bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hidden lesions: a case of burnt remains
Authors: Moghaddam Negahnaz , Campana Lorenzo , Abegg Claudine , Vilarino Raquel , Voland Christelle , Dedouit Fabrice , Genet Pia , Fracasso Tony 
Published: June 2023

Abstract

One of the many challenging cases that forensic pathologists, anthropologists, and forensic imaging experts have to face are burnt human remains. Perpetrators frequently attempt to hide/destroy evidence and make the body unidentifiable by exposing it to fire. We present a case of a partially burnt body found in an apartment after an explosion. First, multidetector computed tomography (MDCT) images and the following autopsy revealed several lesions on the cranium. Forensic anthropologists were involved in order to specify the aetiology of the lesions observed on the cranium. Through an interdisciplinary approach bringing together MDCT scans, 3D surface scans, and anthropological analysis, it was possible to answer the questions raised during the autopsy. Analyses demonstrated that there were signs of blunt force trauma on the cranium vault that the perpetrator likely attempted to hide by exposing the body to fire. This case demonstrates the importance of close collaboration between forensic anthropologists, imaging experts, and forensic pathologists. This multidisciplinary approach allows for a better, more complete reconstitution of forensic cases.

Key points
Dosage-sensitivity shapes how genes transcriptionally respond to allopolyploidy and homoeologous exchange in resynthesized Brassica napus
Authors: Bird Kevin A , Pires J Chris , VanBuren Robert , Xiong Zhiyong , Edger Patrick P 
Published: June 2023

Abstract
The gene balance hypothesis proposes that selection acts on the dosage (i.e. copy number) of genes within dosage-sensitive portions of networks, pathways, and protein complexes to maintain balanced stoichiometry of interacting proteins, because perturbations to stoichiometric balance can result in reduced fitness. This selection has been called dosage balance selection. Dosage balance selection is also hypothesized to constrain expression responses to dosage changes, making dosage-sensitive genes (those encoding members of interacting proteins) experience more similar expression changes. In allopolyploids, where whole-genome duplication involves hybridization of diverged lineages, organisms often experience homoeologous exchanges that recombine, duplicate, and delete homoeologous regions of the genome and alter the expression of homoeologous gene pairs. Although the gene balance hypothesis makes predictions about the expression response to homoeologous exchanges, they have not been empirically tested. We used genomic and transcriptomic data from 6 resynthesized, isogenic Brassica napus lines over 10 generations to identify homoeologous exchanges, analyzed expression responses, and tested for patterns of genomic imbalance. Groups of dosage-sensitive genes had less variable expression responses to homoeologous exchanges than dosage-insensitive genes, a sign that their relative dosage is constrained. This difference was absent for homoeologous pairs whose expression was biased toward the B. napus A subgenome. Finally, the expression response to homoeologous exchanges was more variable than the response to whole-genome duplication, suggesting homoeologous exchanges create genomic imbalance. These findings expand our knowledge of the impact of dosage balance selection on genome evolution and potentially connect patterns in polyploid genomes over time, from homoeolog expression bias to duplicate gene retention.
O03 Penicillin and cephalosporin cross-reactivity: a single-centre UK study
Authors: Duke Eve , Abdelkader Zainab , Mooney Hannah , Byrne Fiona , Mistry Anoop , Denman Sarah 
Published: June 2023

Abstract

Background
Penicillin allergy (PenA) labels limit antimicrobial options, and concerns about cross-reactivity between penicillin and cephalosporins can further restrict prescribing. Alternative therapies are associated with reduced efficacy, poorer safety profiles and increased healthcare costs. Emerging literature suggests the incidence of cross-reactivity between penicillins and cephalosporins may be lower than historically reported rates of 2–10%. Furthermore, there is a lack of real-time data evaluating the percentage of patients with PenA who tolerate a cephalosporin.

Objectives
To determine the percentage of patients with a PenA label who tolerated cephalosporins in a secondary care setting.

Methods
Patients prescribed a cephalosporin from 01 January 2016 to 31 December 2020 at Leeds Teaching Hospitals NHS Trust (LTHT) were identified using the inpatient electronic prescribing system. 1613 with a PenA label were extracted for analysis. The team reviewed and clarified whether each patient (i) had a PenA label that was a potential hypersensitivity reaction, intolerance, or unknown/undocumented label and (ii) tolerated a cephalosporin. Tolerance was defined as receiving ≥1 dose without adverse effects or subsequent cephalosporin allergy label. We recorded if allergy or intolerance was a documented reason for stopping the cephalosporin.

Results
There were 1279 patients with a PenA label that received a cephalosporin. 555 (43%) had documentation in-keeping with a potential IgE-mediated allergic reaction to penicillins, 177 (14%) were deemed to have an intolerance and 547 (43%) had an unknown or undocumented label. 1263 (98.7%) patients tolerated a cephalosporin. Six (0.5%) patients stopped due to intolerance. One patient asked to stop therapy due to ‘changes’ in the skin. Nine (0.7%) patients developed possible allergic symptoms to cephalosporin; 4 patients developed a rash, 2 patients developed facial or lip swelling (without airway compromise), 1 patient developed hypotension, 1 patient developed difficulty breathing and 1 patient developed chest pain, breathlessness and itching. Of the 9 patients that had reactions; 5 had documented PenA labels that were classified as potential hypersensitivity reactions. Four patients had unknown or undocumented reactions to penicillins. Eight patients received a 2nd-generation cephalosporin (cefuroxime) and 1 received a 3rd generation (cefotaxime).

Conclusions
The rate of potential hypersensitivity reaction following administration of a cephalosporin in patients with any PenA label at LTHT was 0.7%. The incidence of cephalosporin allergy is estimated to be 1–3% of the general population (with/without PenA label). We conclude that, for patients with a history of unverified, non-anaphylactic PenA label, any cephalosporin could be administered without an increased risk of hypersensitivity reaction.
P18 Value of pneumococcal PCR in respiratory samples for exclusion of pneumococcal pneumonia
Authors: Van Herendael Bruno , Van Lint Philippe , Hoet Katrien , Willems Philippe , Van Goethem Sam 
Published: June 2023

Abstract

Background
Streptococcus pneumoniae is the main aetiological agent in bacterial pneumonia, making it an essential component of respiratory multiplex PCR panels. Despite its relevance, PCR test results are difficult to interpret due to frequent non-pathogenic colonization on the mucosal surface of the upper airways.

Methods
A retrospective study was conducted for lytA-gene results as target for S. pneumoniae in hospitalized patients that were diagnosed with pneumonia and on which a respiratory multiplex PCR panel was performed. Patients were classified as probable, possible or unlikely of having a pneumococcal pneumonia.

Results
No difference in semi-quantitative Ct-values could be observed between the different groups. Sensitivity of 71.4% and specificity of 89.6% was found, corresponding with a negative predictive value and positive predictive value of 97.6% and 34.2%, respectively, when considering probable versus possible/unlikely.

Conclusions
We conclude that a negative qPCR for the lytA-gene is a good marker for the inability to culture S. pneumoniae in a respiratory sample and is possibly sufficient to exclude S. pneumoniae as a causative agent, due to which we can regard it as a relevant addition to a syndromic multiplex PCR panel.
P19 Nurse evaluation of a local antibiotic IV to oral switch (IVOS) prompt tool
Authors: Bowler Sue , Clarkson Annette 
Published: June 2023

Abstract

Background
Early IVOS has numerous benefits for our patients, our planet, and our nurses.1,2 Importantly, a multisite qualitative study concluded that encouraging the prompt transition from IV to oral antibiotics was perceived favourably by nurses as an antibiotic stewardship nursing role.3 In November 2022, the UK Health Security Agency published the national IVOS criteria;1 these formed the basis of our revised local IVOS prompt tool. The aim of the project was to evaluate nurses’ initial responses to a local IVOS prompt tool.

Objectives
To evaluate if prompting for IVOS is currently viewed as a nursing role; to evaluate how confident nurses feel using the local IVOS prompt tool and its suitability for nursing clinical practice; to consider the need for trust-wide nurse engagement and training and to make recommendations to inform antimicrobial stewardship (AMS) nursing practice.

Methods
The local IVOS prompt tool was shown to nurses between November 2022 and March 2023, using a problem-based learning approach to gather nursing views. Nurses were asked to provide anonymous feedback via a short questionnaire, using a five-point Likert scale.

Results
Ninety-eight nurses participated and completed the questionnaire with the following mean scores obtained. Prompting for IVOS was recognized as a nursing role (4.2/5.0); generally, nurses felt confident to use the IVOS tool during the problem-based learning activity (4.1/5.0) and on the ward to assess their patients (4.2/5.0). Qualitative feedback received included ‘time constraints- another tool [to complete] when there are already many’. It was deemed that the IVOS tool would be best placed in the clinic room (where IV antibiotics are prepared), as reference aid rather than as an assessment tool requiring formal completion.

Conclusions
Nurses consider IVOS to be within their scope of professional practice and felt confident to use the tool to assess for early switch within an educational and practice setting. Application of the tool in clinical practice is a focus for trust-wide nurse engagement, education and future AMS nursing research.
P21 Promoting antimicrobial stewardship and sustainability utilizing a ‘Go Green’ IV to oral switch (IVOST) policy and electronic prescribing prompts in antimicrobials with high oral bioavailability
Authors: Rodger R , Thompson S , Robertson A , Pender C , Ray G , Chisholm L 
Published: June 2023

Abstract

Background
Antimicrobial stewardship (AS) is crucial in reducing antimicrobial resistance (AMR) and the sustainability impact of inappropriate antimicrobial use.1 Promotion of the oral route and IV to oral switch (IVOST) are key AS initiatives providing benefits for patients, staff and the environment including reduced risk of line infections and AMR, reduced workload and costs, reduced plastic waste and improved sustainability.2 A recent quality improvement (QI) initiative to promote oral metronidazole (bioavailability &gt; 90%) in eligible surgical patients at the Royal Alexandra Hospital (RAH) resulted in a change in prescribing behaviour and a 45% median reduction in IV metronidazole use.3

Objectives
To scale and spread promotion of the oral route in antimicrobials with high oral bioavailability with the aim of reducing collective IV use by 20% by February 2023 at RAH.

Methods
A QI approach was used to promote the oral route where appropriate in the following agents: metronidazole, levofloxacin, fluconazole, ciprofloxacin, co-trimoxazole, clindamycin, linezolid and rifampicin. Techniques included the following: ‘Go Green IVOST’ posters in key ward areas highlighting benefits of the oral route; targeted pharmacist and pharmacy technician prospective audit and feedback using the electronic prescribing system; presentations to ward and pharmacy teams; staff champions and electronic IVOST prompts displayed when prescribing and administering the targeted agents IV. To measure improvement, oral and IV usage data were measured at baseline and for 24 months post change. Data were displayed on run charts to determine if the QI target was achieved.

Results
There was a 44% median reduction in IV defined daily doses (DDDs) in the targeted antimicrobials, surpassing the 20% target (Figure 1). There was a median 10% shift in the proportion of these agents given IV as a percentage of total (IV plus oral) use (Figure 2) The greatest reduction (60%) was in IV metronidazole where usage declined from a monthly baseline of 667 to 267 DDDs. This equates to a median reduction of 1200 IV metronidazole administrations and nearly 600 hours nursing time saved per month. IV fluconazole and IV levofloxacin usage declined from baseline by a median of 35% and 24%, respectively.

Conclusions
A QI approach to promote appropriate use of the oral route in antimicrobials with high oral bioavailability resulted in a change in prescribing behaviour and a sustained reduction in IV prescribing of these agents. This is important in terms of improved AS, patient care and safety, healthcare cost and efficiency and environmental sustainability.
P22 Fabrication methodologies for antimicrobial polypropylene surfaces with leachable and non-leachable antimicrobial agents
Authors: Alkarri Saleh , Sharma Dimple , Bergholz Teresa M , Rabnawaz Muhammad 
Published: June 2023

Abstract

Objectives
Develop a methodology for the fabrication of antimicrobial polypropylene (PP) surfaces with (i) leachable copper (II) chloride dihydrate (CuCl2·2H2O) and (ii) non-leachable magnesium hydroxide (Mg (OH)2) biocides.

Methods and results
Two methodologies are used to develop antimicrobial PP surfaces. One method involves melt blending and subsequent injection moulding, where the biocide additives were compounded with PP and subsequently injection moulded. The other method involves the thermal embossing of antimicrobial agents on the surface of a PP substrate. The obtained biocide-bearing PP surfaces were evaluated against Escherichia coli K-12 MG1655 for 0, 4 and 24 h to evaluate their antimicrobial properties. The injection-moulded PP bearing 5% CuCl2·2H2O showed a 6-log reduction of E. coli K-12 MG1655 after 24 h, while only 1 log reduction was observed for PP bearing 5% Mg (OH)2. The thermally embossed PP surfaces bearing CuCl2·2H2O and Mg (OH)2 particles (at a concentration of 10 mg/mL) showed 3 log and 4 log reduction, respectively, against E. coli K-12 MG1655 after 24 h.

Conclusions
The results clearly demonstrate that CuCl2·2H2O conferred antimicrobial properties to PP surfaces that were prepared by both injection moulding and thermal embossing approaches owing to the presence of leachable copper ions. In contrast, the non-leachable Mg (OH)2 imparted antimicrobial properties only to the surface prepared via the thermal embossing technique.

Significance and impact
Plastics with leachable biocides are effective antimicrobial surfaces, but their toxicity is a major concern. This study provides a fabrication methodology for non-leachable PP-based antimicrobial surfaces that are potentially safer. In addition, this strategy can be extended to many other plastic substrates.
P28 Rezafungin efficacy and safety in immunocompromised patients: sub-analyses of the Phase 3 trial in treatment of candidaemia and invasive candidiasis
Authors: Sandison Taylor , Ramos-Martinez Antonio , Kim Young Keun , Chai Louis , Slavin Monica 
Published: June 2023

Abstract

Background
Rezafungin (RZF) once weekly (QWk) is a next-generation echinocandin in development for treatment of candidaemia and invasive candidiasis (IC) and for prevention of invasive fungal disease caused by Candida, Aspergillus, and Pneumocystis spp. in BMT.

Objectives
The Phase 3 ReSTORE treatment trial (NCT03667690) demonstrated RZF QWk noninferiority to caspofungin (CAS) QD. This sub-analysis evaluated efficacy and safety outcomes in patients identified as immunocompromised (immuno-c) during the trial.

Methods
As previously described, adults with confirmed candidaemia and/or IC were randomized to RZF QWk (400 mg Wk1 then 200 mg QWk) or CAS QD for ≥14 days (≤4 weeks) with optional oral fluconazole stepdown for CAS. In this sub-analysis, immuno-c patients were those with prior and/or concomitant use of immunosuppressants (e.g. calcineurin inhibitors and corticosteroids) and/or medical history ongoing at screening of neutropenia, BMT, SOT, lymphoma or leukaemia.

Results
Of 187 patients (mITT population), 90 were immuno-c as defined. Results are for those with data available for analyses: Day 14 global cure—Immuno-c: RZF, 51.1% (23/45); CAS, 55.6% (25/45); –No immuno-c: RZF, 66.7% (32/48); CAS 65.3% (32/49). Day 5 mycological eradication—Immuno-c: RZF, 64.4% (29/45); CAS, 51.1% (23/45); no immuno-c: RZF, 72.9% (35/48); CAS, 71.4% (35/49). Among immuno-c, more had ≥1 AE (96.9%) and ≥1 SAE (64.6%) versus no immuno-c (79.0% and 45.0% respectively).

Conclusions
In this sub-analysis of ReSTORE, immune-c status reduced efficacy rates overall but did not change efficacy rate differences between RZF and CAS.
The effects of cystine and theanine mixture on the chronic survival rate and tumor incidence of rats after total body X-ray irradiation
Authors: Matsuu-Matsuyama Mutsumi , Shichijo Kazuko , Tsuchiya Takashi , Nakashima Masahiro 
Published: June 2023

Abstract
Cystine and theanine (CT), an amino acid mixture, provides the substrates cysteine and glutamic acid that promote glutathione synthesis. We previously reported that CT pre-treatment significantly improved the acute survival rate and reduced acute radiation injury of the small intestine and bone marrow of rats after 5 Gy of total body X-ray irradiation. To examine the long-term effects of CT administration after irradiation, we investigated the effects of CT pre-treatment and pre- and post-treatment on the chronic survival rate and solid tumor (spleen, skin and subcutis, and thyroid) incidence after irradiation using 7-week-old male Wistar rats. CT pre-treatment of 280 mg/kg was administered orally for 5 days before 5 Gy irradiation, and CT pre- and post-treatment was administered 5 days before and 5 days after irradiation. A 0.5% carboxymethyl cellulose solution was administered as a control. The chronic survival rate of the pre-treated rats was higher than that of the control rats at 441 days after irradiation (40 vs 8.1%, P = 0.011). However, the survival rate did not significantly differ between the pre- and post-treatment and control rats at 467 days after irradiation (33.8 vs 30.2%, P = 0.792). In addition, more solid tumors, especially subcutis sarcomas, were observed in the pre-treatment rats (26.1%, 6/23) than in the control rats (4.5%, 1/22) after irradiation. Therefore, pre-administration of CT improves the chronic survival rate after irradiation; however, the occurrence of solid tumors was not suppressed.
Assessing target localization accuracy across different soft-tissue matching protocols using end-exhalation breath-hold cone-beam computed tomography in patients with pancreatic cancer
Authors: Sasaki Makoto , Nakamura Mitsuhiro , Ashida Ryo , Nakata Manabu , Yoshimura Michio , Mizowaki Takashi 
Published: June 2023

Abstract
The purpose of this study was to retrospectively assess target localization accuracy across different soft-tissue matching protocols using cone-beam computed tomography (CBCT) in a large sample of patients with pancreatic cancer and to estimate the optimal margin size for each protocol. Fifty-four consecutive patients with pancreatic cancer who underwent 15-fraction volumetric modulated arc therapy under the end-exhalation breath-hold condition were enrolled. Two soft-tissue matching protocols were used according to the resectability classification, including gross tumor volume (GTV) matching for potentially resectable tumors and planning target volume (PTV) matching for borderline resectable or unresectable tumors. The tolerance of the target localization error in both matching protocols was set to 5 mm in any direction. The optimal margin size for each soft-tissue matching protocol was calculated from the systematic and random errors of the inter- and intrafraction positional variations using the van Herk formula. The inter- and intrafraction positional variations of PTV matching were smaller than those of GTV matching. The percentage of target localization errors exceeding 5 mm in the first CBCT scan of each fraction in the superior–inferior direction was 12.6 and 4.8% for GTV and PTV matching, respectively. The optimal margin sizes for GTV and PTV matching were 3.7 and 2.7, 5.4 and 4.1 and 3.9 and 3.0 mm in the anterior–posterior, superior–inferior and left–right directions, respectively. Target localization accuracy in PTV matching was higher than that in GTV matching. By setting the tolerance of the target localization error, treatment can be successful within the planned margin size.
Partial liver irradiation in rats induces the hypertrophy of nonirradiated liver lobes through hepatocyte proliferation
Authors: Adachi Takuya , Yoshida Yukari , Shibuya Kei , Sato Ken , Yamazaki Yuichi , Kakizaki Satoru , Uraoka Toshio , Takahashi Akihisa 
Published: June 2023

Abstract
Irradiation of the liver induces a regenerative response in the nonirradiated part of the liver. It is unclear whether this leads to actual liver enlargement. The aim of this study was to evaluate the weight of compensatory hypertrophy that occurs in nonirradiated livers and to clarify the mechanism of hypertrophy from the viewpoint of hepatocyte proliferation. The anterior liver lobes (anterior lobes) were irradiated with 60 Gy of X-rays (X60 Gy) under opening laparotomy. Body weights and liver lobe weights were measured before and at 1, 4, 8 and 12 weeks after irradiation, and serum and liver tissue samples were analyzed at each time point. The anterior lobes atrophied progressively, whereas the posterior liver lobes (posterior lobes) hypertrophied in the X-ray irradiated (X-irradiated) group. Although temporary liver damage was observed after irradiation, liver function did not decrease at any time point. Hepatocyte degeneration and loss were observed in the anterior lobes of the X-irradiated group, and significant fibrosis developed 8 weeks postirradiation. Following irradiation, the proportion of Ki-67-positive cells in the anterior lobes decreased markedly in the early postirradiation period, whereas the proportion of positive cells in the posterior lobes increased, peaking at 4 weeks postirradiation (P &lt; 0.05). Increased tumor necrosis factor-α expression was observed only in the anterior liver lobes of the X-irradiated group at 1 and 4 weeks postirradiation. Partial liver irradiation with X60 Gy induced compensatory hypertrophy of nonirradiated liver lobes. This study suggests that liver hypertrophy after partial liver irradiation is caused by increased hepatocyte mitosis.