bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcriptome and proteome changes triggered by overexpression of the transcriptional regulator Maf1 in the human pathogen Leishmania major
Authors: Rivera‐Rivas Luis A. , Florencio‐Martínez Luis E. , Romero‐Meza Gabriela , Ortega‐Ortiz Roberto C. , Manning‐Cela Rebeca G. , Carrero Julio C. , Nepomuceno‐Mejía Tomás , Martínez‐Calvillo Santiago
Published: August 2024

Maf1, originally described as a repressor of RNA polymerase III (RNAP III) transcription in yeast, participates in multiple functions across eukaryotes. However, the knowledge about Maf1 in protozoan parasites is scarce. To initiate the study of Maf1 in Leishmania major, we generated a cell line that overexpresses this protein. Overexpression of Maf1 led to a significant reduction in the abundance of tRNAs, 5S rRNA, and U4 snRNA, demonstrating that Maf1 regulates RNAP III activity in L. major. To further explore the roles played by Maf1 in this microorganism, global transcriptomic and proteomic changes due to Maf1 overexpression were determined using RNA‐sequencing and label‐free quantitative mass spectrometry. Compared to wild‐type cells, differential expression was observed for 1082 transcripts (615 down‐regulated and 467 up‐regulated) and 205 proteins (132 down‐regulated and 73 up‐regulated) in the overexpressing cells. A correlation of 44% was found between transcriptomic and proteomic results. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses revealed that the differentially expressed genes and proteins are mainly involved in transcription, cell cycle regulation, lipid metabolism and transport, ribosomal biogenesis, carbohydrate metabolism, autophagy, and cytoskeleton modification. Thus, our results suggest the involvement of Maf1 in the regulation of all these processes in L. major, as reported in other species, indicating that the functions performed by Maf1 were established early in eukaryotic evolution. Notably, our data also suggest the participation of L. major Maf1 in mRNA post‐transcriptional control, a role that, to the best of our knowledge, has not been described in other organisms.
Research progress on interferon and cellular senescence
Authors: Wang Da , Chen Kaixian , Wang Zheng , Wu Huali , Li Yiming
Published: August 2024

Since the 12 major signs of aging were revealed in 2023, people's interpretation of aging will go further, which is of great significance for understanding the occurrence, development, and intervention in the aging process. As one of the 12 major signs of aging, cellular senescence refers to the process in which the proliferation and differentiation ability of cells decrease under stress stimulation or over time, often manifested as changes in cell morphology, cell cycle arrest, and decreased metabolic function. Interferon (IFN), as a secreted ligand for specific cell surface receptors, can trigger the transcription of interferon‐stimulated genes (ISGs) and play an important role in cellular senescence. In addition, IFN serves as an important component of SASP, and the activation of the IFN signaling pathway has been shown to contribute to cell apoptosis and senescence. It is expected to delay cellular senescence by linking IFN with cellular senescence and studying the effects of IFN on cellular senescence and its mechanism. This article provides a review of the research on the relationship between IFN and cellular senescence by consulting relevant literature.
Evaluating the Knowledge Levels and Attitudes Regarding Pressure Injuries among Nurses in Turkey
Authors: Şahan Seda , Güler Sevil
Published: August 2024

OBJECTIVE

To determine nurses’ knowledge levels and attitudes regarding pressure injury (PI) in Turkey and to reveal the relationship between these two variables.

METHODS

This study was conducted with 604 nurses to obtain 98% power based on the G*Power analysis. The authors used the Pressure Ulcer Knowledge Assessment Tool (PUKAT) 2.0 and Attitude toward Pressure Ulcer Prevention (APuP) instrument for data collection. Regression, correlation analysis, independent-sample t test, and analysis of variance were used in data analysis.

RESULTS

Nurses’ mean total PUKAT 2.0 score was 9.40 ± 2.47 (46.72% correct). Nurses’ mean total score on the APuP instrument was 32.39 ± 2.752. The total knowledge score and total attitude score were positively correlated (ρ = 0.761; P = .007). According to the results of linear regression analysis, the demographic variables of sex, education, seniority, and unit significantly predicted PUKAT 2.0 scores and APuP scores.

CONCLUSIONS

Nurses’ knowledge of PI prevention was insufficient, and their attitudes were average. A significant and positive relationship was identified between nurses’ knowledge and attitudes regarding PI.
Emergency Department Triage, Transfer Times, and Hospital Mortality of Patients Admitted to the ICU: A Retrospective Replication and Continuation Study*
Authors: van Herwerden Michael C. , Groenland Carline N. L. , Termorshuizen Fabian , Rietdijk Wim J. R. , Blokzijl Fredrike , Cleffken Berry I. , Dormans Tom , Epker Jelle L. , Feyz Lida , Gritters van den Oever Niels , van der Heiden Pim , de Jonge Evert , Latten Gideon H. P. , Pruijsten Ralph V. , Sir Özcan , Spronk Peter E. , Vermeijden Wytze J. , van Vliet Peter , de Keizer Nicolette F. , den Uil Corstiaan A.
Published: August 2024

OBJECTIVES:

This study aimed to provide new insights into the impact of emergency department (ED) to ICU time on hospital mortality, stratifying patients by academic and nonacademic teaching (NACT) hospitals, and considering Acute Physiology and Chronic Health Evaluation (APACHE)-IV probability and ED-triage scores.

DESIGN, SETTING, AND PATIENTS:

We conducted a retrospective cohort study (2009–2020) using data from the Dutch National Intensive Care Evaluation registry. Patients directly admitted from the ED to the ICU were included from four academic and eight NACT hospitals. Odds ratios (ORs) for mortality associated with ED-to-ICU time were estimated using multivariable regression, both crude and after adjusting for and stratifying by APACHE-IV probability and ED-triage scores.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 28,455 patients were included. The median ED-to-ICU time was 1.9 hours (interquartile range, 1.2–3.1 hr). No overall association was observed between ED-to-ICU time and hospital mortality after adjusting for APACHE-IV probability (p = 0.36). For patients with an APACHE-IV probability greater than 55.4% (highest quintile) and an ED-to-ICU time greater than 3.4 hours the adjusted OR (ORsadjApache) was 1.24 (95% CI, 1.00–1.54; p < 0.05) as compared with the reference category (< 1.1 hr). In the academic hospitals, the ORsadjApache for ED-to-ICU times of 1.6–2.3, 2.3–3.4, and greater than 3.4 hours were 1.21 (1.01–1.46), 1.21 (1.00–1.46), and 1.34 (1.10–1.64), respectively. In NACT hospitals, no association was observed (p = 0.07). Subsequently, ORs were adjusted for ED-triage score (ORsadjED). In the academic hospitals the ORsadjED for ED-to-ICU times greater than 3.4 hours was 0.98 (0.81–1.19), no overall association was observed (p = 0.08). In NACT hospitals, all time-ascending quintiles had ORsadjED values of less than 1.0 (p < 0.01).

CONCLUSIONS:

In patients with the highest APACHE-IV probability at academic hospitals, a prolonged ED-to-ICU time was associated with increased hospital mortality. We found no significant or consistent unfavorable association in lower APACHE-IV probability groups and NACT hospitals. The association between longer ED-to-ICU time and higher mortality was not found after adjustment and stratification for ED-triage score.
Serendipitous Pathways and Elusive Definitions: Leadership in Continuing Professional Development
Authors: Wiljer David , Paton Morag , Jeyakumar Tharshini , Do Victor , Maniate Jerry M. , Tavares Walter , Schneeweiss Suzan
Published: August 2024

Introduction:

Although the Continuing Professional Development (CPD) field has rapidly expanded in scope, breadth, and depth, there is a gap in how we understand CPD leadership and the role of the leader. Previous scholarship indicates that there is neither an agreed on set of competencies for CPD leadership roles nor a distinct pathway towards those roles. This study is aimed at answering the following question: How is leadership described or defined in CPD and what are the contextual issues that are and/or should be shaping its evolution?

Methods:

Conducted between 2020 and 2022, CPD leadership program learners and CPD leaders with a range of leadership expertise were identified using convenience and purposive sampling and invited to participate in this study. Semistructured interviews were conducted with consenting participants. Interviews were recorded, transcribed, and analyzed using a qualitative thematic template analysis approach.

Results:

Seventeen interviews were conducted. There were multiple components identified that were important to CPD leadership, such as being visionary, or having strong collaboration skills with some components, such as adaptability and flexibility appearing more unique to the CPD context. The role of CPD leadership and the pathway to CPD leadership remain highly variable.

Discussion:

Attaining a CPD leadership position predominantly involves some degree of “serendipity.” While CPD leaders may fundamentally need basic and common leadership skills, an essential attribute of the CPD leader is to effectively respond to the context and the unique needs of the health system. We recommend better articulating and valuing the role of the CPD leader within the health system.
Demystifying Artificial Intelligence for Health Care Professionals: Continuing Professional Development as an Agent of Transformation Leading to Artificial Intelligence–Augmented Practice
Authors: Soleas Eleftherios K. , Dittmer Douglas , Waddington Ashley , van Wylick Richard
Published: August 2024

The rapid rise of artificial intelligence (AI) is transforming society; yet, the education of health care providers in this field is lagging. In health care, where AI promises to facilitate diagnostic accuracy, and allow for personalized treatment, bridging the knowledge and skill gaps for providers becomes vital. This article explores the challenges of AI education, such as the emergence of self-proclaimed experts during the pandemic, and the need for comprehensive training in AI language, mechanics, and ethics. It advocates for a new breed of health care professionals who are both practitioners and informaticians, who are capable through initial training or through continuing professional development of harnessing AI's potential. Interdisciplinary collaboration, ongoing education, and incentives are proposed to ensure health care benefits from AI's trajectory. This perspective article explores the hurdles and the imperative of creating educational programming designed specifically to help health care professionals augment their practice with AI.
Long-term Health Outcomes After Hospital Discharge Among Children Hospitalized for MIS-C or COVID-19, September 29, 2021, to June 21, 2022
Authors: Godfred-Cato Shana , Kunkel Amber , Abrams Joseph Y. , Shah Ami B. , Yousaf Anna , Hammett Teresa A. , Choi Jong-Ha , Perez Maria A. , Hsiao Hui-Mien , Rostad Christina A. , Laham Federico R. , Kao Carol M. , Hunstad David A. , Oster Matthew E. , Campbell Angela P. , Belay Ermias D.
Published: August 2024

Background:

The long-term effects of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) or acute COVID-19 are not well known. Our objective was to determine long-term outcomes.

Methods:

Children hospitalized with MIS-C or COVID-19 at 3 US hospitals from March 2020, through February 2021 were followed to assess health through 2 years post-hospitalization using medical records and patient surveys.

Results:

Medical record abstraction was performed for 183 patients hospitalized with MIS-C, 53 of whom participated in surveys, and 97 patients hospitalized with COVID-19, 35 of whom participated in surveys. Patients with MIS-C were younger (median, 9 vs. 14 years of age for COVID-19 patients; P = 0.004), more frequently male (62% vs. 39%; P < 0.001) and had more cardiac (14% vs. 2%; P = 0.001) and neurologic sequelae (8% vs. 1%; P = 0.023). Children with COVID-19 more often had other comorbidities (59% vs. 19%; P < 0.001). Full mental recovery at the time of survey 2 (median, 16 months post-hospitalization for patients with MIS-C and 20 months for patients with COVID-19) was 85% and 88%, respectively; full physical recovery was 87% and 81%, respectively; and nearly all had resumption of normal activities. Patients with MIS-C reported more frequent headache at 1 month (45% vs. 20%; P = 0.037). Patients with COVID-19 were more likely to report cough at 1 month (37% vs. 17%; P = 0.045). Fatigue persisted >1 year in 15%–20% of patients in both groups.

Conclusions:

Approximately 20% of children with MIS-C and COVID-19 continued to have symptoms including fatigue and headache >1 year after hospital discharge. The duration of these findings emphasizes the importance of providers following patients until sequelae have resolved.
Enhanced D614G and Omicron Variants Antibody Persistence in Infants at 2 Months of Age Following Maternal mRNA Booster Vaccination During Pregnancy or Postpartum
Authors: Munoz Flor M. , Beigi Richard , Posavad Christine M. , Kelly Clifton , Badell Martina L. , Bunge Katherine , Mulligan Mark J. , Parameswaran Lalitha , Richardson Barbra A. , Olsen-Chen Courtney , Novak Richard M. , Brady Rebecca C. , DeFranco Emily , Gerber Jeffrey S. , Shriver Mallory , Suthar Mehul S. , Coler Rhea , Berube Bryan J. , Kim So Hee , Piper Jeanna M. , Miedema Joy , Pasetti Marcela , Neuzil Kathleen M. , Cardemil Cristina V. ,   on behalf of the DMID Study Group
Published: August 2024

Background:

Following maternal COVID-19 vaccination, the persistence of antibodies in sera and breast milk for mothers and infants is not well characterized. We sought to describe the persistence of antibodies through 2 months after delivery in maternal and infant serum and breast milk following maternal COVID-19 mRNA vaccination and to examine differences by receipt of booster dose during pregnancy or postpartum.

Methods:

This is a prospective cohort study with enrollment from July 2021 to January 2022 at 9 US academic sites. Pregnant or postpartum participants and their infants were enrolled after COVID-19 mRNA monovalent vaccination during pregnancy (primary 2-dose series) with booster (third dose) vaccination during pregnancy or within 2 months post-partum. SARS-CoV-2–binding and functional antibody responses at delivery and 2 months after delivery in mothers and infants were measured by spike and receptor-binding domain immunoglobulin (Ig) G, pseudovirus and live neutralizing antibody (nAb) titers to ancestral and Omicron BA.1 and BA.5 strains. Breast milk spike and receptor-binding domain IgG and IgA titers were also measured.

Results:

A total of 237 maternal/infant dyads were included (110 primary series during pregnancy, 99 pregnancy booster and 28 postpartum booster). A pregnancy booster resulted in 2.2-4.7-fold higher IgG and nAb at delivery and 2 months for both mothers and infants compared to the primary series alone (P < 0.001 for all comparisons). While infant IgG and nAb titers decreased by 2 months of age, the proportion of infants with detectable nAb at 2 months was greater in infants of mothers boosted during pregnancy compared with primary series for all variants (D614G: 99% vs. 56%; BA.1: 56% vs. 4% and BA.5: 57% vs. 9%; P < 0.001 for all comparisons). Breast milk spike IgA and IgG were present in 64%-100% and 100% of participants, respectively, and those boosted during pregnancy or postpartum had 3.1-4.6-fold higher levels of breast milk antibodies at 2 months compared to primary series during pregnancy (P < 0.001).

Conclusions:

mRNA COVID-19 monovalent booster vaccination during pregnancy results in significantly higher maternal and infant serum–binding IgG and nAb titers compared to a primary 2-dose series, including against Omicron variants, through 2 months of age. Breast milk antibodies following maternal vaccination during pregnancy or postpartum may provide additional protection during early infancy.
Electrocardiogram Abnormalities in Children With Lyme Arthritis
Authors: Hammett Deborah L. , Del Grippo Erica , Loiselle Claire E. , Thompson Amy D.
Published: August 2024

Background:

Classically, Lyme disease follows a staged illness pattern with carditis occurring in early disseminated disease and arthritis in late-stage disease. A more comprehensive understanding of Lyme suggests that clinical stages may intersect. Little is known regarding the overlap of electrocardiogram (ECG) abnormalities in children with Lyme arthritis. This study aimed to estimate the prevalence of ECG changes in pediatric patients presenting with Lyme arthritis.

Methods:

In this retrospective, cross-sectional study was conducted at a tertiary care children’s hospital in a Lyme endemic area; patients were identified based on Lyme testing performed from January 2012 to August 2022. Children diagnosed with Lyme arthritis by 2-tiered serology with ECGs obtained within 2 days of antibiotic initiation were included. A study cardiologist reviewed all ECGs for evidence of carditis defined as atrioventricular block, ST-T wave changes, QTc interval prolongation, accelerated junctional rhythm or right bundle branch block.

Results:

Two hundred thirty-three patients were diagnosed with Lyme arthritis; 90 (38.6%) had ECGs completed. Five patients (5.6%) had ECG abnormalities: 3 were diagnosed with first-degree atrioventricular block, 1 with QTc prolongation, and 1 with ST-T wave changes. No clinical or laboratory features in patients with Lyme arthritis were associated with an increased likelihood of having an abnormal ECG. All patients with ECG abnormalities were treated with oral antibiotics, and none had clinically significant cardiac disease.

Conclusions:

ECG abnormalities in children with Lyme arthritis rarely occur and, when present, are not reflective of clinically significant cardiac disease. These results do not support routine screening ECGs on asymptomatic pediatric patients with Lyme arthritis.
Efficacy and Safety of Sphingosine 1-Phosphate Receptor Modulators for Ulcerative Colitis
Authors: Mahmud Omar , Fatimi Asad Saulat , Mahar Muhammad Umar , Jahangir Arshia , Kashif Aleena , Abbas Manzar , Waljee Akbar K. , Berinstein Jeffrey A.
Published: August 2024

Background and Aims:

Sphingosine 1-phosphate receptor modulators (S1PRMs) are an effective treatment for ulcerative colitis (UC). This review summarizes all available randomized trial data on the efficacy and safety of S1PRM therapy.

Methods:

Multiple publication databases were systematically searched for randomized control trials (RCTs) of adults with moderate to severe UC treated with S1PRMs. Random effects meta-analysis was performed. The risk of bias was assessed using the Cochrane Risk-of-Bias 2 tool, and the overall quality of evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Results:

We identified 7 RCTs (1737 patients) involving the use of S1PRMs for moderate to severe UC. During induction, S1PRM therapy was efficacious when compared with placebo for clinical remission [RR: 2.65 (95% CI: 2.00, 3.53)], clinical response [RR: 1.68 (95% CI: 1.48, 1.91)], endoscopic improvement [RR: 2.17 (95% CI: 1.76, 2.68)], endoscopic normalization [RR: 2.56 (95% CI: 1.58, 3.83)], mucosal healing [RR: 2.88 (95% CI: 1.94, 4.26)], and histologic remission [RR: 2.42 (95% CI: 1.60, 3.66)]. Similar results were seen throughout the maintenance peroid, although fewer data were available to pool; notably, both sustained [RR: 3.57 (95% CI: 1.23, 10.35)] and steroid-free [RR: 2.92 (95% CI: 1.35, 6.33)] remission were significantly increased by S1PRM. There were no significant differences in adverse events [RR: 1.02 (95% CI: 0.90, 1.15)] and infections [RR: 1.15 (95% CI: 0.82, 1.60)] between S1PRM and placebo.

Conclusion:

Pooling of RCT data confirms that S1PRM therapy is both effective and safe for patients with moderate to severe UC.
Does radical cystectomy still have a role in BCG-unresponsive nonmuscle invasive bladder cancer?
Authors: Xia Leilei , Daneshmand Siamak
Published: August 2024

Purpose of review

Several novel therapies approved by the Food and Drug Administration (FDA) and explosion of clinical trials have changed the landscape Bacillus Calmette-Guérin (BCG)-unresponsive nonmuscle invasive bladder cancer (NMIBC). Given the recent advancements in bladder sparing options, the role of radical cystectomy (RC) in BCG-unresponsive NMIBC remains a subject of debate.

Recent findings

All three novel agents currently approved by the FDA for BCG-unresponsive NMIBC have strict indication [carcinoma in situ (CIS)], low response rate, and short response duration. Some promising new agents are awaiting results and/or FDA approval. RC still provides the best oncologic control and acceptable quality of life, and potentially represents the most cost-effective option.

It is an exciting time for the urologic oncology community to see the FDA approvals of some of the novel bladder sparing therapies and expansion of ongoing clinical trials. Yet, RC should still be considered as the gold standard of BCG-unresponsive NMIBC. We also must be cautious and selective in recommending bladder sparing options for patients with BCG-unresponsive NMIBC.
Cost-effectiveness and health economics for ureteral and kidney stone disease: a systematic review of literature
Authors: Nedbal Carlotta , Tramanzoli Pietro , Castellani Daniele , Gauhar Vineet , Gregori Andrea , Somani Bhaskar
Published: August 2024

Purpose of review

To systematically review costs associated with endourological procedures (ureteroscopy, URS; shockwave lithotripsy, SWL; and percutaneous nephrolithotomy, PCNL) for kidney stone disease (KSD), providing an overview of cost-effectiveness and health economics strategies.

Recent findings

A systematic review of the literature was performed, retrieving 83 English-written full-text studies for inclusion. Papers were labelled according to the respective area of interest: ‘costs of different procedures: SWL, URS, PCNL’, ‘costs of endourological devices and new technologies: reusable and disposable scopes, lasers, other devices’, ‘costs of KSD treatment in the emergency setting: emergency stenting versus primary URS’. Forty-three papers reported on associated cost for different procedures, revealing URS to be the most cost-effective. PCNL follows with higher hospitalization costs, while SWL appears to be least cost effective due to high need of additional procedures. The role of disposable and reusable scope is investigated by 15 articles, while other 16 reported on the role of different lasers, devices and techniques. The last nine studies included discussed the best and more cost-effective treatment for acute stone presentation, with promising results for primary URS versus emergency stenting and delayed URS.

Cost-effective and cost-conscious intervention is equally imperative to consider whilst weighing in clinical efficacy for endourological procedures. When a decision-making choice of SWL, URS or PCNL is offered to a patient, the outcomes must be balanced with a deeper understanding of additional cost burden of retreatment, reimbursement, repeated interventions, and recurrence. In todays’ practice, investing in endourological devices for KSD management must consider carefully the direct and hidden costs of using reusable and disposable technology. Cost control measures should not in any way compromise the quality of life or safety of the patient.
Improving communication
Authors: O'Brady Steven , Contreras George W.
Published: August 2024

The handoff process among the emergency medical technician, paramedic, and RN is crucial when transporting a patient to the ED. It plays a vital role in maintaining continuity of care and preserving patient safety.
Men’s Perceptions and Expectations of Fertility Clinics
Authors: Abdullahzadeh Mehrdad , Vanaki Zohreh , Mohammadi Eesa , Mohtashami Jamileh
Published: August 2024

Background

Most of the research and care in fertility focuses on women, whereas men’s perspectives and expectations are often overlooked.

Objectives

The aim of the study was to explore the experiences and expectations of men with primary infertility regarding fertility clinics and to provide implications for personalized and inclusive care.

Methods

A qualitative study was conducted in Iran between November 2022 and October 2023. Thirteen men with primary infertility were interviewed in-depth using a semistructured approach. Data were analyzed using the inductive content analysis method.

Results

The central theme, “Therapy Environment: Private and Interactive,” was identified. The theme comprises four categories: Effective Interaction—A Key to Therapy Success; Infertility Treatment—A Joint Effort; Personal and Stress-Free Environment—Essential for Treatment; and Treatment Plan—Vital for Successful Outcome.

Discussions

Study findings underscore the importance of tailored approaches to male infertility care. Healthcare providers should prioritize personalized, stress-free environments for male infertility patients and encourage effective communication and joint participation with partners to achieve successful outcomes. Tailored approaches and therapeutic settings should be created to cater to male patients’ unique needs.
Mechanical Thromboprophylaxis and Hospital-Acquired Venous Thromboembolism Among Critically Ill Adolescents: A U.S. Pediatric Health Information Systems Registry Study, 2016–2023
Authors: Betensky Marisol , Vallabhaneni Nikhil , Goldenberg Neil A. , Sochet Anthony A.
Published: August 2024

OBJECTIVES:

To estimate the rate of mechanical thromboprophylaxis (mTP) prescription among critically ill adolescents using a multicenter administrative database and determine whether mTP prescription is inversely associated with hospital-acquired venous thromboembolism.

DESIGN:

Multicenter, observational, retrospective study of the Pediatric Health Information Systems (PHIS) Registry cohort, January 2016 to December 2023.

SETTING:

Thirty PICUs located within quaternary pediatric referral centers in the United States.

PATIENTS:

Critically ill children 12–17 years old, excluding encounters with a principal diagnosis at admission of venous thromboembolism.

INTERVENTIONS:

mTP prescription within the first 24 hours of hospitalization.

MEASUREMENTS AND MAIN RESULTS:

A total of 107,804 children met the study criteria, of which 21,124 (19.6%) were prescribed mTP. Hospital center prescribing rates ranged from 1.4% to 65.4% and decreased by 1.6% per year from 28.2% in 2016 to 17.1% in 2023. As compared with those without mTP, those with mTP more frequently had a concurrent central venous catheter (17.2% vs. 9.4%, p < 0.001), underwent invasive mechanical ventilation (37.4% vs. 24.8%, p < 0.001), were admitted for a primary surgical indication (30.9% vs. 12.7%, p < 0.001), and experienced a longer median duration of hospitalization (7 [interquartile range (IQR): 4–15] vs. 4 [IQR: 2–9] d, p < 0.001). Hospital-acquired venous thromboembolism occurred in 2.7% of the study sample and was more common among those with, as compared with without, prescription of mTP (4% vs. 2.4%, p < 0.001). In multivariable logistic regression models for hospital-acquired venous thromboembolism adjusting for salient prothrombotic risk factors, we failed to identify an association between mTP and greater odds of hospital-acquired venous thromboembolism (HA-VTE) among low-, moderate-, and high-risk tiers. However, we cannot exclude the possibility of 17–50% greater odds of HA-VTE in this population.

CONCLUSIONS:

In the multicenter PHIS cohort, 2016–2023, the prescribing patterns for mTP among critically ill adolescents showed a low rate of mTP prescription (19.6%) that varied widely across institutions, decreased annually over the study period by 1.6%/year, and was not independently associated with HA-VTE risk reduction.
Ten-Year Follow-Up of Lower Limb Replantation
Authors: Zor Fatih , Tekin Levent , Bayram Yalcin , Kulahci Yalcin
Published: August 2024

The decision-making process for lower limb replantation involves several critical factors, such as age, comorbidities, ischemia time, type of injury, and psychosocial considerations. Advances in microsurgical techniques have led to a greater focus on enhancing functionality through limb salvage. To improve functional outcomes, it is essential to gain a better understanding of the current challenges in reconstruction and address them in future cases. Objective functional analysis of lower extremity replantation cases holds the potential to guide us in this endeavor. In this report, we present a lower limb replantation case with a 10-year follow-up, including objective functional evaluation with gait analysis.
ANTIMICROBIAL WOUND DRESSINGS FOR FULL-THICKNESS INFECTED BURN WOUNDS
Authors: Dhyani Abhishek , Repetto Taylor , VanAken Shannon , Nemzek Jean , VanEpps J. Scott , Mehta Geeta , Tuteja Anish
Published: August 2024

Infection of wounds delays healing, increases treatment costs, and leads to major complications. Current methods to manage such infections include antibiotic ointments and antimicrobial wound dressings, both of which have significant drawbacks, including frequent reapplication and contribution to antimicrobial resistance. In this work, we developed wound dressings fabricated with a medical-grade polyurethane coating composed of natural plant secondary metabolites, cinnamaldehyde, and alpha-terpineol. Our wound dressings are easy to change and do not adhere to the wound bed. They kill gram-positive and -negative microbes in infected wounds due to the Food and Drug Administration–approved for human consumption components. The wound dressings were fabricated by dip coating. Antimicrobial efficacy was determined by quantifying the bacteria colonies after a 24 h of immersion. Wound healing and bacterial reduction were assessed in an in vivo full-thickness porcine burn model. Our antimicrobial wound dressings showed a > 5-log reduction (99.999%) of different gram-positive and gram-negative bacteria, while maintaining absorbency. In the in vivo porcine burn model, our wound dressings were superior to bacitracin in decreasing bacterial burden during daily changes, without interfering with wound healing. Additionally, the dressings had a significantly lower adhesion to the wound bed. Our antimicrobial wound dressings reduced the burden of clinically relevant bacteria more than commercial antimicrobial wound dressings. In an in vivo infected burn wound model, our coatings performed as well or better than bacitracin. We anticipate that our wound dressings would be useful for the treatment of various types of acute and chronic wounds.
COMPARISON OF OXIRIS AND CONVENTIONAL CONTINUOUS RENAL REPLACEMENT THERAPY IN MANAGING SEVERE ABDOMINAL INFECTIONS: IMPACT ON SEPTIC SHOCK MORTALITY
Authors: Liao Xiu-Yu , Chen Yu-Ting , Liu Ming-Jun , Liao Qiu-Xia , Lin Jian-Dong , Lin Hai-Rong , Huang Ying-Hong , Zhou Ye
Published: August 2024

Objective: The objective of this study is to assess and compare the efficacy of oXiris with conventional continuous renal replacement therapy (CRRT) in managing severe abdominal infections. Methods: A retrospective analysis encompassing cases from 2017 to 2023 was conducted at the Department of Critical Care Medicine within the First Affiliated Hospital of Fujian Medical University. Parameters including heart rate (HR), mean arterial pressure (MAP), oxygenation index, lactate (Lac), platelet count, neutrophil ratio, procalcitonin, C-reactive protein (CRP), interleukin 6 (IL-6), norepinephrine dosage, Acute Physiology and Chronic Health Evaluation II (APACHE II), and Sequential Organ Failure Assessment (SOFA) were recorded prior to treatment initiation, at 24 h, and 72 h after treatment for both the oXiris and conventional CRRT groups. In addition, the duration of respiratory support, CRRT treatment, length of stay in the intensive care unit (ICU), total hospitalization period, and mortality rates at 14 and 28 days for both groups were recorded. Results: 1) Within the conventional CRRT group, notable enhancement was observed solely in Lac levels at 24 h after treatment compared with pretreatment levels. In addition, at 72 h after treatment, improvements were evident in HR, Lac, CRP, and IL-6 levels. 2) Conversely, the oXiris group exhibited improvements in HR, MAP, Lac, oxygenation index, neutrophil ratio, and IL-6 at 24 h after treatment when compared with baseline values. In addition, reductions were observed in APACHE II and SOFA scores. At 72 h after treatment, all parameters demonstrated enhancement except for platelet count. 3) Analysis of the changes in the indexes (Δ) between the two groups at 24 h after treatment revealed variances in HR, MAP, Lac, norepinephrine dosage, CRP levels, IL-6 levels, APACHE II scores, and SOFA scores. 4) The Δ indexes at 72 h after treatment indicated more significant improvements following oXiris treatment for both groups, except for procalcitonin. 5) The 14-day mortality rate (24.4%) exhibited a significant reduction in the oXiris group when compared with the conventional group (43.6%). However, no significant difference was observed in the 28-day mortality rate between the two groups. 6) Subsequent to multifactorial logistic regression analysis, the results indicated that oXiris treatment correlated with a noteworthy decrease in the 14-day and 28-day mortality rates associated with severe abdominal infections, by 71.3% and 67.6%, respectively. Conclusion: oXiris demonstrates clear advantages over conventional CRRT in the management of severe abdominal infections. Notably, it reduces the fatality rates, thereby establishing itself as a promising and potent therapeutic option.
MYELOID-DERIVED TLR4-TRIF SIGNALING PATHWAY MEDIATES OXIDATIVE STRESS IN LPS/D-GALN-INDUCED ACUTE LIVER FAILURE
Authors: Li Jing , Jiang Li , Zhao Kai , Tang Yiting , Yuan Xiangning , Xu Yunfei
Published: August 2024

Background: Acute liver failure (ALF) is a severe clinical syndrome characterized by massive hepatocyte death in a short time due to viruses, drugs, alcohol, or other factors. Oxidative stress is an important pathogenic mechanism of ALF. LPS-induced internalization of toll-like receptor 4 (TLR4) and the subsequent activation of the toll/IL-1R domain-containing adaptor-inducing IFN-beta (TRIF) signaling pathway widely mediate inflammatory responses in a series of diseases. However, whether the TLR4-TRIF signaling pathway contributes to ALF by mediating oxidative stress processes remains unclear. Methods: An ALF mouse model was induced by lipopolysaccharide (LPS)/D-galactosamine (D-GalN). TLR4-TRIF systemic knockout mice and TLR4 conditional knockout mice were used to determine the role of the TLR4-TRIF signaling pathway in ALF. The effects of TLR4 or TRIF deficiency on oxidative stress were investigated. In addition, we examined the protective role of the clodronate liposomes (macrophage scavengers) and the antioxidant N-acetylcysteine (NAC) in ALF. Results: TLR4 or TRIF deficiency significantly alleviated LPS/D-GalN-induced lethality, hepatic dysfunction, and hepatic pathologic injury, which was dependent on myeloid-derived TLR4. Hence, macrophage clearance exhibits a similar protective effect. Mechanically, TLR4 or TRIF deficiency was observed to inhibit oxidative stress by increasing glutathione, while decreasing malondialdehyde, 8-hydroxy-2-deoxyguanosine, and γ-H2AX. Therefore, the pharmacologic antioxidant NAC exhibited significant hepato-protective effects. Conclusions: Targeting myeloid-derived TLR4-TRIF signaling pathway or antioxidant therapy may be a potential therapeutic direction to treat ALF.
EFFECT OF ARTESUNATE TREATMENT ON INTESTINAL INJURY AFTER CARDIOPULMONARY RESUSCITATION IN SWINE
Authors: Wang Qianqian , Shen Peng , Zhu Jiangang , Zhu Weidong , Xu Jiefeng
Published: August 2024

Introduction

Intestinal injury is often caused by systemic ischemia-reperfusion injury early after cardiac arrest (CA) and resuscitation. Artesunate (Art) has been confirmed to protect vital organs against diverse of regional I/R injury. This study aimed to investigate the effect of Art on intestinal injury after CA and cardiopulmonary resuscitation (CPR) in swine.

Methods

Twenty-two swine were randomly divided into three groups: sham (n = 6), CA/CPR (n = 8), and CA/CPR + Art (n = 8). The CA/CPR swine model was established by inducing 9 minutes of untreated ventricular fibrillation (VF) followed by 6 minutes of CPR. Five minutes after resuscitation, 4.8 mg/kg of Art was intravenously administered for 2 hours in the CA/CPR + Art group. Intestinal fatty acid-binding protein (iFABP) and diamine oxidase (DAO) concentrations were compared among the three groups before CA and at 1, 2, 4, and 24 hours after resuscitation. At 24 hours post-resuscitation, intestinal zonula occluden-1(ZO-1), occludin, apoptosis, caspase-3/gasdermin E (GSDME)-mediated pyroptosis proteins concentrations, and proinflammatory cytokine concentrations were examined to evaluate intestinal injury.

Results

During CPR, spontaneous circulation was achieved in 7 and 6 swine in the CA/CPR and CA/CPR + Art groups, respectively. Serum iFABP and DAO concentrations were significantly higher and intestinal tissue ZO-1 and occludin concentrations were significantly lower in the CA/CPR and CA/CPR + Art groups than in the sham group. However, Art treatment resulted in markedly improved levels of intestinal injury biomarkers compared with those in the CA/CPR group. Additionally, intestinal apoptosis and concentrations of caspase-3/GSDME-mediated pyroptosis proteins and proinflammatory cytokines were significantly higher in the CA/CPR and CA/CPR + Art groups than in the sham group. However, these variables were significantly lower in the CA/CPR + Art group than in the CA/CPR group.

Conclusions

Art treatment effectively alleviates post-resuscitation intestinal injury, possibly by inhibiting the caspase-3/GSDME-mediated pyroptosis pathway in a swine CA and CPR model.
Five-day Wearable Respiratory Support With a Novel Ambulatory Pulmonary Assist System in an Awake Ovine Model
Authors: Hong Yeahwa , Shin Suji , Nasim Umar , Scala Helen M. , Roberts Kalliope G. , Potchernikov Alexander S. , Woolley Brian E. , Skoog David J. , Bacchetta Matthew , Cook Keith E.
Published: August 2024

Background.

The pulmonary assist system (PAS) is a wearable respiratory support system that is currently under development for patients with chronic lung disease as a bridge to lung transplantation or as destination therapy. This study evaluates the long-term performance and biocompatibility of the PAS in a 5-d awake, ovine model.

Methods.

The PAS was attached to normal sheep in venovenous configuration. Components of the PAS included a 0.9 m2 surface area oxygenator and a lightweight, battery-powered axial flow pump. The system was also tested using the Abbott PediMag as the control pump. Each sheep was supported on the PAS for 5 d with 2 L/min blood flow and 4 L/min sweep gas. Activated clotting times of 200–240 s were maintained using intravenous heparin. Pump performance, oxygen transfer, oxygenator resistance, and hematologic parameters were measured throughout the support.

Results.

The PAS, either using the axial flow pump or PediMag (n = 4 each), was well tolerated by the sheep without signs of device-related organ damage or hemolysis. All the studies achieved the full, 5-d study duration. The oxygenator resistance remained consistent without significant clot formation in all experiments with an average resistance of 2.55 ± 0.10 mm Hg/(L/min). The system achieved an average oxygen transfer rate of 116.4 ± 5.5 mL/min, with an average Hb concentration of 9.2 ± 0.6 g/dL. White blood cell, platelet, and hematocrit levels also remained stable and within normal limits throughout the study period.

Conclusions.

The PAS provided 5 d of uncomplicated ambulatory respiratory support with minimal clot formation, stable gas exchange, blood flow resistance, and hematologic parameters.
The P300 component of the auditory event-related potential in adult psychiatric and neurologic disorders: a narrative review of clinical and experimental evidence
Authors: Raggi Alberto , Serretti Alessandro , Ferri Raffaele
Published: August 2024

The auditory P300 wave, also known as P3b, is an event-related potential component thought to reflect central information processes involved in stimulus evaluation or categorization. It is typically elicited using the oddball paradigm, which involves mixing low-probability target items with high-probability standard stimuli. Its latency is associated with the timing of cognitive processes such as stimulus evaluation and response preparation, while its amplitude is related to the amount of attentional resources engaged during the task. Despite decades of use in research settings, its application in clinical practice has been limited. Prolongation of latencies and reduction of amplitudes in the auditory P3b have been observed in both psychiatric and neurological conditions. This includes cases where traditional neuropsychological tests are challenging due to severe motor or speech dysfunctions, or in conditions characterized by subtle cognitive deficits. Additionally, specific laterality patterns in psychoses and a loss of P300 habituation in migraines have been described. The wealth of experimental evidence supports the use of this evoked potential, which can be elicited through a relatively simple paradigm, for objectively evaluating cognition in psychiatric and neurological patients, particularly in follow-up assessments. Therefore, the auditory P300 appears to be a valuable tool for monitoring the clinical course of patients with mental and neurological disorders in certain circumstances.
Novel Gammapapillomavirus type in the nasal cavity of a wild red colobus (Piliocolobus tephrosceles)
Authors: Weary Taylor E. , Mehta Kavi P. M. , Goldberg Tony L.
Published: August 2024

Papillomaviruses (PVs) are double-stranded, circular, epitheliotropic DNA viruses causing benign warts (papillomas) or inducing dysplasia that can progress to cancer. Although they have been identified in all vertebrate taxa, most classified types are human PVs (HPVs); relatively little is known about PVs in other species. Here we characterize a novel Gammapapillomavirus type, PtepPV1, from a nasal swab of a wild red colobus (Piliocolobus tephrosceles) in Kibale National Park, Uganda. The virus has a genome of 6576 bases, encoding the seven canonical early (E) ORFs (E6, E7, E1, E2, E4, E1^E4 and E8^E2) and two late (L) ORFs (L1 and L2) of the gammapapillomaviruses, and is 81.0% similar to HPV-mSK_118, detected in a cutaneous wart from an immunocompromised human patient, in the L1 gene at the amino acid level. Alphapapillomaviruses (genus Alphapapillomavirus) cause anogenital carcinomas such as cervical cancer and have been described previously in several nonhuman primates. However, the first gammapapillomavirus (genus Gammapapillomavirus), which cause transient cutaneous infections, was not described until 2019 in a healthy rhesus macaque (Macaca mulatta) genital swab. The new virus from red colobus, PtepPV1, has many genomic features encoded by high-risk oncogenic PVs, such as the E7 gene LXSXE and CXXC motifs, suggesting potential for pRb and zinc-finger binding, respectively. To our knowledge, PtepPV1 is also the first reported nonhuman primate PV found in the nasal cavity. PtepPV1 expands the known host range, geographical distribution, tissue tropism and biological characteristics of nonhuman primate PVs.
Total body weight estimation by 3D camera systems: potential high-tech solutions for emergency medicine applications? A scoping review
Authors: Wells Mike , Goldstein Lara Nicole , Wells Terran , Ghazi Niloufar , Pandya Abhijit , Furht Borifoje , Engstrom Gabriella , Jan Muhammad Tanveer , Shih Richard
Published: August 2024

Background

Weight estimation is required in adult patients when weight-based medication must be administered during emergency care, as measuring weight is often not possible. Inaccurate estimations may lead to inaccurate drug dosing, which may cause patient harm. High-tech 3D camera systems driven by artificial intelligence might be the solution to this problem. The aim of this review was to describe and evaluate the published literature on 3D camera weight estimation methods.

Methods

A systematic literature search was performed for articles that studied the use of 3D camera systems for weight estimation in adults. Data on the study characteristics, the quality of the studies, the 3D camera methods evaluated, and the accuracy of the systems were extracted and evaluated.

Results

A total of 14 studies were included, published from 2012 to 2024. Most studies used Microsoft Kinect cameras, with various analytical approaches to weight estimation. The 3D camera systems often achieved a P10 of 90% (90% of estimates within 10% of actual weight), with all systems exceeding a P10 of 78%. The studies highlighted a significant potential for 3D camera systems to be suitable for use in emergency care.

Conclusion

The 3D camera systems offer a promising method for weight estimation in emergency settings, potentially improving drug dosing accuracy and patient safety. Weight estimates were extremely accurate. Importantly, 3D camera systems possess characteristics that could make them very appropriate for use during emergency care. Future research should focus on developing and validating this methodology in larger studies with true external and clinical validation.
What is next for costing WASH in healthcare facilities? Applying evidence for policy and practice
Authors: Tantum Lucy K. , Cronk Ryan , Asingwire Narathius , Bohara Prakash , Chettry Laxman Kharal , Hirai Mitsuaki , Kpodzro Sena , Mavi Tariro , Miller Joshua D. , Ripkey Carrie , Sharma Sarbesh , Trinies Victoria , Anderson Darcy
Published: August 2024

Efforts to improve and sustain water, sanitation, hygiene (WASH), waste management, and cleaning services in healthcare facilities in low- and middle-income countries are constrained by limited funding. Assessments of the costs of delivering WASH services are critical for guiding financial planning and investment, but many countries lack costed plans for WASH in healthcare facilities. A 2023 UNC Water and Health Conference workshop explored how policymakers and practitioners collect and use cost data and identify strategies for overcoming cost barriers. Presenters shared case studies that showcased the utility of cost data for creating national costed roadmaps, identifying and addressing budgetary shortfalls, and planning WASH improvements in Nepal, Uganda, and Zimbabwe. In discussions, workshop participants described leveraging collaborations with multiple government entities and non-governmental organizations (NGOs) to collect cost data. Participants also reported using cost data to plan programs and advocate for additional WASH funding. Strategies to coordinate costing approaches across stakeholder groups and standardize data collection tools will enhance the efficiency and effectiveness of planning and budgeting for WASH in healthcare facilities.

Highlights

Local and national governments and NGOs routinely collect and use cost data to inform decisions about WASH services in healthcare facilities

WASH responsibilities are divided across multiple institutions, necessitating coordination for cost data collection

Governments have used costing data to create national costed roadmaps and budgets

Costing data support program planning, monitoring, and advocacy