bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic effect of cataract surgery with simultaneous intravitreal injection of aflibercept on diabetic macular edema: An observational study
Authors: Yen Chu-Yu , Yen Ju-Chuan , Chen Chun-Chen , Hu Hsiao-Yun , Cheng Feng-Shiang , Tseng Po-Chen
Published: August 2022

This study aimed to investigate the therapeutic effect of cataract surgery along with simultaneous intravitreal injection (IVI) of aflibercept on diabetic macular edema (DME). This cohort study enrolled 106 patients aged >40 years with type 2 diabetes mellitus and DME who received cataract surgery from January 1, 2016, to October 31, 2020. The baseline and mean data of the following parameters were collected: age, sex, glycated hemoglobin level, diabetic retinopathy (DR) grading, previous DR treatments including IVI of anti–vascular endothelial growth factor and pan-retinal photocoagulation, intraocular pressure, use of intraocular pressure-lowering medication, central subfield thickness (CST), and log MAR visual acuity (VA). Patients were categorized into 2 groups based on whether they received aflibercept IVI or not during cataract surgery and were compared using the t test and Fisher exact test for continuous and discrete variables, respectively. Beta coefficient and standard error were calculated using multiple linear regression analysis to identify the explanatory variables predictive of the net change of CST and log MAR VA. There was no difference in the net change in CST (15.24 ± 45.07 μm vs 18.62 ± 33.84 μm, P = .772) and log MAR VA (−0.27 ± 0.29 vs −0.37 ± 0.31, P = .215). Gender, glycated hemoglobin level, aflibercept IVI during cataract surgery, and baseline CST did not interfere with the morphological and functional outcomes of DME in cataract surgery. Older age was significantly and independently associated with a greater net change in log MAR VA. Proliferative DR was significantly and independently associated with a greater net change in CST and log MAR VA. A greater baseline log MAR VA was significantly and independently associated with lower net change in log MAR VA. Simultaneous aflibercept IVI for treating DME may not interfere with the functional and tomographic parameters of cataract surgery relative to cataract surgery alone. Factors influencing the outcomes of patients with DME undergoing cataract surgery are as follows: age, baseline DR staging, and baseline VA. Identifying these factors of DME preoperatively may be an important consideration in preventing it from progressing and for improving the overall visual prognosis.
Determination of etiology in patients admitted due to isolated leukopenia
Authors: Mart Gulay , Malkan Umit Y. , Buyukasik Yahya
Published: August 2022

Patients with isolated leukopenia pose difficulties in diagnosis because there is no related guideline in the literature. In this study, our aim was to evaluate the clinical and laboratory associations of isolated, nonspecific (not related to neutropenia) leukopenia.

In this retrospective data review study, patients who were admitted to Hacettepe University Hematology Outpatient Clinic between 2014 and 2019 due to leukopenia were evaluated. The patients with anemia (other than iron deficiency) or thrombocytopenia were excluded. Clinical and laboratory data and the final diagnoses (if present) of the remaining cases and especially of those without neutropenia (the most difficult group to diagnose) were evaluated.

One hundred sixty-nine patients were included in the study. One hundred forty-four (85.2%) patients were female and 25 (14.8%) were male. One hundred ten of them had 1500/µL or higher neutrophil count. In these nonneutropenic cases, the etiological factors contributing to leukopenia were as follows: iron deficiency anemia (21.8%), other autoimmune/autoinflammatory diseases (17.3%), autoimmune thyroid disease (21.8%), autoimmune laboratory tests (2.7%), drugs (12.7%), infection (5.5%), hematopoietic disorder (2.7%), hypersplenism (2.7%), radiotherapy sequel (1.8%), and B12 deficiency (1.8%). No etiology was recognized in 44 patients. On the other hand, the etiological factors in patients with neutrophil count <1500/µL were as follows; iron deficiency anemia (10.2%), other autoimmune/autoinflammatory diseases (17%), autoimmune thyroid disease (5.1%), autoimmune laboratory tests (8.5%), drugs (8.5%), infection (6.8%), hematopoietic disorder (11.9%), hypersplenism (1.7%), radiotherapy sequel (1.7%), and B12 deficiency (1.7%). No etiology was recognized in 25 patients. Physicians ordered bone marrow examination more frequently in patients with neutropenia. If isolated antinuclear antibody positivity was also considered in favor of autoimmunity, 91/169 (53.8%) cases had an autoimmune diagnosis or laboratory finding.

In the present study, the most frequent reasons of isolated leukopenia in nonneutropenic patients are found as iron deficiency anemia, other autoimmune/autoinflammatory diseases, and autoimmune thyroid disease. In neutropenic patients, the most frequent reasons of isolated leukopenia are found as iron deficiency anemia, autoimmune/autoinflammatory diseases, and hematopoietic disorders. Therefore, autoimmunity is detected as an important factor leading to isolated leukopenia.
Blood fibrinogen level as a biomarker of adverse outcomes in patients with coronary artery disease: A systematic review and meta-analysis
Authors: Cui Zhanqian , Zhao Guowei , Liu Xi
Published: August 2022

Background:

The association between elevated fibrinogen level and adverse outcomes in patients with coronary artery disease (CAD) remains conflicting. This systematic review and meta-analysis aims to evaluate the association between fibrinogen level and adverse outcomes in CAD patients.

Methods:

Relevant studies were identified by searching PubMed, Web of Science, and Embase databases from their inception to September 30, 2021. Observational studies that investigated the association of blood fibrinogen level with cardiovascular death, all-cause mortality, and major adverse cardiovascular events were eligible.

Results:

A total of 20,395 CAD patients from 15 articles (13 studies) were included. Comparison with the highest and the lowest fibrinogen level indicated that elevated fibrinogen level was associated with higher risk of cardiovascular death (risk ratio [RR] 2.24; 95% confidence interval [CI] 1.69–2.98), all-cause mortality (RR 1.88; 95% CI 1.50–2.36), and major adverse cardiovascular events (RR 1.46; 95% CI 1.18–1.81).

Conclusion:

Elevated fibrinogen level is significantly associated with an increased risk of cardiovascular and all-cause mortality in patients with CAD. Baseline fibrinogen level can serve as a promising biomarker for risk stratification of CAD.
Skin extension with a digito-lateral flap and early active finger extension training for Dupuytren contracture: A retrospective study
Authors: Yamaguchi Konosuke , Kaji Yoshio , Nakamura Osamu , Tobiume Sachiko , Nomura Yumi , Oka Kunihiko , Negayama Takahiro , Yamamoto Tetsuji
Published: August 2022

In the surgical management of Dupuytren contracture (DC), Y-V plasty (YV) and Z-plasty (ZP) are techniques often used for skin extension. However, achieving sufficient skin extension with these procedures alone is often difficult. Therefore, we addressed this issue with an adjunctive digito-lateral flap (DLF) and report the clinical results of the surgery using a DLF in addition to YV and ZP. Fifteen patients with DC (15 affected fingers) underwent partial fasciectomy using a DLF in addition to YV or ZP, and early active finger extension training was performed immediately after the operation. The flap survival rate, preoperative and postoperative extension angle, Tonkin contracture improvement (TCI) rate, and Tubiana staging grades were evaluated. The contracture sites were at 4 proximal interphalangeal (PIP) and 3 metacarpophalangeal (MP) joints of the little finger and 4 PIP and MP joints each of the ring and little fingers. All the flaps survived, and the extension angle improved at the final observation from a preoperative mean of −45° to −3° and −55° to 5° for the PIP and MP joints, respectively. One patient with PIP joint contracture treated in the early stage of the study experienced a persistent 5° limitation of extension, even though the TCI rate was satisfactory (91.9%) and the outcome was “good.” Full extension of the joints was achieved in 15 patients, in whom the TCI rate was 100% and the outcome was “very good.” This technique was able to solve 3 important steps to achieve full extension: intraoperatively, wound closure, and rehabilitation. We attained and maintained long-term full extension intraoperatively and immediately after surgery and obtained very good treatment results, as shown in this study. In conclusion, highly favorable clinical outcomes were achieved through the combination of a DLF with YV and ZP. Skin extension with a DLF is a useful surgical technique for DC.
Irritable bowel syndrome and its associated factors among Jordanian medical students: A cross-sectional study
Authors: Jadallah Khaled A. , Khatatbeh Moawiah M. , Sarsak Enas W. , Sweidan Aroob N. , Alzubi Bara F.
Published: August 2022

Very scarce studies investigated the prevalence of irritable bowel syndrome (IBS) and its correlates in the Middle East, particularly in college students. We aimed to investigate the prevalence of IBS and its associated factors among Jordanian medical students. We conducted a cross-sectional study at 2 medical facilities in northern Jordan. We recruited 1135 medical students. Participants completed an anonymous questionnaire addressing sociodemographic, lifestyle, and clinical characteristics. An interview questionnaire was used to diagnose IBS according to the Rome III criteria. Comorbid anxiety and depression were diagnosed by using the Hospital Anxiety and Depression Scale. Of the 1135 completed questionnaires, 1094 (94%) had complete data. The prevalence of IBS in our sample was 30.9%. Binary logistic regression analysis of factors associated with IBS indicated having a family history of IBS as a strong predictor of the disease (odds ratio [OR]: 8.09; 95% confidence interval [CI]: 5.84–11.19). Students in the second and third years of their study had ORs of approximately 4 (95% CI: 2.20–6.54) and 3 (95% CI: 1.70–5.30) for suffering from IBS, respectively, compared with those in the first year (P = .001). Increased anxiety score (OR: 1.88; 95% CI: 1.30–2.71), poor sleep quality (OR: 1.76; 95% CI: 1.13–2.76), female sex (OR: 1.59; 95% CI: 1.14–2.20), and living in a school dormitory (OR: 1.35; 95% CI: 1.00–1.84) were significantly associated with IBS (P < .05). IBS is a highly prevalent disorder among Jordanian medical students, with several factors associated with its occurrence.
Gender differences in repeat-year experience, clinical clerkship performance, and related examinations in Japanese medical students
Authors: Komasawa Nobuyasu , Terasaki Fumio , Kawata Ryo , Nakano Takashi
Published: August 2022

While the number of female medical students is increasing in Japan, gender differences in medical school performance have not been studied extensively. This study aimed to compare gender differences in repeat-year experience, Clinical Clerkship (CC) performance, and related examinations in Japanese medical students. We retrospectively analyzed the number of repeat-year students and years to graduation for male and female medical students, and assessed gender differences in performance on computer-based testing (CBT) before CC, CC as evaluated by clinical teachers, the CC integrative test, and the graduation examination in 2018-2020 graduates from our medical school. Subgroup analyses excluding repeat-year students were also performed. From 2018 to 2020, 328 medical students graduated from our medical school. There were significantly fewer repeat-year female students compared to male students (P = .010), and the average number of years to graduate was significantly higher for male students than female students (P < .001). Female students showed higher scores and performance in all integrative tests and CC (P < .05, each). In analysis excluding repeat-year students, there were no significant gender difference in performance on the CBT, and CC integrative test, although female students significantly outperformed male students on the CC and graduation examination. Female medical students had a fewer number of repeat-years and performed better in the CC and graduation examination compared to their male counterparts.
Sudden arrhythmia in the prone position during spinal surgery: A case report
Authors: Kim Ji Hyun , Kim Sora , Yu Taeyoung , Yang Woo Seok , Hong Seong Wook
Published: August 2022

Rationale:

The prone position is the most commonly required position during spinal surgery. Decreasing lumbar lordosis is necessary to facilitate the accessibility of the surgical field. And this can affect the hemodynamic circulation of the patients. The Jackson spine table is one of the most preferred methods, known to have minimal effects on cardiac function.

Patient concerns:

We report a case of sudden arrhythmia that developed during the prone position using a Jackson spine table. It occurred 30 minutes after the positional change.

Diagnoses:

Arrhythmia showed bizarre P and QRS waves. Ectopic P, bundle branch block, or both was suspected.

Interventions:

Because it was difficult to define the exact type or cause of this sudden arrhythmia and considering that other vital signs remained stable, we decided to keep close observation during the operation rather than applying uncertain antiarrhythmic medication.

Outcomes:

Arrhythmia spontaneously developed and subsided repeatedly. And it recovered to normal sinus rhythm immediately after the positional change to the supine position. Therefore, increased intrathoracic pressure caused by the prone position was highly suspected to be the cause of this event.

Lessons:

Although the Jackson spine table is known to have the least effect on cardiac function, the patient experienced arrhythmia in our case. Hence, to achieve better clinical outcomes, an understanding of physiological alterations and possible complications caused by the prone position is necessary for earlier diagnosis and management.
National trends in prevalence, awareness, treatment, and control of hypertension among adults in Mongolia from 4 cross-sectional surveys in 2005, 2009, 2013, and 2019
Authors: Pengpid Supa , Peltzer Karl
Published: August 2022

This study aimed to analyze trends in the prevalence, awareness, treatment, and control of hypertension and associated factors in persons 15 years and older from 2005 to 2019 in Mongolia.

National data were analyzed from 21,342 people (≥15 years) who participated in 4 cross-sectional STEPwise Approach to NCD Risk Factor Surveillance surveys in Mongolia (2005, 2009, 2013, or 2019) and had complete blood pressure measurements. The prevalence, awareness, treatment, and control of hypertension were calculated using sociodemographic factors within each study year. Logistic regression was employed to assess the associations between sociodemographic and health factors and status of hypertension, awareness, treatment, and control by study year and pooled sample.

Trend analyzes showed that the prevalence of hypertension decreased significantly from 28.4% in 2005 to 23.2% in 2019 (P < .001). The prevalence of awareness among hypertensives remained unchanged, the treatment among aware decreased, and the control rate increased. In adjusted logistic regression analysis with the pooled sample, male sex (adjusted odds ratio [AOR]: 1.49, 95% confidence intervals [CI]: 1.32–1.68), older age (≥45 years) (AOR: 5.90, 95% CI: 4.90–7.10), obesity (AOR: 4.29, 95% CI: 3.77–4.88), more frequent alcohol use (≥1–2 days/week) (AOR: 1.69, 95% CI: 1.39–2.05) were positively, and higher educational level (≥12 years) (AOR: 0.77, 95% CI: 0.68–0.87) and urban residence (AOR: 0.84, 95% CI: 0.74–0.97) were negatively associated with hypertension prevalence.

The prevalence of hypertension among Mongolian adults has decreased in recent years. Levels of hypertension awareness were unchanged, treatment decreased, and control increased. Increased health promotion, detection, and treatment of hypertension in Mongolia are indicated.
Bilateral paranasal sinus fungal balls: A retrospective cohort study in 28 patients over a 21-year period
Authors: Kim Jong Seung , Kwon Sam Hyun , Kim Jung Soo , Heo Sung Jae
Published: August 2022

Paranasal fungal balls are rare entities for which a recent increase in reported cases has been observed. Fungal balls are most commonly unilateral, and there are few bilateral cases in the literature. Here we report the clinical features of bilateral fungal balls in 24 patients treated in our institution over the past 20 years.

In this retrospective study, we reviewed the medical records of 5279 patients who underwent endoscopic sinus surgery performed by a single surgeon from January 1996 to December 2016 at a tertiary care center in order to identify patients diagnosed with fungal balls confirmed histopathologically. Demographic data and radiologic findings of patients with bilateral fungal balls were compared with those who had unilateral fungal balls. Multiple logistic regression test was used to compare demographic information between patients with unilateral and bilateral fungal balls.

The most commonly involved sinus in bilateral cases was maxillary (87.5%), followed by ethmoid (37.5%) and sphenoid (33.3%). Of the 24 patients, 19 were female, and patient age ranged from 45 to 83 years, with an average of 65.1 years. Common existing comorbidities were hypertension (45.8%), diabetes (29.2%), cardiac problem (16.7%), cerebral infarction (8.3%), pulmonary tuberculosis (8.3%), and lung cancer (4.2%).

The clinically relevant features of patients diagnosed with bilateral fungal balls from our review include advanced age and immunocompromised status compared to those with unilateral fungal balls. These features contribute to the clinical distinction of bilateral fungal ball disease from unilateral fungal balls and invasive fungal sinusitis.
Telemedicine in pediatric cardiology: pros and cons
Authors: Preminger Tamar J.
Published: August 2022

Purpose of review

The aim of this article is to review recent uses of telemedicine in pediatric cardiology, highlighting merits, challenges, and future directions.

Recent findings

The COVID-19 pandemic accelerated telemedicine use, which has had a positive impact with respect to providers, patients, and their caregivers. Recent data have demonstrated the feasibility and effectiveness of telemedicine through expediting needed care and reducing healthcare utilization, including unnecessary emergency department visits, transports, and hospitalizations. With increasing complexity of cardiac care, telecardiology allows for establishing a medical home, improving access, and continuity of care. Great potential also exists for telecardiology to permit more consistent preventive care, possibly resulting in improved health equity, reduced morbidity and mortality, and associated costs. Challenges to optimal implementation of telecardiology, which are all surmountable, include the currently unaccounted additional workload and administrative burden, licensing restrictions, disparities in access to care, insurance reimbursement, and potential fraud and abuse.

Telecardiology allows for efficient, quality, effective, collaborative care and is foundational to creating innovative, high-value care models. Through integration with accelerating technology and in-person visits, a sustainable hybrid model of optimal care can be achieved. Addressing barriers to progress in telecardiology is critical.
Clinical Debriefing in Cardiology Teams
Authors: Laurens Acevedo Michelle , Diaz-Navarro Cristina , Leon-Castelao Esther , Pérez Ortega Silvia , Bañeras Rius Jordi
Published: August 2022

Background:

Clinical debriefing (CD) improves patient safety and builds team resilience.

Purpose:

We describe the current use of CD by multiprofessional Spanish cardiology team members.

Methods:

A self-administered survey exploring 31 items was disseminated online in October 2020. A comparison was made between respondents that who experience in CD with inexperienced respondents. Inferential analysis was done using Pearson's χ2 test.

Results:

Out of 167 valid responses, 45.5% had been completed by cardiology nurses. One-third of the respondents had experience in CD. Most common situations preceding CD were those with negative outcomes (81.8%). Time constraint was the most commonly reported barrier (76.3%); however, it was significantly less than the expectation of inexperienced respondents (92%, P < .01). Overall, only 28.2% reported self-confidence in their skills to lead a CD.

Conclusions:

There is a necessity in Spanish cardiology teams to receive training in CD and embed it in their daily practice.
Effects of Implementing an Acuity Tool on a Psychiatric Intensive Care Unit
Authors: Kucera Patricia , Kingston Eileen , Ferguson Tysa , Jenkins Katie , Fogarty Melissa , Sayles Harlan , Cohen Marlene Z.
Published: August 2022

Background:

Staff shortages, reduced budgets, and high acuity of violent psychiatric patients can create challenges in psychiatric intensive care units (PICUs).

Local Problem:

Staffing of the psychiatric unit was based on patient census rather than evidence-based practices.

Methods:

A pre-/postintervention design was used to examine changes in nursing satisfaction and patient outcomes as measured with the National Database of Nursing Quality Indicators (NDNQI) survey results.

Interventions:

A psychiatric specific acuity tool was implemented on the PICU of a Veterans Administration hospital.

Results:

After an initial decrease related to the COVID-19 pandemic, total acuity and the total number of nurses remained relatively stable while the unit census declined. NDNQI survey results improved with the largest being a 52-percentile increase for the quality-of-care summary measure.

Conclusions:

An acuity tool can help standardize practice, determine fair patient assignments among staff, increase nurse satisfaction, and promote best practices for patient safety.
The Spanish and Italian Healthcare Professionals’ Contribution to the Safety Attitudes Questionnaire Short Form in the Operating Room: Construct Validity and Reliability
Authors: Bernalte-Martí Vicente
Published: August 2022

Objectives

The aims of the study are to determine the construct validity and reliability of the Spanish and Italian versions of the Safety Attitudes Questionnaire Short Form and to study the capability of this scale of distinguishing between different countries, types of healthcare professionals, and attitudes around patient safety.

Method

This was a cross-sectional study of the scale among registered nurses, surgeons, and anesthetists providing direct patient care at surgical inpatient units within public health services in Spain (Sistema Nacional de Salud) and Italy (Servizio Sanitario Nazionale). Construct validity, in both countries, was firstly assessed by exploratory factor analysis. Then, a confirmatory factor analysis was conducted, and finally an assessment was performed by means of hypothesis testing. The reliability of the scale was calculated using Cronbach α coefficient.

Results

A total of 499 healthcare professionals completed the questionnaire (Spain, n = 183; Italy, n = 316). The questionnaire showed excellent internal consistency (α = 0.85). An exploratory factor analysis identified a new factor model of the scale. The confirmatory factor analysis performed on this new model reflected the fair dimensionality of the construct (χ2 = 1193.63, root mean square error of approximation < 0.05, standardized root mean square residual < 0.08; nonnormed fit index, comparative fit index, incremental fit index, and goodness of fit index values = 0.90, indicating a good fit).

Conclusions

This study provides scientific evidence of the construct validity and reliability of the Safety Attitudes Questionnaire Short Form in both Spain and Italy, showing the capability of this scale of distinguishing between different countries, types of healthcare professionals, and attitudes around patient safety.
Early Prediction of All-Cause Clinical Deterioration in General Wards Patients: Development and Validation of a Biomarker-Based Machine Learning Model Derived From Rapid Response Team Activations
Authors: Saab Antoine , Abi Khalil Cynthia , Jammal Mouin , Saikali Melody , Lamy Jean-Baptiste
Published: August 2022

Objective

The aim of the study is to evaluate the performance of a biomarker-based machine learning (ML) model (not including vital signs) derived from reviewed rapid response team (RRT) activations in predicting all-cause deterioration in general wards patients.

Design

This is a retrospective single-institution study. All consecutive adult patients’ cases on noncritical wards identified by RRT calls occurring at least 24 hours after patient admission, between April 2018 and June 2020, were included. The cases were reviewed and labeled for clinical deterioration by a multidisciplinary expert consensus panel. A supervised learning approach was adopted based on a set of biomarkers and demographic data available in the patient’s electronic medical record (EMR).

Setting

The setting is a 250-bed tertiary university hospital with a basic EMR, with adult (>18 y) patients on general wards.

Patients

The study analyzed the cases of 514 patients for which the RRT was activated. Rapid response teams were extracted from the hospital telephone log data. Two hundred eighteen clinical deterioration cases were identified in these patients after expert chart review and complemented by 146 “nonevent” cases to build the training and validation data set.

Interventions

None

Measurements and Main Results

The best performance was achieved with the random forests algorithm, with a maximal area under the receiver operating curve of 0.90 and F
1 score of 0.85 obtained at prediction time T
0–6h, slightly decreasing but still acceptable (area under the receiver operating curve, >0.8; F
1 score, >0.75) at T
0–42h. The system outperformed most classical track-and-trigger systems both in terms of prediction performance and prediction horizon.

Conclusions

In hospitals with a basic EMR, a biomarker-based ML model could be used to predict clinical deterioration in general wards patients earlier than classical track-and-trigger systems, thus enabling appropriate clinical interventions for patient safety and improved outcomes.
Addressing Patient Safety Hazards Using Critical Incident Reporting in Hospitals: A Systematic Review
Authors: Goekcimen Ken , Schwendimann René , Pfeiffer Yvonne , Mohr Giulia , Jaeger Christoph , Mueller Simon
Published: August 2022

Introduction

Critical incident reporting systems (CIRS) are in use worldwide. They are designed to improve patient care by detecting and analyzing critical and adverse patient events and by taking corrective actions to prevent reoccurrence. Critical incident reporting systems have recently been criticized for their lack of effectiveness in achieving actual patient safety improvements. However, no overview yet exists of the reported incidents’ characteristics, their communication within institutions, or actions taken either to correct them or to prevent their recurrence. Our main goals were to systematically describe the reported CIRS events and to assess the actions taken and their learning effects. In this systematic review of studies based on CIRS data, we analyzed the main types of critical incidents (CIs), the severity of their consequences, their contributing factors, and any reported corrective actions.

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we queried MEDLINE, Embase, CINAHL, and Scopus for publications on hospital-based CIRS. We classified the consequences of the incidents according to the National Coordinating Council for Medication Error Reporting and Prevention index, the contributing factors according to the Yorkshire Contributory Factors Framework and the Human Factors Classification Framework, and all corrective actions taken according to an action hierarchy model on intervention strengths.

Results

We reviewed 41 studies, which covered 479,483 CI reports from 212 hospitals in 17 countries. The most frequent type of incident was medication related (28.8%); the most frequent contributing factor was labeled “active failure” within health care provision (26.1%). Of all professions, nurses submitted the largest percentage (83.7%) of CI reports. Actions taken to prevent future CIs were described in 15 studies (36.6%). Overall, the analyzed studies varied considerably regarding methodology and focus.

Conclusions

This review of studies from hospital-based CIRS provides an overview of reported CIs’ contributing factors, characteristics, and consequences, as well as of the actions taken to prevent their recurrence. Because only 1 in 3 studies reported on corrective actions within the healthcare facilities, more emphasis on such actions and learnings from CIRS is required. However, incomplete or fragmented reporting and communication cycles may additionally limit the potential value of CIRS. To make a CIRS a useful tool for improving patient safety, the focus must be put on its strength of providing new qualitative insights in unknown hazards and also on the development of tools to facilitate nomenclature and management CIRS events, including corrective actions in a more standardized manner.
Risk factors for pneumococcal carriage in adults living with HIV on antiretroviral therapy in the infant pneumococcal vaccine era in Malawi
Authors: Thindwa Deus , Mwalukomo Thandie S. , Msefula Jacquline , Jambo Kondwani C. , Brown Comfort , Kamng’ona Arox , Mwansambo Charles , Ojal John , Flasche Stefan , French Neil , Heyderman Robert S. , Swarthout Todd D.
Published: August 2022

Objective:

Adults living with HIV (ALWHIV) on antiretroviral therapy (ART) are at high risk of pneumococcal carriage and disease. To help evaluate carriage risk in African ALWHIV at least 4 years after infant pneumococcal conjugate vaccination introduction in 2011, we assessed association between pneumococcal carriage and potential risk factors.

Methods:

Nasopharyngeal swabs were collected from adults aged 18–40 years attending an ART clinic during rolling, cross-sectional surveys in Blantyre, Malawi between 2015 and 2019. We fitted generalized additive models to estimate the risk of sex, social economic status (SES), living with a child less than 5 years, and ART duration on carriage.

Results:

Of 2067 adults, median age was 33 years (range 28–37), 1427 (69.0%) were women, 1087 (61.4%) were in low–middle socioeconomic-status (SES), 910 (44.0%) were living with a child less than 5 years, and median ART duration was 3 years (range 0.004–17). We estimated 38.2 and 60.6% reductions in overall and vaccine-serotype carriage prevalence. Overall carriage was associated with low SES, living with a child less than 5 years and shorter duration on ART. By contrast, vaccine-type carriage was associated with living without a child less than 5 years and male sex.

Conclusion:

Despite temporal reductions in overall and vaccine-serotype carriage, there is evidence of incomplete vaccine-serotype indirect protection. A targeted-vaccination campaign should be considered for ALWHIV, along with other public health measures to further reduce vaccine-serotype carriage and therefore disease.
With the Increasing Health Awareness: Clinical and Computed Tomography Findings in Primary Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma Lymphoma
Authors: Xie Xiaodong , Dong Min , Zhang Lei , Ding Deqin , Huang Xing , Shen Wenrong , Zhou Zhengyang
Published: August 2022

Objective

The objective of this study is to investigate the clinical manifestations, computed tomography (CT) findings, and prognosis of primary pulmonary mucosa-associated lymphoid tissue lymphoma (MALToma) with the improved health awareness nowadays.

Methods

Clinical data and CT images of patients with pathologically confirmed MALToma from October 2012 to October 2021 were retrospectively analyzed.

Results

Eighteen MALToma patients were included in the study (8 men and 10 women; mean age, 56.17 years; range, 33–73 years). Six men had a long-term history of smoking (>20 years). One patient had an autoimmune disease (Sjögren syndrome). Eight patients (44.44%) were asymptomatic, and 10 (55.56%) had mild chest or systemic symptoms. Most lesions (88.89%) were subpleural or located along the bronchovascular tree. According to the CT characteristics, the lesions were divided into 4 groups: nodular type (n = 8; 44.44%, including 5 solid nodules and 3 ground-glass nodules), mass type (n = 4, 22.22%), patch or consolidate type (n = 5, 27.78%), and mixed type (n = 1, 5.56%). Air bronchogram (11/18, 61.11%) and angiogram sign (8/16, 50%) were the most frequent CT findings and may help differential diagnosis. The patients were misdiagnosed with lung cancer (n = 11, 61.11%), inflammatory or chronic inflammatory disease (n = 4, 22.22%), bronchiectasis accompanied by infection (n = 1, 5.56%), diffuse interstitial lung disease (n = 1, 5.56%), and granuloma or tuberculosis (n = 1, 5.56%). The prognosis of all patients was favorable; 1 patient was lost to follow-up.

Conclusions

Nowadays, patients with MALToma are usually asymptomatic or paucisymptomatic. Nodular lesions, including ground-glass nodules, are the most common presentation. Mucosa-associated lymphoid tissue lymphoma is most likely misdiagnosed as lung cancer. Lesions located in the subpleural areas or along the bronchovascular tree and presenting with an air bronchogram or angiogram sign could indicate a MALToma diagnosis.
Congenital Midline Cervical Cleft (CMCC): Z-Plasty Versus Linear Cutaneous Repair
Authors: Moreno Stephen D. , Christopher Patrick , Kloostra Paul
Published: August 2022

Congenital midline cervical cleft (CMCC) is a rare congenital difference. Accurate diagnosis is important to ensure appropriate treatment. CMCC results in both functional and esthetic concerns addressed by surgical management. While the majority of reported CMCC cases have been treated with a z-plasty, the best method of repair has been debated in the literature. The authors present a case of CMCC and review of the literature.
PLATELET FUNCTION IN TRAUMA: IS CURRENT TECHNOLOGY IN FUNCTION TESTING MISSING THE MARK IN INJURED PATIENTS?
Authors: Schriner Jacob B. , George Mitchell J. , Cardenas Jessica C. , Olson Scott D. , Mankiewicz Kimberly A. , Cox Charles S. , Gill Brijesh S. , Wade Charles E.
Published: August 2022

Platelets are subcellular anucleate components of blood primarily responsible for initiating and maintaining hemostasis. After injury to a blood vessel, platelets can be activated via several pathways, resulting in changed shape, adherence to the injury site, aggregation to form a plug, degranulation to initiate activation in other nearby platelets, and acceleration of thrombin formation to convert fibrinogen to fibrin before contracting to strengthen the clot. Platelet function assays use agonists to induce and measure one or more of these processes to identify alterations in platelet function that increase the likelihood of bleeding or thrombotic events. In severe trauma, these assays have revealed that platelet dysfunction is strongly associated with poor clinical outcomes. However, to date, the mechanism(s) causing clinically significant platelet dysfunction remain poorly understood. We review the pros, cons, and evidence for use of many of the popular assays in trauma, discuss limitations of their use in this patient population, and present approaches that can be taken to develop improved functional assays capable of elucidating mechanisms of trauma-induced platelet dysfunction. Platelet dysfunction in trauma has been associated with need for transfusions and mortality; however, most of the current platelet function assays were not designed for evaluating trauma patients, and there are limited data regarding their use in this population. New or improved functional assays will help define the mechanisms by which platelet dysfunction occurs, as well as help optimize future treatment.
Aestuariicella albida sp. nov., isolated from surface water of the Yellow Sea, and proposal of the genus Aestuariicella as a member of the family Cellvibrionaceae
Authors: Xue Hua-Peng , Li Jia-Yu , Zhang Dao-Feng , Zhang Ai Hua , Huang Jian-Ke , Liu Chuang , Zhao Zhe
Published: August 2022

A Gram-stain-negative, non-motile and aerobic bacterium, designated HHU G3-2T, was isolated from surface water of the Yellow Sea, PR China. Strain HHU G3-2T was positive for oxidase activity and negative for catalase. Optimal growth occurred at 28 °C (range, 20–37 °C), pH 7.0 (range, pH 6.0–9.0) and in the presence of 2–5 % (w/v) NaCl (range, 1–7%). Phylogenetic analysis based on 16S rRNA gene sequences and 120 ubiquitous single-copy protein-coding genes indicated that strain HHU G3-2T formed a distinct phylogenetic lineage with

Aestuariicella hydrocarbonica

JCM 30134T, sharing a 16S rRNA gene sequence similarity of 98.05%. Average nucleotide identity and digital DNA–DNA hybridization values between strain HHU G3-2T and

A. hydrocarbonica

JCM 30134T were 75.74 and 17.80%, respectively, which were below the threshold values of 95–96 and 70 %, respectively. The DNA G+C content of the genomic DNA was 51.17 mol%. The major fatty acids (>10 %) were C17 : 1
ω8c (19.8 %), summed feature 3 (C16 : 1
ω7c/C16 : 1
ω6c; 15.9 %), summed feature 8 (C18 : 1
ω7c/C18 : 1
ω6c; 13.8 %) and C17 : 0 (10.3 %). The predominant isoprenoid quinone was ubiquinone-8. The polar lipid profile consisted of diphosphatidylglycerol, phosphatidylethanolamine and phosphatidylglycerol. Based on the polyphasic taxonomic data, strain HHU G3-2T represents a novel species of the genus

Aestuariicella

, for which the name Aestuariicella albida sp. nov. is proposed. The type strain is HHU G3-2T (=MCCC 1K04224T=JCM 34652T=GDMCC 1.2418T=CGMCC 1.17397T). In addition, we proposed the genus

Aestuariicella

as a member of the family

Cellvibrionaceae

.
Production of quorum sensing-related metabolites and phytoalexins during Pseudomonas aeruginosa–Brassica napus interaction
Authors: Cook Jamie , Hui Joseph P. M. , Zhang Janie , Kember Michaela , Berrué Fabrice , Zhang Junzeng , Cheng Zhenyu
Published: August 2022

Pseudomonas aeruginosa is an opportunistic bacterial pathogen that has been shown to interact with many organisms throughout the domains of life, including plants. How this broad-host-range bacterium interacts with each of its diverse hosts, especially the metabolites that mediate these interactions, is not completely known. In this work, we used a liquid culture root infection system to collect plant and bacterial metabolites on days 1, 3 and 5 post-P. aeruginosa (strain PA14) infection of the oilseed plant, canola (Brassica napus). Using MS-based metabolomics approaches, we identified the overproduction of quorum sensing (QS)-related (both signalling molecules and regulated products) metabolites by P. aeruginosa while interacting with canola plants. However, the P. aeruginosa infection induced the production of several phytoalexins, which is a part of the hallmark plant defence response to microbes. The QS system of PA14 appears to only mediate part of the canola–P. aeruginosa metabolomic interactions, as the use of isogenic mutant strains of each of the three QS signalling branches did not significantly affect the induction of the phytoalexin brassilexin, while induction of spirobrassinin was significantly decreased. Interestingly, a treatment of purified QS molecules in the absence of bacteria was not able to induce any phytoalexin production, suggesting that active bacterial colonization is required for eliciting phytoalexin production. Furthermore, we identified that brassilexin, the only commercially available phytoalexin that was detected in this study, demonstrated a MIC of 400 µg ml−1 against P. aeruginosa PA14. The production of phytoalexins can be an effective component of canola innate immunity to keep potential infections by the opportunistic pathogen P. aeruginosa at bay.
Study Protocol for a Research and Development Project: Optimizing a Unified Parent Training Intervention to Prevent Child Mental Health Problems and Neglect
Authors: Tømmerås Truls , Backer-Grøndahl Agathe , Arnesen Anne , Apeland Anett , Laland Hanne , Askeland Elisabeth , Kjøbli John , Idsøe Thormod , Grønlie Anette Arnesen , Begõna Gomez Maria , Aakre Karlsson Line Ragna , Dyrkoren Elise , Torsvik Sissel , Høstmælingen Andreas , Amlund-Hagen Kristine , Forgatch Marion , Fisher Phillip Andrew
Published: August 2022

This protocol describes a research and development (R&D) project aimed at optimizing a targeted, preventive, efficacious, and tailored intervention called Supportive Parents – Coping Kids (SPARCK). Combining recent developments in basic and intervention research, the goal of this project is to develop, test and optimize a unified parent training intervention targeting children who display externalizing and internalizing symptoms and parents who are at risk of exhibiting maladaptive or neglectful parenting behaviors. We plan to utilize various design-based research methodologies to investigate what works for whom in which context, points which are essential to the innovation process, by employing a mixed methods research design and an iterative optimization process of testing and refinement. Furthermore, we introduce a cocreation process for SPARCK to involve relevant stakeholders working in Norwegian frontline services for children and their families to ensure that the intervention adheres to the needs and constraints encountered by these stakeholders and thereby promote the scalability and sustainable implementation of SPARCK. In this paper, we present the theoretical and methodological background of this approach to R&D in the field of mental health prevention as well as the operationalization of innovative methodology in the current project. This R&D approach aims to produce new knowledge concerning individual change mechanisms in parent training interventions and stakeholder feedback pertaining to intervention components and implementation strategies, all of which are imperative for the iterative SPARCK design process.
A conserved HOTAIRM1-HOXA1 regulatory axis coordinates early neuronal differentiation
Authors: Segal Dana , Coulombe Samy , Sim Jasper , Dostie Josée
Published: August 2022

HOTAIRM1 is unlike most long non-coding RNAs in that its sequence is highly conserved across mammals. Such evolutionary conservation points to it having a role in key cellular processes. We previously reported that HOTAIRM1 is required to curb premature activation of downstream HOXA genes in a cell model recapitulating their sequential induction during development. We found that it regulates 3’ HOXA gene expression by a mechanism involving epigenetic and three-dimensional chromatin changes. Here we show that HOTAIRM1 is required for proper progression through the early stages of neuronal differentiation. We found that it associates with the HOXA1 transcription factor and participates in its downstream transcriptional program. Particularly, HOTAIRM1 affects the NANOG/POU5F1/SOX2 core pluripotency network maintaining an undifferentiated cell state. HOXA1 depletion similarly perturbed expression of these pluripotent factors, suggesting that HOTAIRM1 is a modulator of this transcription factor pathway. Also, given that binding of HOTAIRM1 to HOXA1 was observed in different cell types and species, our results point to this ribonucleoprotein complex as an integral part of a conserved HOTAIRM1-HOXA1 regulatory axis controlling the transition from a pluripotent to a differentiated neuronal state.
Mathematical Modeling Of Systems Biology
Authors: Gupta Aaditya Prasad
Published: August 2022

A modeling is a mathematical tool, like a microscope, which allows consequences to logically follow from a set of assumptions by which a real world problem can be described by a mathematical formulation. It has become indispensable tools for integrating and interpreting heterogeneous biological data, validating hypothesis and identifying potential diagnostic markers. The modern molecular biology that is characterized by experiments that reveal the behaviours of entire molecular systems is called systems biology. A fundamental step in synthetic biology and systems biology is to derive appropriate mathematical model for the purposes of analysis and design. This manuscript has been engaged in the use of mathematical modeling in the Gene Regulatory System (GRN). Different mathematical models that are inspired in gene regulatory network such as Central dogma, Hill function, Gillespie algorithm, Oscillating gene network and Deterministic vs Stochastic modelings are discussed along with their codes that are programmed in Python using different modules. Here, we underlined that the model should describes the continuous nature of the biochemical processes and reflect the non-linearity. It is also found that the stochastic model is far better than deterministic model to calculate future event exactly with low chance of error.
Epistasis lowers the genetic barrier to SARS-CoV-2 neutralizing antibody escape
Authors: Witte Leander , Baharani Viren , Schmidt Fabian , Wang Zijun , Cho Alice , Raspe Raphael , Guzman-Cardozo Maria C. , Muecksch Frauke , Gaebler Christian , Caskey Marina , Nussenzweig Michel C. , Hatziioannou Theodora , Bieniasz Paul D.
Published: August 2022

Consecutive waves of SARS-CoV-2 infection have been driven in part by the repeated emergence of variants with mutations that confer resistance to neutralizing antibodies Nevertheless, prolonged or repeated antigen exposure generates diverse memory B-cells that can produce affinity matured receptor binding domain (RBD)-specific antibodies that likely contribute to ongoing protection against severe disease. To determine how SARS-CoV-2 omicron variants might escape these broadly neutralizing antibodies, we subjected chimeric viruses encoding spike proteins from ancestral, BA.1 or BA.2 variants to selection pressure by a collection of 40 broadly neutralizing antibodies from individuals with various SARS-CoV-2 antigen exposures. Notably, pre-existing substitutions in the BA.1 and BA.2 spikes facilitated acquisition of resistance to many broadly neutralizing antibodies. Specifically, selection experiments identified numerous RBD substitutions that did not confer resistance to broadly neutralizing antibodies in the context of the ancestral Wuhan-Hu-1 spike sequence, but did so in the context of BA.1 and BA.2. A subset of these substitutions corresponds to those that have appeared in several BA.2 daughter lineages that have recently emerged, such as BA.5. By including as few as 2 or 3 of these additional changes in the context of BA.5, we generated spike proteins that were resistant to nearly all of the 40 broadly neutralizing antibodies and were poorly neutralized by plasma from most individuals. The emergence of omicron variants has therefore not only allowed SARS-CoV-2 escape from previously elicited neutralizing antibodies but also lowered the genetic barrier to the acquisition of resistance to the subset of antibodies that remained effective against early omicron variants.