bluuebunny/crossref_metadata_2025 huggingface dataset:
Insight into the peristaltic motion through a tapered channel with Newton’s cooling subject to viscous dissipation, Lorentz force, and velocity slip
Authors: Rafiq Muhammad Yousuf , Abbas Zaheer , Hasnain Jafar , Khaliq Sabeeh
Published: April 2024

Peristalsis has gained significant attention due to its numerous applications in the medical field, engineering, and manufacturing industries. Therefore, the current work intends to look into the effects of variable liquid properties on the magnetohydrodynamics of peristaltic flow exhibited by viscous fluid through a tapered channel. The viscosity of the liquid differs over the thickness of the channel, and temperature-dependent thermal conductivity is considered. The constitutive relation for energy is formulated with the addition of viscous dissipation and heat generation/absorption. The assumption of velocity slip along with the convective boundary condition energizes the thermal system as well as the flow phenomena. The mathematical formulation is established on the grounds of low Reynolds number and long wavelength approximations. Perturbation solution were obtained for the resulting non-linear differential equations of momentum and energy for small values of variable viscosity and variable thermal conductivity. The effects of various relevant parameters on flow properties were investigated through graphical analysis. The results show that the maximum velocity does not occur in the middle of the tapered channel, but moves toward the upper wall with the increase in the variable viscosity difference between the walls. The application of viscosity is essential in many engineering and industrial processes.
Design of constant-force mechanisms using origami
Authors: Hu Junfeng , Pan Hao
Published: April 2024

The origami mechanisms possess numerous unique advantages, including folding, reconfigurability, and multi-stability. The presence of multi-stability introduces a novel concept for the design of constant force mechanisms (CFM). In this study, we present a CFM with multi-segment constant-force regions by leveraging the multi-stable characteristics of the origami mechanism. The design principle behind this CFM involves combining an accordion origami structure with positive stiffness and a Kresling origami structure with multi-segment negative stiffness regions. To achieve zero stiffness, the Kresling origami structure is aligned parallel to the accordion origami. To effectively utilize both the Kresling and accordion origamis, we have established a mechanical model that describes their respective stiffness characteristics to establish design rules for the constant-force mechanism. By carefully designing the parameters of these two origami structures, we evaluate how variations in the structural parameters of Kresling influence the constant force properties of our proposed multi-segment CFM. To illustrate its inherent property of providing constant force across multiple segments, we employ finite element analysis and experiments to obtain force-displacement curves for our mechanism. The results demonstrate the feasibility of our presented design method which paves the way for constructing a simple CFM.
Freight train air brake modelling with emergency valves
Authors: Jiang Fan , Li Kai , Wu Honghua , Luo Shihui
Published: April 2024

The 120-type air brake system is unique around global rail industry and critical for Chinese freight train operation. Existing research about its simulations does not include detailed models for the emergency brake valves. This paper filled this research gap by developing a detailed fluid dynamic air brake system with a focus on the emergency brake valve. The working principle of the emergency brake vale was reviewed. The brake system model was based on gas flow governing equations (mass and momentum) and orifice flow equations. The model was validated by comparing with measured data from a 150-wagon train. Four braking scenarios were compared. The simulated maximum cylinder pressure was only 5 kPa out of the range of the measured data. The maximum difference regarding the time when cylinder pressure reaches maximum pressure was 4 s. The simulation results have also shown variable switch pressure points for the two-stage brake valve. This is agreed by the measured results and was not shown in previously published research.
Feasibility study on the active structural attenuation of multiple band vibrations from two dimensional continuous structures in automotive vehicles
Authors: Hong Dongwoo , Moon Hojoon , Kim Byeongil
Published: April 2024

Automotive engine mounts have recently begun using active elements, while prior studies did not account for the actual engine mounting position. The placement and orientation of real automobile engine mounts are considered when modeling, analyzing, and controlling a source structure with an active mounting system. A piezoelectric stack actuator connected in series with an elastomeric mount composes an active mount. When harmonic excitation forces are used, the secondary force required for each active mount is mathematically determined, and the control signal may reduce the vibration by interfering with the input signal. Additionally, the dynamic relationship of the source structure with a variable parameter may be used to reduce horizontal vibrations. Several simulation findings show that these multidirectional (vertical and horizontal) active mounts may minimize excitation vibrations. Additionally, a simulation was performed to reduce vibrations when a complex signal and noise were present. This was achieved by monitoring the system response using the normalized least mean squares (NLMS) algorithm, an adaptive filter. The control performance degrades as noisy and complicated signals are generated; however, the mitigation trend is the same according to simulations utilizing adaptive filters.
Improving diet through a recommendation system using physical activity data and healthy diet indexes of female futsal players
Authors: Orue-Saiz Iñigo , Rico-González Markel , Pino-Ortega José , Méndez-Zorrilla Amaia
Published: April 2024

Sports data analysis can revolutionize how coaches and athletes train, leading to enhanced skills and improved team outcomes by providing valuable insights into performance metrics, enabling personalized training programs, and fostering a data-driven approach to decision-making. Sports data analysis has evolved in tandem with the increasing availability of data and the widespread adoption of data-driven practices in sports. Futsal stands out as one of the most challenging team sports to analyze, particularly in the case of female futsal, which has received limited research attention. The high-paced nature of the game, the smaller playing area, and the emphasis on close ball control necessitate a specialized approach to data collection and analysis. This situation presents a significant opportunity for in-depth exploration. By recognizing a gap in utilizing nutrition and physical activity data for female futsal players, researchers embarked on the journey to design and develop a recommendation system based on diet and training data. The study enlisted 14 talented female futsal players, and data was collected using an advanced LPS (Local Positioning System) device. Despite having limited player information, researchers successfully addressed the well-known “cold start” challenge. They created a content-based filtering recommendation system that accurately predicts the caloric expenditure of futsal players, achieving an impressive determination coefficient of 0.94. This innovative system has the potential to revolutionize the training methods of female futsal players, paving the way for advancements in sports data analysis and opportunities to enhance the visibility of women’s futsal on a broader stage.
A seesaw of equilibrium, midwives’ experiences of infection prevention and control guideline adherence: A qualitative descriptive study
Authors: McCarthy Maura , Giltenane Martina , Doody Owen
Published: April 2024

Background

Infection prevention and control guidelines play a key role in preventing infections which can impact mothers and their newborn’s quality of life. Despite the presence of evidenced-based infection prevention and control guidelines, midwives’ adherence can be suboptimal internationally. The identification of facilitators and barriers to infection prevention and control guidelines can support practice and facilitate midwifery care.

Aim

To understand midwives’ experiences of the barriers and facilitators when adhering to infection prevention and control guidelines.

Methods

A qualitative descriptive study using semi-structured interviews with 10 midwives from February to March 2022. The interviews were audio recorded, transcribed verbatim, and analysed utilising Braun and Clarke’s thematic analysis framework involving the six steps of becoming familiar with the data, generating initial codes, generating themes, reviewing themes, defining and naming the themes, and presenting themes.

Findings

Two themes developed; seesaw for equilibrium and back to basics: learning on your feet. Midwives experienced conflicting emotional motivators in the need for professional integrity towards infection prevention and control guideline adherence. The work environment impacts on midwives’ ability to adhere to guidelines and communication and education have a vital role to play in infection prevention and control guideline adherence.

Conclusions

While midwives have a strong sense of protection of professional integrity, work conditions such as environment, organisational structures, and management systems affect midwives’ adherence to infection prevention and control guidelines. Effective education, training, and communication are required to promote infection prevention and control guideline adherence.
Evaluation of the safety and efficacy of peripheral vasopressors to decrease central line placement and associated bloodstream infections
Authors: Dansereau Angela C , Marti Kristen E , Mah John W , Pugliese Nicholas M
Published: April 2024

Background

In 2020, as a result of evidence of demonstrated safety of an initial pilot program, our institution set out to implement a peripheral vasopressor infusion protocol.

Objective

To evaluate the use of peripheral lines for vasopressor administration to reduce placement of unnecessary central lines and central line days.

Methods

This is an Institutional Review Board approved, single center retrospective chart review conducted as pre/post-analysis. Our hospital is a quaternary care, level 1 trauma center in Hartford, Connecticut that serves 100,000-120,000 patients annually. Patients >18 years admitted to an intensive care unit (ICU) were included if meeting protocol specific inclusion criteria pertaining to moderate expected duration and dose of vasopressor. Patients were excluded if vasculature not supportive of placement of two peripheral intravenous (PIV) sites, PIV sites without brisk blood return, had a limb restriction, or metacarpal line. All analyses were conducted with SPSS v. 26 (IBM; Armonk, NY 2019), using an a priori alpha level of 0.05 such that all results yielding p < .05 were deemed statistically significant. Primary efficacy outcomes of this study are number of central lines placed and number of central line days. The primary safety outcome is the number of extravasation events attributed to peripheral administration of vasopressors.

Results

Overall, 146 patients avoided central line placement constituting a 58.4% ( p < .001) decrease in central line placement with peripheral vasopressor use. Out of 382 administrations there were a total of 14 extravasation events that occurred with peripheral vasopressor use in the post-intervention group. Implementation was associated with a statistically significant reduction in CLABSI occurrence.

Conclusions

The results of this analysis demonstrate that vasopressors can peripherally administered safely, when proximal to the antecubital fossa, at lower doses, and for short durations of infusion with minimal adverse events.
Chronic California herbal tea use causing biopsy-proven Melanosis coli
Authors: Bizuneh Segenet , Fentahun Shibabaw , Lema Gebrehiwot , Azaje Andinet
Published: April 2024

Melanosis coli is a dark to brown pigmentation of the colon due to lipofuscin deposition within the cytoplasm of cells. It is a benign condition associated with excessive use of laxatives, particularly those that are anthracene derivatives and common herbal remedies like Cassia Angustifolla (senna). It is usually asymptomatic and diagnosed incidentally during colonoscopy or histopathologic evaluation. We present a case of a 56-year-old male patient who presented with diarrhea of 3 months duration, which started after he began to use California herbal tea for his constipation. Colonoscopic evaluation revealed an intense pigmentation throughout the colon suggestive of Melanosis coli, which was confirmed on histopathology. In patients with prolonged use of California herbal tea and dark to brown pigmentations of colonic mucosa on colonoscopy, there should be a high index of suspicion for Melanosis coli. And patients should be aware of the risk of developing Melanosis coli following prolonged herbal tea use. The findings presented in our case are in support of few previous literature that showed relations between chronic herbal tea use and Melanosis coli.
Gastric diverticulum mimicking a left renal mass: A case report
Authors: Dghoughi Basma , Imrani Kaoutar , Beqqali Basma , Maslouhi Kaoutar , Benelhosni Khadija , Moatassim Billah Nabil , Nassar Ittimade
Published: April 2024

Gastric diverticula are a rare condition; they are divided into true diverticula, which are congenital, and pseudodiverticula, which are acquired. True diverticula are usually located in the posterior fundus wall, below the esophagogastric junction, and appear on abdominal computed tomography as a cystic mass that is commonly taken for an extra digestive mass, especially adrenal mass. We report the case of an asymptomatic 24-year-old female patient with gastric diverticulum who was mistakenly diagnosed in ultrasound with a renal mass.
The complexity of phosphatase and tensin homolog hamartoma tumor syndrome: A case report
Authors: Bregvadze Kakha , Jabeen Sheeda , Rafi Shifa Mohamed , Tkemaladze Tinatin
Published: April 2024

Germline pathogenic variants found in the phosphatase and tensin homolog gene are associated with a range of rare syndromes that collectively fall under the umbrella of phosphatase and tensin homolog hamartoma tumor syndromes. Due to the wide array of possible clinical presentations and the varying degrees of symptom severity, many individuals with phosphatase and tensin homolog hamartoma tumor syndromes might remain undiagnosed for an extended period. We describe a case of a male child who received the diagnosis at the age of 12. His clinical features included macrocephaly, hypertrophy in the left arm, thyroid nodules, penile freckles, developmental delay, and an autism spectrum disorder. Whole exome sequencing revealed a de novo heterozygous variant in the phosphatase and tensin homolog. The case highlights the diverse and complex nature of phosphatase and tensin homolog hamartoma tumor syndromes, emphasizing the necessity for early diagnosis, multidisciplinary care, and surveillance protocols, offering the potential for improved prognostic outcomes and enhanced quality of life for affected individuals.
Peripheral PRP in the Operating Room vs Standard Clinic PRP for the Initial Treatment of PDR
Authors: Feist Jack E. , Drummond Sean C. , Fuerst Jonathan S. , Crosson Jason N. , Feist Richard M.
Published: April 2024

Purpose: To compare the long-term outcomes of standard panretinal photocoagulation (PRP) performed in the operating room (OR) with peripheral PRP performed in the clinic in treatment-naïve patients with proliferative diabetic retinopathy (PDR). Methods: Consecutive cases from 2017 to 2022 were retrospectively reviewed. Exclusion criteria included previous PRP, pars plana vitrectomy performed at the time of the initial PRP, PRP performed in another setting within 3 months of the initial treatment, a documented plan for future PRP at the time of the initial treatment, and less than 3 years of follow-up. Negative binomial regressions were used to compare the number of subsequent interventions between the 2 groups and t tests to compare the visual acuity (VA) outcomes. Results: Of the 961 eyes of 679 patients screened, 82 eyes of 53 patients met the inclusion criteria. The initial PRP was performed in the OR (OR cohort) in 57 eyes of 38 patients and in the clinic (clinic cohort) in 25 eyes of 15 patients. The OR cohort had a mean of 0.4 subsequent surgeries and 0.8 subsequent PRP treatments and the clinic cohort, 0.8 subsequent surgeries ( P < .05) and 1.8 subsequent PRP treatments ( P < .05). No significant between-group difference was found in the VA outcomes over the long-term follow-up (mean, 44.2 months). Conclusions: Peripheral PRP performed in the OR resulted in fewer subsequent interventions than standard PRP in the clinic and may afford better control of PDR.
The Association Between Self-Surveillance and Self-Rated Health in College Women: A Mechanistic Approach
Authors: Lamont Jean M.
Published: April 2024

Although women outlive men, women report poorer self-rated physical health over much of the lifespan. Objectification theory may offer insight into this gender difference. Objectifying culture promotes self-surveillance, which encourages prioritizing the body’s appearance over its physical functioning and well-being. As women may engage in self-surveillance more so than men, this sequence of events may help explain this gender difference in self-rated health. However, the few studies examining this idea show an inconsistent relationship between self-surveillance and self-rated health. Nonetheless, self-surveillance may promote body shame and diminished awareness of internal bodily states. As these factors are associated with poor self-rated health, self-surveillance may predict poor self-rated health via these mechanisms. In study 1 ( N = 166 undergraduate women), self-surveillance was unrelated to self-rated health. However, body shame and low interoceptive awareness mediated this relationship. In study 2 ( N = 347 undergraduate women and men), self-surveillance correlated negatively with self-rated health for female participants but not male participants. Female participants reported poorer self-rated health, and this effect was serially mediated by self-surveillance, body shame, and low body responsiveness. These studies suggest a potential avenue by which self-surveillance may explain the gender difference in self-rated health in college samples, providing an important basis for future longitudinal investigations in more diverse samples. Moreover, these results suggest that interventions targeting body shame and low internal awareness may be used to promote good self-rated health as well as to prevent disease and poor health behaviors related to self-rated health.
Measuring Patient-Reported Use and Outcomes From Complementary and Integrative Health Therapies: Development of the Complementary and Integrative Health Therapy Patient Experience Survey
Authors: Taylor Stephanie L , Elwy A Rani , Bokhour Barbara G , Coggeshall Scott S , Cohen Amy , Der-Martirosian Claudia , Haderlein Taona , Haun Jolie , Kligler Benjamin , Kloehn Alex T , Lorenz Karl A , Lott Briana , Shin Marlena H , Schult Tammy , Toyama Joy , Whitehead Alison M , Zhang Xiaoyi , Zeliadt Steven B
Published: April 2024

Background

Assessing the use and effectiveness of complementary and integrative health (CIH) therapies via survey can be complicated given CIH therapies are used in various locations and formats, the dosing required to have an effect is unclear, the potential health and well-being outcomes are many, and describing CIH therapies can be challenging. Few surveys assessing CIH therapy use and effectiveness exist, and none sufficiently reflect these complexities.

Objective

In a large-scale Veterans Health Administration (VA) quality improvement effort, we developed the “Complementary and Integrative Health Therapy Patient Experience Survey”, a longitudinal, electronic patient self-administered survey to comprehensively assess CIH therapy use and outcomes.

Methods

We obtained guidance from the literature, subject matter experts, and Veteran patients who used CIH therapies in designing the survey. As a validity check, we completed cognitive testing and interviews with those patients. We conducted the survey (March 2021-April 2023), inviting 15,608 Veterans with chronic musculoskeletal pain with a recent CIH appointment or referral identified in VA electronic medical records (EMR) to participate. As a second validity check, we compared VA EMR data and patient self-reports of CIH therapy utilization a month after survey initiation and again at survey conclusion.

Results

The 64-item, electronic survey assesses CIH dosing (amount and timing), delivery format and location, provider location, and payor. It also assesses 7 patient-reported outcomes (pain, global mental health, global physical health, depression, quality of life, stress, and meaning/purpose in life), and 3 potential mediators (perceived health competency, healthcare engagement, and self-efficacy for managing diseases). The survey took 17 minutes on average to complete and had a baseline response rate of 45.3%. We found high degrees of concordance between self-reported and EMR data for all therapies except meditation.

Conclusions

Validly assessing patient-reported CIH therapy use and outcomes is complex, but possible.
Field observations on the damage to road bridges after the 2023 Turkey Earthquake
Authors: Shirato Masahiro , Odawara Yuichi
Published: April 2024

A series of large-scale earthquakes occurred on February 6 in southern Turkey. The authors had the opportunity to join the Japan Disaster Relief (JDR) Expert Team and visit several damaged areas in Turkey from March 10 to 12, 2023. This article highlights damage cases of a road tunnel and several road bridges the authors observed around Antakya, Nurdağı, and Malatya. From the features of the observations, this article discusses the following three items for further study in the seismic design of road bridges: (1) seismic details for robustness, (2) seismic responses of bridges with longer natural periods, and (3) post-event inspection.
Transcriptomic analysis of Anopheles gambiae from Benin reveals overexpression of salivary and cuticular proteins associated with cross-resistance to pyrethroids and organophosphates
Authors: Saizonou Helga , Impoinvil Lucy Mackenzie , Derilus Dieunel , Omoke Diana , Okeyo Stephen , Dada Nsa , Corredor Claudia , Mulder Nicola , Lenhart Audrey , Ochomo Eric , Djogbénou Luc S.
Published: April 2024

Background

Insecticide resistance (IR) is one of the major threats to malaria vector control programs in endemic countries. However, the mechanisms underlying IR are poorly understood. Thus, investigating gene expression patterns related to IR can offer important insights into the molecular basis of IR in mosquitoes. In this study, RNA-Seq was used to characterize gene expression in Anopheles gambiae surviving exposure to pyrethroids (deltamethrin, alphacypermethrin) and an organophosphate (pirimiphos-methyl).

Results

Larvae of An. gambiae s.s. collected from Bassila and Djougou in Benin were reared to adulthood and phenotyped for IR using a modified CDC intensity bottle bioassay. The results showed that mosquitoes from Djougou were more resistant to pyrethroids (5X deltamethrin: 51.7% mortality; 2X alphacypermethrin: 47.4%) than Bassila (1X deltamethrin: 70.7%; 1X alphacypermethrin: 77.7%), while the latter were more resistant to pirimiphos-methyl (1.5X: 48.3% in Bassila and 1X: 21.5% in Djougou). RNA-seq was then conducted on resistant mosquitoes, non-exposed mosquitoes from the same locations and the laboratory-susceptible An. gambiae s.s. Kisumu strain. The results showed overexpression of detoxification genes, including cytochrome P450s (CYP12F2, CYP12F3, CYP4H15, CYP4H17, CYP6Z3, CYP9K1, CYP4G16, and CYP4D17), carboxylesterase genes (COEJHE5E, COE22933) and glutathione S-transferases (GSTE2 and GSTMS3) in all three resistant mosquito groups analyzed. Genes encoding cuticular proteins (CPR130, CPR10, CPR15, CPR16, CPR127, CPAP3-C, CPAP3-B, and CPR76) were also overexpressed in all the resistant groups, indicating their potential role in cross resistance in An. gambiae. Salivary gland protein genes related to ‘salivary cysteine-rich peptide’ and ‘salivary secreted mucin 3’ were also over-expressed and shared across all resistant groups.

Conclusion

Our results suggest that in addition to metabolic enzymes, cuticular and salivary gland proteins could play an important role in cross-resistance to multiple classes of insecticides in Benin. These genes warrant further investigation to validate their functional role in An. gambiae resistance to insecticides.
Optimization of fermentation conditions and medium components for chrysomycin a production by Streptomyces sp. 891-B6
Authors: Hu Zhe , Weng Qiangang , Cai Zhehui , Zhang Huawei
Published: April 2024

Background

Chrysomycin A (CA) is a promising antibiotic for treatment of Gram-positive bacterial infections and cancers. In order to enhance CA yield, optimization of fermentation conditions and medium components was carried out on strain Streptomyces sp. 891-B6, an UV-induced mutant with improved CA titer compared with its wide-type marine strain 891.

Results

Using one-way experiment, the optimal fermentation conditions for CA production in 1-L shake flask were obtained as follows: 12 days of fermentation time, 5 days of seed age, 5% of inoculum volume ratio, 200 mL of loading volume and 6.5 of initial pH. By response surface methodology, the optimal medium components determined as glucose (39.283 g/L), corn starch (20.662 g/L), soybean meal (15.480 g/L) and CaCO3 (2.000 g/L).

Conclusion

Validation tests showed that the maximum yield of CA reached 1601.9 ± 56.7 mg/L, which was a 60% increase compared to the initial yield (952.3 ± 53.2 mg/L). These results provided an important basis for scale-up production of CA by strain 891-B6.
Comparative secretome analysis of Striga and Cuscuta species identifies candidate virulence factors for two evolutionarily independent parasitic plant lineages
Authors: Bradley James M. , Butlin Roger K. , Scholes Julie D.
Published: April 2024

Background

Many parasitic plants of the genera Striga and Cuscuta inflict huge agricultural damage worldwide. To form and maintain a connection with a host plant, parasitic plants deploy virulence factors (VFs) that interact with host biology. They possess a secretome that represents the complement of proteins secreted from cells and like other plant parasites such as fungi, bacteria or nematodes, some secreted proteins represent VFs crucial to successful host colonisation. Understanding the genome-wide complement of putative secreted proteins from parasitic plants, and their expression during host invasion, will advance understanding of virulence mechanisms used by parasitic plants to suppress/evade host immune responses and to establish and maintain a parasite-host interaction.

Results

We conducted a comparative analysis of the secretomes of root (Striga spp.) and shoot (Cuscuta spp.) parasitic plants, to enable prediction of candidate VFs. Using orthogroup clustering and protein domain analyses we identified gene families/functional annotations common to both Striga and Cuscuta species that were not present in their closest non-parasitic relatives (e.g. strictosidine synthase like enzymes), or specific to either the Striga or Cuscuta secretomes. For example, Striga secretomes were strongly associated with ‘PAR1’ protein domains. These were rare in the Cuscuta secretomes but an abundance of ‘GMC oxidoreductase’ domains were found, that were not present in the Striga secretomes. We then conducted transcriptional profiling of genes encoding putatively secreted proteins for the most agriculturally damaging root parasitic weed of cereals, S. hermonthica. A significant portion of the Striga-specific secretome set was differentially expressed during parasitism, which we probed further to identify genes following a ‘wave-like’ expression pattern peaking in the early penetration stage of infection. We identified 39 genes encoding putative VFs with functions such as cell wall modification, immune suppression, protease, kinase, or peroxidase activities, that are excellent candidates for future functional studies.

Conclusions

Our study represents a comprehensive secretome analysis among parasitic plants and revealed both similarities and differences in candidate VFs between Striga and Cuscuta species. This knowledge is crucial for the development of new management strategies and delaying the evolution of virulence in parasitic weeds.
Super-refractory status epilepticus, rhabdomyolysis, central hyperthermia and cardiomyopathy attributable to spinal anesthesia: a case report and review of literature
Authors: Ehelepola N. D.B. , Ranathunga R. M.D.C. , Abeysundara A. B. , Jayawardana H. M.R.P. , Nanayakkara P. S.K.
Published: April 2024

Background

There are only six past reports of super-refractory status epilepticus induced by spinal anesthesia. None of those patients have died. Only < 15 mg of bupivacaine was administered to all six of them and to our case. Pathophysiology ensuing such cases remains unclear.

Case presentation

A 27 year old gravida 2, para 1, mother at 37 weeks of gestation came to the operating theater for an elective cesarean section. She had no significant medical history other than controlled hypothyroidism and one episode of food allergy. Her current pregnancy was uneventful. Her American Society of Anesthesiologists (ASA) grade was 2. She underwent spinal anesthesia and adequate anesthesia was achieved. After 5–7 min she developed a progressive myoclonus. After delivery of a healthy baby, she developed generalized tonic clonic seizures that continued despite the induction of general anesthesia. She had rhabdomyolysis, one brief cardiac arrest and resuscitation, followed by stress cardiomyopathy and central hyperthermia. She died on day four. There were no significant macroscopic or histopathological changes in her brain that explain her super refractory status epilepticus. Heavy bupivacaine samples of the same batch used for this patient were analyzed by two specialized laboratories. National Medicines Quality Assurance Laboratory of Sri Lanka reported that samples failed to confirm United States Pharmacopeia (USP) dextrose specifications and passed other tests. Subsequently, Therapeutic Goods Administration of Australia reported that the drug passed all standard USP quality tests applied to it. Nonetheless, they have detected an unidentified impurity in the medicine.

Conclusions

After reviewing relevant literature, we believe that direct neurotoxicity by bupivacaine is the most probable cause of super-refractory status epilepticus. Super-refractory status epilepticus would have led to her other complications and death. We discuss probable patient factors that would have made her susceptible to neurotoxicity. The impurity in the drug detected by one laboratory also would have contributed to her status epilepticus. We propose several possible mechanisms that would have led to status epilepticus and her death. We discuss the factors that shall guide investigators on future such cases. We suggest ways to minimize similar future incidents. This is an idiosyncratic reaction as well.

Graphical Abstract
IgG4-Related disease with diffuse myopericardial involvement- value of CMR: a case report and literature review of cardiac involvement
Authors: Houshmand Golnaz , Moosavi Najme-Sadat , Shahbazkhani Amirhossein , Pouraliakbar Hamidreza
Published: April 2024

Background

IgG4-related disease is a fibro-inflammatory disorder with an unknown etiology, which can affect multiple organ systems, including the cardiovascular system. While most reported cases of cardiovascular involvement are primarily associated with the aorta, there have been sporadic reports of isolated cardiac involvement.

Case presentation

This paper presents a documented case of IgG4-related systemic disease with symptoms indicative of restrictive cardiomyopathy. Subsequent Cardiac Magnetic Resonance imaging revealed diffuse myopericardial involvement, characterized by pericardial thickening and enhancement, accompanied by subepicardial and myocardial infiltration. Considering the rarity of cardiac involvement in our case, we conducted a thorough review of the existing literature pertaining to various patterns of cardiac involvement in IgG4-related disease, as well as the diagnostic modalities that can be employed for accurate identification and assessment.

Conclusions

This case report sheds light on the importance of recognizing and evaluating cardiac manifestations in IgG4-related systemic disease to facilitate timely diagnosis and appropriate management.
Molecular epidemiology of carbapenem-resistant gram-negative bacilli in Ecuador
Authors: Soria-Segarra Claudia , Soria-Segarra Carmen , Molina-Matute Marcos , Agreda-Orellana Ivanna , Núñez-Quezada Tamara , Cevallos-Apolo Kerly , Miranda-Ayala Marcela , Salazar-Tamayo Grace , Galarza-Herrera Margarita , Vega-Hall Victor , Villacis José E. , Gutiérrez-Fernández José
Published: April 2024

Introduction

Carbapenem-resistant gram-negative bacilli are a worldwide concern because of high morbidity and mortality rates. Additionally, the increasing prevalence of these bacteria is dangerous. To investigate the extent of antimicrobial resistance and prioritize the utility of novel drugs, we evaluated the molecular characteristics and antimicrobial susceptibility profiles of carbapenem-resistant Enterobacterales, Pseudomonas aeruginosa and Acinetobacter baumannii in Ecuador in 2022.

Methods

Ninety-five clinical isolates of carbapenem non-susceptible gram-negative bacilli were collected from six hospitals in Ecuador. Carbapenem resistance was confirmed with meropenem disk diffusion assays following Clinical Laboratory Standard Institute guidelines. Carbapenemase production was tested using a modified carbapenemase inactivation method. Antimicrobial susceptibility was tested with a disk diffusion assay, the Vitek 2 System, and gradient diffusion strips. Broth microdilution assays were used to assess colistin susceptibility. All the isolates were screened for the blaKPC,blaNDM,blaOXA-48,blaVIM and blaIMP genes. In addition, A. baumannii isolates were screened for the blaOXA-23, blaOXA-58 and blaOXA-24/40 genes.

Results

Carbapenemase production was observed in 96.84% of the isolates. The blaKPC, blaNDM and blaOXA-48 genes were detected in Enterobacterales, with blaKPC being predominant. The blaVIM gene was detected in P. aeruginosa, and blaOXA-24/40 predominated in A. baumannii. Most of the isolates showed co-resistance to aminoglycosides, fluoroquinolones, and trimethoprim/sulfamethoxazole. Both ceftazidime/avibactam and meropenem/vaborbactam were active against carbapenem-resistant gram-negative bacilli that produce serin-carbapenemases.

Conclusion

The epidemiology of carbapenem resistance in Ecuador is dominated by carbapenemase-producing K. pneumoniae harbouring blaKPC. Extensively drug resistant (XDR) P. aeruginosa and A. baumannii were identified, and their identification revealed the urgent need to implement strategies to reduce the dissemination of these strains.
A survey of the impact of self-supervised pretraining for diagnostic tasks in medical X-ray, CT, MRI, and ultrasound
Authors: VanBerlo Blake , Hoey Jesse , Wong Alexander
Published: April 2024

Self-supervised pretraining has been observed to be effective at improving feature representations for transfer learning, leveraging large amounts of unlabelled data. This review summarizes recent research into its usage in X-ray, computed tomography, magnetic resonance, and ultrasound imaging, concentrating on studies that compare self-supervised pretraining to fully supervised learning for diagnostic tasks such as classification and segmentation. The most pertinent finding is that self-supervised pretraining generally improves downstream task performance compared to full supervision, most prominently when unlabelled examples greatly outnumber labelled examples. Based on the aggregate evidence, recommendations are provided for practitioners considering using self-supervised learning. Motivated by limitations identified in current research, directions and practices for future study are suggested, such as integrating clinical knowledge with theoretically justified self-supervised learning methods, evaluating on public datasets, growing the modest body of evidence for ultrasound, and characterizing the impact of self-supervised pretraining on generalization.
Prevention of alcohol exposed pregnancies in Europe: the FAR SEAS guidelines
Authors: Bruguera Carla , Segura-García Lidia , Okulicz-Kozaryn Katarzyna , Gandin Claudia , Matrai Silvia , Braddick Fleur , Zin-Sędek Marta , Slodownik Luiza , Scafato Emanuele , Colom Joan
Published: April 2024

Introduction

Drinking during pregnancy is the leading cause of birth defects and child developmental disorders in Europe. The adverse effects of drinking during pregnancy may include physical, behavioural and cognitive problems, known collectively as fetal alcohol spectrum disorders (FASD). Evidence-based comprehensive recommendations at the European level on how to implement preventive and treatment policies to reduce alcohol-exposed pregnancies are needed. FAR SEAS, a tendered service contract (number 20,187,106) awarded by the European Commission, aimed at developing guidelines to respond to this knowledge gap.

Methods

FAR SEAS recommendations were built on (1) a two-phase review of interventions, (2) an international expert consultation, and (3) a pilot study on prevention of FASD conducted in the Mazovia region of Poland. The review of interventions included nineteen electronic open access databases, several repositories of grey literature and a key informant consultation covering most European Union (EU) countries and an additional guidelines search. After triangulating sources, 94 records were collected. Experts contributed in the design of the research questions, addressing the gaps in the literature and reviewing the recommendations formulated. The Polish pilot added nuances from real world practice to the formulated recommendations, resulting in the final set of guidelines for dissemination.

Results

The FAR SEAS Guidelines comprise 23 recommendations grouped into different topics areas of policies, communication strategies, screening, brief intervention and referral to treatment, treatment and social services. The recommendations highlight the need to respect women’s autonomy and avoid discrimination and stigmatization; using universal screening for women of childbearing age, including detection of other psychosocial risks (such as domestic violence); and individualized, comprehensive and multidisciplinary supportive interventions for those who require it, such as those with alcohol use disorders, including women’s partners. Policies to prevent FASD should be multicomponent, and public health communication should combine information about the risks together with self-efficacy messages to promote changes.

Conclusions

The FAR SEAS guidelines are a tool to support policy-makers and service managers in implementing effective programmes to reduce prenatal alcohol exposure among general and at-risk population groups. FASD prevention has to involve comprehensive and multi-level evidence-based policies and practice, with services and activities tailored to the needs of women at differing levels of risk, and with due attention to reducing stigma.
Assessment of relevance and actual implementation of person-centeredness in healthcare and social support services for women with unintended pregnancy in Germany (CarePreg): results of expert workshops
Authors: Lindig Anja , Heger Stefanie , Zill Jördis Maria
Published: April 2024

Introduction

Person-centeredness is a key principle in the German healthcare system. However, access to high-quality care for women with unintended pregnancy is limited due to social stigma and legal restrictions. There is little research on the adoption of person-centeredness in care for women with unintended pregnancy. The aim of this study was to analyze relevance and actual implementation of dimensions of person-centeredness in psycho-social and medical abortion care from the view of abortion care providers.

Methods

Counselors and gynecologist working in psycho-social or medical abortion care participated in one of two digital workshops. Discussions were semi-structured based on the 16 dimensions of an integrative model of person-centeredness, audio-recorded and transcribed verbatim. During qualitative content analysis, deductive categories based on the integrative model of person-centeredness were applied and inductive categories were developed. Additionally, participants rated relevance and actual implementation of the dimensions in an online survey.

Results

The 18 workshop participants most intensively discussed the dimensions “access to care”, “person-centered characteristics of healthcare providers” and “personally tailored information”. Four additional categories on a macro level (“stigmatization of women with unintended pregnancy”, “stigmatization of healthcare providers”, “political and legal aspects” and “corona pandemic”) were identified. Most dimensions were rated as highly relevant but implementation status was described as rather low.

Conclusions

In Germany, high quality person-centered care for women with unintended pregnancy is insufficiently implemented through limited access to information, a lack of abortion care providers, and stigmatization. There is a need for changes in health care structures to enable nationwide person-centered care for women with unintended pregnancy. Those changes include a more easy access to evidence-based information and person-centered abortion care, more education on abortion care for healthcare providers, integration of topics of abortion care in medical schools and promotion of de-stigmatizing actions to enable abortions as part of the general healthcare.
Longitudinal association between fitness and metabolic syndrome: a population-based study over 29 years follow-up
Authors: Wiemann Johannes , Krell-Roesch Janina , Woll Alexander , Boes Klaus
Published: April 2024

Objectives

To examine the longitudinal associations between fitness and metabolic syndrome (MetS) in community-dwelling adults over 29 years of follow-up.

Design

Ongoing, population-based cohort study of adults aged ≥ 33 years at baseline residing in the city of Bad Schönborn, Germany.

Methods

The sample comprised 89 persons (41 females; mean age 40.1 years at baseline) who participated at baseline (in the year 1992) and 29-years follow-up (in the year 2021). Fitness (predictor variable) was assessed using 15 standardized and validated tests that measured strength, gross motor coordination, mobility/ flexibility and cardiorespiratory fitness/ endurance, and a z-transformed fitness score was calculated for analysis. MetS (outcome of interest) was assessed through five criteria related to waist circumference, blood glucose, HDL cholesterol, triglycerides, and blood pressure, and a sum score was created for analysis. We ran partial correlations to examine the association between fitness score at baseline and MetS score at 29-years follow-up, adjusted for age, sex, socio-economic status, smoking status, sleep quality, and physical activity engagement in minutes/ week.

Results

A higher fitness score at baseline was significantly associated with a lower MetS score indicative of better metabolic health at 29-years follow-up (r=-0.29; p = 0.011). These associations were present in participants aged ≤ 40 years (r=-0.33; p = 0.025) as well as those aged > 40 years (r=-0.43; p = 0.045).

Conclusions

Fitness may be a predictor of longitudinal metabolic health, and potentially also mediates previously reported longitudinal associations between physical activity and metabolic health. More research is needed to confirm these observations, and to also explore underlying mechanisms.
Comparative biomechanics of all-on-4 and vertical implant placement in asymmetrical mandibular: a finite element study
Authors: Sun Xin , Tang Xiaodong , Cheng Kangjie , Xia Zhuoheng , Liu Yunfeng , Yang Fan , Wang Linhong
Published: April 2024

Background

Clinical scenarios frequently present challenges when patients exhibit asymmetrical mandibular atrophy. The dilemma arises: should we adhere to the conventional All-on-4 technique, or should we contemplate placing vertically oriented implants on the side with sufficient bone mass? This study aims to employ three-dimensional finite element analysis to simulate and explore the biomechanical advantages of each approach.

Methods

A finite element model, derived from computed tomography (CT) data, was utilized to simulate the nonhomogeneous features of the mandible. Three configurations—All-on-4, All-on-5-v and All-on-5-o were studied. Vertical and oblique forces of 200 N were applied unilaterally, and vertical force of 100 N was applied anteriorly to simulate different masticatory mechanisms. The maximum von Mises stresses on the implant and framework were recorded, as well as the maximum equivalent strain in the peri-implant bone.

Results

The maximum stress values for all designs were located at the neck of the distal implant, and the maximum strains in the bone tissue were located around the distal implant. The All-on-5-o and All-on-5-v models exhibited reduced stresses and strains compared to All-on-4, highlighting the potential benefits of the additional implant. There were no considerable differences in stresses and strains between the All-on-5-o and All-on-5-v groups.

Conclusions

With the presence of adequate bone volume on one side and severe atrophy of the contralateral bone, while the “All-on-4 concept” is a viable approach, vertical implant placement optimizes the transfer of forces between components and tissues.