFMD of at least 2.6% and significant pre-post intervention differences of SVA and endomiRs as well as of the tertiary outcomes in the intervention group. VascuFit may demonstrate the effectiveness of NLPE to improve endothelial function, thus vascular health, in the general sedentary population. Furthermore, this project might demonstrate the potential of selected molecular and cellular biomarkers to monitor endothelial adaptations to aerobic exercise.

Trial registration

The trial was registered onwww.clinicaltrials.gov(NCT05235958) in February 11th2022.
Association between overall dietary quality and constipation in American adults: a cross-sectional study
Authors: Liu Qingye , Kang Yulong , Yan Jin
Published: October 2022

Background

Constipation seriously affects people’s life quality, and dietary adjustment has been one of the effective methods. Overall dietary quality has been reported to be associated with some diseases, while its association with constipation has not been reported. This study aims to explore the association between overall dietary quality and constipation.

Methods

A cross-sectional study was designed and data were extracted from National Health and Nutrition Examination Survey (NHANES). Overall dietary quality was assessed by healthy eating index-2015 (HEI-2015), and constipation was defined by either stool consistency or stool frequency. The association between overall dietary quality or components of HEI-2015 and constipation was assessed using logistic regression, with results expressed as odds ratio (OR) and 95% confidence intervals (95%CI). Subgroup analysis was conducted according to age and gender.

Results

A total of 13,945 participants were eligible, with 1,407 in constipation group and 12,538 in non-constipation group. Results showed that higher adherence to HEI-2015 was associated with reduced odds of constipation (OR: 0.98, 95%CI: 0.98–0.99) after adjusting potential confounders. Further, we found higher intake of total fruits, whole fruits, total vegetables, greens and beans, whole grains, total protein foods, seafood and plant proteins, and higher fatty acids ratio decreased the odds of constipation, while higher intake of sodium increased the odds (all P < 0.05). We also found negative association between HEI-2015 and constipation in participants with male sex, female sex, age ≥ 65 years, and age < 65 years (all P < 0.05).

Conclusion

We found higher adherence to HEI-2015 decreased the odds of constipation, suggesting that increasing HEI-2015 adherence may be one of effective methods to alleviate constipation.
An observational study of the effects of smoking cessation earlier on the clinical characteristics and course of acute exacerbations of chronic obstructive pulmonary disease
Authors: Li Xiaolong , Wu Zhen , Xue Mingyue , Du Wei
Published: October 2022

Background

Previous studies have focused on the negative effects of continued smoking on chronic obstructive pulmonary disease (COPD). However, few studies have investigated the positive effects of long-term smoking cessation on patients suffering from acute exacerbations of COPD.

Methods

The study recruited and followed current or former smokers who had been hospitalized and diagnosed with AECOPD. An in-depth analysis of clinical and laboratory indicators was conducted.

Results

125 patients were covered, including 72 short-term quitters and 53 long-term quitters. The results showed that long-term smoking cessation may result in milder dyspnea and cough, a higher oxygenation index, a lower arterial partial pressure of carbon dioxide, and milder pulmonary hypertension, airflow restriction, and gas retention in patients with AECOPD. However, despite the lower treatment intensity for long-term quitters, improvement in dyspnea and an increase in oxygenation index were comparable to those achieved by short-term quitters. Furthermore, patients with mild phlegm, which accounted for 84% of all subjects, showed greater improvement in phlegm in AECOPD patients with long-term cessation of smoking.

Conclusion

It was found that in patients with AECOPD who quit smoking for a long period of time, there was a reduction in symptoms, improvement in lung function, reduction in treatment intensity, and better improvement in phlegm symptoms after therapy. It is beneficial and necessary to quit smoking early, even if you smoke a small amount of cigarettes.