bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of surgical glue versus suture to repair perineal tears: a randomised controlled trial
Authors: Caroci-Becker Adriana , Brunelli Wesllanny Sousa , de Oliveira Pimentel Lima Marlise , Ochiai Angela Megumi , Oliveira Sheila Guimarães , Riesco Maria Luiza 
Published: April 2023

Abstract
Background
Surgical glue has been used in several body tissues, including perineal repair, and can benefit women.

Objectives
To evaluate the effectiveness of n-butyl-2-cyanoacrylate surgical glue compared to the polyglactin 910 suture in repairing first- and second-degree perineal tears and episiotomy in vaginal births.

Design
A parallel randomised controlled open trial.

Setting
Birth centre in Itapecerica da Serra, São Paulo, Brazil.

Participants and methods
The participants were 140 postpartum women allocated into four groups: two experimental groups repaired with surgical glue (n = 35 women with a first-degree tear; n = 35 women with a second-degree tear or episiotomy); two control groups sutured with thread (n = 35 women with a first-degree tear; n = 35 women with a second-degree tear or episiotomy). The outcomes were perineal pain and the healing process. Data collection was conducted in six stages: (1) up to 2 h after perineal repair; (2) from 12 to 24 h postpartum; (3) from 36 to 48 h; (4) from 10 to 20 days; (5) from 50 to 70 days; and (6) from 6 to 8 months. ANOVA, Student's t, Monte Carlo, x-square and Wald tests were used for the statistical analysis.

Results
One hundred forty women participated in the first three stages, 110 in stage 4, 122 in stage 5, and 54 in stage 6. The women treated with surgical glue had less perineal pain (p ≤ 0.001). There was no difference in the healing process, but the CG obtained a better result in the coaptation item (p ≤ 0.001).

Conclusions
Perineal repair with surgical glue has low pain intensity and results in a healing process similar to suture threads.

Trial registration
Brazilian Registry of Clinical Trials (UTN code: U1111-1184-2507; RBR-2q5wy8o); date of registration 01/25/2018; www.ensaiosclinicos.gov.br/rg/RBR-2q5wy8/
Mild hypercholesterolemia impacts achilles sub-tendon mechanical properties in young rats
Authors: Waugh Charlie M. , Mousavizadeh Rouhollah , Lee Jenny , Screen Hazel R. C. , Scott Alexander 
Published: April 2023

Abstract
Background
Hypercholesterolemia is associated with tendon pathology, but the reasons underpinning this relationship are not well understood. Cholesterol can accumulate in the tendon non-collagenous matrix which may affect both global and local tissue mechanics. Changes to the local strain environment within tendon may have significant implications for mechanosensitive tenocytes. Here, we investigated the association between elevated blood cholesterol and presence of tendon lipids in the Achilles tendon. We expected lipids to be localised in the proteoglycan-rich inter-sub-tendon matrix (ISTM), therefore we also sought to examine the impact of this on the biomechanical and viscoelastic properties of the ISTM.

Methods
The Achilles tendons of 32 young wild-type (SD) and 32 apolipoprotein E knock-out rats (ApoE−/−) were harvested at 15.6 ± 2.3 weeks of age. 32 specimens underwent histological examination to assess the distribution of lipids throughout sub-tendons and ISTM. The remaining specimens were prepared for biomechanical testing, where the ISTM between the gastrocnemius and soleus sub-tendons was subjected to shear load mechanical testing. A sub-set of tests were video recorded to enable a strain analysis.

Results
ApoE−/− serum cholesterol was double that of SD rats (mean 2.25 vs. 1.10 mg/ml, p < 0.001) indicating a relatively mild hypercholesterolemia phenotype. Nonetheless, we found histological evidence of esterified lipids in the ISTM and unesterified lipids in the sub-tendons, although the location or intensity of staining was not appreciably different between rat strains. Despite a lack of observable histological differences in lipid content between groups, there were significant differences in the mechanical and viscoelastic behaviour of the Achilles sub-tendon matrix.

Conclusion
Even slightly elevated cholesterol may result in subtle changes to tendon biomechanical properties and hence injury risk. The young age of our cohort and the mild phenotype of our ApoE−/− rats are likely to have limited our findings and so we also conclude that the ApoE−/− rat model is not well suited for investigating the biomechanical impact of tendon xanthomas on Achilles sub-tendon function.
Drain fluid and serum amylase concentration ratio is the most reliable indicator for predicting postoperative pancreatic fistula after distal pancreatectomy
Authors: Fukada Masahiro , Murase Katsutoshi , Higashi Toshiya , Yasufuku Itaru , Sato Yuta , Tajima Jesse Yu , Kiyama Shigeru , Tanaka Yoshihiro , Okumura Naoki , Takahashi Takao , Matsuhashi Nobuhisa 
Published: April 2023

Abstract
Background
Postoperative pancreatic fistula (POPF) is a major complication of pancreatic surgery. Drain fluid amylase concentration (DAC) is considered a predictive indicator of POPF. However, other indicators related to postoperative drain fluid amylase status exist, and the most reliable indicator for predicting POPF remains unclear. The object of this study is to identify the single most accurate indicator related to drain fluid amylase status of POPF after distal pancreatectomy (DP).

Methods
This single-institution retrospective study included 122 patients who underwent DP. The study was conducted between 2010 and 2022 at Gifu University Hospital. We statistically analyzed DAC, drain fluid amylase amount (DAA) calculated by multiplying DAC and daily drainage volume, and drain and serum amylase concentration ratio (DSACR) to assess the correlation with POPF.

Results
Based on the definition and grading of the International Study Group of Pancreatic Fistula, 24.6 (%) of the 122 patients had Grades B and C POPF. The result of the receiver operating characteristic (ROC) curve for predicting POPF after DP, DSACR had the highest area under curve(AUC) value among DAC, DAA, and DSACR both POD1 and POD3. The cutoff value of DSACR on POD1 was 17 (AUC 0.69, sensitivity 80.0%, specificity 58.2%, and accuracy 63.6%). The cutoff value of DSACR on POD3 was 22 (AUC 0.77, sensitivity 77.7%, specificity 73.3%, and accuracy 73.6%). Overall, DSACR on POD3 had the highest AUC value. Furthermore, a multivariate logistic regression analysis revealed that pancreatic texture (soft; odds ratio [OR] 9.22; 95% confidence interval [CI] 2.22–44.19; p < 0.01) and DSACR on POD3 (> 22; OR 8.76; 95% CI 2.78–31.59; p < 0.001) were independently associated with POPF after DP.

Conclusions
DSACR is the most reliable indicator of drain fluid amylase status for predicting POPF after DP.
Impact of the Covid-19 pandemic on the performance of machine learning algorithms for predicting perioperative mortality
Authors: Andonov D. I. , Ulm B. , Graessner M. , Podtschaske A. , Blobner M. , Jungwirth B. , Kagerbauer S. M. 
Published: April 2023

Abstract
Background
Machine-learning models are susceptible to external influences which can result in performance deterioration. The aim of our study was to elucidate the impact of a sudden shift in covariates, like the one caused by the Covid-19 pandemic, on model performance.

Methods
After ethical approval and registration in Clinical Trials (NCT04092933, initial release 17/09/2019), we developed different models for the prediction of perioperative mortality based on preoperative data: one for the pre-pandemic data period until March 2020, one including data before the pandemic and from the first wave until May 2020, and one that covers the complete period before and during the pandemic until October 2021. We applied XGBoost as well as a Deep Learning neural network (DL). Performance metrics of each model during the different pandemic phases were determined, and XGBoost models were analysed for changes in feature importance.

Results
XGBoost and DL provided similar performance on the pre-pandemic data with respect to area under receiver operating characteristic (AUROC, 0.951 vs. 0.942) and area under precision-recall curve (AUPR, 0.144 vs. 0.187). Validation in patient cohorts of the different pandemic waves showed high fluctuations in performance from both AUROC and AUPR for DL, whereas the XGBoost models seemed more stable. Change in variable frequencies with onset of the pandemic were visible in age, ASA score, and the higher proportion of emergency operations, among others. Age consistently showed the highest information gain. Models based on pre-pandemic data performed worse during the first pandemic wave (AUROC 0.914 for XGBoost and DL) whereas models augmented with data from the first wave lacked performance after the first wave (AUROC 0.907 for XGBoost and 0.747 for DL). The deterioration was also visible in AUPR, which worsened by over 50% in both XGBoost and DL in the first phase after re-training.

Conclusions
A sudden shift in data impacts model performance. Re-training the model with updated data may cause degradation in predictive accuracy if the changes are only transient. Too early re-training should therefore be avoided, and close model surveillance is necessary.
Cultural competence in critical care nurses and its relationships with empathy, job conflict, and work engagement: a cross-sectional descriptive study
Authors: Soleimani Mohsen , Yarahmadi Sajad 
Published: April 2023

Abstract
Background
Cultural competence is more important than ever for nurses today; therefore, it may be helpful to learn more about it and examine how it relates to empathy, job conflict, and work engagement. The purpose of this study was to determine (a) the level of cultural competence, empathy, job conflict, and work engagement; (b) the relationship between cultural competence, demographic information, and main variables; (c) the predictors of cultural competence among critical care nurses.

Methods
A multicenter, descriptive cross-sectional study was conducted in Iran from August to October 2022. Through convenience sampling, 153 critical care nurses from three hospitals participated. The research tool consisted of five parts: Demographic information questionnaire, Cultural Competence Questionnaire, Jefferson Scale Empathy, Dobrin Job Conflict, and Utrecht Work Engagement, which were collected by paper self-report. Descriptive statistics, the correlation between variables, and linear regression were used to analyze the data.

Results
Among critical care nurses (response rate 79.27%), the mean (SD) scores for cultural competence, empathy, job conflict, and work engagement were 74.05 (7.96), 83.44 (29.17), 11.00 (2.38), and 43.69 (16.33), respectively. There was a significant correlation between cultural competence and age (r = 0.46, p = 0.001), marital status (r = 0.27, p = 0.004), academic degree (r = 0.44, p = 0.001), work experiences (r = 0.43, p = 0.001), empathy (r = 0.50, p = 0.001), and job conflict (r=-0.16, p = 0.049). Academic degree (β = 0.36, p < 0.001) and empathy (β = 0.26, p < 0.001) were significant explanatory variables that predict cultural competence.

Conclusion
In Iranian critical care nurses, cultural competence and job conflict were moderate, empathy was good, and work engagement was poor. There was a significant relationship between cultural competence, age, marital status, academic degree, work experiences, empathy, and job conflict. Academic degree and empathy predict cultural competence.
Community knowledge, attitude and practices regarding zoonotic viral haemorrhagic fevers in five geo-ecological zones in Tanzania
Authors: Rugarabamu Sima , Sindato Calvin , Rumisha Susan F. , Mwanyika Gaspary O. , Misinzo Gerald , Lim Hee Young , Mboera Leonard E. G. 
Published: April 2023

Abstract
Background
Viral haemorrhagic fevers (VHF) cause significant economic and public health impact in Sub-Saharan Africa. Community knowledge, awareness and practices regarding such outbreaks play a pivotal role in their management and prevention. This study was carried out to assess community knowledge, attitude and practices regarding VHF in five geo-ecological zones in Tanzania.

Methods
A cross-sectional study was conducted in Buhigwe, Kalambo, Kyela, Kinondoni, Kilindi, Mvomero, Kondoa and Ukerewe districts representing five geo-ecological zones in Tanzania. Study participants were selected by multistage cluster sampling design. A semi-structured questionnaire was used to collect socio-demographic and information related to knowledge, attitude and practices regarding VHFs. Descriptive statistics and logistic regression were used for the analysis.

Results
A total of 2,965 individuals were involved in the study. Their mean age was 35 (SD ± 18.9) years. Females accounted for 58.2% while males 41.8%. Most of the respondents (70.6%; n = 2093) had never heard of VHF, and those who heard, over three quarters (79%) mentioned the radio as their primary source of information. Slightly over a quarter (29.4%) of the respondents were knowledgeable, 25% had a positive attitude, and 17.9% had unfavourable practice habits. The level of knowledge varied between occupation and education levels (P < 0.005). Most participants were likely to interact with a VHF survivor or take care of a person suffering from VHF (75%) or visit areas with known VHF (73%). There were increased odds of having poor practice among participants aged 36–45 years (AOR: 3.566, 95% CI: 1.593–7.821) and those living in Western, North-Eastern and Lake Victoria zones (AOR: 2.529, 95% CI: 1.071–6.657; AOR: 2.639, 95% CI: 1.130–7.580 AOR: 2.248, 95% CI: 1.073–3.844, respectively).

Conclusion
Overall, the knowledge on VHF among communities is low, while a large proportion of individuals in the community are involved in activities that expose them to the disease pathogens in Tanzania. These findings highlight the need for strengthening health educational and promotion efforts on VHF targeting specific populations.
The genome of the pygmy right whale illuminates the evolution of rorquals
Authors: Wolf Magnus , Zapf Konstantin , Gupta Deepak Kumar , Hiller Michael , Árnason Úlfur , Janke Axel 
Published: April 2023

AbstractBackgroundBaleen whales are a clade of gigantic and highly specialized marine mammals. Their genomes have been used to investigate their complex evolutionary history and to decipher the molecular mechanisms that allowed them to reach these dimensions. However, many unanswered questions remain, especially about the early radiation of rorquals and how cancer resistance interplays with their huge number of cells. The pygmy right whale is the smallest and most elusive among the baleen whales. It reaches only a fraction of the body length compared to its relatives and it is the only living member of an otherwise extinct family. This placement makes the pygmy right whale genome an interesting target to update the complex phylogenetic past of baleen whales, because it splits up an otherwise long branch that leads to the radiation of rorquals. Apart from that, genomic data of this species might help to investigate cancer resistance in large whales, since these mechanisms are not as important for the pygmy right whale as in other giant rorquals and right whales.ResultsHere, we present a first de novo genome of the species and test its potential in phylogenomics and cancer research. To do so, we constructed a multi-species coalescent tree from fragments of a whole-genome alignment and quantified the amount of introgression in the early evolution of rorquals. Furthermore, a genome-wide comparison of selection rates between large and small-bodied baleen whales revealed a small set of conserved candidate genes with potential connections to cancer resistance.ConclusionsOur results suggest that the evolution of rorquals is best described as a hard polytomy with a rapid radiation and high levels of introgression. The lack of shared positive selected genes between different large-bodied whale species supports a previously proposed convergent evolution of gigantism and hence cancer resistance in baleen whales.
Prenatal environmental exposures associated with sex differences in childhood obesity and neurodevelopment
Authors: Cáceres Alejandro , Carreras-Gallo Natàlia , Andrusaityte Sandra , Bustamante Mariona , Carracedo Ángel , Chatzi Leda , Dwaraka Varun B. , Grazuleviciene Regina , Gutzkow Kristine Bjerve , Lepeule Johanna , Maitre Léa , Mendez Tavis L. , Nieuwenhuijsen Mark , Slama Remy , Smith Ryan , Stratakis Nikos , Thomsen Cathrine , Urquiza Jose , Went Hannah , Wright John , Yang Tiffany , Casas Maribel , Vrijheid Martine , González Juan R. 
Published: April 2023

Abstract
Background
Obesity and neurodevelopmental delay are complex traits that often co-occur and differ between boys and girls. Prenatal exposures are believed to influence children’s obesity, but it is unknown whether exposures of pregnant mothers can confer a different risk of obesity between sexes, and whether they can affect neurodevelopment.

Methods
We analyzed data from 1044 children from the HELIX project, comprising 93 exposures during pregnancy, and clinical, neuropsychological, and methylation data during childhood (5–11 years). Using exposome-wide interaction analyses, we identified prenatal exposures with the highest sexual dimorphism in obesity risk, which were used to create a multiexposure profile. We applied causal random forest to classify individuals into two environments: E1 and E0. E1 consists of a combination of exposure levels where girls have significantly less risk of obesity than boys, as compared to E0, which consists of the remaining combination of exposure levels. We investigated whether the association between sex and neurodevelopmental delay also differed between E0 and E1. We used methylation data to perform an epigenome-wide association study between the environments to see the effect of belonging to E1 or E0 at the molecular level.

Results
We observed that E1 was defined by the combination of low dairy consumption, non-smokers’ cotinine levels in blood, low facility richness, and the presence of green spaces during pregnancy (ORinteraction = 0.070, P = 2.59 × 10−5). E1 was also associated with a lower risk of neurodevelopmental delay in girls, based on neuropsychological tests of non-verbal intelligence (ORinteraction = 0.42, P = 0.047) and working memory (ORinteraction = 0.31, P = 0.02). In line with this, several neurodevelopmental functions were enriched in significant differentially methylated probes between E1 and E0.

Conclusions
The risk of obesity can be different for boys and girls in certain prenatal environments. We identified an environment combining four exposure levels that protect girls from obesity and neurodevelopment delay. The combination of single exposures into multiexposure profiles using causal inference can help determine populations at risk.
Adipose tissue specific CCL18 associates with cardiometabolic diseases in non-obese individuals implicating CD4+ T cells
Authors: Subramanian Narmadha , Hofwimmer Kaisa , Tavira Beatriz , Massier Lucas , Andersson Daniel P , Arner Peter , Laurencikiene Jurga 
Published: April 2023

Abstract
Aim
Obesity is linked to cardiometabolic diseases, however non-obese individuals are also at risk for type 2 diabetes (T2D) and cardiovascular disease (CVD). White adipose tissue (WAT) is known to play a role in both T2D and CVD, but the contribution of WAT inflammatory status especially in non-obese patients with cardiometabolic diseases is less understood. Therefore, we aimed to find associations between WAT inflammatory status and cardiometabolic diseases in non-obese individuals.

Methods
In a population-based cohort containing non-obese healthy (n = 17), T2D (n = 16), CVD (n = 18), T2D + CVD (n = 19) individuals, seventeen different cytokines were measured in WAT and in circulation. In addition, 13-color flow cytometry profiling was employed to phenotype the immune cells. Human T cell line (Jurkat T cells) was stimulated by rCCL18, and conditioned media (CM) was added to the in vitro cultures of human adipocytes. Lipolysis was measured by glycerol release. Blocking antibodies against IFN-γ and TGF-β were used in vitro to prove a role for these cytokines in CCL18-T-cell-adipocyte lipolysis regulation axis.

Results
In CVD, T2D and CVD + T2D groups, CCL18 and CD4+ T cells were upregulated significantly compared to healthy controls. WAT CCL18 secretion correlated with the amounts of WAT CD4+ T cells, which also highly expressed CCL18 receptors suggesting that WAT CD4+ T cells are responders to this chemokine. While direct addition of rCCL18 to mature adipocytes did not alter the adipocyte lipolysis, CM from CCL18-treated T cells increased glycerol release in in vitro cultures of adipocytes. IFN-γ and TGF-β secretion was significantly induced in CM obtained from T cells treated with CCL18. Blocking these cytokines in CM, prevented CM-induced upregulation of adipocyte lipolysis.

Conclusion
We suggest that in T2D and CVD, increased production of CCL18 recruits and activates CD4+ T cells to secrete IFN-γ and TGF-β. This, in turn, promotes adipocyte lipolysis – a possible risk factor for cardiometabolic diseases.
Engineering osmolysis susceptibility in Cupriavidus necator and Escherichia coli for recovery of intracellular products
Authors: Adams Jeremy David , Sander Kyle B. , Criddle Craig S. , Arkin Adam P. , Clark Douglas S. 
Published: April 2023

Abstract
Background
Intracellular biomacromolecules, such as industrial enzymes and biopolymers, represent an important class of bio-derived products obtained from bacterial hosts. A common key step in the downstream separation of these biomolecules is lysis of the bacterial cell wall to effect release of cytoplasmic contents. Cell lysis is typically achieved either through mechanical disruption or reagent-based methods, which introduce issues of energy demand, material needs, high costs, and scaling problems. Osmolysis, a cell lysis method that relies on hypoosmotic downshock upon resuspension of cells in distilled water, has been applied for bioseparation of intracellular products from extreme halophiles and mammalian cells. However, most industrial bacterial strains are non-halotolerant and relatively resistant to hypoosmotic cell lysis.

Results
To overcome this limitation, we developed two strategies to increase the susceptibility of non-halotolerant hosts to osmolysis using Cupriavidus necator, a strain often used in electromicrobial production, as a prototypical strain. In one strategy, C. necator was evolved to increase its halotolerance from 1.5% to 3.25% (w/v) NaCl through adaptive laboratory evolution, and genes potentially responsible for this phenotypic change were identified by whole genome sequencing. The evolved halotolerant strain experienced an osmolytic efficiency of 47% in distilled water following growth in 3% (w/v) NaCl. In a second strategy, the cells were made susceptible to osmolysis by knocking out the large-conductance mechanosensitive channel (mscL) gene in C. necator. When these strategies were combined by knocking out the mscL gene from the evolved halotolerant strain, greater than 90% osmolytic efficiency was observed upon osmotic downshock. A modified version of this strategy was applied to E. coli BL21 by deleting the mscL and mscS (small-conductance mechanosensitive channel) genes. When grown in medium with 4% NaCl and subsequently resuspended in distilled water, this engineered strain experienced 75% cell lysis, although decreases in cell growth rate due to higher salt concentrations were observed.

Conclusions
Our strategy is shown to be a simple and effective way to lyse cells for the purification of intracellular biomacromolecules and may be applicable in many bacteria used for bioproduction.