bluuebunny/crossref_metadata_2025 huggingface dataset:
Physicians are over optimistic in recognizing inpatients’ survival and palliative care needs: a large-scale multi-center study in Taiwan
Authors: Huang C -M , Huang S -J , Wu T -Y , Chen Y -C , Hsiao S -H , Chu D
Published: October 2023

Background

Physicians’ recognition of end of life (EOL) has key influences on patients’ ‘good death’.

Aim

We aimed to study physicians’ attitude toward EOL, and to analyze the relationship between physicians’ assessment and patients’ actual survival and the trigger effect on patient’s access to palliative consultation and palliative care.

Design

This is a multi-center retrospective cohort study in seven community hospitals in Taiwan.

Methods

Inpatients admitted between 1 March 2016 and 31 December 2020, scored ≥4 points using Taiwan version-Palliative Care Screening Tool (TW-PCST), and expired before 31 December 2020 were enrolled. Physicians answered three questions regarding these inpatients: ‘surprised of mortality within 6–12 months’, ‘EOL’ and ‘in need of palliative care’. We followed up patients’ actual survival and access to palliative consultation and services.

Results

We enrolled 10 304 cases. There was high correlation among the three questions. The median survival of patients with ‘not surprised of death within 6–12 months’, ‘EOL’, and ‘needing palliative care’ were 68, 60 and 58 days, respectively. Those with opposite responses were 206, 166 and 186 days, respectively. Patients’ main diagnosis, TW-PCST score, physicians’ palliative care qualifications and reward measures were all associated with physicians’ recognition of EOL. Physicians’ assessment, physicians’ training, disease characteristics and TW-PSCT scores were all associated with palliative consultation and palliative care.

Conclusions

Physicians are still over optimistic in recognizing inpatients’ survival and palliative care needs. EOL talks can be initiated when the TW-PCST score is high. Universal palliative care training can be integrated into medical education.
Parental autoimmunity and offspring risks of rheumatic diseases: a nationwide population-based study
Authors: Shao Yu-Hsuan Joni , Chen Yi-Ming
Published: October 2023

Objective

Familial aggregation of systemic autoimmune diseases is frequently reported, but little is known about how fathers and mothers differentially contribute to the development of autoimmune diseases in their offspring. This study aimed to investigate the impact of maternal and paternal autoimmunity on the risk of offspring rheumatic diseases.

Methods

We constructed a nationwide population-based cohort using data from the Maternal and Child Health Database and the Taiwan National Health Insurance Research Data (NHIRD) from 2004 to 2019. The outcome was presence of an autoimmune disease in the offspring. Inverse probability of treatment–weighted Cox models were used to estimate adjusted hazard ratios (aHRs) and 95% CIs for autoimmune diseases.

Results

Babies born to a father or mother with an autoimmune disease had, respectively, 1.22 times and 1.38 times the risk of developing an autoimmune disease compared with their counterparts with no parental autoimmune diseases. Maternal autoimmunity substantially contributed to the risk of SLE (aHR = 5.46, 95% CI: 5.28–5.66), and paternal autoimmunity contributed to the risk of JIA (aHR = 1.76, 95% CI: 1.71–1.81) and of type 1 diabetes mellitus (aHR = 1.59, 95% CI: 1.39–1.81) in their offspring. The contributions of mothers to the risk of development of SLE (aHR = 8.55, 95% CI: 8.10–9.02) and inflammatory myopathy (aHR = 2.08, 95% CI: 1.72–2.51) in their offspring were exacerbated in boys. Babies of two parents with an autoimmune disease showed a 1.39-fold risk of developing an autoimmune disease. The maternal contribution effect was stronger for preterm births than for full-term births.

Conclusion

This study demonstrated broadly how autoimmune diseases pass from parents to infants of both genders and separately quantified the maternal and paternal contributions to disease.
Role of independent research at AERB for ensuring safety of nuclear facilities in India
Authors: Mohapatra Dinakrushna
Published: October 2023

The mission of Atomic Energy Regulatory Board (AERB) of India is to ensure that the use of ionising radiation and nuclear energy in India does not cause unacceptable impact on the workers, members of the public and to the environment. AERB has the mandate to carry out detailed safety review for the siting, construction, commissioning, operation and decommissioning of nuclear and radiation facilities established within the country. To deliver and maintain a strong, credible and technically sound regulation, AERB has established the Safety Research Institute (SRI) at Kalpakkam with a robust technical infrastructure and wide knowledge base. This paper highlights the independent safety research activities carried out at SRI and its role to support and facilitate the decision-making process by AERB at various stages of regulatory review for ensuring safety of the nuclear facilities in India.
Mettl3 induced miR‐338‐3p expression in dendritic cells promotes antigen‐specific Th17 cell response via regulation of Dusp16
Authors: Wei Yankai , Yang Chao , Liu Yuling , Sun Deming , Li Xiaorong , Wei Ruihua , Nian Hong
Published: October 2023

Pathogenic Th17 cells are critical drivers of multiple autoimmune diseases, including uveitis and its animal model, experimental autoimmune uveitis (EAU). However, how innate immune signals modulate pathogenic Th17 responses remains largely unknown. Here, we showed that miR‐338‐3p endowed dendritic cells (DCs) with an increased ability to activate interphotoreceptor retinoid‐binding protein (IRBP)1–20‐specific Th17 cells by promoting the production of IL‐6, IL‐1β, and IL‐23. In vivo administration of LV‐miR‐338‐infected DCs promoted pathogenic Th17 responses and exacerbated EAU development. Mechanistically, dual‐specificity phosphatase 16 (Dusp16) was a molecular target of miR‐338‐3p. miR‐338‐3p repressed Dusp16 and therefore strengthened the mitogen‐activated protein kinase (MAPK) p38 signaling, resulting in increased production of Th17‐polarizing cytokines and subsequent pathogenic Th17 responses. In addition, methyltransferase like 3 (Mettl3), a key m6A methyltransferase, mediated the upregulation of miR‐338‐3p in activated DCs. Together, our findings identify a vital role for Mettl3/miR‐338‐3p/Dusp16/p38 signaling in DCs‐driven pathogenic Th17 responses and suggest a potential therapeutic avenue for uveitis and other Th17 cell‐related autoimmune disorders.
Moderate asthma: burden, mechanisms and therapeutic perspectives
Authors: De Ferrari Laura , Riccio Anna Maria , Braido Fulvio
Published: October 2023

Purpose of review

Global Initiative for Asthma (GINA) document provides a classification of asthma severity according with the current level of treatment required to achieve diseases control and underlines the limitations of this approach. In this review, we will provide an overview of recent investigations that have analyzed clinical and molecular features of moderate asthma.

Recent findings

Moderate asthma is heterogeneous in terms of response to inhaled treatment and pathogenetic mechanisms underlying the clinical features. Analysis of inflammatory pathways in patients who do not achieve disease remission allows identification of patient subgroups that may benefit from specific biological treatments.

Scientific progress makes increasingly clear that there are biological mechanisms capable of identifying and justifying the degree of severity of asthma. The identification of these, combined with the development of new pharmacological treatments, will be the cornerstones of improving the management of asthma in its degrees of severity.
Anal Monkeypox Disease: Description of 65 Cases
Authors: Le Vavasseur Benjamin , Bendaoud Sihem , Taieb Sarah , Heym Beate , Dahlouk Saliha Ysmael , Leclerc Eloise , Metaye Antonin , Bessanguem Bernard , Bourguignon Josée , Taouk Milad , Gabarre Anne , Marot Stéphane , Tepper Sarah , Lidove Olivier , Etienney Isabelle
Published: October 2023

BACKGROUND:

Monkeypox is a zoonosis endemic in Africa caused by three orthopoxvirus clades. Knowledge of the disease is limited, but a worldwide outbreak declared in April 2022 involving a new route of transmission.

OBJECTIVE:

This study aimed to describe anal symptoms and outcomes in patients suffering from Monkeypox infection attending an emergency proctology unit in Paris.

DESIGN:

This was an observational study

SETTING:

We reported anal symptoms of all consecutive patients with monkeypox anal infection in a single proctology center between 6/16/2022 and7/262022. Association with sexually transmitted infections (STI) and outcome were also recorded.

PATIENTS:

Sixty-five men aged 39.6 [19.9-64.6] years with confirmed monkeypox anal infection

MAIN OUTCOME MEASURES:

Anal symptoms and their severity were clinically assessed. A favorable outcome consisted in a complete resolution of clinical manifestation.

RESULTS:

Sexual transmission was reported in 51 (78.4%) patients among whom 63 (97%) were men who have sex with men. Twenty-eight (43%) were living with HIV, and 24 (36.9%) were taking tenofovir/emtricitabine for HIV pre-exposure prophylaxis. Anal symptoms appeared first in 36 (55.4%) patients and skin rash or other general symptoms in 22 (33.8%). Incubation time was 6.9 [1-26] days. Symptoms included painful perianal (n = 42 patients, 64.6%), anal (n = 28, 43%) and rectal (n = 25, 38.4%) ulcerations and perianal vesicles (n = 24, 36.9%). Proctitis was observed in 49 (75.4%) patients. It was mild in 20 (40.8%) and intense in 29 (59.2%), and severe proctitis mimicking high intersphincteric suppuration in 4 (8.2%). Fifteen (23.1%) patients had concurrent STI and 3 were hospitalized. Complete symptom resolution occurred within 12 days.

LIMITATIONS:

We performed a single-center study during a short period of time.

CONCLUSION:

Proctological symptoms are frequent in the current outbreak of monkeypox disease, probably linked to route of transmission. Rectal ulcerations mimicking high intersphincteric suppuration should be recognized to avoid unnecessary surgery..
Effects of virtual reality on psychophysical measures of pain: superiority to imagination and nonimmersive conditions
Authors: Tesarz Jonas , Herpel Christopher , Meischner Meike , Drusko Armin , Friederich Hans-Christoph , Flor Herta , Reichert Julian
Published: October 2023

Virtual reality (VR) has been shown to be effective in pain management. However, to date, little is known about the mechanisms by which immersive experiences influence pain processing. The aim of this study was to investigate the direct effects of an immersive VR environment on the perception of experimental pain in individuals with chronic pain and pain-free controls. The immersion in a VR landscape was compared with mental imagery and a nonimmersive control condition. Using a randomized within-crossover design, pressure pain detection and tolerance thresholds, spatial and temporal summation (SSP, TSP), and conditioned pain modulation (CPM) were measured in 28 individuals with chronic pain and 31 pain-free controls using phasic cuff pressure on the legs. Direct comparison between the groups showed that although individuals with pain had significantly lower pain thresholds, reduced CPM effects, and increased TSP, the VR condition had the same pain-inhibitory effect on pain thresholds as in pain-free controls. Conditioned pain modulation effects were reduced by all conditions compared with baseline. There were no significant differences between conditions and baseline for TSP and SSP. Overall, pain modulatory effects were largest for VR and smallest for imagery. These results demonstrate that immersion in a VR environment has an increasing effect on pain thresholds, reduces pain inhibition in a CPM paradigm, and has no effects on TSP. This applies for participants with chronic pain and pain-free controls. These VR effects exceeded the effects of mental imagery on the nonimmersive control condition. This indicates that VR effectively modulates pain perception in both patients and controls irrespective of differences in pain perception.
Reliability of quantitative sensory testing in the assessment of somatosensory function after high-frequency stimulation–induced sensitisation of central nociceptive pathways
Authors: Fawsitt-Jones Harriet , Vollert Jan , O'Daly Owen , Williams Steven C.R. , McMahon Stephen B. , Howard Matthew A. , Hughes Sam W.
Published: October 2023

The high frequency stimulation (HFS) model can be used alongside quantitative sensory testing (QST) to assess the sensitisation of central nociceptive pathways. However, the validity and between-session reliability of using QST z-score profiles to measure changes in mechanical and thermal afferent pathways in the HFS model are poorly understood. In this study, 32 healthy participants underwent QST before and after HFS (5× 100 Hz trains; 10× electrical detection threshold) in the same heterotopic skin area across 2 repeated sessions. The only mechanical QST z-score profiles that demonstrated a consistent gain of function across repeated test sessions were mechanical pain threshold (MPT) and mechanical pain sensitivity (MPS), which were associated with moderate and good reliability, respectively. There was no relationship between HFS intensity and MPT and MPS z-score profiles. There was no change in low intensity, but a consistent facilitation of high-intensity pin prick stimuli in the mechanical stimulus response function across repeated test sessions. There was no change in cold pain threshold (CPT) and heat pain threshold (HPT) z-score profiles across session 1 and 2, which were associated with moderate and good reliability, respectively. There were inconsistent changes in the sensitivity to innocuous thermal QST parameters, with cool detection threshold (CDT), warm detection threshold (WDT), and thermal sensory limen (TSL) all producing poor reliability. These data suggest that HFS-induced changes in MPS z-score profiles is a reliable way to assess experimentally induced central sensitisation and associated secondary mechanical hyperalgesia in healthy participants.
Addressing the Elephant in the Room: Perceptions and Treatment of Underrepresented in Medicine Physician Assistants/Associate Educators
Authors: Drumgold Michelle J. , Brown Sheena D. , Frizell Carl A. , Stewart-Clark Skylar , Sturges Daytheon
Published: October 2023

On Thursday, June 27, 2023, the US Supreme Court struck down race-conscious admission practices in higher education. While other demographic factors, such as the traditional Health Resources and Services Administration-disadvantaged background indicators, can be considered during the holistic admission process, explicit consideration based on race and/or ethnicity is prohibited. As a result, physician assistant/associate (PA) programs are tasked with developing novel ways to address equity, diversity, and inclusion during the admission and hiring processes. As Drumgold et al note, closing the PA workforce diversity gap is necessary to achieve health equity. Despite this, PA programs consistently struggle to attract and retain underrepresented in medicine (URiM) faculty, staff, and students. The latest PA Education Association Student Report indicates that more than 75% of applicants consider faculty and student body diversity when applying to programs. As such, addressing disparities in the recruitment, promotion, evaluation, and retention of URiM faculty is paramount. Here, the authors outline ongoing recruitment and retention challenges for URiM faculty along with institutional recommendations to ensure URiM PA faculty success and engagement.
Accreditation Outcomes: Does Program Director Experience Matter?
Authors: Snyder Jennifer , Quincy Brenda , Brown Darwin , Asprey David
Published: October 2023

Purpose

The program director (PD) is responsible for providing effective leadership and possessing knowledge of accreditation. The aim of this study was to evaluate whether a PD's experience in higher education affects the accreditation outcome.

Methods

This cross-sectional study includes Physician Assistant (PA) programs that underwent an accreditation visit between January 2012 and January 2022. Data analysis was primarily descriptive, stratified by demographic variables, and outcomes of accreditation standards. Inferential analysis included chi-squared tests of statistical independence.

Results

The chi-squared analysis test of statistical independence of PD's experience and accreditation decision identified a statistically significant association between the PD's experience as a PD and the accreditation outcome for continuing reviews. However, a minimum of 3 years of experience in higher education and the accreditation outcome were statistically independent for provisional and continuing reviews.

Conclusion

Few PDs are hired with more than 3 years of PD experience, but they tend to have more higher education or PA program educational experience. A PD's years of higher education experience was not associated with accreditation outcome, which may suggest that other supports are more critical for achieving and maintaining accreditation.
Can Willingness to Breastfeed Be an Opportunity for Smoking Pregnant Women to Quit Smoking?
Authors: Tiryaki Öznur , Menekşe Dilek , Çınar Nursan
Published: October 2023

Purpose:

Smoking during pregnancy and/or not breastfeeding have considerable negative health outcomes for the mother and infant. This descriptive and cross-sectional study determined the relationship between the prediction of smoking cessation success in pregnant women and their breastfeeding attrition prediction during lactation. The other aim of the study was to determine the predictor of smoking cessation success and the factors affecting breastfeeding attrition prediction.

Methods:

The present study was conducted with 131 smoking pregnant women. Data were collected using the Personal Information Form, the Smoking Cessation Success Prediction Scale, and the Breastfeeding Attrition Prediction Tool.

Results:

A statistically significant and positive correlation was revealed between the Smoking Cessation Success Prediction Scale and the positive breastfeeding attitude (r = 0.349, P < .01). Of the change in positive breastfeeding attitudes, 14.7% was explained by the prediction of smoking cessation success (adjusted R
2 = 0.147).

Conclusion:

The study revealed that the prediction of smoking cessation success increased with an increase in the positive breastfeeding attitude of smoking pregnant women.
The Salivary Microbiome During Pregnancy
Authors: Koerner Rebecca , Prescott Stephanie , McSkimming Daniel , Alman Amy , Duffy Allyson , Groer Maureen
Published: October 2023

Purpose:

Poor oral health has been associated with adverse pregnancy outcomes, and the oral microbiome may play a role in these mechanisms. We aimed to examine the salivary microbiome for alterations in diversity or relative abundance throughout pregnancy and its associations with adverse pregnancy outcomes and sociodemographic characteristics.

Study Design and Methods:

We conducted an ancillary study from a previous cohort study of 37 women during their second and third trimesters of pregnancy using preexisting, participant-collected salivary samples to examine the oral microbiome using 16S rRNA sequencing.

Results:

The salivary microbiome demonstrated stability throughout pregnancy, as there were no significant differences in alpha or beta diversity. Individuals who were diagnosed with preeclampsia had differences in beta diversity at the genus level (F = 2.65, df = 1, P = .015). There were also differences in beta diversity at the species level in Hispanic individuals compared with non-Hispanic individuals (F = 1.7183, df = 1, P = .04).

Conclusion:

The salivary microbiome demonstrated stability throughout the second and third trimesters but may be different in Hispanics or those diagnosed with preeclampsia. As such, clinical providers need to demonstrate culturally competent care during pregnancy and continue to educate women about the importance of oral healthcare during the perinatal period. Future research is needed to examine the mechanisms associated with oral microbiome dysbiosis in Hispanic women during pregnancy and in women with preeclampsia.
Psychosocial Factors and Parent-Infant Bonding
Authors: Ngai Fei-Wan , Xie Yao Jie
Published: October 2023

Background:

Parent-infant bonding plays a significant role in promoting the psychosocial well-being of the child. This study aimed to examine the relationships between family sense of coherence, marital satisfaction, depressive symptoms, and parent-infant bonding among Chinese parents at 6 weeks postpartum.

Methods:

A secondary data analysis was conducted of an intervention study for postnatal depression. The participants were Chinese parents recruited from public hospitals. Family sense of coherence, marital satisfaction, depressive symptoms, and parent-infant bonding were measured using the Family Sense of Coherence Scale, the Dyadic Adjustment Scale, the Edinburgh Postnatal Depression Scale, and the Postpartum Bonding Questionnaire, respectively. Path analysis was performed on data collected from the control group (n = 211) at 6 weeks postpartum.

Results:

Less impairment of mother-infant bonding at 6 weeks postpartum was found among mothers who had a stronger family sense of coherence and lower levels of depressive symptoms. Less impairment of father-infant bonding at 6 weeks postpartum was found among fathers who had greater marital satisfaction and family sense of coherence and fewer depressive symptoms. The mothers' levels of family sense of coherence, marital satisfaction, and parent-infant bonding were closely related to those of their partners.

Conclusion:

The study highlights the importance of developing culturally appropriate interventions that focus on strengthening family sense of coherence, enhancing marital satisfaction, and reducing depressive symptoms in both parents to promote the quality of parent-infant bonding at early postpartum.
Pericarotid Fat Stranding at Computed Tomography Angiography: A Marker of the Short-Term Prognosis of Acute Ischemic Stroke
Authors: Liu Ying , Zhao Yinan , Guo Zhongping , Li Mengshuang , Shan Hangsheng , Zhang Yonggang , Miao Chongchang , Gu Yan
Published: October 2023

Purpose

Perivascular epicardial fat stranding detected in the coronary computed tomography (CT) angiography is associated with culprit lesions and provides helpful information on the risk of acute coronary syndrome. This study aimed to evaluate the potential clinical significance of pericarotid fat stranding (PCFS) and investigate the association between PCFS and short-term prognosis in acute stroke using head and neck CT angiography (CTA).

Methods

This study included 80 patients (mean age, 69.69 ± 11.03; 58 men) who underwent both head and neck CTA and magnetic resonance imaging within a 1-week period. Baseline characteristics, pericarotid adipose tissue attenuation, plaque characteristics, ischemic penumbra, infarct core volume, infarct core growth rate (CGR), and the grade of collateral status were recorded and compared between a PCFS group and a non-PCFS group. Data were compared using the 2-sample t test, Mann-Whitney U test, Fisher exact test, and Spearman rank correlation analysis.

Results

We found that patients with PCFS had a significantly higher pericarotid adipose tissue density than patients without PCFS (−55.75 ± 5.53 vs −65.82 ± 9.65, P < 0.001). Patients with PCFS showed a larger infarct core volume (166.43 ± 73.07 vs 91.43 ± 55.03, P = 0.001) and faster CGR (39.57 ± 12.01 vs 19.83 ± 32.77; P < 0.001), and the frequency of adverse prognosis was more significant than in control participants (83.33% vs 19.11%).

Conclusions

Individuals with PCFS showed higher CGR, which was substantially related to worse outcomes in patients with acute stroke with ipsilateral carotid atherosclerosis. Recognition of PCFS may help predict stroke prognosis and allow doctors to take early action to improve patient prognosis.
INTRACOLON COOLING INCREASES SURVIVAL RATE IN THE RAT MODEL OF LETHAL HEMORRHAGE
Authors: Arya Awadhesh K. , Hu Kurt , Chen Alice , Olivas-Garcia Yamileck , Coyne Christopher , Tanaka Hideaki , Liu Chunli , Doucet Jay , Chan Theodore , Hu Bingren
Published: October 2023

Background: The objective of this study was to investigate whether transrectal intracolon (TRIC) cooling can prolong the survival duration in a rat hemorrhagic shock (HS) model. Methods: A lethal HS was induced by bleeding 47% of the total blood volume. A TRIC device was placed into the colon to maintain the intracolon temperature either at 37°C (TRIC37) or at 10°C (TRIC10) post-HS. In the surface cooling (SC) rats, the body temperatures were maintained at the same level as the esophageal temperature of the TRIC10 rats. A separated group of TRIC10 rats were resuscitated (Res) at 90 min post-HS. A total of six groups were as follows: (i) Sham TRIC37 (n = 5), (ii) Sham TRIC10 (n = 5), (iii) HS TRIC37 (n = 5), (iv) HS TRIC10 (n = 6), (v) HS SC (n = 6), and (vi) HS TRIC10 + Res (n = 6). Results: An average post-HS survival time was 18.4 ± 9.4 min in HS TRIC37 and 82 ± 27.82 min in the HS SC group. In striking contrast, the HS TRIC10 group exhibited an average survival time of 150.2 ± 66.43 min. The post-HS blood potassium level rose significantly in the HS TRIC37 and HS SC, whereas it remained unchanged in the TRIC10 groups. Post-HS intestinal damage occurred in HS TRIC37 and HS SC groups but virtually absent in HS TRIC10 groups. After resuscitation at 90 min post-HS, all HS TRIC10 rats were fully recovered from the lethal HS. Conclusions: TRIC10 reversed the high blood potassium level, prevented the intestinal damage, and prolonged the survival duration by sixfold relative to normothermia and by twofold compared with SC post-HS. All TRIC10 rats were successfully resuscitated at 90 min post-HS.
C-Type Lectin-2D Receptor Contributes to Histone-Induced Vascular Barrier Dysfunction During Burn Injury
Authors: Yang Xiaoyuan , Zheng Ethan , Sun Xiaoqi , Reynolds Amanda , Gonzalez Monica , Hernandez Villamil Juan , Pando Briana D. , Smith David J. , Yuan Sarah Y. , Wu Mack H.
Published: October 2023

Severe burns are associated with massive tissue destruction and cell death where nucleus histones and other damage-associated molecular patterns are released into the circulation and contribute to the pathogenesis of multiple organ dysfunction. Currently, there is limited information regarding the pathophysiology of extracellular histones following burns, and the mechanisms underlying histone-induced vascular injury are not fully understood. In this study, by comparing the blood samples from healthy donors and burn patients, we confirmed that burn injury promoted the release of extracellular histones into the circulation, evidenced by increased plasma levels of histones correlating with injury severity. The direct effects of extracellular histones on human endothelial monolayers were examined and the results showed that histones caused cell-cell adherens junction discontinuity and barrier dysfunction in a dose-related manner. Like burn patients, mice subjected to a scald burn covering 25% total body surface area also displayed significantly increased plasma histones. Intravital microscopic analysis of mouse mesenteric microcirculation indicated that treatment with a histone antibody greatly attenuated burn-indued plasma leakage in postcapillary venules, supporting the pathogenic role of extracellular histones in the development of microvascular barrier dysfunction during burns. At the molecular level, intrigued by the recent discovery of C-type lectin domain family 2 member D (Clec2d) as a novel receptor of histones, we tested its potential involvement in the histone interaction with endothelial cells. Indeed, we identified abundant expression of Clec2d in vascular endothelial cells. Further proximity ligation assay demonstrated a close association between extracellular histones and endothelial expressing Clec2d. Functionally,in vivoadministration of an anti-Clec2d antibody attenuated burn-induced plasma leakage across mesenteric microvessels. Consistently, Clec2d knockdown in endothelial cells partially inhibited histone-induced endothelial barrier dysfunction. Together, our data suggest that burn injury-induced increases in circulating histones contribute to microvascular leakage and endothelial barrier dysfunction via a mechanism involving the endothelial Clec2d receptor.
Hemorrhagic Shock Assessed by Tissue Microcirculatory Monitoring: A Narrative Review
Authors: Yao Zixuan , Chen Yuansen , Li Duo , Li Yongnan , Liu Yanqing , Fan Haojun
Published: October 2023

Hemorrhagic shock (HS) is a common complication after traumatic injury. Early identification of HS can reduce patients’ risk of death. Currently, the identification of HS relies on macrocirculation indicators such as systolic blood pressure and heart rate, which are easily affected by the body's compensatory functions. Recently, the independence of the body's overall macrocirculation from microcirculation has been demonstrated, and microcirculation indicators have been widely used in the evaluation of HS. In this study, we reviewed the progress of research in the literature on the use of microcirculation metrics to monitor shock. We analyzed the strengths and weaknesses of each metric and found that microcirculation monitoring could not only indicate changes in tissue perfusion before changes in macrocirculation occurred but also correct tissue perfusion and cell oxygenation after the macrocirculation index returned to normal following fluid resuscitation, which is conducive to the early prediction and prognosis of HS. However, microcirculation monitoring is greatly affected by individual differences and environmental factors. Therefore, the current limitations of microcirculation assessments mean that they should be incorporated as part of an overall assessment of HS patients. Future research should explore how to better combine microcirculation and macrocirculation monitoring for the early identification and prognosis of HS patients.
Mobile health follow-up screening to risk stratify patients in need of further care in a low resource setting: Results from a prospective multisite implementation study
Authors: Christie S. Ariane , Mbianyor Mbiarikai , Oke Rasheedat , Dissak-Delon Fanny , Yakue Florentine , Essomba Frank , Mbuh Golda , Yost Mark , Dicker Rochelle , Chichom-Mefire Alain , Juillard Catherine
Published: October 2023

BACKGROUND

Routine in-person follow-up for injured patients after hospital discharge is unfeasible in low- and middle-income countries where trauma morbidity and mortality are the highest. Mobile technology screening may facilitate early detection of complications and timely treatment. In this prospective, multisite implementation study, we cross-validate the performance of a cellphone screening tool developed to risk stratify trauma patients in need of further care after discharge in Cameroon.

METHODS

Between June 2019 and August 2022, research assistants contacted trauma patients by cellphone 2 weeks after discharge to administer a 14-question follow-up survey. All surveyed patients were asked to return for a physical examination. Physicians blinded to survey results categorized patients as low or moderate or high risk (HR) for poor outcomes without further care. Logistic regression tested associations between each survey question and physician examination. Predictive survey questions generated a preliminary model with high sensitivity for identifying patients in need of further care.

RESULTS

Of 1,712 successfully contacted patient households, 96% (1643) participated in telephone triage compared with 33% (560) who returned for physician examination. Physicians designated 39% (220) as being HR. On multiple logistic regression, 8 of 13 candidate triage questions were independently associated with HR. Positive survey response on the resultant eight question screen yielded 89.2% sensitivity for HR with a 10.8% false negative rate. Weighted for variable importance based on triage risk scores, 39% of triaged patients screened as low risk, 39% as moderate risk, and 22% as high risk for HR. Likelihood of HR was significantly greater for patients screening as high (odds ratio, 5.9) or moderate risk (odds ratio, 1.9; both p < 0.01).

CONCLUSION

Cellphone triage provides sensitive risk stratification of patients in need of further care after hospital discharge in Cameroon. Given low in-person return rates, limited resources should highly prioritize efforts to repatriate patients screening as high risk for poor outcomes.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.
Effects of prior injury on long term patient reported outcomes after trauma
Authors: Beyer Carl A. , Hatchimonji Justin S. , Candido Katelyn , Chreiman Kristen , Martin Niels , Cannon Jeremy W. , Reilly Patrick M. , Kaufman Elinore J. , Seamon Mark J.
Published: October 2023

BACKGROUND

Trauma is an episodic, chronic disease with substantial, long-term physical, psychological, emotional, and social impacts. However, the effect of recurrent trauma on these long-term outcomes remains unknown. We hypothesized that trauma patients with a history of prior traumatic injury (PTI) would have poorer outcomes 6 months (6mo) after injury compared with patients without PTI.

METHODS

Adult trauma patients admitted at an urban, academic, Level I trauma center were screened for inclusion (October 2020 to November 2021). Enrolled patients were administered the PROMIS-29 instrument, the primary care post-traumatic stress disorder screen, and standardized questions about prior trauma hospitalization, substance use, employment, and living situation at baseline and 6mo after injury. Assessment data was merged with clinical registry data, and outcomes were compared with respect to PTI.

RESULTS

Of 3,794 eligible patients, 456 completed baseline assessments and 92 completed 6mo surveys. Between those with or without PTI, there were no differences at 6mo after injury in the proportion of patients reporting poor function in social participation, anxiety, depression, fatigue, pain interference, or sleep disturbance. Prior traumatic injury patients reported poor physical function less often than patients without PTI (10 [27.0%] vs. 33 [60.0%], p = 0.002). After controlling for age, gender, race, injury mechanism, and Injury Severity Score, PTI correlated with a fourfold decrease in poor physical function risk (adjusted odds ratio, 0.243; 95% confidence interval, 0.081–0.733; p = 0.012) in the multivariable logistic regression model.

CONCLUSION

Compared with patients suffering their first injury, trauma patients with PTI have better self-reported physical function after a subsequent injury and otherwise equivalent outcomes across a range of HRQoL domains at 6mo. There remains substantial room for improvement to mitigate the long-term challenges faced by trauma patients and to facilitate their societal reintegration, regardless of the number of times they are injured.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.
Finding the bleeding edge: 24-hour mortality by unit of blood product transfused in combat casualties from 2002–2020
Authors: Gurney Jennifer M. , Staudt Amanda M. , Holcomb John B. , Martin Matthew , Spinella Phil , Corley Jason B. , Rohrer Andrew J. , Trevino Jennifer D. , del Junco Deborah J. , Cap Andrew , Schreiber Martin
Published: October 2023

BACKGROUND

Transfusion studies in civilian trauma patients have tried to identify a general futility threshold. We hypothesized that in combat settings there is no general threshold where blood product transfusion becomes unbeneficial to survival in hemorrhaging patients. We sought to assess the relationship between the number of units of blood products transfused and 24-hour mortality in combat casualties.

METHODS

A retrospective analysis of the Department of Defense Trauma Registry supplemented with data from the Armed Forces Medical Examiner. Combat casualties who received at least one unit of blood product at US military medical treatment facilities (MTFs) in combat settings (2002–2020) were included. The main intervention was the total units of any blood product transfused, which was measured from the point of injury until 24 hours after admission from the first deployed MTF. The primary outcome was discharge status (alive, dead) at 24 hours from time of injury.

RESULTS

Of 11,746 patients included, the median age was 24 years, and most patients were male (94.2%) with penetrating injury (84.7%). The median injury severity score was 17 and 783 (6.7%) patients died by 24 hours. Median units of blood products transfused was 8. Most blood products transfused were red blood cells (50.2%), followed by plasma (41.1%), platelets (5.5%), and whole blood (3.2%). Among the 10 patients who received the most units of blood product (164 units to 290 units), 7 survived to 24 hours. The maximum amount of total blood products transfused to a patient who survived was 276 units. Of the 58 patients who received over 100 units of blood product, 20.7% died by 24 hours.

CONCLUSION

While civilian trauma studies suggest the possibility of futility with ultra-massive transfusion, we report that the majority (79.3%) of combat casualties who received transfusions greater than 100 units survived to 24 hours. These results do not support a threshold for futility of blood product transfusion. Further analysis as to predictors for mortality will help in situations of blood product and resource constraints.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
Assessment of ethynylestradiol-3-sulfate on coagulation, metabolism, and survival in pigs with traumatic hemorrhage
Authors: Martini Wenjun Z. , Xia Hui , Le Tuan D. , Cap Andrew P.
Published: October 2023

BACKGROUND

The beneficial effects of estrogens on survival from hemorrhage have been suggested in some preclinical models. This study investigated the effects of ethynylestradiol-3-sulfate (EE-3-S) on coagulation, metabolism and survival in pigs following traumatic hemorrhage.

METHODS

Twenty-six pigs were randomized into: normal saline group (NS, n = 10), EE-3-S group (EE-3, n = 11) groups, and no resuscitation group (NR, n = 5). Femur fracture was performed in each pig's left leg, followed by hemorrhage of 55% of estimated blood volume and a 10-minute shock period. Afterward, pigs were resuscitated with a small volume of either NS alone (4 mL/kg) or EE-3-S with NS (1 mL/kg at concentration of 1 mg/mL, plus NS solution of 3 mL/kg). Pigs in NR group were not resuscitated with any fluid. All pigs were then monitored for 6 hours or until death, with hemodynamics and survival times recorded. Blood samples were taken during the study for measurements of oxygen metabolism (oxygen delivery, extraction, and consumption) and coagulation function (using Rotem with Extem reagents).

RESULTS

All baseline measurements were similar among the three groups. In the NS group, femur fracture and hemorrhage immediately reduced mean arterial pressure (MAP, 74 ± 3 mm Hg to 44 ± 4 mm Hg) and increased heart rate (97 ± 5 bpm to 218 ± 14 bpm, both p < 0.05). Similar changes in MAP and heart rate were observed in the EE-3 and NR groups. There were no differences observed in changes of Rotem® measurements or oxygen metabolism among the groups during the study. At 6 hours, four pigs in NS, four pigs in EE-3-S, and two pigs in the NR group survived to the end of the study. The mean survival times were similar among the NS (212 ± 43 minutes), EE-3 (212 ± 39 minutes), and NR (223 ± 63 minutes) groups (p = 0.9845).

CONCLUSION

Following severe traumatic hemorrhage, hypotensive resuscitation with EE-3-S did not impact coagulation, metabolism, or survival in pigs.
How often are male mosquitoes attracted to humans?
Authors: Paris Véronique , Hardy Christopher , Hoffmann Ary A. , Ross Perran A.
Published: October 2023

Many mosquito species live close to humans where females feed on human blood. While male mosquitoes do not feed on blood, it has long been recognized that males of some species can be attracted to human hosts. To investigate the frequency of male mosquito attraction to humans, we conducted a literature review and human-baited field trials, as well as laboratory experiments involving males and females of three commonAedesspecies. Our literature review indicated that male attraction to humans is limited to a small number of species, includingAe. aegyptiandAe. albopictus. In our human-baited field collections, only 4 out of 13 species captured included males. In laboratory experiments, we found that maleAe. notoscriptusandAe. vigilaxshowed no attraction to humans, while maleAe. aegyptiexhibited persistent attraction for up to 30 min. Both male and femaleAe. aegyptidisplayed similar preferences for different human subjects, suggesting that maleAe. aegyptirespond to similar cues as females. Additionally, we found that mosquito repellents applied to human skin effectively repelled male mosquitoes. These findings shed light on mosquito behaviour and have implications for mosquito control programmes, particularly those involving the release or monitoring of the male mosquito population.
The genome of the deep-sea anemone
Actinernus
sp. contains a mega-array of ANTP-class homeobox genes
Authors: Law Sean Tsz Sum , Yu Yifei , Nong Wenyan , So Wai Lok , Li Yiqian , Swale Thomas , Ferrier David E. K. , Qiu Jianwen , Qian Peiyuan , Hui Jerome Ho Lam
Published: October 2023

Members of the phylum Cnidaria include sea anemones, corals and jellyfish, and have successfully colonized both marine and freshwater habitats throughout the world. The understanding of how cnidarians adapt to extreme environments such as the dark, high-pressure deep-sea habitat has been hindered by the lack of genomic information. Here, we report the first chromosome-level deep-sea cnidarian genome, of the anemone
Actinernus
sp., which was 1.39 Gbp in length and contained 44 970 gene models including 14 806 tRNA genes and 30 164 protein-coding genes. Analyses of homeobox genes revealed the longest chromosome hosts a mega-array of Hox cluster, HoxL, NK cluster and NKL homeobox genes; until now, such an array has only been hypothesized to have existed in ancient ancestral genomes. In addition to this striking arrangement of homeobox genes, analyses of microRNAs revealed cnidarian-specific complements that are distinctive for nested clades of these animals, presumably reflecting the progressive evolution of the gene regulatory networks in which they are embedded. Also, compared with other sea anemones, circadian rhythm genes were lost in
Actinernus
sp., which likely reflects adaptation to living in the dark. This high-quality genome of a deep-sea cnidarian thus reveals some of the likely molecular adaptations of this ecologically important group of metazoans to the extreme deep-sea environment. It also deepens our understanding of the evolution of genome content and organization of animals in general and cnidarians in particular, specifically from the viewpoint of key developmental control genes like the homeobox-encoding genes, where we find an array of genes that until now has only been hypothesized to have existed in the ancient ancestor that pre-dated both the cnidarians and bilaterians.
Osteoarticular tuberculosis of the ankle, a rare localization: a case report
Authors: Malihy Zakaria , Benaissa Elmostafa , Ben Lahlou Yassine , Maleb Adil , Elouennass Mostafa
Published: October 2023

Tuberculosis poses a considerable public health problem in countries where the disease is endemic. Osteoarticular tuberculosis represents 3–5 % of all tuberculosis cases and 10–15 % of extra-pulmonary tuberculosis cases. Involvement of the foot and ankle is rarer. We report a case of osteoarticular tuberculosis of the ankle in a 71-year-old patient with type 2 diabetes and hypertension who presented to the trauma department of the Mohammed V Military Hospital with a painful swelling of the ankle. Standard X-rays and computed tomography scans of the ankle showed inflammatory involvement of the bone and joints. Antitubercular therapy was instituted. Given the context of endemicity, any atypical presentation of lingering bone lesions should raise the suspicion of an osteoarticular tuberculosis in order to ensure early therapeutic management.
Striatin plays a major role in angiotensin II-induced cardiomyocyte and cardiac hypertrophy in micein vivo
Authors: Cull JJ , Cooper STE , Alharbi HO , Chothani SP , Rackham OJL , Meijles DN , Dash PR , Kerkelä Risto , Ruparelia N , Sugden PH , Clerk A
Published: October 2023

The three striatins (STRN, STRN3, STRN4) form the core ofSTRiatin-InteractingPhosphatase andKinase (STRIPAK) complexes. These place protein phosphatase 2A (PP2A) in proximity to protein kinases thereby restraining kinase activity and regulating key cellular processes. Our aim was to establish if striatins play a significant role in cardiac remodelling associated with cardiac hypertrophy and heart failure. All striatins were expressed in control human hearts, with upregulation of STRN and STRN3 in failing hearts. We used mice with global heterozygote gene deletion to assess the roles of STRN and STRN3 in cardiac remodelling induced by angiotensin II (AngII; 7 days). Using echocardiography, we detected no differences in baseline cardiac function or dimensions in STRN+/-or STRN3+/-male mice (8 weeks) compared with wild-type littermates. Heterozygous gene deletion did not affect cardiac function in mice treated with AngII, but the increase in left ventricle mass induced by AngII was inhibited in STRN+/-(but not STRN3+/-) mice. Histological staining indicated that cardiomyocyte hypertrophy was inhibited. To assess the role of STRN in cardiomyocytes, we converted the STRN knockout line for inducible cardiomyocyte-specific gene deletion. There was no effect of cardiomyocyte STRN knockout on cardiac function or dimensions, but the increase in left ventricle mass induced by AngII was inhibited. This resulted from inhibition of cardiomyocyte hypertrophy and cardiac fibrosis. The data indicate that cardiomyocyte striatin is required for early remodelling of the heart by AngII and identify the striatin-based STRIPAK system as a signalling paradigm in the development of pathological cardiac hypertrophy.

Clinical perspectives

Background.Striatins form the core ofSTRiatin-InteractingPhosphataseAndKinase (STRIPAK) complexes that regulate crucial cellular processes such as those associated with heart failure.

Summary.The three striatins are expressed in human hearts, with upregulation of STRN and STRN3 in failing hearts, whilst studies in mice indicate that STRN is required in cardiomyocytes for early remodelling of the hypertensive heart.

Potential significance of results to human health and disease.STRN-based STRIPAKs represent a novel signalling paradigm in the development of pathological cardiac hypertrophy, and modulating this system may provide therapeutic options for managing the cardiac effects of hypertensive heart disease.