bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suction circuit flushing with chlorhexidine decreases ventilator-associated pneumonia: a quasi-experimental study
Authors: Eid Mohamed H. , Ţânţu Monica – Marilena , Latour Jos M. , Sultan Mohammed Ahmed , Kandeel Nahed Attia 
Published: December 2023

BackgroundEndotracheal suctioning of mechanically ventilated patients differs across the world. In many low and middle-income countries, endotracheal suctioning is often performed with a sterile suctioning catheter that is used for 12 h or during the length of one nursing shift. The effect of flushing multiple used endotracheal suction system with chlorhexidine after suctioning to reduce ventilator associated pneumonia (VAP) remains unclear.AimThe aim of the study is to assess the effectiveness of flushing multiple-used open endotracheal suction catheters and suctioning system with chlorhexidine gluconate 0.2% to reduce VAP in mechanically ventilated patients in a resource-limited Intensive Care Unit (ICU).MethodsDue to the difficulty of blinding the intervention for nurses who perform endo-tracheal suction procedures, we adopted a quasi-experimental method with a randomized controlled trial design. A sample of 136 ICU patients were allocated to the intervention (n = 68) or control group (n = 68) between May and November 2020. The intervention was flushing the multiple-used suction catheter and suction system with 40ml chlorhexidine gluconate 0.2% and in the control group we used normal saline to flush the catheter and suction system. The primary outcome was incidence of VAP and the cost of the flushing solutions was the secondary outcome measure.ResultsPatients in the intervention group had a lower incidence of VAP compared to patients in the control group; 15 (22.1%) vs 29 (42.6%), p = 0.01. The incidence of late-onset VAP was 26.2% in the intervention group and 49% in the control group (p = 0.026) and the early-onset VAP was 13.2% in the intervention group and 25% in the control group (p = 0.081). Chlorhexidine gluconate 0.2% reduced the cost of suction system flushing (median: 78.4 vs 300 EGP, p &lt; 0.001).ConclusionUsing chlorhexidine gluconate 0.2% to flush multiple-used suctioning catheters after every endo-tracheal suction procedure might reduce the incidence of VAP in mechanically ventilated patients. Chlorhexidine gluconate 0.2% can be a cost-effective solution for flushing the suction circuit. Nurses working in resource-limited ICUs and using suctioning catheters multiple times might consider using chlorhexidine gluconate 0.2% instead of normal saline or distilled water when flushing the suction system.Clinical trial registrationClinicalTrials.gov, identifier NCT05206721.
Tacrolimus monitoring in hair samples of kidney transplant recipients
Authors: Born Alexander , Bocchi Federica , Kuhn Christian , Amstutz Ursula , Baumgartner Markus R. , Sidler Daniel 
Published: December 2023

BackgroundCalcineurin inhibitors, including tacrolimus, remain a cornerstone of immunosuppressive therapy after kidney transplantation. However, the therapeutic window is narrow, and nephrotoxic side effects occur with overdose, while the risk of alloimmunization and graft rejection increases with underdose. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) allows quantification of tacrolimus in biological samples from patients. This study investigates the feasibility of quantifying tacrolimus in scalp hair from kidney transplant (KT) recipients and correlates hair tacrolimus concentrations with tacrolimus dosage and blood trough levels. The aim was to provide proof-of-principle for hair tacrolimus drug monitoring in KT recipients.MethodSingle-center prospective study between September 9, 2021 and December 4, 2021, including KT recipients under tacrolimus. Minors, patients with active skin or hair diseases, and patients with scalp hair shorter than 4 cm were excluded from participation. Scalp hair was collected from the posterior vertex of patients, cut into segments, and analyzed for tacrolimus by LC-MS/MS. Patients filled out a questionnaire on hair treatments and washing habits. In parallel, tacrolimus trough levels were measured in whole blood and correlated with hair tacrolimus concentrations.ResultsIn total, 39 consenting KT recipients were included, and hair samples were collected at 53 visits. Tacrolimus was detected in 98% of hair samples from patients exposed to the drug. Tacrolimus hair levels and whole blood trough levels were correlated with a beta coefficient of 0.42 (95% CI: −0.22–1.1, p = n.s.). Age and dark hair affected hair tacrolimus measurements, while different tacrolimus formulations (immediate release vs. extended release), hair washes, and permanent coloring did not. Longitudinal measurements in a subgroup of patients indicate that long-term measurement of hair tacrolimus levels is feasible.ConclusionMeasuring tacrolimus in hair is a potentially reliable method to monitor drug exposure in KT patients. Rapid wash-in effects and consistent concentrations over time indicate that tacrolimus is incorporated into the hair matrix, allowing temporal resolution in the analysis of recent exposure and exposure history. This method provides a simple and low-risk alternative to regular blood sampling, sparing patients from frequent hospital visits through the self-collection of hair samples.
Phenotypic shifts induced by environmental pre-stressors modify antibiotic resistance in Staphylococcus aureus
Authors: Wee Gui Nam , Lyou Eun Sun , Nishu Susmita Das , Lee Tae Kwon 
Published: December 2023

IntroductionEscalating prevalence of antibiotic resistance in Staphylococcus aureus has necessitated urgent exploration into the fundamental mechanisms underlying antibiotic resistance emergence, particularly in relation to its interaction with environmental stressors. This study aimed to investigate the effects of environmental stressors prior to antibiotic exposure on the antibiotic resistance of S. aureus.MethodsWe used Raman spectroscopy and flow cytometry to measure prior stress-induced phenotypic alterations of S. aureus, and identified the association between phenotypic shifts and the antibiotic resistance.ResultsThe results revealed a multifaceted relationship between stressors and the development of antibiotic resistance. The stressors effectuate distinct phenotypic diversifications and subsequently amplify these phenotypic alterations following antibiotic treatments, contingent upon the specific mode of action; these phenotypic shifts in turn promote the development of antibiotic resistance in S. aureus. This study’s findings demonstrated that the presence of pre-stress conditions triggered an augmentation of resistance to vancomycin (VAN), while concurrently attenuating resistance to norfloxacin. Marked shifts in Raman peaks associated with lipids and nucleic acids demonstrated correlations with elevated survival rates following VAN treatment.ConclusionConsequently, these observations indicate that pre-stress conditions “prime” bacterial cells for differential responses to antibiotics and bear significant implications for formulating clinical therapeutic strategies.
The effect of doorway characteristics on freezing of gait in Parkinson’s disease
Authors: Cockx Helena M. , Lemmen Eefke M. , van Wezel Richard J. A. , Cameron Ian G. M. 
Published: December 2023

BackgroundFreezing of gait is a debilitating symptom in Parkinson’s disease, during which a sudden motor block prevents someone from moving forward. Remarkably, doorways can provoke freezing. Most research has focused on the influence of doorway width, and little is known about other doorway characteristics influencing doorway freezing.ObjectiveFirstly, to provide guidelines on how to design doorways for people with freezing. Secondly, to compare people with doorway freezing to people without doorway freezing, and to explore the underlying mechanisms of doorway freezing.MethodsWe designed a web-based, structured survey consisting of two parts. Part I (n = 171 responders), open to people with Parkinson’s disease with freezing in general, aimed to compare people with doorway freezing to people without doorway freezing. We explored underlying processes related to doorway freezing with the Gait-Specific Attention Profile (G-SAP), inquiring about conscious movement processes occurring during doorway passing. Part II (n = 60), open for people experiencing weekly doorway freezing episodes, inquired about the influence of specific doorway characteristics on freezing.ResultsPeople with doorway freezing (69% of Part I) had higher freezing severity, longer disease duration, and scored higher on all sub scores of the G-SAP (indicating heightened motor, attentional, and emotional thoughts when passing through doorways) than people without doorway freezing. The main categories provoking doorway freezing were: dimensions of the door and surroundings, clutter around the door, lighting conditions, and automatic doors.ConclusionWe provide recommendations on how to maximally avoid freezing in a practical setting. Furthermore, we suggest that doorways trigger freezing based on visuomotor, attentional, and emotional processes.
Association of ulcerative colitis and acute gastroenteritis with prostate specific antigen: results from National Health and Nutrition Examination Survey from (2009 to 2010) and Mendelian randomization analyses
Authors: Li Hongxiao , Zheng Jiefang , Dong Weimin , Huang Yiqiao , Su Zhengming , Jiang Xianhan 
Published: December 2023

BackgroundAn increasing number of studies have demonstrated that gastrointestinal inflammation may increase prostate cancer risk and raise the prostate-specific antigen (PSA) level. However, the association between ulcerative colitis (UC) and acute gastroenteritis (AGE) with PSA remains unclear and complicated. Herein, we evaluated the relationship between UC and AGE with PSA concentration using the National Health and Nutrition Examination Survey (NHANES) database and Mendelian randomization (MR) analyses.Materials and methodsA total of 1,234 participants fit into the study after conducting the screening based on the NHANES survey conducted from 2009 to 2010. UC and AGE were the independent variables, and PSA was the dependent variable. Weighted multiple linear regressions were utilized to estimate the association of UC and AGE with PSA concentration. To detect the causal relationship between UC and AGE with PSA, a two-sample Mendelian randomized analysis was conducted.ResultsAfter controlling for all covariates, PSA (log2 transform) concentrations in the UC group were increased by 0.64 (0.07, 1.21). AGE was not independently associated with PSA levels after adjusting potential confounders. In patients with coronary artery disease, AGE promotes elevated PSA (log2 transform) concentrations (β = 1.20, 95% CI: 0.21–2.20, p &lt; 0.001). Moreover, an IVW MR analysis indicated that genetically predicted UC was associated with increased PSA, and that AGE was not associated with PSA.ConclusionThis study indicated that a positive causal association exists between UC and the PSA level. However, there is no evidence to support the relationship between AGE and the PSA level.
PD-L1 expression complements CALGB prognostic scoring system in malignant pleural mesothelioma
Authors: Avilés-Salas Alejandro , Cabrera-Miranda Luis , Hernández-Pedro Norma , Vargas-Lías Diana Sofía , Samtani Suraj , Muñoz-Montaño Wendy , Motola-Kuba Daniel , Corrales-Rodríguez Luis , Martín Claudio , Cardona Andrés F. , Palomares-Palomares Cittim B. , Arrieta Oscar 
Published: December 2023

BackgroundProgrammed death ligand-1 (PD-L1) expression is a predictive biomarker in patients with lung cancer, but its role in malignant pleural mesothelioma (MPM) remains unclear. Evidence suggests that higher PD-L1 expression is correlated with worse survival. CALGB is the main scoring system used to predict the benefit of chemotherapy treatment. This study aimed to determine the prognostic value of PD-L1 expression and its addition to CALGB scoring system in patients with MPM.MethodsIn this retrospective analysis, we evaluated samples with confirmed locally advanced or metastatic MPM. PD-L1 Tumor Proportional Score (TPS) was determined by immunohistochemistry at diagnosis.Results73 patients were included in this study. A cutoff value of 15 was set for a high or low PD-L1 TPS. In total, 71.2% (n=52) and 28.8% (n=21) of individuals harbored low or high PD-L1 expression, respectively. PD-L1High was associated with worse median progression-free Survival (mPFS) [4.9 vs. 10.8 months; HR 2.724, 95% CI (1.44-5.14); p = 0.002] and Overall Survival (OS) [6.0 vs. 20.9 months; HR 6.87, 95% CI (3.4-8.7); p&lt;0.001] compared to patients with PD-L1Low. Multivariate analysis confirmed that PD-L1 expression was an independent factor for PFS and OS in patients with MPM and CALGB score of 5-6.ConclusionPD-L1 addition to CALGB scale improves its prognostic estimation of MPM survival and should be considered in future research.
Impact of early heparin therapy on outcomes in patients with solid malignancy associated sepsis: a marginal structural model causal analyse
Authors: Huang Jia-jia , Cai Ji-zhen , Zhou Zhi-peng , Liu Yan , Yang Zhen-jia , Li Da-zheng , Chen Yu-hua , Luan Ying-yi , Yao Yong-ming , Wu Ming 
Published: December 2023

Background: Previous studies documented that heparin can inhibit the invasion and metastasis of tumors, but its role on outcomes in patients with solid malignancy complicated sepsis remains unclear.Methods: A retrospective cohort study was conducted in critically ill patients with solid malignancy associated sepsis from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The primary endpoint was intensive care unit (ICU) mortality, secondary outcomes were thrombosis and hospital mortality. Propensity score matching (PSM), marginal structural Cox model (MSCM), cox proportional hazards model, stratification analysis and E-value were used to account for baseline differences, time-varying confounding and unmeasured variables.Results: A total of 1,512 patients with solid malignancy complicated sepsis were enrolled, of which 683 in the heparin group with intensive care unit mortality, thrombosis rate and hospital mortality were 9.7%, 5.4%, 16.1%, and 829 in the non-heparin group with ICU mortality, thrombosis rate and hospital mortality were 14.6%, 12.5%, 22.6%. Similar results were observed on outcomes for patients with PSM (ICU mortality hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.41–0.92), thrombosis rate (HR 0.42, 95% confidence interval 0.26–0.68); hospital mortality HR 0.70, 95% CI 0.50–0.99). marginal structural Cox model further reinforced the efficacy of heparin in reducing ICU mortality (HR 0.48, 95% CI 0.34–0.68). Logistic regression and Cox regression model showed heparin use also markedly reduced thrombosis (HR 0.42; 95% CI 0.26–0.68; p &lt; 0.001) and hospital mortality (HR 0.70; 95% CI 0.50–0.99; p = 0.043). Stratification analysis with the MSCM showed an effect only those with digestive system cancer (HR 0.33, 95% CI 0.16–0.69).Conclusion: Early heparin therapy improved outcomes in critically ill patients with solid malignancy complicated sepsis. These results are evident especially in those with digestive system cancer. A prospective randomized controlled study should be designed to further assess the relevant findings.
The effects of emotion and COVID-19 context priming on the size and color of drawings: based on human figure drawings and tree drawings
Authors: Cao Huijing , Zhang Xiaohan , Zhang Xinlei , Yan Wenhua 
Published: December 2023

IntroductionThis study aimed to investigate the effects of emotional themes and the COVID-19 pandemic context priming on the size and color of drawings.MethodsA 3 (emotion: peacefulness, gratitude, loneliness) × 2 (context: pandemic, regular) mixed design was used and 113 university students in Shanghai were recruited to draw human figures and trees using 10 marker colors.ResultsThe size of the drawings depicting loneliness was smaller than that of the those depicting peacefulness and gratitude. Drawings depicting loneliness used more cool and non-preferred colors; drawings depicting gratitude used more warm and preferred colors. Drawings in the pandemic context were larger, which may reflect the more significant threat perceived by individuals. Drawings in the pandemic context used more red colors, showing symbolic meanings such as danger.DiscussionThe drawing size and drawing color are influenced by emotional themes and the pandemic context priming.
Early predictors in language-based learning disabilities: a bibliometric analysis
Authors: Alabbad Maryam , Khan Muhammad Ajmal , Siddique Nadeem , Hassan Jaber Abou , Bashir Shahid , Abualait Turki 
Published: December 2023

IntroductionLanguage-based learning disabilities (LBLD) refers to a spectrum of neurodevelopmental-associated disorders that are characterized by cognitive and behavioral differences in comprehending, processing and utilizing spoken and/or written language. The focus of this work was on identifying early predictors of three main specific LBLD including dyslexia, dyscalculia, and dysgraphia.MethodsThe Web of Science (WoS) was searched for literature related to (neurocognitive, neurophysiological, and neuroimaging) measurements used to identify early predictors of LBLD from 1991 to 25 October 2021. A retrospective bibliometric analysis was performed to analyze collaboration among countries, institutions, authors, publishing journals, reference co-citation patterns, keyword co-occurrence, keyword clustering, and burst keywords using Biblioanalytics software.ResultsIn total, 921 publications related to the identification of LBLD using (neurocognitive, neurophysiological, and neuroimaging) modalities were included. The data analysis shows a slow growth in research on the topic in the 90s and early 2000 and growing trend in recent years. The most prolific and cited journal is Neuroimage, followed by Neuropsychologia. The United States and Finland’s Universities Jyvaskyla and Helsinki are the leading country and institution in this field, respectively. “Neuroimaging,” “brain,” “fMRI,” “cognitive predictor,” “comorbidity,” “cortical thickness” were identified as hotspots and trends of (neurocognitive, neurophysiological, and neuroimaging) modalities in the identification of LBLD.DiscussionEarly predictors of LBLDs would be useful as targets for specific prevention and intervention programs to be implemented at very young ages, which could have a significant clinical impact. A novel finding of neuroimaging predictors combined with neurocognitive and neuropsychological batteries may have implications for future research.
Learning journeys – student learning development in the first years of a medical degree: an analysis of student conversations
Authors: Gilbert Kerry G. 
Published: December 2023

IntroductionStudents starting medical school generally come from a learning background that expects them to learn content, which is reproduced to pass an exam. As a part of their learning development, they must adapt and become self-motivated learners who can determine the underlying principles or concepts and use these to problem solve in the uncertainty of real-life clinical practice. Whilst much has been written about designing curricula to promote learning development, there is no one-size fits all approach to facilitating this type of learning, thus an analysis of what helps and hinders learning development is indicated.MethodsStudent pairs in Y2 and Y3 of an undergraduate Bachelor of Medicine, Bachelor of Surgery (BMBS) programme of a South-West UK medical school, were asked to audio record a conversation about their learning through a facilitated problem-based learning approach during the BMBS course so far. They were provided with a brief to aid them in their discussion in the style of the outside broadcast method of BBC Radio 4s listening project. Using this method, the conversation was unfacilitated and allowed to take its natural course. Conversations were transcribed and coded to determine emerging themes with respect to the developing understanding of the students about what and how they were learning.ResultsFour student pairs volunteered for the project one from Y2 and three from Y3. Five key themes were identified including: from ‘learning it all, to structured learning’; ‘developing understanding and the spiral curriculum’; ‘working alone versus working with others’; ‘integrated learning and understanding context’ and ‘assessment and resources.’ Narrative analysis within these themes suggested that over the course of the first two to three years of study, participants developed a better understanding of how best to learn, although there were differences in both time and order that participants reached a point where learning felt more natural to them.DiscussionAnalysis of the data suggested that students develop independently towards being self-motivated lifelong learners. There were several key aspects of curriculum design that could be used to facilitate this development, which could easily be incorporated into developing or creating problem- / enquiry-based curricula.
L’Ausone de Placentin ?
Authors: Dolveck Franz 
Published: December 2023

The value of MS Paris, BNF, lat. 18275 is manyfold. This paper gives a new, exhaustive description and a precise dating (c. 1170), and suggests that the MS may have been copied by or for the jurist Placentinus, maybe in Southern France, or in Northern Italy – and anyway,
it used French as well as Italian sources. This MS is a key witness to the tradition of Ausonius, and, in particular, it alone transmits two extracts, so far neglected, that belong most probably to Ausonius.
FAULT LOCALIZATION BY RADIOSENSOR DIAGNO
Authors: Бойков К.А. 
Published: December 2023

Показана возможность локализации неисправности сложного программно-аппаратного электронного средства новым методом радиосенсорной технической диагностики. Представлен способ регистрации электрической составляющей электромагнитного поля – сигнального радиопрофиля радиоэлектронного узла, излученного самим радиоэлектронным средством. Проведен эксперимент по регистрации сигнального радиопрофиля, представлено его аналитическое выражение и выполнен корреляционный анализ исходного и восстановленного сигнального радиопрофиля. Представлена обобщенная методика проведения радиосенсорной технической диагностики с локализацией неисправности. На примере элемента системы «умный дом» – контроллера отопления с намеренно введенными неисправностями в его релейный блок управления – показана возможность определения и локализации неисправности на ранней стадии возникновения.
The paper shows the possibility of localizing a malfunction of a complex hardware-software electronic tool with a new method of radio-sensor technical diagnostics. A method is presented for registering the electrical component of the electromagnetic field – the signal radio profile of a radioelectronic unit emitted by the radio-electronic device itself. An experiment was carried out to register the signal radio profile, its analytical expression was presented, and a correlation analysis of the original and reconstructed signal radio profile was performed. A generalized technique for conducting radiosensor technical diagnostics with fault localization is presented. Using the example of an element of the “smart home” system – a heating controller with intentionally introduced malfunctions into its relay control unit, the possibility of detecting and localizing a malfunction at an early stage of occurrence is shown.