bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Tracheostomy May Be Performed Safely in Obese COVID-19 Patients Supported on VV-ECMO
Authors: Tamargo Ian A. , Creel-Bulos Christina , Callahan Maria C. , Miller Casey , Dave Sagar B. , Parrilla Gustavo A. , Chan Joshua L. , Daneshmand Mani A. , Javidfar Jeffrey
Published: October 2023

Objective:

Obese patients with coronavirus disease 2019 (COVID-19)–associated acute respiratory failure (ARDS) often require prolonged intubation. However, data are sparse regarding optimal tracheostomy timing in obese adults with COVID-19 requiring venovenous extracorporeal membrane oxygenation (VV-ECMO). This study retrospectively describes the course of obese patients with COVID-19 who underwent tracheostomy on VV-ECMO between March 2020 and December 2022.

Methods:

There were 62 participants with a median age of 43 (interquartile range [IQR] 33 to 53) years and a median body mass index of 42 (IQR 34 to 50) kg/m2 who received VV-ECMO for COVID-19–associated ARDS. Of those, 42 underwent tracheostomy on VV-ECMO, and 50% ( n = 21) of the 42 patients underwent early (within 14 days of initiated ventilatory support) tracheostomy.

Results:

Among patients who received tracheostomies, the combined respiratory tract and lung parenchymal bleeding rate was 29% ( n = 12), but only 7% required surgical intervention for bleeding from the tracheostomy site ( n = 3). The hospital length of stay (LOS) was 42 (IQR 36 to 57) days, and mortality rate was 38% ( n = 16). Tracheostomy timing was not associated with differences in respiratory tract bleeding, mechanical ventilatory support duration, VV-ECMO support duration, intensive care unit LOS, hospital LOS, mortality, or survival probability.

Conclusions:

Although an individualized and holistic approach to clinical decision making continues to be necessary, the findings of this study suggest that early tracheostomy may be performed safely in obese patients with COVID-19 on VV-ECMO.
Designing Feasible and Effective Cognitive Assessment for Older Adults in Long-Term Care
Authors: Iglar Alyssa , Chignell Mark , Zhi Hu You , Barton Debbie , Steeves Grace , Henry Justine L.
Published: October 2023

Cognitive assessment and training are needed to avoid accelerated cognitive decline. We have developed BrainTagger, a suite of serious games that evaluate and potentially train cognitive abilities such as inhibitory control, processing speed, cognitive flexibility, and working memory. Ideally, cognitive assessments can be used as sentinels to detect problems that might damage brain functions (e.g., dehydration, poor nutrition, depression, delirium, inappropriate medication). In this paper, we report on a multi-year effort to develop hardware and software solutions that support effective implementation of cognitive assessment games (CAGs) in long-term care. Issues and constraints addressed include accommodating physical disabilities; making cognitive assessment enjoyable and engaging; providing scientific evidence that each game is measuring the intended construct; and reporting game results in a meaningful way. This article describes how we addressed some of these issues and demonstrates the sustained effort required to make this type of functionality work in practice. We also include some preliminary design guidelines, based on our experience, that may be useful in guiding future work on developing CAGs.
Emotion Recognition in Virtual Reality: Investigating the Effect of Gameplay Variations on Affective Responses
Authors: Bayro Allison , Buneo Christopher , Jeong Heejin
Published: October 2023

Virtual reality (VR) technology offers a unique platform for affective computing research, which aims to create intelligent systems capable of recognizing, interpreting, and responding to human emotions in immersive and interactive virtual environments. This study examined how different variations of VR games can elicit different emotional responses in players. Thirty participants played three VR Pong games, and their emotional responses were measured using the Self-Assessment Manikin and physiological measures. Results showed that different gameplay variations evoked varying emotional responses in players, and two features, average heart rate and the non-specific skin conductance responses (in peaks per min), were found to differ significantly between the games. The study suggests that VR gameplay can provide an engaging and interactive platform to study human emotions and behavior, with implications for designing and developing affective computing systems in fields such as healthcare, marketing, and humancomputer interaction.
Application of a Multi-Stage Testing and Evaluation Approach for a Safety-Related Digital Upgrade at a Nuclear Power Plant
Authors: Kovesdi Casey R.
Published: October 2023

There is an imminent need for existing United States nuclear power plants to reduce their operating and maintenance costs to remain economically viable. Digital technology provides significant opportunity for the existing nuclear power plant fleet to transform that way in which work is accomplished to reduce costs and allow the fleet to remain economically competitive. However, a careful understanding of the human-technology integration is needed to ensure the continued safe and reliable operation of these existing plants with new digital capabilities. This work presents interim findings in applying human factors engineering to a safety-significant digital upgrade for a United States nuclear power plant, following the new Alternative Review Process in the recently revised Digital Instrumentation and Control Interim Staff Guidance Licensing Process, Revision 2. The interim results described in this work provides an industry perspective, based on ongoing work, to support recent work published from Vazquez, Green, and Desaulniers (2022).
Effects of Task Difficulty and Presentation Order in Subjective Usability Measurement
Authors: Rice Rachel E. , Aagarwal Shrreya P. , Kortum Philip T.
Published: October 2023

The System Usability Scale (SUS) is a tool widely used in industry for measuring the usability of products and systems. Users are often asked to complete two or more tasks of varying complexity before evaluating a product using the SUS. However, task order effects may influence the overall usability rating of a product, but previous literature has not examined this issue. To test the effect of task order on the SUS, participants were asked to complete two tasks involving locating specific information on a college website. Participants completed an easy task and a hard task, and presentation of the tasks was randomized. Results showed that when participants completed the easy task first, they rated the overall usability of the website lower than when the hard task was presented first. This suggests that practitioners should be cautious when designing usability studies with tasks of varying difficulties.
Racial and ethnic disparities in long-term contraception use among the birthing population at an academic hospital in the Southeastern United States
Authors: Akintunde Tosin , Howard Jeffrey , Wilson Dulaney , Gore Amartha , Morton Christine , Hebbar Latha , Goodier Chris , Alfred Myrtede C.
Published: October 2023

Ensuring women and birthing people have access to the contraceptive of their choice is essential for patient-centered care, health equity, and reproductive justice. While trends in national data in the United States reveal racial disparities in long-term contraceptive use, health-system and hospital-level investigations are essential to understand disparities and encourage interventions. We used data from 5011 patients who delivered at a large academic hospital to determine the effect of race/ethnicity and social vulnerability index (SVI) on the odds of undergoing a long-term contraceptive procedure. Results indicate that SVI substantially affects the odds of long-term contraception for non-Hispanic White women and birthing people. In contrast, Hispanic and non-Hispanic Black women and birthing people have significantly higher odds of undergoing a long-term contraceptive procedure due to race/ethnicity. Contributions to these disparities may be based on factors including healthcare providers, organizational and external policies. Interventions at all levels of care are essential to address disparities in contraceptive care, outcomes, and patient experience.
A Meta-Analytic Approach to Investigating the Relationship Between Human-Automation Trust and Attention Allocation
Authors: Sato Tetsuya , Inman Jessica , Politowicz Michael S. , Chancey Eric T. , Yamani Yusuke
Published: October 2023

Trust and attention allocation are pivotal determinants in human-automation interaction. However, there are scarce empirical findings regarding the relationship between trust and attention allocation. Observations from our previous work suggested there may be a negative correlation between trust in automation and eye movement towards automation, though no formal analysis of these data had been conducted to quantify this relationship. The present meta-analysis examined the relationship between three dimensions of trust in automation (performance, process, and purpose) and visual attention allocation to the automation. Specifically, we applied Cumming’s (2014) meta-analysis technique to combine evidence across three experiments. Results indicated a negative correlation between trust in automation and visual sampling of the automated system monitoring task for performance-based trust, but not for process- or purpose-based trust. These findings suggest that operators scanned the automation’s behavior less frequently when indicating higher performance-based trust towards the automation.
Do Grip Strength Dynamometer Readings Improve After Cervical Spine Surgery?
Authors: Zuckerman Scott L. , Goldberg Jacob L. , Cerpa Meghan , Vulapalli Meghana , Delgardo Mychael W. , Flowers Xena E. , Leskinen Sandra , Kerolus Mena G. , Buchanan Ian A. , Ha Alex S. , Riew K. Daniel
Published: October 2023

Study design

Retrospective, cohort study

Objectives

Hand function can be difficult to objectively assess perioperatively. In patients undergoing cervical spine surgery by a single-surgeon, we sought to: (1) use a hand dynamometer to report pre/postoperative grip strength, (2) distinguish grip strength changes in patients with radiculopathy-only vs myelopathy, and (3) assess predictors of grip strength improvement.

Methods

Demographic and operative data were collected for patients who underwent surgery 2015-2018. Hand dynamometer readings were pre/postoperatively at three follow-up time periods (0-3 m, 3-6 m, 6-12 m).

Results

262 patients (mean age of 59 ± 14 years; 37% female) underwent the following operations: ACDF (80%), corpectomy (25%), laminoplasty (19%), and posterior cervical fusion (7%), with 81 (31%) patients undergoing multiple operations in a single anesthetic setting. Radiculopathy-only was seen in 128 (49%) patients, and myelopathy was seen 134 (51%) patients. 110 (42%) had improved grip strength by ≥10-lbs, including 69/128 (54%) in the radiculopathy-only group, and 41/134 (31%) in the myelopathy group. Those most likely to improve grip strength were patients undergoing ACDF (OR 2.53, P = .005). Patients less likely to improve grip strength were older (OR = .97, P = .003) and underwent laminoplasty (OR = .44, 95% CI .23, .85, P = .014). Patients undergoing surgery at the C2/3-C5/6 levels and C6/7-T1/2 levels both experienced improvement during the 0-3-month time range (C2-5: P = .035, C6-T2: P = .015), but only lower cervical patients experienced improvement in the 3-6-month interval ( P = .030).

Conclusions

Grip strength significantly improved in 42% of patients. Patients with radiculopathy were more likely to improve than those with myelopathy. Patients undergoing surgery from the C2/3-C5/6 levels and the C6/7-T1/2 levels both significantly improved grip strength at 3-month postoperatively.
MaaS modelling: a review of factors, customers’ profiles, choices and business models
Authors: Cisterna Carolina , Madani Negarsadat , Bandiera Claudia , Viti Francesco , Cools Mario
Published: October 2023

Mobility-as-a-Service (MaaS) system is regarded as one of the emerging solutions to offer integrated, seamless, and flexible multi-modal mobility services as an alternative to privately owned mobility resources. MaaS is expected to change the way users will choose their modes of transport to reach their daily activities, and how service providers will generate profits, cooperate, and compete. To successfully deploy MaaS to reach the intended goals, it is critical to develop feasible and sustainable models that capture the diverse needs of customers as well as the diverse and often competing objectives of service providers. This paper aims to provide a general modelling framework and a critical and descriptive analysis of the relevant literature relating all main actors in the MaaS ecosystem, and identify and discuss all factors that are considered relevant, focusing on the actor’s decision-making processes and their correlations. This review shows the large variety and interaction of factors influencing MaaS adoption and their impact on forecasting MaaS appeal. It is also observed that current travel behaviour and multi-modal transport models are not fully capturing the diverse travel needs and choices of potential MaaS users. Recent advancements in agent-based simulation and discrete choice modelling offer potential solutions to address this gap, and future research should aim in that direction. Finally, the review analyses the interaction between MaaS actors, including customers, service providers, the government, and the MaaS Broker, highlighting the complexity of the modelling process comprising all actors of the MaaS ecosystem. Therefore, it is recommended to prioritise future research in exploring these areas.
Genome-wide analysis of PIN genes in cultivated peanuts (Arachis hypogaea L.): identification, subcellular localization, evolution, and expression patterns
Authors: Bian Jianxin , Cui Yuanyuan , Li Jihua , Guan Yu , Tian Shuhua , Liu Xiaoqin
Published: October 2023

Background

Auxin is an important hormone in plants and the PIN-FORMED (PIN) genes are essential to auxin distribution in growth and developmental processes of plants. Peanut is an influential cash crop, but research into PIN genes in peanuts remains limited.

Results

In this study, 16 PIN genes were identified in the genome of cultivated peanut, resolving into four subfamilies. All PIN genes were predicted to be located in the plasma membrane and a subcellular location experiment confirmed this prediction for eight of them. The gene structure, cis-elements in the promoter, and evolutionary relationships were elucidated, facilitating our understanding of peanut PINs and their evolution. In addition, the expression patterns of these PINs in various tissues were analyzed according to a previously published transcriptome dataset and qRT-PCR, which gave us a clear understanding of the temporal and spatial expression of PIN genes in different growth stages and different tissues. The expression trend of homologous genes was similar. AhPIN2A and AhPIN2B exhibited predominant expression in roots. AhPIN1A-1 and AhPIN1B-1 displayed significant upregulation following peg penetration, suggesting a potential close association with peanut pod development. Furthermore, we presented the gene network and gene ontology enrichment of these PINs. Notably, AhABCB19 exhibited a co-expression relationship with AhPIN1A and AhPIN1B-1, with all three genes displaying higher expression levels in peanut pegs and pods. These findings reinforce their potential role in peanut pod development.

Conclusions

This study details a comprehensive analysis of PIN genes in cultivated peanuts and lays the foundation for subsequent studies of peanut gene function and phenotype.
Metabolic profiles of peanut (Arachis hypogaea L.) in response to Puccinia arachidis fungal infection
Authors: Rathod Visha , Rathod Khyati , Tomar Rukam S. , Tatamiya Ritisha , Hamid Rasmieh , Jacob Feba , Munshi Nasreen Shakil
Published: October 2023

Background Puccinia arachidis fungus causes rust disease in the peanut plants (Arachis hypogaea L.), which leads to high yield loss. Metabolomic profiling of Arachis hypogaea was performed to identify the pathogen-induced production of metabolites involved in the defense mechanism of peanut plants. In this study, two peanut genotypes, one susceptible (JL-24) and one resistant (GPBD-4) were inoculated with Puccinia arachidis fungal pathogen. The metabolic response was assessed at the control stage (0 day without inoculation), 2 DAI (Day after inoculation), 4 DAI and 6 DAI by Gas Chromatography-Mass Spectrometry (GC-MS). Results About 61 metabolites were identified by NIST library, comprising sugars, phenols, fatty acids, carboxylic acids and sugar alcohols. Sugars and fatty acids were predominant in leaf extracts compared to other metabolites. Concentration of different metabolites such as salicylic acid, mannitol, flavonoid, 9,12-octadecadienoic acid, linolenic acid and glucopyranoside were higher in resistant genotype than in susceptible genotype during infection. Systemic acquired resistance (SAR) and hypersensitive reaction (HR) components such as oxalic acid was elevated in resistant genotype during pathogen infection. Partial least square-discriminant analysis (PLS-DA) was applied to GC-MS data for revealing metabolites profile between resistant and susceptible genotype during infection. Conclusion The phenol content and oxidative enzyme activity i.e. catalase, peroxidase and polyphenol oxidase were found to be very high at 4 DAI in resistant genotype (p-value < 0.01). This metabolic approach provides information about bioactive plant metabolites and their application in crop protection and marker-assisted plant breeding.
Genome-wide identification and expression analysis of the NRT genes in Ginkgo biloba under nitrate treatment reveal the potential roles during calluses browning
Authors: Feng Jin , Zhu Can , Cao Jiaqi , Liu Chen , Zhang Jiaqi , Cao Fuliang , Zhou Xiaohong
Published: October 2023

Nitrate is a primary nitrogen source for plant growth, and previous studies have indicated a correlation between nitrogen and browning. Nitrate transporters (NRTs) are crucial in nitrate allocation. Here, we utilized a genome-wide approach to identify and analyze the expression pattern of 74 potential GbNRTs under nitrate treatments during calluses browning in Ginkgo, including 68 NITRATE TRANSPORTER 1 (NRT1)/PEPTIDE TRANSPORTER (PTR) (NPF), 4 NRT2 and 2 NRT3. Conserved domains, motifs, phylogeny, and cis-acting elements (CREs) were analyzed to demonstrate the evolutionary conservation and functional diversity of GbNRTs. Our analysis showed that the NPF family was divided into eight branches, with the GbNPF2 and GbNPF6 subfamilies split into three groups. Each GbNRT contained 108–214 CREs of 19–36 types, especially with binding sites of auxin and transcription factors v-myb avian myeloblastosis viral oncogene homolog (MYB) and basic helix-loop-helix (bHLH). The E1X1X2E2R motif had significant variations in GbNPFs, indicating changes in the potential dynamic proton transporting ability. The expression profiles of GbNRTs indicated that they may function in regulating nitrate uptake and modulating the signaling of auxin and polyphenols biosynthesis, thereby affecting browning in Ginkgo callus induction. These findings provide a better understanding of the role of NRTs during NO3− uptake and utilization in vitro culture, which is crucial to prevent browning and develop an efficient regeneration and suspension production system in Ginkgo.
Imprinted Dlk1-Gtl2 cluster miRNAs are potential epigenetic regulators of lamb fur quality
Authors: Zhang Letian , Wang Jiankui , Cai Ganxian , Ma Lina , Zhao Zhengwei , Ma Qing , Deng Xuemei
Published: October 2023

Background

Tan and Hu sheep are well-known local breeds in China, producing lamb fur with unique ornamental and practical values highly appreciated by consumers worldwide. Fur quality is optimal at one month of age and gradually declines with time. Despite active research on its genetic mechanism using transcriptomic and whole genome bisulfite sequencing analysis, the main effective gene locus has not been found, and its regulatory mechanism is still unclear, which limits the breeding and improvement of fur traits.

Results

Scapular skin samples from newborn (1-month old) and adult (24-month old) Tan sheep were utilized for small ribonucleic acid (RNA) sequencing Principal Component Analysis (PCA) showed that the newborn and adult groups were completely separated. Differential expression analysis of micro-RNAs (miRNAs) identified 32 up-regulated miRNAs and 48 down-regulated miRNAs in the newborn groups. All up-regulated miRNAs were located in the imprinted.

Dlk1-Gtl2 locus on chromosome 18, whereas all down-regulated miRNAs were distributed across the sheep chromosomes, without a clear pattern of positional consistency. Further, by systematically analyzing the target genes and signaling pathways of all 32 up-regulated miRNAs, we found that the PI3K-AKT signaling pathway has the potential to be targeted and regulated by most of the miRNAs in the Dlk1-Gtl2 region. In addition, we also re-analyzed miRNA sequencing data from public databases on Hu lambs (full sibling Hu lambs with high- and low-quality fur characteristics). Again, it was found that most of the up-regulated miRNAs in lambs with high-quality fur were also located in the Dlk1-Gtl2 region, whereas this patter was not present for down-regulated miRNAs.

Conclusion

Sequencing of miRNAs in conjunction with public databases was employed to identify miRNAs within the imprinted Dlk1-Gtl2 region on chromosome 18, suggesting their potential roles as epigenetic regulators of fur traits. Small RNAs located at the Dlk1-Gtl2 locus were identified as having the potential to systematically regulate the PI3K-AKT signaling pathway, thereby indicating the relevance of the Dlk1-Gtl2/PI3K-AKT axis in the context of fur traits. Selection of parental specific expressed imprinted genes in the process of conserving and exploiting lamb fur traits should be emphasized.
Cardiac autonomic dysfunction in adult congenital heart disease
Authors: Pizarro Carmen , Bosse Franziska Luise , Begrich Charlotte , Reznakova Barbora , Beiert Thomas , Schrickel Jan Wilko , Nickenig Georg , Skowasch Dirk , Momcilovic Diana
Published: October 2023

Purpose

Due to recent advances in diagnosis and treatment, the number of adults with congenital heart disease (ACHD) has substantially increased. This achievement is mitigated by rhythm disorders. Here, we sought to determine alterations in heart rate variability (HRV) and their prognostic value in ACHD.

Methods

Ninety seven ACHD patients (39.2 ± 14.1 years, 51.5% female) and 19 controls (39.7 ± 15.0 years, 47.4% female) underwent 24-h Holter monitoring.

Results

As compared to controls, ACHD patients offered a significantly higher burden of premature ventricular contractions (p = 0.02) and decreased HRV indices (natural logarithmic transformation of very low frequency (lnVLF): 7.46 ± 0.76 ms2 vs. 7.91 ± 0.92ms2, p = 0.03; natural logarithmic transformation of low frequency (lnLF): 6.39 ± 0.95ms2 vs. 7.01 ± 1.07ms2, p = 0.01; natural logarithmic transformation of the ratio of low to high frequency spectra (lnLF/HF): 0.81 ± 0.74 vs. 1.17 ± 0.51, p = 0.04). No differences in HRV measures were observed across ACHD lesion groups. NT-proBNP levels were significantly related to both time and frequency domain indices (natural logarithmic transformation of the standard deviation of NN intervals (lnSDNN): Spearman´s rho = -0.32, p = 0.001; natural logarithmic transformation of the standard deviation of the average NN intervals for each 5-min segment of a 24-h Holter monitoring (lnSDANN): Spearman´s rho: -0.33, p = 0.001; natural logarithmic transformation of the total power (lnTP): Spearman´s rho: -0.25, p = 0.01; lnVLF: Spearman´s rho: -0.33, p = 0.001; lnLF: Spearman´s rho: -0.35, p < 0.001; lnLF/HF: Spearman´s rho: -0.34, p = 0.001).

After a mean follow-up of 3.9 ± 0.7 years, 8 patients died and 3 patients survived sudden cardiac death (SCD). Several HRV parameters were significantly higher in event-free ACHD patients than in those who died or survived SCD (natural logarithmic transformation of the average of the standard deviations of NN intervals for each 5-min segment of a 24-h Holter monitoring (lnASDNN): p = 0.04; lnPNN30: p = 0.04; lnVFL: p = 0.03; lnLF: p < 0.01). On univariate Cox regression analysis, the time domain indices lnSDNN, lnASDNN and lnPNN30, as well as the frequency domain parameters lnTP, lnVLF and lnLF were associated with death and survived cardiac arrest.

Conclusion

ACHD is accompanied by HRV impairment that carries prognostic implications on ACHD mortality and survived SCD.
Biliary sepsis complication with congenital hepatic fibrosis: an unexpected outcome
Authors: Sun Jiawei , Mi Xiaoxiao , Ye Xiaoying , ShenTu Yiling , Liu Chun , Tang Dong , Yang WenJun , Yang Jie , Ye Xiaoping , Ma Xiaojie , Shi Junping , Chen Gongying , Gong Ling
Published: October 2023

Background

CHF (Congenital hepatic fibrosis) is a rare hereditary disease characterized by periportal fibrosis and ductal plate malformation. Little is known about the clinical presentations and outcome in CHF patients with an extraordinary complication with biliary sepsis.

Case summary

Our case described a 23-year-old female diagnosed as CHF combined with biliary sepsis. Her blood culture was positive for KP (Klebsiella pneumoniae), and with a high level of CA19-9 (> 1200.00 U/ml, ref: <37.00 U/ml). Meanwhile, her imaging examinations showed intrahepatic bile duct dilatation, portal hypertension, splenomegaly, and renal cysts. Liver pathology revealed periportal fibrosis and irregularly shaped proliferating bile ducts. Whole-exome sequencing identified two heterozygous missense variants c.3860T > G (p. V1287G) and c.9059T > C (p. L3020P) in PKHD1 gene. After biliary sepsis relieved, her liver function test was normal, and imaging examination results showed no significant difference with the results harvested during her biliary sepsis occurred.

Conclusion

The diagnosis of CHF complicated with biliary sepsis in the patient was made. Severely biliary sepsis due to KP infection may not inevitably aggravate congential liver abnormality in young patients. Our case provides a good reference for timely treatment of CHF patients with biliary sepsis.
Nucleocapsid single point-mutation associated with drop-out on RT-PCR assay for SARS-CoV-2 detection
Authors: de Mello Malta Fernanda , Amgarten Deyvid , Marra Alexandre Rodrigues , Petroni Roberta Cardoso , da Silva Nali Luiz Henrique , Siqueira Ricardo Andreotti , Neto Miguel Cendoroglo , Oler Silvia Cassiano , Pinho João Renato Rebello
Published: October 2023

Background

Since its beginning, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been a challenge for clinical and molecular diagnostics, because it has been caused by a novel viral agent. Whole-genome sequencing assisted in the characterization and classification of SARS-CoV-2, and it is an essential tool to genomic surveillance aiming to identify potentials hot spots that could impact on vaccine immune response and on virus diagnosis. We describe two cases of failure at the N2 target of the RT-PCR test Xpert® Xpress SARS-CoV-2.

Methods

Total nucleic acid from the Nasopharyngeal (NP) and oropharyngeal (OP) swab samples and cell supernatant isolates were obtained. RNA samples were submitted to random amplification. Raw sequencing data were subjected to sequence quality controls, removal of human contaminants by aligning against the HG19 reference genome, taxonomic identification of other pathogens and genome recovery through assembly and manual curation. RT-PCR test Xpert® Xpress SARS-CoV-2 was used for molecular diagnosis of SARS-CoV-2 infection, samples were tested in duplicates.

Results

We identified 27 samples positive for SARS-CoV-2 with a nucleocapsid (N) gene drop out on Cepheid Xpert® Xpress SARS-CoV-2 assay. Sequencing of 2 of 27 samples revealed a single common mutation in the N gene C29197T, potentially involved in the failed detection of N target.

Conclusions

This study highlights the importance of genomic data to update molecular tests and vaccines.
Case report: isolated prevotella intermedia causing intracranial infection detected using metagenomic next generation sequencing
Authors: Ye Zhinan , He Jinfeng , Ji Hailong , Xu Hao , Zhang Yaping , Zhou Kaiyu , Liu Hongwei
Published: October 2023

Background

Isolated Prevotella intermedia, a rare gram-negative, rod-shaped, anaerobic bacterium, is rarely detected in clinical practice. It has been associated with infections of the oral cavity and female genital tract, but has never been detected in cerebrospinal fluid (CSF) of patients in China. Accurate detection of causative pathogens is still an arduous task owing to the difficult conditions of anaerobic bacterial culture. Isolated Prevotella intermedia can be detected by metagenomic next generation sequencing (mNGS) of the CSF. Correct diagnosis and antibiotic treatment can help patients avoid life-threatening events.

Case presentation

Herein, we describe the case of a 64-year-old Chinese woman who presented with typical features of meningoencephalitis. Routine CSF culture failed to identify the causative pathogen. Isolated Prevotella intermedia was detected by mNGS, and the patient was treated with antibacterial agents including ceftriaxone, vancomycin, moxifloxacin, meropenem, metronidazole, and linezolid. The patient underwent surgical treatment for abscess of left frontal parietal lobe, which was observed on magnetic resonance imaging (MRI) and was suspected to be caused by Prevotella intermedia. It was further confirmed that it was a secondary infection from the oral cavity, and the possible etiology might have been dental surgery. Treatment was rendered to the patient based on metagenomic test result, and her condition improved after two months.

Conclusions

This case highlights the role of mNGS in accurate diagnosis of patients with central nervous system infection. In particular, mNGS can be used to identify rare pathogens and confirm the diagnosis in patients with unknown etiology.
Overall survival of patients with hepatocellular carcinoma treated with sintilimab and disease outcome after treatment discontinuation
Authors: Wang Kang , Xiang Yan-Jun , Yu Hong-Ming , Cheng Yu-Qiang , Feng Jin-Kai , Liu Zong-Han , Shan Yun-Feng , Zheng Yi-Tao , Ni Qian-Zhi , Cheng Shu-Qun
Published: October 2023

Background

The use of Anti-PD-1 therapy has yielded promising outcomes in hepatocellular carcinoma (HCC). However, limited research has been conducted on the overall survival (OS) of patients with varying tumor responses and treatment duration.

Methods

This retrospective study analyzed HCC patients who received sintilimab between January 2019 and December 2020 at four centers in China. The evaluation of tumor progression was based on Response Evaluation Criteria in Solid Tumors version 1.1. The study investigated the correlation between tumor response and OS, and the impact of drug use on OS following progressive disease (PD).

Results

Out of 441 treated patients, 159 patients satisfied the inclusion criteria. Among them, 77 patients with disease control exhibited a significantly longer OS compared to the 82 patients with PD (median OS 26.0 vs. 11.3 months, P < 0.001). Additionally, the OS of patients with objective response (OR) was better than that of patients with stable disease (P = 0.002). Among the 47 patients with PD who continued taking sintilimab, the OS was better than the 35 patients who discontinued treatment (median OS 11.4 vs. 6.9 months, P = 0.042).

Conclusions

In conclusion, the tumor response in HCC patients who received sintilimab affects OS, and patients with PD may benefit from continued use of sintilimab.
Impact of BMI on the survival outcomes of non-small cell lung cancer patients treated with immune checkpoint inhibitors: a meta-analysis
Authors: Zhang Tongtong , Li Shuluan , Chang Jianhua , Qin Yan , li Chao
Published: October 2023

Objectives

ICIs have become the standard treatment for advanced NSCLC patients. Currently, PD-L1 is the most widely useful biomarker to predict ICI efficacy, but the sensitivity and specificity are limited. Therefore, the useful predictive biomarkers of ICI efficacy is urgently needed. BMI is an internationally used measure of body health. Obesity may affect ICI efficacy by changing T cell functions. This meta-analysis aimed to clarify the relationship between BMI and survival outcomes of NSCLC patients treated with ICIs.

Methods

A systematic review was conducted to identify studies that assessed the association between BMI and survival outcomes in patients treated with ICIs. OS was the primary endpoint, and PFS was the secondary endpoint. Random-effect models or fixed-effect models were utilized to combine study effects according to the Cochran Q and I2 tests.

Results

Nine studies, including 4602 NSCLC patients treated with ICIs, that met the inclusion criteria were selected for this meta-analysis. There was no significant difference in PFS (HR 0.885; 95% CI 0.777–1.009, p = 0.068) or OS (HR 0.947; 95% CI 0.789–1.137, p = 0.560) between the low BMI group and the high BMI group. However, in the subgroup analysis, compared with normal-weight patients, overweight and obese patients achieved prolonged PFS (HR 0.862; 95% CI 0.760–0.978, p = 0.021) and OS (HR 0.818; 95% CI 0.741–0.902, p<0.0001).

Conclusion

Overweight and obese NSCLC patients tend to achieve prolonged survival time with ICI regimens. Further prospective studies are needed to strengthen the association between ICI outcomes and BMI levels.
The optimal intravesical maintenance chemotherapy scheme for the intermediate-risk group non-muscle-invasive bladder cancer
Authors: Chen Jian-Xin , Huang Wen-Ting , Zhang Qing-Yun , Deng Cheng-En , Wei Jue-ling , Xie Yuan-Liang , Lin Rui , Feng Guan-Zheng , Yang Guang-Lin , Long Jun , Lu Hao-Yuan , Mo Zeng-nan
Published: October 2023

Objective

Although the current European Association of Urology(EAU) guideline recommends that patients with intermediate-risk non-muscle-invasive bladder cancer (NMIBC) should accept intravesical chemotherapy or Calmette-Guerin (BCG) for no more than one year after transurethral resection of bladder tumor(TURBT), there is no consensus on the optimal duration of chemotherapy. Hence, we explored the optimal duration of maintenance intravesical chemotherapy in patients with intermediate-risk NMIBC.

Subjects and Methods

This was a real-world single-center retrospective cohort study. In total 158 patients with pathologically confirmed intermediate-risk NMIBC were included, who were divided into 4 subgroups based on the number of instillations given. We used Cox regression analysis and survival analysis chart to explore the 3-yr recurrence outcomes of tumor.The optimal duration was determined by receive operating characteristic curve (ROC).

Results

The median follow-up was 5.2 years. Compared with instillation for 1–2 months, the Hazard Ratios(HR) values of instillation for less than 1 month, maintenance instillation for 3–6 months and > 6 months were 3.57、1.57 and 0.22(95% CI 1.27–12.41;0.26–9.28;0.07–0.80, P = 0.03;0.62;0.02, respectively). We found a significant improvement in 3-yr relapse-free survival in intermediate-risk NMIBC patients who maintained intravesical instillation chemotherapy for longer than 6 months, and the best benefit was achieved with 10.5 months of maintenance chemotherapy by ROC.

Conclusions

In our scheme, the optimal duration of intravesical instillation with pirrubicin is 10.5 months. This new understanding provides valuable experience for the precise medical treatment model of intermediate-risk NMIBC.
Acute bilateral blindness due to diffuse outer retinopathy following clear lens exchange: a case report
Authors: Gurtler Nicolas , Bughin Alice , Vaclavik Veronika , Kaisari Eirini , Guex-Crosier Yan
Published: October 2023

Background

As the trend of refractive lens exchange for presbyopia continues to grow, our case report shows the first occurrence of an acute bilateral outer retinopathy following uncomplicated sequential clear lens extraction in an otherwise healthy individual.

Case presentation

A 54-year-old male without significant medical history benefited from a sequential bilateral lens exchange for presbyopia. He then experienced a rapid vision loss in both eyes, accompanied by photopsias and myodesopsias, with symptoms appearing respectively 4 and 3 weeks after the surgeries. Multimodal imaging revealed a fulminant outer retinopathy, leading to a total loss of light perception within a few days. Immediate intravenous corticosteroid therapy was administered, permitting to recover a small area of central visual function in both eyes, enabling shape and color distinction. The primary diagnostic hypothesis is a presumed autoimmune retinopathy, triggered by the cataract extraction, while an alternative diagnosis could be a toxic reaction secondary to the use of intracameral cefuroxime and lidocaine during the surgery.

Conclusion

In this report, the authors describe the first recorded instance of outer retinopathy following cataract surgery. This occurrence raises the possibility of auto-immunization leading to retinal atrophy and vision loss as a potential outcome after undergoing cataract surgery.
Prevalence and associated factors of diabetic retinopathy among people with diabetes screened using fundus photography at a community diabetic retinopathy screening program in Nepal
Authors: Thapa Raba , Sharma Sanjita , Pradhan Eli , Duwal Sushma , Poudel Manish , Shrestha Krishna Gopal , Paudyal Govinda Prasad
Published: October 2023

Background

This study aimed to assess the prevalence and associated factors of diabetic retinopathy (DR) and vision threatening DR (VTDR) among people with diabetes screened using fundus photography in Nepal.

Methods

This is a retrospective study among people with diabetes presented for DR screening using fundus photography from 2013 to 2019. Detailed demographics, duration of diabetes, medical history, visual acuity, and grading of DR on fundus photography were analyzed. Fundus camera used in the study were;Topcon digital fundus camera 900 CXR and digital portable fundus cameras (Nidek-10 portable non-mydriatric fundus camera; Versacam & Trade & Alpha, France), and a Zeiss portable fundus camera (Zeiss Visucout 100). Macula centred and disc centred 45 degree two images were taken from each eye. Pupil were dilated in cases where there was media haze in un-dilated cases. DR was graded using early treatment diabetic retinopathy study criteria. The images were graded by fellowship trained retina specialist. DR prevalence included any DR changes in one or both eyes.

Results

Total of 25,196 patients with diabetes were enrolled. Mean age was 54.2 years with Standard Deviation (S.D):12.9 years, ranging from 6 years to 97 years. Type 1 and type 2 diabetes comprised of 451 people (1.79%) and 24,747 (98.21%) respectively. Overall, 1.8% of the images were un-gradable. DR prevalence was 19.3% (95% Confidence Interval (CI): 18.8 − 19.7%). DR prevalence in type 1 and type 2 diabetes was 15.5% (95% CI: 12.5 − 18.6%) and 19.3% (CI: 18.8 − 19.8%) respectively. Clinically significant macular edema (CSME) was found in 5.9% (95% CI: 5.6-6.2%) and VTDR in 7.9% (95% CI: 7.7-8.3%). In multivariate analysis, our study revealed strong evidence to suggest that there is meaningful association between DR and VTDR with duration of diabetes, diabetic foot, diabetic neuropathy, agriculture occupation, those under oral hypoglycaemic agents or insulin or both as compared to those under diet only, and presenting visual acuity > 0.3LogMAR.

Conclusion

Prevalence and associated factors for DR and VTDR were similar to other DR screening programs in the region. Emphasis on wider coverage of DR screening could help for timely detection and treatment of STDR to avoid irreversible blindness.
Study protocol for a randomized controlled trial with rituximab for psychotic disorder in adults (RCT-Rits)
Authors: Bejerot Susanne , Eklund Daniel , Hesser Hugo , Hietala Max Albert , Kariis Tarmo , Lange Niclas , Lebedev Alexander , Montgomery Scott , Nordenskjöld Axel , Petrovic Predrag , Söderbergh Annika , Thunberg Per , Wikström Sverre , Humble Mats B. ,   RCT-Rits study collaboration group, Asellus Peter , Bergman-Nordgren Lise , Bylund Simon , Eberhard Jonas , Figueras Diaz Clara , Jacobson Karin , Lindeborg Erica , Lowert Yvonne , Nordström Erik , Terstad Ollén David
Published: October 2023

Background

The role of inflammation in the aetiology of schizophrenia has gained wide attention and research on the association shows an exponential growth in the last 15 years. Autoimmune diseases and severe infections are risk factors for the later development of schizophrenia, elevated inflammatory markers in childhood or adolescence are associated with a greater risk of schizophrenia in adulthood, individuals with schizophrenia have increased levels of pro-inflammatory cytokines compared to healthy controls, and autoimmune diseases are overrepresented in schizophrenia. However, treatments with anti-inflammatory agents are so far of doubtful clinical relevance.

The primary objective of this study is to test whether the monoclonal antibody rituximab, directed against the B-cell antigen CD20 ameliorates psychotic symptoms in adults with schizophrenia or schizoaffective disorder and to examine potential mechanisms. A secondary objective is to examine characteristics of inflammation-associated psychosis and to identify pre-treatment biochemical characteristics of rituximab responders. A third objective is to interview a subset of patients and informants on their experiences of the trial to obtain insights that rating scales may not capture.

Methods

A proof-of-concept study employing a randomised, parallel-group, double-blind, placebo-controlled design testing the effect of B-cell depletion in patients with psychosis. 120 participants with a diagnosis of schizophrenia spectrum disorders (SSD) (ICD-10 codes F20, F25) will receive either one intravenous infusion of rituximab (1000 mg) or saline. Psychiatric measures and blood samples will be collected at baseline, week 12, and week 24 post-infusion. Brief assessments will also be made in weeks 2 and 7. Neuroimaging and lumbar puncture, both optional, will be performed at baseline and endpoints. Approximately 40 of the patients and their informants will be interviewed for qualitative analyses on the perceived changes in well-being and emotional qualities, in addition to their views on the research.

Discussion

This is the first RCT investigating add-on treatment with rituximab in unselected SSD patients. If the treatment is helpful, it may transform the treatment of patients with psychotic disorders. It may also heighten the awareness of immune-psychiatric disorders and reduce stigma.

Trial registration

NCT05622201, EudraCT-nr 2022–000220-37 version 2.1. registered 14th of October 2022.
Addressing discrimination and violence against Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) persons from Brazil: a mobile health intervention
Authors: Malta Monica , da Silva Angelica Baptista , da Silva Cosme Marcelo Furtado , LeGrand Sara , Seixas Michele , Benevides Bruna , Kalume Clarisse , Whetten Kathryn
Published: October 2023

Background

Sexual and gender minorities (SGM) experience higher rates of discrimination and violence when compared to cis, heterosexual peers. However, violent crimes and other hate incidents against SGM persons are consistently not reported and prosecuted because of chronic distrust between the SGM community and police. Brazil is one of the most dangerous countries for SGM persons globally. Herein, we describe the development of a mobile health intervention to address the rampant violence against this population, the Rainbow Resistance—Dandarah app.

Methods

We conducted community-based participatory research (CBPR) between 2019 and 2020. The study started with in-depth interviews (IDIs) and focus group discussions (FGDs) with representatives of the SGM community from Brazil. Descriptive qualitative data analysis included the plotting of a ‘word cloud’, to visually represent word frequency, data coding and analysis of more frequent themes related to app acceptability, usability, and feasibility. A sub-sample of SGM tested the app and suggested improvements, and the final version was launched in December 2019.

Results

Since the app was launched in December 2019, the app recorded 4,114 active SGM users. Most participants are cisgender men (50.9%), self-identified as gay (43.5%), White (47.3%), and aged 29 or less (60.9%). FGDs and IDIs participants discussed the importance of the app in the context of widespread violence toward SGM persons. Study participants perceived this mHealth strategy as an important, effective, and accessible for SGM surviving violence. The CBPR design was highlighted as a key strategy that allowed SGM persons to collaborate in the design of this intervention actively. Some users reported how the panic button saved their lives during violent attacks.

Conclusions

Rainbow Resistance—Dandarah app was endorsed as a powerful tool for enhancing reporting episodes of violence/discrimination against SGM persons and a key strategy to connect users with a safe network of supportive services. Results indicate that the app is an engaging, acceptable, and potentially effective mHealth intervention. Participants reported many advantages of using it, such as being able to report harassment and violence, connect with a safe network and receive immediate support.
Optimizing the utilization of maternal and reproductive healthcare services among women in low-resourced Nigerian settings
Authors: Ene Jacinta Chibuzor , Ajibo Henry Tochukwu
Published: October 2023

Introduction

Quality care delivery is an essential lifesaving interventions for maternal healthcare and reduction in mortality from preventable reproductive conditions. In African countries like Nigeria, numerous perceptions and militating factors present unique challenges in optimizing the utilization of maternal and reproductive healthcare services. As women continuously evolve away from the utilization of healthcare services, achieving universal health coverage for all emerges as a matter of concern.

Method

A phenomenological and descriptive research design was used. The study participants comprised a total of 38 women selected from primary and tertiary healthcare institutions. They were purposively selected from four healthcare institutions in Nsukka, Enugu State, Nigeria.

Result

Findings revealed that most rural women at the prenatal stage, utilize maternal healthcare services, but at the postnatal stage, they reject reproductive healthcare services owing to certain perceptions. Concerns about sub-optimal utilization of maternal and reproductive healthcare services were found under enabling, predisposing and need factors. Evidence-based interventions included instituting health insurance policies, improving the healthcare sector, personnel, collaboration among stakeholders, and grass-roots community education. Participants showed little knowledge of social workers’ engagement in healthcare institutions.

Conclusion

Functional network of care between private and public healthcare system is the key to optimizing maternal and reproductive healthcare utilization. The study recommends stakeholder and community engagement in achieving functional networks of care, strengthening relational linkages between frontline health workers and equip rural women with better knowledge. All these are geared toward achieving optimal utilization of maternal and reproductive healthcare services among women in low-resourced Nigerian settings.