bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanisms of Offshore Solid and Liquid Freshwater Flux from the East Greenland Current
Authors: Spall Michael A. , Semper Stefanie , Våge Kjetil
Published: November 2023

The mechanisms that control the export of freshwater from the East Greenland Current, in both liquid and solid form, are explored using an idealized numerical model and scaling theory. A regional, coupled ocean–sea ice model is applied to a series of calculations in which key parameters are varied and the scaling theory is used to interpret the model results. The offshore ice flux, occurring in late winter, is driven primarily by internal stresses and is most sensitive to the thickness of sea ice on the shelf coming out of Fram Strait and the strength of alongshore winds over the shelf. The offshore liquid freshwater flux is achieved by eddy fluxes in late summer while there is an onshore liquid freshwater flux in winter due to the ice–ocean stress, resulting in only weak annual mean flux. The scaling theory identifies the key nondimensional parameters that control the behavior and reproduces the general parameter dependence found in the numerical model. Climate models predict that winds will increase and ice export from the Arctic will decrease in the future, both of which will lead to a decrease in the offshore flux of sea ice, while the influence on liquid freshwater may increase or decrease, depending on the relative changes in the onshore Ekman transport and offshore eddy fluxes. Additional processes that have not been considered here, such as more complex topography and synoptic wind events, may also contribute to cross-shelf exchange.

Significance Statement

The purpose of this study is to provide a basic understanding of what controls the flux of sea ice and low-salinity water from the East Greenland shelf into the interior of the Greenland and Iceland Seas. This is a potentially important process since it has been shown that sufficient freshening of the surface waters in the interior of the Nordic seas can inhibit deep convection and the associated air–sea heat flux and water mass transformation. A combination of idealized computer models and basic theory indicates that the fluxes of liquid and solid freshwater are controlled by different mechanisms and occur at different times of the year. Accurate representation in climate models will require representation of small-scale processes such as mesoscale eddies and gradients of ice thickness across the shelf.
The Role of Childhood Circumstances on Social Conditions and Health of Middle-Aged and Older Adults: Ardakan Cohort Study on Aging (ACSA)
Authors: Tabatabaei Fatemeh-sadat , Delbari Ahmad , Bidkhori Mohammad , Saatchi Mohammad , Zanjari Nasibeh , Hooshmand Elham
Published: November 2023

Some studies suggest that childhood can affect some later outcomes. This cross-sectional study of the first phase of the Ardakan Cohort Study on Aging (ACSA) on 5,197 individuals examined the effects of childhood socioeconomic and health on aging well. Childhood socioeconomic status (SES) was measured using parents’ education and self-expressed family’s financial status. Quality of Life (SF-12), Satisfaction with Life Scale (SWLS), WHO well-being scale, and self-reported health questionnaire were used. All data, including childhood experiences, was collected at a single time point. Poor childhood health was associated with lower well-being, life satisfaction, and mental quality of life (OR: .53, p = .032, OR: 0.49, p = .019, and β: −3.51, p = .008, respectively). The family’s financial status during childhood was associated with the mental and physical quality of life, satisfaction, well-being, and health (all p < .05). Fathers and mothers who had some level of education increased the odds of being healthy by 1.20 and 1.49 times, respectively. Childhood circumstances affect older adults’ health and social conditions. Policies to improve childhood health and SES should be prioritized.
A new damage constitutive model for frozen-thawed sandstone under triaxial conditions: Considering the characteristics of pre-peak compaction and post-peak residual strength
Authors: Xiong Xin , Zhou Keping , Gao Feng , Xu Chun , Li Jielin
Published: November 2023

The study of the constitutive model under stress loading for rock after undergoing freeze-thaw weathering cycles (FTWCs) treatment has important theoretical significance for the site operation and numerical calculation of rock mass engineering in cold regions. In this work, a series of FTWCs treatment tests of sandstone were carried out, and the evolution characteristics of the T2 spectrum distribution curve for sandstone before and after FTWCs treatment were analyzed utilizing nuclear magnetic resonance (NMR) technology. The schematic diagram of freeze-thaw damage evolution for sandstone was drawn, and the damage evolution mechanism was analyzed. Evolution laws of the stress-strain curves, peak and residual strength, peak and residual strain, and Young's modulus of sandstone under different FTWCs and confining pressures were analyzed by conventional triaxial compression tests. A piecewise constitutive model under triaxial stress loading for sandstone after undergoing FTWCs treatment was established, and the model considered the significant influence of FTWCs on the nonlinear deformation in the compaction stage and residual strength. By introducing error analysis indexes, the proposed model and published models were compared with the experimental data, it was found that the proposed model's performance is better than the published models, which indicated that the proposed model has good performance and strong universality.
Between anger and love: A multi-level study on the impact of policy issues on user reactions in national election campaigns on Facebook in Germany, Hungary, and Norway
Authors: Tønnesen Hedvig , Bene Márton , Haßler Jörg , Larsson Anders Olof , Magin Melanie , Skogerbø Eli , Wurst Anna-Katharina
Published: November 2023

Eliciting user reactions is an important tactic for political actors using social media like Facebook to seek attention for campaign messages on policy issues. Still, little is known about policy issues’ effect on user reactions and how structural factors play into this relationship. Applying a standardized manual content analysis on Facebook posts from political parties and their top candidates during the German, Hungarian, and Norwegian national election campaigns in 2021/2022 ( N = 4988), we investigate the relationship between policy issues and two of Facebook’s “emotional reactions” (“angry” and “love”). We find that posts addressing the economy, energy policy, and foreign policy drive more “angry” reactions, while environmental posts drive more “love” reactions. While effects are largely uniform across different party types, there are more variations between countries. Our analyses suggest that differences between individual parties and candidates and situational factors are vital to understanding the relationship between policy issues and user reactions.
FastCAR: fast correction for ambient RNA to facilitate differential gene expression analysis in single-cell RNA-sequencing datasets
Authors: Berg Marijn , Petoukhov Ilya , van den Ende Inge , Meyer Kerstin B. , Guryev Victor , Vonk Judith M. , Carpaij Orestes , Banchero Martin , Hendriks Rudi W. , van den Berge Maarten , Nawijn Martijn C.
Published: November 2023

Cell type-specific differential gene expression analyses based on single-cell transcriptome datasets are sensitive to the presence of cell-free mRNA in the droplets containing single cells. This so-called ambient RNA contamination may differ between samples obtained from patients and healthy controls. Current ambient RNA correction methods were not developed specifically for single-cell differential gene expression (sc-DGE) analyses and might therefore not sufficiently correct for ambient RNA-derived signals. Here, we show that ambient RNA levels are highly sample-specific. We found that without ambient RNA correction, sc-DGE analyses erroneously identify transcripts originating from ambient RNA as cell type-specific disease-associated genes. We therefore developed a computationally lean and intuitive correction method, Fast Correction for Ambient RNA (FastCAR), optimized for sc-DGE analysis of scRNA-Seq datasets generated by droplet-based methods including the 10XGenomics Chromium platform. FastCAR uses the profile of transcripts observed in libraries that likely represent empty droplets to determine the level of ambient RNA in each individual sample, and then corrects for these ambient RNA gene expression values. FastCAR can be applied as part of the data pre-processing and QC in sc-DGE workflows comparing scRNA-Seq data in a health versus disease experimental design. We compared FastCAR with two methods previously developed to remove ambient RNA, SoupX and CellBender. All three methods identified additional genes in sc-DGE analyses that were not identified in the absence of ambient RNA correction. However, we show that FastCAR performs better at correcting gene expression values attributed to ambient RNA, resulting in a lower frequency of false-positive observations. Moreover, the use of FastCAR in a sc-DGE workflow increases the cell-type specificity of sc-DGE analyses across disease conditions.
Identification of hypervirulent Klebsiella pneumoniae based on biomarkers and Galleria mellonella infection model
Authors: Mai Dongmei , Wu Anqi , Li Ran , Cai Donghao , Tong Huichun , Wang Nan , Tan Junqing
Published: November 2023

Background

Currently, clinical laboratories lack an effective method to differentiate between classical Klebsiella pneumoniae (cKP) and hypervirulent Klebsiella pneumoniae (hvKP) strains, leading to delays in diagnosing and treating hvKP infections. Previous studies have identified peg-344, iroB, iucA, prmpA, prmpA2, and siderophores (SP) yields greater than 30 μg/ml as reliable markers for distinguishing hvKP from cKp strains. However, these diagnostic tests were conducted on a relatively small study population and lacked sufficient clinical data support. In this study, hvKP strains were identified by biomarker analysis and the Galleria mellonella model. Combined with in vitro and in vivo experiments, the reliability of clinical identification method of hvKP was verified, which provided an experimental basis for timely diagnosis of hvKP infection.

Results

According to the clinical data, a total of 108 strains of hvKP were preliminary screened. Among them, 94 strains were further identified using PCR analysis of biomarkers and quantitative determination of SP. The high virulence of hvKP was subsequently confirmed through infection experiments on Galleria mellonella. Additionally, susceptibility testing revealed the identification of 58 carbapenem-resistant hvKP (CR-hvKP) strains and 36 carbapenem-sensitive hvKP (CS-hvKP) strains. By comparing molecular diagnostic indexes, molecular characteristics such as high SP production of CR-hvKP were found.

Conclusion

The combination of clinical data and molecular diagnostic index analysis effectively enables the identification of hvKP, particularly CR-hvKP. This study provides a scientific basis for accurate clinical identification and timely treatment of hvKP.
A novel report on the emerging and zoonotic neurotropic fungus Trichosporon japonicum in the brain tissue of the endangered Brazilian guitarfish (Pseudobatos horkelii) off the southeastern coast of Brazil
Authors: Peixoto-Rodrigues Maria Carolina , da Costa Gisela Lara , Pinto Tatiane Nobre , Adesse Daniel , Oliveira Manoel Marques Evangelista , Hauser-Davis Rachel Ann
Published: November 2023

Yeast infections have gained significant attention in the field of marine biology in recent years. Among the broad diversity of marine organisms affected by these infections, elasmobranchs (sharks and rays) have emerged as highly susceptible, due to climate change effects, such as increasing water temperatures and pollution, which can alter the composition and abundance of fungal communities. Additionally, injuries, or compromised immune systems resulting from pollution or disease may increase the likelihood of fungal infections in elasmobranchs. Studies are, however, still lacking for this taxonomic group. In this context, this study aimed to screen yeast species in cell cultures obtained from the brain of artisanally captured Pseudobatos horkelii, a cartilaginous fish that, although endangered, is highly captured and consumed worldwide. Fungi were isolated during an attempt to establish primary cultures of elasmobranch neural cells. Culture flasks were swabbed and investigated using morphological, phenotypic, and molecular techniques. Two isolates of the emerging opportunistic pathogen Trichosporon japonicum were identified, with high scores (1.80 and 1.85, respectively) by the MALDI-ToF technique. This is the first report of the basidiomycetous yeast T. japonicum in Pseudobatos horkelii in Brazil. This finding highlights the need for further research to determine the potential impact on elasmobranch health, ecology, as well as on commercial fisheries.
survextrap: a package for flexible and transparent survival extrapolation
Authors: Jackson Christopher H.
Published: November 2023

Background

Health policy decisions are often informed by estimates of long-term survival based primarily on short-term data. A range of methods are available to include longer-term information, but there has previously been no comprehensive and accessible tool for implementing these.

Results

This paper introduces a novel model and software package for parametric survival modelling of individual-level, right-censored data, optionally combined with summary survival data on one or more time periods. It could be used to estimate long-term survival based on short-term data from a clinical trial, combined with longer-term disease registry or population data, or elicited judgements. All data sources are represented jointly in a Bayesian model. The hazard is modelled as an M-spline function, which can represent potential changes in the hazard trajectory at any time. Through Bayesian estimation, the model automatically adapts to fit the available data, and acknowledges uncertainty where the data are weak. Therefore long-term estimates are only confident if there are strong long-term data, and inferences do not rely on extrapolating parametric functions learned from short-term data. The effects of treatment or other explanatory variables can be estimated through proportional hazards or with a flexible non-proportional hazards model. Some commonly-used mechanisms for survival can also be assumed: cure models, additive hazards models with known background mortality, and models where the effect of a treatment wanes over time. All of these features are provided for the first time in an R package, , in which models can be fitted using standard R survival modelling syntax. This paper explains the model, and demonstrates the use of the package to fit a range of models to common forms of survival data used in health technology assessments.

Conclusions

This paper has provided a tool that makes comprehensive and principled methods for survival extrapolation easily usable.
Enlarged fistulotomy of the papilla as access to the biliary tract during ERCP
Authors: Gomes Alexandre , Haidar Ana Sarah Rafka , Padilha Giovani Caetano , Bara Juliana , Nonato Mariana Sussai , da Silva Rodrigues José Mauro , Pinto Pérsio Campos Correia , de Oliveira Ayres Ricardo , Borghesi Ronaldo Antonio
Published: November 2023

Background

Demonstration of access to the bile duct through Enlarged Papillary Fistulotomy, a method different from conventional fistulotomy.

Aims

Demonstration of the EFP technique with dissection in layers of the papilla for accessing the common bile duct, its efficiency and safety, rescue of cases of failure in cannulation and cases of access failure by EFP in the first attempt, facilitating cannulation in the second attempt.

Methods

Cross-sectional study, with retrospective data collection from 2233 ERCP exams with 528 EFP procedures, analysis of success and complications.

Results

528 patients underwent EFP on the first attempt, with success in 465 cases (88.06%) and 63 failures (11.94%). Of these failures, 33 patients (52.38%) returned for a second EFP attempt, with success in 30 cases (90.9%) and failure in 3 cases (9.1%). Deep bile duct cannulation was achieved in 93.75% of EFP procedures, and cannulation failure occurred in 33 cases (6.25%).

Conclusion

EFP showed efficiency in CBD cannulation, did not induce post-ERCP pancreatitis, no cases of perforation or false tract, but resulted in higher rates of minor bleeding, rescued cases of access failure by EFP, facilitated the posterior approach on the second attempt, it is safe, effective, low risk and associated with few comorbidities.
Global incidence and death estimates of chronic kidney disease due to hypertension from 1990 to 2019, an ecological analysis of the global burden of diseases 2019 study
Authors: Liu Yan , He Qin , Li Qiying , Tian Min , Li Xiaojiao , Yao Xufeng , He Dongmei , Deng Chunying
Published: November 2023

Background

The intricate relationship between hypertension and chronic kidney disease (CKD) presents a global challenge for prevention of hypertension-related CKD. This study’s objective is to analyze age, gender, regional disparities, and evolving trends in the disease burden of hypertension-related CKD. We aim to estimate changing spatial and temporal trends in incidence and mortality rates, considering the socio-demographic index (SDI), to inform health strategies effectively.

Method

Age-standardized incidence rates (ASIR) and death rates (ASDR) were collected from the GBD 2019. Trend analysis was conducted by Joinpoint regression of ASRs from 1990 to 2019. Spatial autocorrelation analysis was performed to obtain spatial patterns. The association between SDI and burden of CKD due to hypertension was estimated using a Pearson correlation analysis.

Results

The global ASIR and ASDR due to hypertension-related CKD were 19.45 (95% CI, 17.85 to 21.09) and 5.88 (95% CI, 4.95 to 6.82) per 100 K population in 2019, representing increases of 17.89% and 13.29% compared to 1990, respectively. The elderly population and males were found the highest ASIR and ASDR. The high SDI region had the highest ASIRs, while low SDI regions experienced the highest ASDRs. Joinpoint regression found both global ASIR and ASDR showed increasing trends, with the highest increases observed in middle- and high-SDI regions, respectively. The SDI exhibited a positive association with ASIRs but displayed an inverse V-shaped correlation with the average annual percentage change (AAPC) of ASIRs. Spatial autocorrelation analysis revel significant positive spatial autocorrelation for the AAPC of ASDRs and ASIRs, from 1990 to 2019.

Conclusions

Results met the objectives, and demonstrated a rising global burden of hypertension-related CKD. Factors such as aging, gender, and regional variations should be considered when designing control measures and developing healthcare systems to effectively address the burden of this complex condition.
Impact of compliance to oral cysteamine treatment on the costs of Kidney failure in patients with nephropathic cystinosis in the United Kingdom
Authors: Lashilola Seun , Xu Weiwei , Azimpour Khashayar , McCarthy Michael , Carlot Sara , Game David , van der Voort Judith
Published: November 2023

Background

Nephropathic Cystinosis (NC), a rare disease characterised by intra-lysosomal accumulation of cystine, results in progressive kidney failure (KF). Compliance to lifelong oral cysteamine, the only therapy, is often compromised. The relationship between compliance and costs of NC has not been previously formally assessed. The present study evaluates the impact of compliance on lifetime (direct) costs of treating KF in NC patients in the United Kingdom.

Methods

A three-state (KF-free, post-KF, death) partitioned survival model was developed for hypothetical ‘Good Compliance’ (GC) and ‘Poor Compliance’ (PC) cohorts. Survival in the KF-free state was determined by a published regression function of composite compliance score (CCS). The CCS is a summation of annual compliance scores (ACS) over treatment duration prior to KF. ACSs are indexed on annual (average) leukocyte cystine levels (LCL). The Poor Compliance cohort was defined to reflect NC patients in a previous study with a mean LCL of 2.35 nmols nmol half-cystine/mg protein over the study period – and an estimated mean ACS of 1.64 over a 13.4 year treatment duration. The Good Compliance cohort was assumed to have an ACS of 2.25 for 21 years. Major KF costs were evaluated – i.e., dialysis, kidney transplants, and subsequent monitoring.

Results

The mean CCS was 47 for the GC and 22 for the PC cohort respectively, corresponding to estimated lifetime KF costs of £92,370 and £117,830 respectively – i.e., a cost saving of £25,460/patient, or £1,005/patient for every 1-unit improvement in CCS.

Conclusion

This analysis indicates that lifetime costs of KF in NC can be reduced through improved treatment compliance with oral cysteamine.
Potential value of gastrointestinal myoelectrical activity in the diagnosis of anxiety-depression disorder: a population-based study
Authors: Li Baichuan , Peng Anjiao , Yang Danxuan , Yang Na , Zhao Xia , Feng Peimin , Wang Zhenlei , Chen Lei
Published: November 2023

Background

Depression and anxiety are frequently coexisted mental illness. The lack of solid objective diagnostic criteria has led to a high rate of suicide. The brain-gut axis bridges the gastrointestinal system with neuropsychiatric disorders. However, it is still not possible to reflect mental disease with gastrointestinal information. The study aimed to explore the auxiliary diagnostic value of gastrointestinal myoelectrical activity in anxiety-depression disorders (ADD) without gastrointestinal disturbance.

Methods

A natural population cohort from 3 districts in Western China were established. The Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 were used to assess ADD. Gastrointestinal myoelectrical activity of ADD were measured by multi-channel cutaneous electrogastroenterogram (EGEG). Then the parameters of EGEG between ADD and healthy controls were analyzed.

Results

The average amplitude and response area of intestinal channel in ADD were significantly lower than those of controls (153.49 ± 78.69 vs. 179.83 ± 103.90, 57.27 ± 29.05 vs. 67.70 ± 38.32), which were shown to be protective factors for ADD (OR = 0.944 and 0.844, respectively). Further, the scale item scores related to the core symptoms of anxiety and depression were also associated with these two channels (p < 0.05), and the gastrointestinal electrical signals of ADD are significantly changed in the elderly compared to the young adults.

Conclusions

The intestinal myoelectrical activity has a certain auxiliary diagnostic value in psychiatric disorders and is expected to provide objective reference for the diagnosis of anxiety and depression.
Efficacy of immune checkpoint inhibitors in non-small cell lung cancer with NTRK family mutations
Authors: Shang Xiaoling , Zhang Wengang , Han Wenfei , Xia Handai , Liu Ni , Wang Xiuwen , Liu Yanguo
Published: November 2023

Background

The efficacy of immune checkpoint inhibitors (ICIs) in non-small cell lung cancer (NSCLC) patients harboring neurotrophin receptor kinase (NTRK) family mutations remains obscure.

Methods

The Zehir cohort from cBioPortal was used to analyze the mutations (MT) frequency of NTRK family in patients with NSCLC, and their correlation with clinical characteristics and patient survival. The influence of NTRK MT on ICIs efficacy was evaluated in ICIs-treated patients from Samstein cohort and further validated by use of data from OAK/POPLAR cohort.

Results

In the Zehir cohort, a significant difference was observed in median overall survival (mOS) between patients with NTRK MT and wild-type (WT) (mOS: 18.97 vs. 21.27 months, HR = 1.34, 95%CI 1.00-1.78; log-rank P = 0.047). In Samstein cohort, the mOS of NTRK mutant patients receiving ICIs has improved compared to WT patients (mOS: 21.00 vs. 11.00 months, log-rank P = 0.103). Notably, in subgroup analysis, ICIs significantly prolonged mOS in patients with NTRK3 MT than in WT patients (mOS: not available vs. 11.00 months, HR = 0.36, 95%CI 0.16–0.81; log-rank P = 0.009). Identical mOS between NTRK MT and WT patients receiving ICIs treatment (mOS: 13.24 vs. 13.50 months, log-rank P = 0.775) was observed in OAK/POPLAR cohort. Moreover, a similar programmed death ligand 1 (PD-L1) expression, but higher tumor mutational burden (TMB), blood TMB (bTMB) and enriched anti-tumor immunity were observed in NTRK MT compared to WT (P < 0.05).

Conclusion

Taking high TMB or bTMB into consideration, patients with NTRK mutant NSCLC could benefit from ICIs treatment.
Health professionals’ perceptions of patient safety competencies: psychometric properties of the French version of the H-PEPSS in France and Switzerland
Authors: Boloré Sylvain , Sovet Laurent , Guirimand Nicolas
Published: November 2023

Background

Several initiatives have been implemented to develop, manage, and assess patient safety (PS) competencies, which are considered as a serious public health issue across the world. The Health Professional Education in Patient Safety Survey (H-PEPSS) is widely used as a psychometric scale for evaluating perceived PS competencies but has not been validated in French. The purpose of the study was to investigate the main psychometric properties of the French version of the H-PEPSS.

Methods

A total of 449 students enrolled in nursing and physiotherapy schools in France and French-speaking Switzerland completed a self-administered questionnaire. The 38 items of the H-PEPSS were translated into French following a committee approach. The scale’s construct validity was assessed using confirmatory factor analysis. Reliability of the six factors of the H-PEPSS was evaluated using Cronbach α and McDonald’s ω. Measurement invariance across countries and academic majors as well as discriminant validity were also investigated.

Results

After we removed one item, the H-PEPSS 6-factor model demonstrated adequate goodness-of-fit statistics (χ2[194] = 316.633, χ2/df = 1.632, p < 0.001, CFI = 0.934, TLI = 0.922, RMSEA = 0.041 [0.033, 0.049], SRMR = 0.044). The total score can be also used as an overall measure of PS competence (χ2[203] = 342.251, χ2/df = 1.686, p < 0.001, CFI = 0.925, TLI = 0.915, RMSEA = 0.043 [0.035, 0.051], SRMR = 0.047). One item was removed because of its high multicollinearity with other items. The reliability was deemed satisfactory (Cronbach α ≥ 0.60), except for the “Understanding human and environmental factors” subscale. Consistently, this subscale was often reported with the lowest reliability in previous studies. We confirmed scalar invariance between countries and partial scalar invariance between majors (ΔCFI ≤ 0.01). The heterotrait-monotrait ratio of correlations ranged from 0.63 to 0.91. In our results, country, academic year, and academic satisfaction were frequently the main predictors of self-reported PS competencies.

Conclusion

Perceived PS competencies can be assessed and fairly compared across France and Switzerland and across nursing and physiotherapy students. We discuss the relevance of the introduction of the H-PEPSS in the training pathway of health professions degree courses and the fallout in clinical contexts.
Sepsis-coded hospitalisations and associated costs in Australia: a retrospective analysis
Authors: Kumar Ashwani , Hammond Naomi , Abbenbroek Brett , Thompson Kelly , Taylor Colman , Venkatesh Bala , Delaney Anthony , Finfer Simon
Published: November 2023

Objective

To report trends in Australian hospitalisations coded for sepsis and their associated costs.

Design

Retrospective analysis of Australian national hospitalisation data from 2002 to 2021.

Methods

Sepsis-coded hospitalisations were identified using the Global Burden of Disease study sepsis-specific ICD-10 codes modified for Australia. Costs were calculated using Australian-Refined Diagnosis Related Group codes and National Hospital Cost Data Collection.

Results

Sepsis-coded hospitalisations increased from 36,628 in 2002-03 to 131,826 in 2020-21, an annual rate of 7.8%. Principal admission diagnosis codes contributed 13,843 (37.8%) in 2002-03 and 44,186 (33.5%) in 2020-21; secondary diagnosis codes contributed 22,785 (62.2%) in 2002-03 and 87,640 (66.5%) in 2020-21. Unspecified sepsis was the most common sepsis code, increasing from 15,178 hospitalisations in 2002-03 to 68,910 in 2020-21. The population-based incidence of sepsis-coded hospitalisations increased from 18.6 to 10,000 population (2002-03) to 51.3 per 10,000 (2021-21); representing an increase from 55.1 to 10,000 hospitalisations in 2002-03 to 111.4 in 2020-21. Sepsis-coded hospitalisations occurred more commonly in the elderly; those aged 65 years or above accounting for 20,573 (55.6%) sepsis-coded hospitalisations in 2002-03 and 86,135 (65.3%) in 2020-21. The cost of sepsis-coded hospitalisations increased at an annual rate of 20.6%, from AUD199M (€127 M) in financial year 2012 to AUD711M (€455 M) in 2019.

Conclusion

Hospitalisations coded for sepsis and associated costs increased significantly from 2002 to 2021 and from 2012 to 2019, respectively.
Cost of in-patient management of COVID-19 patients in a general hospital in Kuwait
Authors: Nur Amrizal Muhammad , Aljunid Syed Mohamed , Almari Mohammad
Published: November 2023

Background

Among the GCC countries affected by COVID-19 infections, Kuwait has been significantly impacted, with 658,520 cases and 2,563 deaths reported by the WHO on September 30, 2022. However, the impact of the COVID-19 epidemic on Kuwait’s economy, especially in the healthcare sector, remains unknown. Objective: This study aims to determine the total cost of managing COVID-19 in-patients in Kuwait.

Method

A cross-sectional design was employed for this study. A total of 485 COVID-19 patients admitted to a general hospital responsible for COVID-19 cases management were randomly selected for this study from May 1st to September 31st, 2021. Data on sociodemographic information, length of stay (LOS), discharge status, and comorbidities were obtained from the patients’ medical records. The data on costs in this study cover administration, utility, pharmacy, radiology, laboratory, nursing, and ICU costs. The unit cost per admission was calculated using a step-down costing method with three levels of cost centers. The unit cost was then multiplied by the individual patient’s length of stay to determine the cost of care per patient per admission.

Findings

The mean cost of COVID-19 in-patient care per admission was KD 2,216 (SD = 2,018), which is equivalent to USD 7,344 (SD = 6,688), with an average length of stay of 9.4 (SD = 8.5) days per admission. The total treatment costs for COVID-19 in-patients (n = 485) were estimated to be KD 1,074,644 (USD 3,561,585), with physician and nursing care costs constituting the largest share at 42.1%, amounting to KD 452,154 (USD 1,498,529). The second and third-largest costs were intensive care (20.6%) at KD 221,439 (USD 733,893) and laboratory costs (10.2%) at KD 109,264 (USD 362,123). The average cost for severe COVID-19 patients was KD 4,626 (USD 15,332), which is almost three times higher than non-severe patients of KD 1,544 (USD 5,117).

Conclusion

Managing COVID-19 cases comes with substantial costs. This cost information can assist hospital managers and policymakers in designing more efficient interventions, especially for managing high-risk groups.
Operational demonstration and process evaluation of non-pneumatic anti-shock garment (NASG) introduction to the public health system of Northern Province, Zambia
Authors: Medina-Jaudes Naomi , Carmone Andy E. , Prust Margaret L. , Ngosa Lupenshyo , Aladesanmi Oluwaseun , Zulu Morrison , Storey Andrew , Muntanga Beauty , Chizuni Caren , Mwiche Angel , Shakwelele Hilda , Kamanga Aniset
Published: November 2023

Background

A disproportionate burden of maternal deaths occurs in low- and middle-income countries (LMICs), and obstetric hemorrhage (OH) is a leading cause of excess mortality. In Zambia, most of maternal deaths are directly caused by OH. The Non-Pneumatic Anti-Shock Garment (NASG) is a first aid tool that uses compression to the abdomen and lower body to stop and reverse hypovolemic shock secondary to OH. We describe the process and experiences introducing the NASG into the Zambia public health system to encourage the development of national policies, clinical guidelines, and implementation plans that feature the NASG.

Methods

We conducted an observational study of NASG introduction to 143 public health facilities in Northern Province, Zambia, organizing observations into the five dimensions of the RE-AIM evaluation framework: reach, effectiveness, adoption, implementation, and maintenance. The NASG was introduced in August 2019, and the introduction was evaluated for 18 months. Data on healthcare worker training and mentorship, cases where NASG was used, and NASG availability and use during the study period were collected and analyzed.

Results

The NASG was successfully introduced and integrated into the Zambia public health system, and appropriately used by healthcare workers when responding to cases of OH. Sixteen months after NASG introduction, NASGs were available and functional at 99% of study sites and 88% reported ever using a NASG. Of the 68 cases of recorded OH where a NASG was applied, 66 were confirmed as clinically appropriate, and among cases where shock index (SI) could be calculated, 59% had SI ≥ 0.9. Feedback from healthcare providers revealed that 97% thought introducing the NASG was a good decision, and 92% felt confident in their ability to apply the NASG after initial training. The RE-AIM average for this study was 0.65, suggesting a public health impact that is not equivocal, and that NASG introduction had a positive population-based effect.

Conclusions

A successful NASG demonstration took place over the course of 18 months in the existing health system of Northern Province, Zambia, suggesting that incorporation of NASG into the standard of care for obstetric emergency in the Zambia public sector is feasible and can be maintained without external support.
Clinical efficacy of sodium bicarbonate in treating pediatric metabolic acidosis with varying level of acid–base balance parameters: a real-world study
Authors: Liu Huaqing , Cao Yanmei , Xue Xiaoyan , Bai Zhenjiang , Wu Shuiyan
Published: November 2023

Background

Sodium bicarbonate (SB) infusion is commonly used to correct metabolic acidosis, but its clinical efficacy remains controversial. This study aims to investigate whether acid–base balance parameters should be a consideration for administering SB treatment.

Methods

Children with metabolic acidosis (pH < 7.35 and bicarbonate < 22 mmol/L) who were treated with or without 50 mg/ml SB injection were grouped and extracted from a retrospective cohort database of the Pediatric Intensive Care Unit. The interaction between acid–base balance parameters and SB treatment on mortality was analyzed through mortality curves and cross-effect models. Logistic regression was conducted to estimate the risk of death following SB treatment in the overall children as well as in subgroups, and potential confounding factors were adjusted for. After employing propensity score matching to account for confounding factors, further analysis was performed to evaluate the effectiveness of SB treatment within each chloride subgroup.

Results

A total of 5865 children with metabolic acidosis were enrolled, of which 2462 (42.0%) received SB treatment. In the overall population, it was found that SB treatment did not reduce hospital mortality or 28-day mortality. Interactions between acid–base balance parameters (chloride and anion gap) and SB treatment on mortality were observed. Subgroup analysis clarified that when chloride levels were below 107 mmol/L, children treated with SB had higher in-hospital mortality (29.8% vs 14.9%) and 28-day mortality (26.5% vs 13.4%), with adjusted ORs of 2.065 (95% CI, 1.435–2.97) and 1.947 (95% CI, 1.332–2.846), respectively. In contrast, when chloride levels were greater than or equal to 113 mmol/L, children treated with SB had a shorter stay in the PICU (median: 1.1 days vs 5.1 days, adjusted p = 0.004) and lower in-hospital mortality (4.3% vs 10.3%) and 28-day mortality (4.0% vs 8.4%), with adjusted ORs of 0.515 (95% CI, 0.337–0.788) and 0.614 (95% CI, 0.391–0.965), respectively. After controlling for confounding factors through matching, the impact of SB treatment on the risk of death in each chloride subgroup was consistent with the aforementioned results. However, treatment with SB did not significantly increase the risk of death in newborns or children with moderate to severe metabolic acidosis when chloride levels were below 107 mmol/L (p > 0.05).

Conclusions

The use of sodium bicarbonate for treating metabolic acidosis has been found to increase mortality in children with low chloride levels but decrease mortality in those with high chloride levels in this study. Further prospective multi-center clinical studies and basic research are needed to validate these findings.
Corynebacterium oculi-related bacterium may act as a pathogen and carrier of antimicrobial resistance genes in dogs: a case report
Authors: Tresch Milena , Watté Christine , Stengard Michele , Ritter Corinne , Brodard Isabelle , Feyer Simon , Gohl Estelle , Akdesir Ezgi , Perreten Vincent , Kittl Sonja
Published: November 2023

Background

The genus Corynebacterium comprises well-known animal and human pathogens as well as commensals of skin and mucous membranes. Species formerly regarded as contaminants are increasingly being recognized as opportunistic pathogens. Corynebacterium oculi has recently been described as a human ocular pathogen but has so far not been reported in dogs.

Case presentation

Here we present two cases of infection with a novel Corynebacterium sp., a corneal ulcer and a case of bacteriuria. The two bacterial isolates could not be identified by MALDI-TOF MS. While 16 S rRNA gene (99.3% similarity) and rpoB (96.6% identity) sequencing led to the preliminary identification of the isolates as Corynebacterium (C.) oculi, whole genome sequencing revealed the strains to be closely related to, but in a separate cluster from C. oculi. Antimicrobial susceptibility testing showed high minimal inhibitory concentrations of lincosamides, macrolides, tetracycline, and fluoroquinolones for one of the isolates, which also contained an erm(X) and tet-carrying plasmid as well as a nonsynonymous mutation leading to an S84I substitution in the quinolone resistance determining region of GyrA.

Conclusions

While the clinical signs of both dogs were alleviated by antimicrobial treatment, the clinical significance of these isolates remains to be proven. However, considering its close relation with C. oculi, a known pathogen in humans, pathogenic potential of this species is not unlikely. Furthermore, these bacteria may act as reservoir for antimicrobial resistance genes also in a One Health context since one strain carried a multidrug resistance plasmid related to pNG3 of C. diphtheriae.
The ZJU index is associated with the risk of obstructive sleep apnea syndrome in Chinese middle-aged and older people: a cross-sectional study
Authors: Wang Liping , Nie Guqiao , Yan Fengqin , Zhou Nianli , Zhang Meng , Peng Wen
Published: November 2023

Background

The ZJU index, a novel calculation that combines body mass index, triglycerides, fasting blood glucose and the ratio of alanine aminotransferase to aspartate aminotransferase, is a closely related measure of obesity and insulin resistance. Studies of the ZJU index in relation to obstructive sleep apnea syndrome (OSAS) have not been reported. This study assessed the correlation between the ZJU values and OSAS risk.

Methods

A total of 2,130 participants who underwent polysomnographic monitoring were included in the study. The participants’ basic information and laboratory biochemical indicators were collected, and the ZJU index was computed. The ZJU index was divided into quartiles. The correlation between the different ZJU index levels and OSAS risk was assessed using logistic regression. Drew a receiver operating characteristic (ROC) relationship curve, with prediction efficacy judged by the area under the curve (AUC), and found the optimum cut-off point for ZJU index to predict OSAS. Relative risks were presented as odds ratios (OR). The range of OR values is expressed in the form of 95% confidence intervals (95% CI).

Results

The number of patients diagnosed with OSAS increased progressively with increasing ZJU index (T1: 9.4%; T2: 20.6%; T3: 28.3%; T4: 41.7%; P < 0.001). The additional confounders were adjusted by the logistic regression models, the study revealed an independent correlation between ZJU index and OSAS. (P < 0.001). The OSAS risk was notably higher at the highest ZJU index levels. (OR = 2.046 [95% CI: 1.057 to 3.964]). The ROC curve for the ZJU index showed an AUC of 0.64 (P < 0.001) for males and 0.75 (P < 0.001) for females, with a specificity of 64% and 55% and a sensitivity of 60% and 92% for males and females, respectively, with the optimum cut-off values of 36.568 and 34.722, respectively.

Conclusion

A high ZJU index was significantly associated with an increasing risk of OSAS. The ZJU is expected to be a meaningful index for detecting OSAS in the general population.
DNA methylation and histone post-translational modifications in atherosclerosis and a novel perspective for epigenetic therapy
Authors: Zhang Liang , Xia Chenhai , Yang Yongjun , Sun Fangfang , Zhang Yu , Wang Huan , Liu Rui , Yuan Ming
Published: November 2023

Atherosclerosis, which is a vascular pathology characterized by inflammation and plaque build-up within arterial vessel walls, acts as the important cause of most cardiovascular diseases. Except for a lipid-depository and chronic inflammatory, increasing evidences propose that epigenetic modifications are increasingly associated with atherosclerosis and are of interest from both therapeutic and biomarker perspectives. The chronic progressive nature of atherosclerosis has highlighted atherosclerosis heterogeneity and the fact that specific cell types in the complex milieu of the plaque are, by far, not the only initiators and drivers of atherosclerosis. Instead, the ubiquitous effects of cell type are tightly controlled and directed by the epigenetic signature, which, in turn, is affected by many proatherogenic stimuli, including low-density lipoprotein, proinflammatory, and physical forces of blood circulation. In this review, we summarize the role of DNA methylation and histone post-translational modifications in atherosclerosis. The future research directions and potential therapy for the management of atherosclerosis are also discussed.
Novel roles of PIWI proteins and PIWI-interacting RNAs in human health and diseases
Authors: Wu Zeyu , Yu Xiao , Zhang Shuijun , He Yuting , Guo Wenzhi
Published: November 2023

Non-coding RNA has aroused great research interest recently, they play a wide range of biological functions, such as regulating cell cycle, cell proliferation, and intracellular substance metabolism. Piwi-interacting RNAs (piRNAs) are emerging small non-coding RNAs that are 24–31 nucleotides in length. Previous studies on piRNAs were mainly limited to evaluating the binding to the PIWI protein family to play the biological role. However, recent studies have shed more lights on piRNA functions; aberrant piRNAs play unique roles in many human diseases, including diverse lethal cancers. Therefore, understanding the mechanism of piRNAs expression and the specific functional roles of piRNAs in human diseases is crucial for developing its clinical applications. Presently, research on piRNAs mainly focuses on their cancer-specific functions but lacks investigation of their expressions and epigenetic modifications. This review discusses piRNA’s biogenesis and functional roles and the recent progress of functions of piRNA/PIWI protein complexes in human diseases.
C–C chemokine receptor 5 is essential for conventional NK cell trafficking and liver injury in a murine hepatitis virus-induced fulminant hepatic failure model
Authors: Liu Yun-Hui , Zhu Lin , Zhang Zhong-Wei , Liu Ting-Ting , Cheng Qiu-Yu , Zhang Meng , Niu Yu-Xin , Ding Lin , Yan Wei-Ming , Luo Xiao-Ping , Ning Qin , Chen Tao
Published: November 2023

Background

Previous studies have demonstrated that natural killer (NK) cells migrated into the liver from peripheral organs and exerted cytotoxic effects on hepatocytes in virus-induced liver failure.

Aim

This study aimed to investigate the potential therapeutic role of chemokine receptors in the migration of NK cells in a murine hepatitis  virus strain 3 (MHV-3)-induced fulminant hepatic failure (MHV-3-FHF) model and its mechanism.

Results

By gene array analysis, chemokine (C–C motif) receptor 5 (CCR5) was found to have remarkably elevated expression levels in hepatic NK cells after MHV-3 infection. The number of hepatic CCR5+ conventional NK (cNK) cells increased and peaked at 48 h after MHV-3 infection, while the number of hepatic resident NK (rNK) cells steadily declined. Moreover, the expression of CCR5-related chemokines, including macrophage inflammatory protein (MIP)-1α, MIP-1β and regulated on activation, normal T-cell expressed and secreted (RANTES) was significantly upregulated in MHV-3-infected hepatocytes. In an in vitro Transwell migration assay, CCR5-blocked splenic cNK cells showed decreased migration towards MHV-3-infected hepatocytes, and inhibition of MIP-1β or RANTES but not MIP-1α decreased cNK cell migration. Moreover, CCR5 knockout (KO) mice displayed reduced infiltration of hepatic cNK cells after MHV-3 infection, accompanied by attenuated liver injury and improved mouse survival time. Adoptive transfer of cNK cells from wild-type mice into CCR5 KO mice resulted in the abundant accumulation of hepatic cNK cells and aggravated liver injury. Moreover, pharmacological inhibition of CCR5 by maraviroc reduced cNK cell infiltration in the liver and liver injury in the MHV-3-FHF model.

Conclusion

The CCR5-MIP-1β/RANTES axis played a critical role in the recruitment of cNK cells to the liver during MHV-3-induced liver injury. Targeted inhibition of CCR5 provides a therapeutic approach to ameliorate liver damage during virus-induced acute liver injury.