bluuebunny/crossref_metadata_2025 huggingface dataset:
Inferior ST segment elevation myocardial infarction combined with hyperextension cervical spine injury: A rare case report
Authors: Li Jiaying , Zhong Ping , Wang Zheng , Han Shufang
Published: March 2023

Rationale:

Inferior ST-segment elevation myocardial infarction (STEMI) is usually caused by acute occlusion of the right coronary artery or left circumflex coronary artery (LCX). Inferior STEMI can cause a high-grade atrioventricular block, sinus bradycardia, and hypotension, leading to hemodynamic collapse, syncope, and disturbance of consciousness.

Patient concerns:

A case of a sudden disturbance of consciousness after chest tightness as the initial symptom, followed by incomplete paralysis and paresthesia of the extremities due to the collision of the face with the ground.

Diagnoses:

Coronary angiography showed about 99% of stenosis in the LCX. Cervical spine magnetic resonance imaging showed C2/3, C3/4, C4/5, and C5/6 intervertebral disc herniation with secondary spinal stenosis, spinal cord compression, and edema. The patient was diagnosed with inferior STEMI combined with hyperextension cervical spine injury.

Interventions and outcomes:

Bivalirudin was used for anticoagulation, the LCX lesion was pre-expanded with a balloon and the thrombus was removed, and anti-platelet aggregation therapy was given postoperatively. After rehabilitation therapy, hyperextension cervical spine injury improved. There was no recurrence of syncope and precordial pain during the 6-month follow-up.

Lessons:

Hyperextension cervical spine injury has unique hemodynamic features that mimic those associated with inferior STEMI, so a detailed medical history inquiry and physical examination should be carried out to avoid missed diagnoses.
Total tubeless percutaneous nephrolithotomy without artificial hydronephrosis in preschool children: Three case reports
Authors: Zhang Xicai , Zhang Yonghe , Li Fengyue , He Wenbo , Cao Xiande
Published: March 2023

Rationale:

Indwelling ureteral catheter, double J tube, or nephrostomy tube are routine procedures for percutaneous nephrolithotomy (PCNL) in children. There are a few cases in which PCNL has been performed in children without any additional instruments being left in place.

Patient concerns:

In this study, 3 children were treated for hematuria and complicated with different degrees of urinary tract infection. All of them were diagnosed as upper urinary tract calculi by abdominal computed tomography.

Diagnosis:

Three preschoolers were diagnosed with upper urinary tract calculi before surgery, one with no hydronephrosis and the other 2 with different degrees of hydronephrosis.

Interventions:

After preoperative evaluation, all the children successfully completed PCNL without indwelling ureteral catheter, double J tube, or nephrostomy tube.

Outcomes:

The operation was successful and there were no residual stones observed during postoperative review. The operating times for the children were 33 minutes, 17 minutes, and 20 minutes, and the intraoperative bleeding volumes were 1 mL, 2 mL, and 2 mL. The catheter was removed on the second day after the operation, the postoperative review of the abdominal computed tomography or ultrasound did not indicate any stone residue, and there were no fever, bleeding, and other related complications after the operation.

Lessons:

We believe that total tubeless PCNL without artificial hydronephrosis can be achieved in the preschool population.
Impact of oral care modalities on the incidence of ventilator-associated pneumonia in the intensive care unit: A meta-analysis
Authors: Fu Li-Sang , Zhu Li-Mei , Yang Yuan-Ping , Lin Ling , Yao Li-Qun
Published: March 2023

Background:

At present, evidence of the role of oral hygiene in ICU-related pneumonia is rare. The study aimed to evaluate the effectiveness of toothbrush-based oral care in preventing ventilator-associated pneumonia (VAP) in patients with mechanical ventilation in the ICU.

Methods:

Ten databases were searched for randomized controlled trials (RCTs) evaluating toothbrush-based oral care for preventing VAP in patients with mechanical ventilation in ICU. Quality assessment and data extraction were independently performed by 2 researchers. The meta-analysis was performed using RevMan 5.3 software.

Results:

Thirteen RCTs with 657 patients were included. Tooth brushing + 0.2%/0.12% chlorhexidine was associated with reduced incidence of VAP compared to chlorhexidine (OR = 0.63, 95% confidence interval [CI]: 0.43–0.91, P = .01) or tooth brushing + placebo (OR = 0.47, 95% CI: 0.25–0.86, P = .02) in patients with mechanical ventilation in ICU, but was similar to cotton wipe with 0.2% or 0.12% chlorhexidine (OR = 1.33, 95% CI: 0.77–2.29, P = .31).

Conclusions:

Tooth brushing combined with chlorhexidine mouthwash can prevent VAP in patients with mechanical ventilation in ICU. There is no advantage of tooth brushing combined with chlorhexidine mouthwash over cotton wipe with chlorhexidine mouthwash for preventing VAP in these patients.
Efficacy of Epley’s maneuver plus betahistine in the management of PC-BPPV: A systematic review and meta-analysis
Authors: Li Wei , Sun Jinqiang , Zhao Zeqi , Xu Jifeng , Wang Hao , Ding Rui , Zhang Yanqiu
Published: March 2023

Background:

To evaluate the efficacy of Epley’s maneuver plus betahistine in the management of patients with posterior canal benign paroxysmal positional vertigo (PC-BPPV).

Methods:

Electronic databases including PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, and Wanfang were searched from their inception to April, 2022. The effect size was analyzed by calculating the pooled risk ratio estimates of efficacy rate, recurrence rate, and standardized mean differences (SMD) of dizziness handicap inventory (DHI) score with a 95% confidence interval (CI). Sensitive analysis was performed simultaneously.

Results:

A total of 9 randomized controlled trials with 860 PC-BPPV patients were included in the meta-analysis, in which 432 were treated with Epley’s maneuver plus betahistine, and 428 received Epley’s maneuver alone. The meta-analysis revealed that Epley’s maneuver plus betahistine significantly improved DHI score than Epley’s maneuver alone (SMD = −0.61, 95% CI −0.96 to −0.26, P = .001). In addition, both Epley’s maneuver plus betahistine and Epley’s maneuver groups had comparable outcomes in efficacy rate and recurrence rate.

Conclusion:

This meta-analysis shows that Epley’s maneuver plus betahistine in PC-BPPV patients had favorable effects on DHI score.
The largest and heaviest giant juvenile fibroadenoma of the breast in the Chinese population: A case report
Authors: Zhang Yuanxin , Huang Junhua , Zhou Ling , Leng Ying
Published: March 2023

Rationale:

Fibroadenoma is the most common benign tumor of the breast, but giant juvenile fibroadenoma exceeding 20 cm is much rare. This report presents the largest and heaviest giant juvenile fibroadenoma in an 18-year-old Chinese girl.

Diagnosis and interventions:

An 18-year-old adolescent girl with a 2-year history of a large left breast mass with progressive expansion over 11 months. A 28 × 21 cm soft swelling occupied the entire outer quadrants of the left breast. The huge mass sagged below the belly button, resulting in high asymmetry of the shoulders. Contralateral breast examination results were normal except for hypopigmentary detected on the nipple-areola complex. Under general anesthesia, the lump was completely excised along the outer envelope of the tumor, while reserving excessive resection of the skin. The patient’s postoperative recovery was uneventful, and the surgical wound healed well.

Outcomes:

A radial incision operation was finally performed to remove the huge mass and to preserve the normal breast tissue and the nipple-areolar complex, not only considering the aesthetics but also preserving the ability to lactate.

Lessons:

Currently, there is a lack of clear guidelines regarding the diagnostic and treatment modalities for a giant juvenile fibroadenoma. The principle of surgical choice is to balance aesthetics and function preservation.
Efficacy of the enhanced recovery after surgery protocol in operating room nursing of patients following single-port video-assisted thoracoscopic lung cancer surgery: A retrospective study
Authors: Wei Lijun , Wang Yingying
Published: March 2023

This study assessed the efficacy of the enhanced recovery after surgery (ERAS) protocol in operating room nursing care for patients who underwent single-port video-assisted thoracoscopic lung cancer surgery. The study included 82 surgical lung cancer cases. The patients underwent single-port video-assisted thoracoscopic lung cancer surgery between April 1, 2021, and June 31, 2022. Of the 82 patients, 42 received nursing care under the ERAS protocol (experimental group) and 40 had routine nursing care (control group) in the operation room. Based on the 2 different nursing care approaches, the postoperative functional recovery efficacy, quality of life, postoperative complications, and psychological status were compared between the 2 groups. In our analysis, the mean anal venting time, average early out-of-bed time, the average time to liquid resumption, atelectasis, and pulmonary infection rate were significantly lower in the experimental group than in the control group (P < .05). The Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS) scores were also significantly lower in the experimental group than in the control group (P < .05). Other indicators were not significantly different between the 2 groups. Our results show that the implementation of an ERAS protocol in operating room nursing care is feasible and should be clinically applied. The ERAS protocol may enhance the recovery of patients who underwent single-port video-assisted thoracoscopic lung cancer surgery.
Diagnosis and treatment of gastric hamartomatous inverted polyp (GHIP) by endoscopic submucosal dissection: A case report
Authors: Han Yi-Ping , Min Cong-Cong , Li Yu-Bei , Chen Yun-Qing , Liu Hua , Tian Zi-Bin , Yin Xiao-Yan
Published: March 2023

Rationale:

Gastric hamartomatous inverted polyps (GHIP) is not a common disease, and it has rarely been reported in the literature. Preoperative diagnosis is difficult due to the deep position and surface covered with normal gastric mucosa. However, with the progress of endoscopic technology, endoscopic submucosal dissection (ESD) can play a crucial role in the diagnosis and treatment of GHIP.

Patient concerns:

A 61-year-old Chinese man underwent gastroscopy due to abdominal pain 2 months prior that revealed chronic superficial nonatrophic gastritis with erosion and a submucosal tumor in the gastric body (an ultrasound gastroscopy was recommended). Therefore, he was admitted to our hospital for further diagnosis and treatment.

Diagnoses:

A hemispherical submucosal tumor was found in the middle segment of the stomach, with a size of approximately 30 mm × 35 mm and a smooth surface without central ulceration or mucosal bridge formation. Ultrasound gastroscopy showed that the lesion was a hypoechoic mass with uniform internal echo originating from the muscularis propria.

Interventions:

The tumor was completely removed by using ESD. The postoperative pathological results indicated a monocystic structure in the submucosa that was not connected with the surface mucosa. The surface of the cyst was covered with foveolar cells and mucous-neck cells (part of which had low-grade intraepithelial neoplasia), and GHIP was considered to be diagnosed.

Outcomes:

According to the abovementioned endoscopic and pathological features, the patient was finally diagnosed with GHIP. The patient was successfully discharged after surgery and received regular follow-up observations.

Lessons:

GHIP is located in the submucosa layer and has the potential risk of malignant transformation. However, it is not easy to diagnose by using gastroscopy and ultrasound gastroscopy. ESD can obtain complete specimens, which contributes to the diagnosis and treatment of GHIP.
Level of Care Appropriateness in VA Inpatient Surgery Cases
Authors: Neugaard Britta , Politi Ruth , McCay Christy
Published: March 2023

Purpose of Study:

Within the Veterans Health Administration, utilization management (UM) focuses on reducing unnecessary or inappropriate hospitalizations by applying evidence-based criteria to evaluate whether the patient is placed in the right level of care. This study examined inpatient surgery cases to classify reasons for not meeting criteria and to identify the appropriate level of care for admissions and subsequent bed days of care.

Primary Practice Settings:

There were 129 VA Medical Centers in which inpatient UM reviews were performed during that time, of which 109 facilities had UM reviews conducted in Surgery Service.

Methodology and Sample:

All admissions to surgery service during fiscal year 2019 (October 1, 2018 to September 30, 2019) that had a UM review entered in the national database were extracted, including current level of care, recommended level of care, and reasons for not meeting criteria. The following demographic and diagnostic fields were supplemented from a national data warehouse: age, gender, marital status, race, ethnicity, and service connection status. Data were analyzed with descriptive statistics. Characteristics of patient demographics were compared using the χ2 test for categorical variables and the Student's t test.

Results:

A total of 363,963 reviews met conditions to be included in the study: 87,755 surgical admission reviews and 276,208 continued stay reviews. There were 71,274 admission reviews (81.22%) and 198,521 (71.87%) continued stay reviews that met the InterQual criteria. The primary reason for not meeting admission criteria was clinical variance (27.70%), followed by inappropriate level of care (26.85%). The leading reason for not meeting continued stay criteria was inappropriate level of care (27.81%), followed by clinical instability (25.67%). Of the admission reviews not meeting admission criteria, 64.89% were in the wrong level of care and 64.05% of continued stay reviews were also in the wrong level of care. Half of the admission reviews not meeting criteria had a recommended level of care as home/outpatient (43.51%), whereas nearly one-third (28.81%) continued stay reviews showed a recommended level of care of custodial care or skilled nursing.

Implications for Case Management Practice:

This study identified system inefficiencies through admission and continued stay reviews of surgical inpatients. Patients admitted for ambulatory surgery or for preoperative testing prior to day of surgery resulted in avoidable bed days of care that may have contributed to patient flow issues and limited the available hospital beds for other patients. Through early collaboration with case management and care coordination professionals, alternatives can be explored that safely address the patient needs, such as temporary lodging options. There may be conditions or complications that can be anticipated on the basis of patient history. Proactive efforts to address these conditions may help avoid unnecessary bed days and extended lengths of stay.
Assessment of Veterans Affairs Case Managers Using a Leadership Conceptual Framework
Authors: Perla Lisa Y. , Barry Erin S. , Grunberg Neil E.
Published: March 2023

Purpose/Objectives:

Case management in Veterans Affairs (VA) depends on leadership skills such as effective communication, excellent resource management, self-governance, patient advocacy, and a distinctly professional attitude. VA registered nurses (RNs) and social workers (SWs) also provide case management services, a role and service, which is pivotal to veteran satisfaction and effective health care coordination.

The leader–follower framework (LF2) was used to assess and compare the responses of RNs, SWs, and case managers (CMs) on the annual VA All Employee Survey (AES) to provide insight regarding VA case management performance, which has influenced veteran satisfaction.

Primary Practice Setting:

VA CMs work in a variety of clinical settings, which, in recent years, includes the use of telehealth modalities because of COVID-19. VA CMs remain flexible working in environments where and when veterans require their services while promoting safe, effective, and equitable health care services.

Findings/Conclusions:

RNs and SWs indicated greater agreement and satisfaction scores in 2019 compared with 2018 on questions related to the leadership element of character and questions regarding mutual respect between VA senior leaders and the respondents. In contrast, RNs and SWs indicated less agreement and satisfaction scores on questions related to the leadership elements of competence, context, communication, personal, interpersonal, team, organizational, and greater burnout in 2019 than in 2018. RN response scores in 2018 and 2019 were greater and burnout scores were less than SWs. Additionally, the one-way analysis of variance indicated no difference for RNs and SWs who were performing the duties of a CM.

Implications for Case Management Practice:

The responses of RNs indicated greater satisfaction and less burnout than SWs and were consistent whether RNs and SWs were in case management roles or not. These are important findings and concerning trends warranting further discussion and research.
Mapping Critical Thinking, Clinical Reasoning, and Clinical Judgment Across the Curriculum
Authors: Noll Kelley , Hunt Caralise , Jones Meghan
Published: March 2023

Background:

Critical thinking, clinical reasoning, and clinical judgment are skills nurses use when caring for clients. However, teaching and evaluation of clinical judgment are challenging for faculty.

Problem:

Before revising a curriculum, it is necessary to map current practices and determine a framework for revisions.

Approach:

Faculty mapped critical thinking, clinical reasoning, and clinical judgment activities across the 5-semester traditional baccalaureate program. Use of an external consultant helped faculty to determine additional activities that could be used to assess clinical judgment in classroom and clinical settings. Faculty worked together to develop teaching strategies and Next Generation National Council Licensure Examination (NCLEX) item types for assessing clinical judgment.

Conclusion:

Using the National Council of State Boards of Nursing Clinical Judgment Model as an educational framework can guide faculty in curriculum mapping, revisions, and development of clinical judgment activities and assessment.
Ankle contracture in people with acquired brain injury (ABI), intervention, and outcome following inpatient neurorehabilitation categorized by severity
Authors: Ashford Stephen , Elsmore Charlotte , Steed Aideen , Diggins Alexia , Walden-Smith Alice , Williams Heather
Published: March 2023

Background:

Acquired brain injury frequently causes difficulty with moving and walking, which if not actively managed, can lead to secondary contracture and deformity. Intervention to manage ankle contracture may include conservative methods (eg, serial casting, standing) or more invasive methods (eg, Achilles-tendon lengthening surgery).

Methods:

Data were extracted from the UK Rehabilitation Outcomes Collaborative database for all admissions from 2015 to 2018 with a diagnosis of acquired brain injury from 1 tertiary rehabilitation center. Clinical records were reviewed to identify the 101/357 (28%) with ankle contracture. Categorization according to the degree of contracture was performed, as mild (>plantigrade), moderate (−21°) based on ankle range of movement. Data were analyzed to determine the change in the range of movement, function, outcome, and categorize intervention type. Primary measures: range of movement, UK Functional Independence Measure+Functional Assessment Measure, and Functional Ambulatory Category.

Results:

In the cohort, significant improvement in range of movement occurred following treatment (54.17; P=0.000). Treatment interventions applied included stretch interventions such as serial casting. Standing programmes, orthotics, and task practice were the most frequently applied interventions. Achilles-tendon lengthening surgery was used in a small number of cases (n=13). A statistically significant change in the range of movement was not seen in the mild category (1.05; P=0.29) but was in the moderate (5.436; P=0.001) and severe categories (10.4; P=0.001). Improvement in locomotion was noted in all 3 groups (6.10; P=0.001) but was most pronounced in the moderate and severe groups.

Discussion:

Improved functional outcome was observed in mild contracture with less change in joint range. In those categorized as moderate and severe, greater improvement in joint range of movement as well as function were identified following intervention.
Development and validation of a pentaplex assay for the identification of antibodies against common viral diseases in cattle
Authors: Rodriguez Ana , Alonso-Morales Rogelio , Lassala Arantzatzu , Rangel P Lucia , Ramírez-Andoney Vianey , Gutierrez Carlos G
Published: March 2023

Animal welfare and economic implications of infectious diseases in cattle demand an efficient surveillance as the foundation for control and eradication programmes. Bovine respiratory syncytial virus (BRSV), Parainfluenza virus type 3 (PI3V), Bovine herpes virus-1 (BoHV-1), Bovine viral diarrhoea virus (BVDV), and Enzootic bovine leukosis virus (EBLV) cause common and often underdiagnosed diseases in cattle that are endemic in most countries (WAHIS 2020). A hallmark of individual exposure to a viral pathogen is the presence of antibodies directed towards that virus. The aim of this study was to develop and validate a pentaplex assay to simultaneously detect and quantify antibodies against BRSV, PI3V, BoHV-1, BVDV and EBLV in serum, as an efficient tool to yield epidemiological data. Monoplex assays were initially developed using either complete BRSV or BoHV-1 viral lysates, or recombinant proteins for BVDV, EBLV or PI3V as capture antigens. In addition, 125 serum samples from unvaccinated cattle, which were classified as positive or negative for each of the viruses by commercial ELISA kits, were used for validation. Conditions established for the Luminex monoplex assays were adopted for the pentaplex assay. The accuracy, determined by the area under the ROC curve, was greater than 0.97, and assay diagnostic sensitivities and specificities were over 95% and 90% respectively for all antigens. Intra (r) and interassay (R) coefficients of variation were under 10% and 20%, respectively. Selectivity towards target viruses was shown by binding inhibition assays where unbound viruses reduced fluorescence intensities. Diagnostic agreement for samples analysed simultaneously in the monoplex and multiplex assays was almost perfect. In conclusion, a highly sensitive pentaplex assay was validated for the simultaneous identification of antibodies directed against BVDV, BoHV-1, PI3V, BRSV, and EBLV in serum. The developed pentaplex assay complies with performance characteristics established by international guidelines for diagnostic tests and may be used as a tool for the implementation of epidemiological surveillance.
OCT5k: A dataset of multi-disease and multi-graded annotations for retinal layers
Authors: Arikan Mustafa , Willoughby James , Ongun Sevim , Sallo Ferenc , Montesel Andrea , Ahmed Hend , Hagag Ahmed , Book Marius , Faatz Henrik , Cicinelli Maria Vittoria , Fawzi Amani A , Podkowinski Dominika , Cilkova Marketa , de Almeida Deanna , Zouache Moussa , Ramsamy Ganesham , Lilaonitkul Watjana , Dubis Adam M
Published: March 2023

The thickness and appearance of retinal layers are essential markers for diagnosing and studying eye diseases. Despite the increasing availability of imaging devices to scan and store large amounts of data, analyzing retinal images and generating trial endpoints has remained a manual, error-prone, and time-consuming task. In particular, the lack of large amounts of high-quality labels for different diseases hinders the development of automated algorithms. Therefore, we have compiled 5016 pixel-wise manual labels for 1672 optical coherence tomography (OCT) scans featuring two different diseases as well as healthy subjects to help democratize the process of developing novel automatic techniques. We also collected 4698 bounding box annotations for a subset of 566 scans across 9 classes of disease biomarker. Due to variations in retinal morphology, intensity range, and changes in contrast and brightness, designing segmentation and detection methods that can generalize to different disease types is challenging. While machine learning-based methods can overcome these challenges, high-quality expert annotations are necessary for training. Publicly available annotated image datasets typically contain few images and/or only cover a single type of disease, and most are only annotated by a single grader. To address this gap, we present a comprehensive multi-grader and multi-disease dataset fortraining machine learning-based algorithms. The proposed dataset covers three subsets of scans (Age-related Macular Degeneration, Diabetic Macular Edema, and healthy) and annotations for two types of tasks (semantic segmentation and object detection).
Toward overcoming pyrethroid resistance in mosquito control: the role of sodium channel blocker insecticides
Authors: Niklas Beata , Rydzewski Jakub , Lapied Bruno , Nowak Wieslaw
Published: March 2023

Diseases spread by mosquitoes lead to death of 700,000 people each year. The main way to reduce transmission is vector control by biting prevention with chemicals. However, the most commonly used insecticides lose efficacy due to the growing resistance. Voltage-gated sodium channels (VGSCs), membrane proteins responsible for the depolarizing phase of an action potential, are targeted by a broad range of neurotoxins, including pyrethroids and sodium channel blocker insecticides (SCBIs). Reduced sensitivity of the target protein due to the point mutations threatened malaria control with pyrethroids. Although SCBIs – indoxacarb (a pre-insecticide bioactivated to DCJW in insects) and metaflumizone – are used in agriculture only, they emerge as promising candidates in mosquito control. Therefore, a thorough understanding of molecular mechanisms of SCBIs action is urgently needed to break the resistance and stop disease transmission. In this study, by performing an extensive combination of equilibrium and enhanced sampling molecular dynamics simulations (3.2 μs in total), we found the DIII-DIV fenestration to be the most probable entry route of DCJW to the central cavity of mosquito VGSC. Our study revealed that F1852 is crucial in limiting SCBI access to their binding site. Result explain the role of the F1852T mutation found in resistant insects and the increased toxicity of DCJW compared to its bulkier parent compound, indoxacarb. We also delineated residues that contribute to both SCBIs and non-ester pyrethroid etofenprox binding and thus could be involved in the target site cross-resistance.

Abstract Figure
High Variability of Body Mass Index Independently Associated with Incident Heart Failure
Authors: Liu Chang , Chiang Yiyun , Hui Qin , Zhou Jin J. , Wilson Peter W.F. , Joseph Jacob , Sun Yan V.
Published: March 2023

Background

Heart failure (HF) is a serious condition with increasing prevalence, high morbidity, and increased mortality. Obesity is an established risk factor for cardiovascular diseases, including HF. Fluctuation in body mass index (BMI) has shown a higher risk of cardiovascular outcomes. We investigated the association between BMI variability and incident HF.

Methods

In the UK Biobank, we established a prospective cohort after excluding participants with prevalent HF or cancer at enrollment. A total of 99,368 White (British, Irish, and any other white background) participants with ≥ 3 BMI measures during > 2 years preceding enrollment were included, with a median follow-up of 12.5 years. The within-participant variability of BMI was evaluated using standardized standard deviation (SD) and coefficient of variation (CV). The association of BMI variability with incident HF was assessed using Fine and Gray’s competing risk model, and adjusted for age, sex, smoking history, alcohol consumption, diabetes, hypertension, history of heart attack, stroke, atrial fibrillation, lipids, estimated glomerular filtration rate and mean BMI per individual.

Results

In the fully adjusted model, higher BMI variability measured in both SD and CV were significantly associated with higher risk in HF incidence (SD: Hazard Ratio [HR] 1.05, 95% Confidence Interval [CI] 1.02 - 1.07, p = 0.0002; CV: HR 1.06, 95% CI 1.04 - 1.09, p < 0.0001).

Conclusions

Longitudinal health records capture BMI fluctuation, which independently predicts HF incidence. Integration of long-term BMI and other routinely measured health factors may improve risk prediction of HF and other cardiovascular outcomes.
Microbiome diversity: A barrier to the environmental spread of antimicrobial resistance?
Authors: Klümper Uli , Gionchetta Giulia , Catao Elisa C. P. , Bellanger Xavier , Dielacher Irina , Fang Peiju , Galazka Sonia , Goryluk-Salmonowicz Agata , Kneis David , Okoroafor Uchechi , Radu Elena , Szadziul Mateusz , Szekeres Edina , Teban-Man Adela , Coman Cristian , Kreuzinger Norbert , Popowska Magdalena , Vierheilig Julia , Walsh Fiona , Woegerbauer Markus , Bürgmann Helmut , Merlin Christophe , Berendonk Thomas U.
Published: March 2023

Background

In the environment, microbial communities are constantly exposed to invasion by antimicrobial resistant bacteria (ARB) and their associated antimicrobial resistance genes (ARGs) that were enriched in the anthroposphere. A successful invader has to overcome the biotic resilience of the habitat, which is more difficult with increasing biodiversity. The capacity to exploit resources in a given habitat is enhanced when communities exhibit greater diversity, reducing opportunities for invaders, leading to a lower persistence. In the context of antimicrobial resistance (AMR) dissemination, exogenous ARB reaching a natural community may persist longer if the biodiversity of the autochthonous community is low, increasing the chance of ARGs to transfer to community members. Reciprocally, high microbial diversity could serve as a natural long-term barrier towards invasion by ARB and ARGs.

Results

To test this hypothesis, a sampling campaign across seven European countries was carried out to obtain 172 environmental samples from sites with low anthropogenic impact. Samples were collected from contrasting environments: stationary structured forest soils, or dynamic river biofilms and sediments. Microbial diversity and relative abundance of 27 ARGs and 5 mobile genetic element marker genes were determined. In soils, higher diversity, evenness and richness were all significantly negatively correlated with the relative abundance of the majority (>85%) of ARGs. Furthermore, the number of detected ARGs per sample was inversely correlated with diversity. However, no such effects were found for the more dynamic, regularly mixed rivers. Conclusions: In conclusion, we demonstrate that diversity can serve as barrier towards AMR dissemination in the environment. This effect is mainly observed in stationary, structured environments, where long-term, diversity-based resilience against invasion can evolve. Such barrier effects can in the future be exploited to limit the environmental proliferation of AMR.
Genomic characterization of the antiviral arsenal of Actinobacteria
Authors: Georjon H. , Tesson F. , Shomar H. , Bernheim A.
Published: March 2023

Phages are ubiquitous in nature, and bacteria with very different genomics, metabolisms, and lifestyles are subjected to their predation. Yet, the defense systems that allow bacteria to resist their phages have rarely been explored experimentally outside a very limited number of model organisms. Actinobacteria are a phylum of GC-rich gram-positive bacteria, which often produce an important diversity of secondary metabolites. Despite being ubiquitous in a wide range of environments, from soil to fresh and sea water but also the gut microbiome, relatively little is known about the anti-phage arsenal of Actinobacteria. In this work, we used DefenseFinder to systematically detect 131 anti-phage defense systems in 22,803 fully sequenced prokaryotic genomes, among which 2,253 Actinobacteria of more than 700 species. We show that, like other bacteria, Actinobacteria encode many diverse anti-phage systems that are often encoded on mobile genetic elements. We further demonstrate that most detected defense systems are absent or rarer in Actinobacteria than in other bacteria, while a few rare systems are enriched (notably gp29-gp30 and Wadjet). We characterize the spatial distribution of anti-phage systems onStreptomyceschromosomes and show that some defense systems (e.g. RM systems) tend to be encoded in the core region, while others (e.g. Lamassu and Wadjet) are enriched towards the extremities. Overall, our results suggest that Actinobacteria might be a source of novel anti-phage systems and provide clues to characterize mechanistic aspects of known anti-phage systems.
S:D614G and S:H655Y are gateway mutations that act epistatically to promote SARS-CoV-2 variant fitness
Authors: Yurkovetskiy Leonid , Egri Shawn , Kurhade Chaitanya , Diaz-Salinas Marco A. , Jaimes Javier A. , Nyalile Thomas , Xie Xuping , Choudhary Manish C. , Dauphin Ann , Li Jonathan Z. , Munro James B. , Shi Pei-Yong , Shen Kuang , Luban Jeremy
Published: March 2023

Abstract/Summary

SARS-CoV-2 variants bearing complex combinations of mutations that confer increased transmissibility, COVID-19 severity, and immune escape, were first detected after S:D614G had gone to fixation, and likely originated during persistent infection of immunocompromised hosts. To test the hypothesis that S:D614G facilitated emergence of such variants, S:D614G was reverted to the ancestral sequence in the context of sequential Spike sequences from an immunocompromised individual, and within each of the major SARS-CoV-2 variants of concern. In all cases, infectivity of the S:D614G revertants was severely compromised. The infectivity of atypical SARS-CoV-2 lineages that propagated in the absence of S:D614G was found to be dependent upon either S:Q613H or S:H655Y. Notably, Gamma and Omicron variants possess both S:D614G and S:H655Y, each of which contributed to infectivity of these variants. Among sarbecoviruses, S:Q613H, S:D614G, and S:H655Y are only detected in SARS-CoV-2, which is also distinguished by a polybasic S1/S2 cleavage site. Genetic and biochemical experiments here showed that S:Q613H, S:D614G, and S:H655Y each stabilize Spike on virions, and that they are dispensable in the absence of S1/S2 cleavage, consistent with selection of these mutations by the S1/S2 cleavage site. CryoEM revealed that either S:D614G or S:H655Y shift the Spike receptor binding domain (RBD) towards the open conformation required for ACE2-binding and therefore on pathway for infection. Consistent with this, an smFRET reporter for RBD conformation showed that both S:D614G and S:H655Y spontaneously adopt the conformation that ACE2 induces in the parental Spike. Data from these orthogonal experiments demonstrate that S:D614G and S:H655Y are convergent adaptations to the polybasic S1/S2 cleavage site which stabilize S1 on the virion in the open RBD conformation and act epistatically to promote the fitness of variants bearing complex combinations of clinically significant mutations.

Abstract Figure

Highlights

S:D614G is ubiquitous among SARS-CoV-2 B-lineage Spikes and is required for infectivity of the main Variants of Concern

In an example of convergent evolution, SARS-CoV-2 A lineage viruses maintained transmission chains in the absence of S:D614G, but were instead dependent upon S:Q613H or S:H655Y

S:D614G and S:H655Y are both adaptations to the polybasic S1/S2 cleavage site

Increased infectivity of S:D614G and S:H655Y is associated with a more open RBD conformation and increased steady-state levels of virion-associated S1
Expanding HIV Clinical Monitoring: The Role of CD4, CD8, and CD4/CD8 Ratio in Predicting Non-AIDS Events
Authors: Martínez-Sanz Javier , Álvarez Jorge Díaz , Rosas Marta , Ron Raquel , Iribarren José Antonio , Bernal Enrique , Gutiérrez Félix , García Federico , Cabello Noemi , Olalla Julián , Moreno Santiago , Serrano-Villar Sergio
Published: March 2023

Background

While a low CD4/CD8 ratio during HIV treatment correlates with immunosenescence, its value in identifying patients at an increased risk for clinical events remains unclear.

Methods

We analyzed data from the CoRIS cohort to determine whether CD4 count, CD8 count, and CD4/CD8 ratio at year two of antiretroviral therapy (ART) could predict the risk of serious non-AIDS events (SNAEs) during the next five years. These included major adverse cardiovascular events, non-AIDS-defining malignancies, and non-accidental deaths. We used pooled logistic regression with inverse probability weighting to estimate the survival curves and cumulative risk of clinical events.

Results

The study included 4625 participants, of whom 4.3% experienced an SNAE during the follow-up period. A CD4/CD8 ratio <0.3 predicted an increased risk of SNAEs during the next five years (OR 1.63, 95%CI 1.03-2.58). The effect was stronger at a CD4/CD8 ratio cut-off of <0.2 (OR 3.09, 95%CI 1.57-6.07). Additionally, low CD4 count at cut-offs of <500 cells/μL predicted an increased risk of clinical events. Among participants with a CD4 count ≥500 cells/μL, a CD8 count ≥1500 cells/μL or a CD4/CD8 ratio <0.4 predicted increased SNAE risk.

Conclusions

Our results support the use of the CD4/CD8 ratio and CD8 count as predictors of clinical progression. Patients with CD4/CD8 ratio <0.3 or CD8 count ≥1500/μL, regardless of their CD4 count, may benefit from closer monitoring and targeted preventive interventions.

This study found that a low CD4/CD8 ratio (<0.3) or a CD8 count ≥1500/μL after two years of antiretroviral therapy predicts an increased risk of serious non-AIDS events, regardless of CD4 count. These patients may benefit from closer follow-up.
darfix – data analysis for dark-field X-ray microscopy
Authors: Garriga Ferrer Júlia , Rodríguez-Lamas Raquel , Payno Henri , De Nolf Wout , Cook Phil , Solé Jover Vicente Armando , Yildirim Can , Detlefs Carsten
Published: March 2023

A Python package for the analysis of dark-field X-ray microscopy (DFXM) and rocking curve imaging (RCI) data is presented. DFXM is a non-destructive diffraction imaging technique that provides three-dimensional maps of lattice strain and orientation. The darfix package enables fast processing and visualization of these data, providing the user with the essential tools to extract information from the acquired images in a fast and intuitive manner. These data processing and visualization tools can be either imported as library components or accessed through a graphical user interface as an Orange add-on. In the latter case, the different analysis modules can be easily chained to define computational workflows. Operations on larger-than-memory image sets are supported through the implementation of online versions of the data processing algorithms, effectively trading performance for feasibility when the computing resources are limited. The software can automatically extract the relevant instrument angle settings from the input files' metadata. The currently available input file format is EDF and in future releases HDF5 will be incorporated.
Two new cases of polymorphism in diagonally substituted rubrene derivatives
Authors: Clapham Margaret L. , Douglas Christopher J.
Published: March 2023

The crystal structures of two rubrene derivatives, 5,11-diphenyl-6,12-bis[4-(trifluoromethyl)phenyl]tetracene, C44H26F6, and 5,11-bis(4-tert-butylphenyl)-6,12-diphenyltetracene, C50H44, are presented. Each are substituted on diagonal (5/11) phenyl rings. Each derivative has one polymorph reported previously. A discussion of the differences between each derivative and its previously reported polymorph is provided. The triclinic packing of the CF3-substituted structure is similar to the packing of the parent rubrene's triclinic polymorph. In the tert-butyl-substituted structure, a planar tetracene core formed, which has been hypothesized but never published. Crystallization conditions are provided as they differ from previous reports.
Revisiting the effects of renewable and non-renewable energy consumption on economic growth for eight countries: asymmetric panel quantile approach
Authors: Alqaralleh Huthaifa , Hatemi-J. Abdulnasser
Published: March 2023

Purpose

This study aims to investigate the dynamic relationship between renewable and non-renewable energy sources on the economic growth of eight countries, the capital stock and labour force being used as control variables in each case. Questions that need to be asked include the following: Is there is an asymmetric and, hence, a non-linear relationship between variables? If yes, how does economic growth interact with both renewable and non-renewable energy consumption (EC)? How different are these relationships in the countries highly rated in the performance of renewable EC compared to those lowly rated?

Design/methodology/approach

This paper uses asymmetric quantile-based methods to extract possible asymmetric and, hence, non-linear relationships between the underlying variables.

Findings

A newly developed asymmetric panel quantile approach suggests that EC has a significant effect on economic growth in both directions of shocks as well as for the considered sample. The results further support the findings in recent literature on renewable energy deployment, given the importance of renewable EC for economic growth with the increased levels of renewable EC, although the initial investments may have a negative effect on economic growth for some countries.

Originality/value

This study contributes to the literature in twofold. Firstly, it aims to contribute to the ongoing debate in literature by incorporating both renewable and non-renewable energy resources in the production function with labour and capital to test their asymmetric impact on economic growth. Secondly, this paper uses asymmetric quantile-based methods to extract possible asymmetric and, hence, non-linear relationships between the underlying variables. Another point that should be emphasised in this study is the need for studies analysing economic growth and EC for a sample of G20 countries based on a comparative view for the renewable and non-renewable EC in literature.
Consumers' (ir)responsible shopping during emergencies: drivers and concerns
Authors: Scarpi Daniele , Pantano Eleonora , Marikyan Davit
Published: March 2023

Purpose

During emergencies and times of widespread social fear, such as wars and epidemics, society witnesses many instances of consumer misbehaviour (e.g. panic buying). Therefore, this study aims to understand what drives consumers to enact socially irresponsible while shopping during emergencies.

Design/methodology/approach

This study employs a quantitative approach with 400 responses from consumers who shopped during the pandemic.

Findings

Results show a positive relationship between consumers' awareness of the negative social consequences of shopping misbehaviour and their ascription of responsibility, which is positively moderated by death-by-emergency-related anxiety. Ascription of responsibility, in turn, has a positive impact on socially responsible behaviour.

Originality/value

This research is the first to examine new applications of norm activation theory in retailing. Furthermore, this research is the first to extend the theory by examining psychological factors that may regulate socially irresponsible behaviour. The research demonstrates the significant role of anxiety and attachment in facilitating the impact of awareness of negative consequences and aspirations of responsibility in the retailing during emergencies.
Smart home devices and B2C e-commerce: a way to reduce failed deliveries
Authors: Seghezzi Arianna , Mangiaracina Riccardo
Published: March 2023

Purpose

Failed deliveries (i.e. deliveries not accomplished due to the absence of customers) represent a critical issue in B2C (Business-to-consumer) e-commerce last-mile deliveries, implying high costs for e-commerce players and negatively affecting customer satisfaction. A promising option to reduce them would be scheduling deliveries based on the probability to find customers at home. This work proposes a solution based on presence data (gathered through Internet of Things [IoT] devices) to organise the delivery tours, which aims to both minimise the travelled distance and maximise the probability to find customers at home.

Design/methodology/approach

The adopted methodology is a multi-method approach, based on interviews with practitioners. A model is developed and applied to Milan (Italy) to compare the performance of the proposed innovative solution with traditional home deliveries (both in terms of cost and delivery success rate).

Findings

The proposed solution implies a significant reduction of missed deliveries if compared to the traditional operating mode. Accordingly, even if allocating the customers to time windows based on their availability profiles (APs) entails an increase in the total travel time, the average delivery cost per parcel decreases.

Originality/value

On the academic side, this work proposes and evaluates an innovative last-mile delivery (LMD) solution that exploits new AI (Artificial Intelligence)-based technological trends. On the managerial side, it proposes an efficient and effective novel option for scheduling last-mile deliveries based on the use of smart home devices, which has a significant impact in reducing costs and increasing the service level.
A systematic review of customer behavior in business-to-business markets and agenda for future research
Authors: Bilro Ricardo Godinho , Loureiro Sandra Maria Correia , Souto Pedro
Published: March 2023

Purpose

The purpose of this paper is to offer a comprehensive overview of current research on customer behavior in the business-to-business (B2B) context and propose a research agenda for future studies. Despite being a relatively recent area of interest for academics and practitioners, a literature review that synthesizes existing knowledge into coherent topics and outlines a research agenda for future research is still lacking.

Design/methodology/approach

Drawing on a systematic literature review of 219 papers and using a text-mining approach based on the Latent Dirichlet Allocation algorithm, this paper enhances the existing knowledge of B2B customer behavior and provides a descriptive analysis of the literature.

Findings

From this review, ten major research topics are found and analyzed. These topics were analyzed through the lens of the Theory, Context, Characteristics and Method framework, providing a summary of key findings from prior studies. Additionally, an integrative framework was developed, offering insights into future research directions.

Originality/value

This study presents a novel contribution to the field of B2B by providing a systematic review of the topic of customer behavior, filling a gap in the literature and offering a valuable resource for scholars and managers seeking to advance the field.