bluuebunny/crossref_metadata_2025_split huggingface dataset:
Economic and legal bases of the Carpathian Euroregion development during the COVID-19 pandemic (Hungary, Slovakia, Poland, Ukraine)
Authors: Khusainov Ruslan V. , Lisnik Anton , Zatrochová Monika , Babiuk Alla M. , Mashkov Kostiantyn Ye. 
Published: July 2023

AbstractThe article dwells upon the history of the Carpathian Euroregion as the form of a cross-border cooperation. The peculiarities of the economic development of the Carpathian Euroregion before the COVID-19 pandemic were considered. The main ways of obtaining financial resources for the development of the Euroregion economy were identified. The structure of the Carpathian Euroregion and the system of normative legal acts regulating the activity of this association were analyzed. The main consequences and impact of the COVID-19 pandemic on the economic development of the Carpathian Euroregion were identified. Priority measures and activities for tourism development in the Carpathian Euroregion were discussed. The expediency of creating a tourist brand of the Euroregion and the need to promote tourism in the Euroregion at the international level were argued. The main international projects and programs of the Carpathian Euroregion regarding the cooperation between the states of the EU were studied. Proposals were made to improve the investment attractiveness of the Carpathian Euroregion and to overcome the consequences of the pandemic. The need to create a separate authority that will operate independently and ensure active communication in the Euroregion was established. It will also help find new sources of financial resources, develop a set of measures to support small and medium businesses, connections between the territories of the Euroregion and ensure an effective border and customs regime in the Carpathian Euroregion.
Cardiopulmonary exercise testing before and after intravenous iron in preoperative patients: a prospective clinical study
Authors: Plumb James O. M. , Otto James M. , Kumar Shriya B. , Bali Sitara , Wakatsuki Mai , Schmidt Walter F. J. , Montgomery Hugh E. , Grocott Michael P. W. , Levett Denny Z. 
Published: July 2023

Abstract
Background
Anemia is associated with impaired physical performance and adverse perioperative outcomes. Iron-deficiency anemia is increasingly treated with intravenous iron before elective surgery. We explored the relationship between exercise capacity, anemia, and total hemoglobin mass (tHb-mass) and the response to intravenous iron in anemic patients prior to surgery.

Methods
A prospective clinical study was undertaken in patients having routine cardiopulmonary exercise testing (CPET) with a hemoglobin concentration ([Hb]) < 130 g.l−1 and iron deficiency/depletion. Patients underwent CPET and tHb-mass measurements before and a minimum of 14 days after receiving intravenous (i.v.) Ferric derisomaltose (Monofer®) at the baseline visit. Comparative analysis of hematological and CPET variables was performed pre and post-iron treatment.

Results
Twenty-six subjects were recruited, of whom 6 withdrew prior to study completion. The remaining 20 (9 [45%] male; mean ± SD age 68 ± 10 years) were assessed 25 ± 7 days between baseline and the final visit. Following i.v. iron, increases were seen in [Hb] (mean ± SD) from 109 ± 14 to 116 ± 12 g l−1 (mean rise 6.4% or 7.3 g l−1, p =  < 0.0001, 95% CI 4.5–10.1); tHb-mass from 497 ± 134 to 546 ± 139 g (mean rise 9.3% or 49 g, p =  < 0.0001, 95% CI 29.4–69.2). Oxygen consumption at anerobic threshold ($$\dot{\text{V}}$$

V
˙

O2 AT) did not change (9.1 ± 1.7 to 9.8 ± 2.5 ml kg−1 min−1, p = 0.09, 95% CI − 0.13 − 1.3). Peak oxygen consumption ($$\dot{\text{V}}$$

V
˙

O2 peak) increased from 15.2 ± 4.1 to 16 ± 4.4 ml.kg.−1 min−1, p = 0.02, 95% CI 0.2–1.8) and peak work rate increased from 93 [67–112] watts to 96 [68–122] watts (p = 0.02, 95% CI 1.3–10.8).

Conclusion
Preoperative administration of intravenous iron to iron-deficient/deplete anemic patients is associated with increases in [Hb], tHb-mass, peak oxygen consumption, and peak work rate. Further appropriately powered prospective studies are required to ascertain whether improvements in tHb-mass and performance in turn lead to reductions in perioperative morbidity.

Trial registration
ClinicalTrials.gov identifier: NCT 033 46213.
The impact of enhanced screening for carbapenemase-producing Enterobacterales in an acute care hospital in South Korea
Authors: Park Sun Hee , Yi Yunmi , Suh Woosuck , Ji Seul Ki , Han Eunhee , Shin Soyoung 
Published: July 2023

Abstract
Background
Carbapenemase-producing Enterobacterales (CPE) poses a significant challenge to infection control in healthcare settings. Active screening is recommended to prevent intra-hospital CPE transmission.

Methods
CPE screening was initiated at a 660-bed hospital in South Korea in September 2018, targeting patients previously colonized/infected or admitted to outside healthcare facilities (HCFs) within 1 month. Universal intensive care unit (ICU) screening was performed at the time of admission. After a hospital-wide CPE outbreak in July-September 2019, the screening program was enhanced by extending the indications (admission to any HCF within 6 months, receipt of hemodialysis) with weekly screening of ICU patients. The initial screening method was changed from screening cultures to the Xpert Carba-R assay. The impact was assessed by comparing the CPE incidence per 1000 admissions before (phase 1, September 2018-August 2019) and after instituting the enhanced screening program (phase 2, September 2019-December 2020).

Results
A total of 13,962 (2,149 and 11,813 in each phase) were screened as indicated, among 49,490 inpatients, and monthly screening compliance increased from 18.3 to 93.5%. Compared to phase 1, the incidence of screening positive patients increased from 1.2 to 2.3 per 1,000 admissions (P = 0.005) during phase 2. The incidence of newly detected CPE patients was similar (3.1 vs. 3.4, P = 0.613) between two phases, but the incidence of hospital-onset CPE patients decreased (1.9 vs. 1.1, P = 0.018). A significant decrease was observed (0.5 to 0.1, P = 0.014) in the incidence of patients who first confirmed CPE positive through clinical cultures without a preceding positive screening. Compared to phase 1, the median exposure duration and number of CPE contacts were also markedly reduced in phase 2: 10.8 days vs. 1 day (P < 0.001) and 11 contacts vs. 1 contact (P < 0.001), respectively. During phase 2, 42 additional patients were identified by extending the admission screening indications (n = 30) and weekly in-ICU screening (n = 12).

Conclusions
The enhanced screening program enabled us to identify previously unrecognized CPE patients in a rapid manner and curtailed a hospital-wide CPE outbreak. As CPE prevalence increases, risk factors for CPE colonization can broaden, and hospital prevention strategies should be tailored to the changing local CPE epidemiology.
Association between leptin and NAFLD: a two-sample Mendelian randomization study
Authors: Guo Ziwei , Du Hongbo , Guo Yi , Jin Qian , Liu Ruijia , Yun Zhangjun , Zhang Jiaxin , Li Xiaoke , Ye Yong’an 
Published: July 2023

Abstract
Background
The etiology of nonalcoholic fatty liver disease (NAFLD) involves a complex interaction of genetic and environmental factors. Previous observational studies have revealed that higher leptin levels are related to a lower risk of developing NAFLD, but the causative association remains unknown. We intended to study the causal effect between leptin and NAFLD using the Mendelian randomization (MR) study.

Methods
We performed a two-sample Mendelian randomization (TSMR) analysis using summary GWAS data from leptin (up to 50,321 individuals) and NAFLD (8,434 cases and 770,180 controls) in a European population. Instrumental variables (IVs) that satisfied the three core assumptions of Mendelian randomization were selected. The TSMR analysis was conducted using the inverse variance weighted (IVW) method, MR-Egger regression method, and weighted median (WM) method. To ensure the accuracy and stability of the study results, heterogeneity tests, multiple validity tests, and sensitivity analyses were conducted.

Results
The findings of the TSMR correlation analysis between NAFLD and leptin were as follows: IVW method (odds ratio (OR) 0.6729; 95% confidence interval (95% CI) 0.4907–0.9235; P = 0.0142), WM method (OR 0.6549; 95% CI 0.4373–0.9806; P = 0.0399), and MR-Egger regression method (P = 0.6920). Additionally, the findings of the TSMR correlation analysis between NAFLD and circulating leptin levels adjusted for body mass index (BMI) were as follows: IVW method (OR 0.5876; 95% CI 0.3781–0.9134; P = 0.0181), WM method (OR 0.6074; 95% CI 0.4231–0.8721; P = 0.0069), and MR-Egger regression method (P = 0.8870). It has also been shown that higher levels of leptin are causally linked to a lower risk of developing NAFLD, suggesting that leptin may serve as a protective factor for NAFLD.

Conclusions
Using TSMR analysis and the GWAS database, we investigated the genetic relationship between elevated leptin levels and lowered risk of NAFLD in this study. However, further research is required to understand the underlying mechanisms.
Predictors of bacteremia and death, including immune status, in a large single-center cohort of unvaccinated ICU patients with COVID-19 pneumonia
Authors: Frattari Antonella , Polilli Ennio , Rapacchiale Giorgia , Coladonato Simona , Ianniruberto Stefano , Mazzotta Elena , Patarchi Alessandro , Battilana Mariangela , Ciulli Raffaella , Moretta Angelo , Visocchi Lina , Savini Vincenzo , Spacone Antonella , Zocaro Rosamaria , Carinci Fabrizio , Parruti Giustino 
Published: July 2023

Abstract
Background
We investigated the possible role of the immune profile at ICU admission, among other well characterized clinical and laboratory predictors of unfavorable outcome in COVID-19 patients assisted in ICU.

Methods
Retrospective analysis of clinical and laboratory data collected for all consecutive patients admitted to the ICUs of the General Hospital of Pescara (Abruzzo, Italy), between 1st March 2020 and 30th April 2021, with a confirmed diagnosis of COVID-19 respiratory failure. Logistic regressions were used to identify independent predictors of bacteremia and mortality.

Results
Out of 431 patients included in the study, bacteremia was present in N = 191 (44.3%) and death occurred in N = 210 (48.7%). After multivariate analysis, increased risk of bacteremia was found for viral reactivation (OR = 3.28; 95% CI:1.83–6.08), pronation (3.36; 2.12–5.37) and orotracheal intubation (2.51; 1.58–4.02). Increased mortality was found for bacteremia (2.05; 1.31–3.22), viral reactivation (2.29; 1.29–4.19) and lymphocytes < 0.6 × 103c/µL (2.32; 1.49–3.64).

Conclusions
We found that viral reactivation, mostly due to Herpesviridae, was associated with increased risk of both bacteremia and mortality. In addition, pronation and intubation are strong predictors of bacteremia, which in turn together with severe lymphocytopenia due to SARS-CoV2 was associated with increased mortality. Most episodes of bacteremia, even due to Acinetobacter spp, were not predicted by microbiological evidence of colonization.
Factors affecting soil quality among smallholder macadamia farms in Malawi
Authors: Zuza Emmanuel Junior , Maseyk Kadmiel , Bhagwat Shonil A. , Chemura Abel , Brandenburg Rick L. , Emmott Andrew , Rawes Will , Hancock Wayne , Mnthambala Frank , Araya Yoseph N. 
Published: July 2023

AbstractDeclining soil fertility limits smallholder macadamia productivity in Malawi. To reverse this trend, it is essential to apply organic and inorganic fertilisers in an efficient and effective manner. Yet, fertilizer recommendations for smallholder macadamia (Macadamia integrifolia) production in Malawi are not site-specific. Nutrient imbalances can occur if fertilisers are applied without a clear understanding of whether they are required or not. This may lead to yield losses, unnecessary costs, and other environmental issues associated with excess fertiliser application. To address this research need/ knowledge gap, our study examined the current soil fertility status among smallholder macadamia farms in Malawi. Specifically, the objective was to establish an evidence base for promoting soil fertility restoration interventions for smallholder macadamia production. One hundred and eighty nine soil samples at a depth of 0–15 cm were collected from sixty three smallholder macadamia farms belonging to the Highlands Macadamia Cooperative Union Limited members in central and southern Malawi. We found that the majority of the soils were sandy loams (52%), strongly acidic (mean pH ≤ 5.1), and deficient in essential nutrients required for the healthy growth of macadamia. The soils had an average low cation exchange capacity of 1.67 cmol ( +) kg−1, which is inadequate for macadamia cultivation. More than half of the sampled soils had very low organic matter content (≤ 1%). The low soil organic matter content, coupled with the sandy texture and high acidity, contributed to the observed low concentrations of essential nutrients and cation exchange capacity. Poor agronomic practices and inherent soil characteristics are responsible for this low soil fertility. Altogether, our findings underscore the urgent need to identify and implement more sustainable and effective soil nutrient management practices that help to improve the soil fertility of macadamia farms under smallholder systems.
Gut barrier-microbiota imbalances in early life lead to higher sensitivity to inflammation in a murine model of C-section delivery
Authors: Barone M. , Ramayo-Caldas Y. , Estellé J. , Tambosco K. , Chadi S. , Maillard F. , Gallopin M. , Planchais J. , Chain F. , Kropp C. , Rios-Covian D. , Sokol H. , Brigidi P. , Langella P. , Martín R. 
Published: July 2023

Abstract
Background
Most interactions between the host and its microbiota occur at the gut barrier, and primary colonizers are essential in the gut barrier maturation in the early life. The mother–offspring transmission of microorganisms is the most important factor influencing microbial colonization in mammals, and C-section delivery (CSD) is an important disruptive factor of this transfer. Recently, the deregulation of symbiotic host-microbe interactions in early life has been shown to alter the maturation of the immune system, predisposing the host to gut barrier dysfunction and inflammation. The main goal of this study is to decipher the role of the early-life gut microbiota-barrier alterations and its links with later-life risks of intestinal inflammation in a murine model of CSD.

Results
The higher sensitivity to chemically induced inflammation in CSD mice is related to excessive exposure to a too diverse microbiota too early in life. This early microbial stimulus has short-term consequences on the host homeostasis. It switches the pup’s immune response to an inflammatory context and alters the epithelium structure and the mucus-producing cells, disrupting gut homeostasis. This presence of a too diverse microbiota in the very early life involves a disproportionate short-chain fatty acids ratio and an excessive antigen exposure across the vulnerable gut barrier in the first days of life, before the gut closure. Besides, as shown by microbiota transfer experiments, the microbiota is causal in the high sensitivity of CSD mice to chemical-induced colitis and in most of the phenotypical parameters found altered in early life. Finally, supplementation with lactobacilli, the main bacterial group impacted by CSD in mice, reverts the higher sensitivity to inflammation in ex-germ-free mice colonized by CSD pups’ microbiota.

Conclusions
Early-life gut microbiota-host crosstalk alterations related to CSD could be the linchpin behind the phenotypic effects that lead to increased susceptibility to an induced inflammation later in life in mice.
‘Terminal anorexia’: a lived experience perspective
Authors: Asaria Alykhan 
Published: July 2023

AbstractHaving suffered from longstanding anorexia nervosa (AN) for more than a decade, and after meeting many patients who have also been labelled as ‘treatment-resistant’, ‘treatment-refractory’, or similar terms, I feel a strong responsibility to express my deep fears and sadness about the more harmful new label of ‘terminal anorexia’. This article is based on a reflective and private email that I emotionally wrote in Autumn 2022, soon after reading a thought-provoking paper (Guarda et al. in J Eat Disord 10:79, 2022) about the new term. When I wrote the email, I had not read the Gaudiani et al. (J Eat Disord 10:23, 2022) paper that proposed clinical characteristics for the new diagnosis. Hence, my email was not, and this article is not, a response to Gaudiani et al. (2022). Challenging the criteria that they proposed is beyond the scope of this article, which is just a lived experience reaction to the concept of ‘terminal anorexia’ (regardless of who created it and who tries to define it).Before learning about ‘terminal anorexia’ in 2022, I assumed that ‘unconditional positive regard’ included mental health professionals’ unconditional hope for their patients’ ability to live meaningful lives, irrespective of how severe or chronic their patients’ conditions were. Therefore, I was very disheartened when the label ‘terminal anorexia’ was circulated by professionals. Research is not just read, seen, and heard about by the professionals who promote it. Vulnerable and conflicted eating disorder (ED) sufferers, and their families, can be victims of theoretical academic discourse that has real-world, life-or-death implications.The purpose of my article is not to suppress the arbitrary new term, which is sadly already commonly used in clinical practice and amongst very young ED sufferers, despite it having no agreed definition. I intend to outline some of the reasons why I believe that the term (not its hypothesised criteria, which are beyond the scope of my article) is harming ED sufferers, so that these harms can be addressed before it is too late. I have grouped these reasons into six key themes that inevitably overlap and cannot be perfectly separated. They are: [1] Hope and identity destruction; [2] Avoidance and collusion; [3] Self-diagnosis and misdiagnosis; [4] Comparisons; [5] Dangerous precedents; [6] Current and future treatments.
Association of body mass index with mortality of sepsis or septic shock: an updated meta-analysis
Authors: Bai Le , Huang Jingyi , Wang Dan , Zhu Dongwei , Zhao Qi , Li Tingyuan , Zhou Xianmei , Xu Yong 
Published: July 2023

Abstract
Background
The effects of body mass index (BMI) on mortality of sepsis remain unknown, since previous meta-analyses have reported conflicting results. Several observational studies published recently have provided new evidence. Thus, we performed this updated meta-analysis.

Methods
PubMed, Embase, Web of Science, and Cochran Library were searched for articles published before February 10, 2023. Observational studies that assessed the association of BMIs with mortality of sepsis patients aged > 18 years were selected. We excluded studies of which data were unavailable for quantitative synthesis. Odds ratios (OR) with 95% confidence interval (CI) were the effect measure, which were combined using fixed-effect or random-effect models. The Newcastle–Ottawa Scale was applied for quality assessment. Subgroups analyses were conducted according to potential confounders.

Results
Fifteen studies (105,159 patients) were included in the overall analysis, which indicated that overweight and obese BMIs were associated with lower mortality (OR: 0.79, 95% CI 0.70–0.88 and OR: 0.74, 95% CI 0.67–0.82, respectively). The association was not significant in patients aged ≤ 50 years (OR: 0.89, 95% CI 0.68–1.14 and OR: 0.77, 95% CI 0.50–1.18, respectively). In addition, the relationship between morbidly obesity and mortality was not significant (OR: 0.91, 95% CI 0.62–1.32).

Conclusions
Overweight and obese BMIs (25.0–39.9 kg/m2) are associated with reduced mortality of patients with sepsis or septic shock, although such survival advantage was not found in all crowds.
Trial registration The protocol of this study was registered in PROSPERO (registration number CRD42023399559).
Correlation between tissue Doppler-derived left ventricular systolic velocity (S’) and left ventricle ejection fraction in sepsis and septic shock: a retrospective cohort study
Authors: Chawla Sanchit , Sato Ryota , Duggal Abhijit , Alwakeel Mahmoud , Hasegawa Daisuke , Alayan Dina , Collier Patrick , Sanfilippo Filippo , Lanspa Michael , Dugar Siddharth 
Published: July 2023

Abstract
Background
Tissue Doppler-derived left ventricular systolic velocity (mitral S’) has shown excellent correlation to left ventricular ejection fraction (LVEF) in non-critically patients. However, their correlation in septic patients remains poorly understood and its impact on mortality is undetermined. We investigated the relationship between mitral S’ and LVEF in a large cohort of critically-ill septic patients.

Methods
We conducted a retrospective cohort study between 01/2011 and 12/2020. All adult patients (≥ 18 years) who were admitted to the medical intensive care unit (MICU) with sepsis and septic shock that underwent a transthoracic echocardiogram (TTE) within 72 h were included. Pearson correlation test was used to assess correlation between average mitral S’ and LVEF. Pearson correlation was used to assess correlation between average mitral S’ and LVEF. We also assessed the association between mitral S’, LVEF and 28-day mortality.

Results
2519 patients met the inclusion criteria. The study population included 1216 (48.3%) males with a median age of 64 (IQR: 53–73), and a median APACHE III score of 85 (IQR: 67, 108). The median septal, lateral, and average mitral S’ were 8 cm/s (IQR): 6.0, 10.0], 9 cm/s (IQR: 6.0, 10.0), and 8.5 cm/s (IQR: 6.5, 10.5), respectively. Mitral S’ was noted to have moderate correlation with LVEF (r = 0.46). In multivariable logistic regression analysis, average mitral S’ was associated with an increase in both 28-day ICU and in-hospital mortality with odds ratio (OR) 1.04 (95% CI 1.01–1.08, p = 0.02) and OR 1.04 (95% CI 1.01–1.07, p = 0.02), respectively.

Conclusions
Even though mitral S’ and LVEF may be related, they are not exchangeable and were only found to have moderate correlation in this study. LVEF is U-shaped, while mitral S’ has a linear relation with 28-day ICU mortality. An increase in average mitral S’ was associated with higher 28-day mortality.

Graphical Abstract