bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification and analysis of imprinted genes in wild strawberry uncover a regulatory pathway in endosperm development
Authors: Joldersma Dirk , Guo Lei , Alger Elizabeth I , Ippoliti Christina , Luo Xi , Platts Adrian E , Edger Patrick P , Liu Zhongchi
Published: September 2024

Fertilization is a fundamental process that triggers seed and fruit development, but the molecular mechanisms underlying fertilization-induced seed development are poorly understood. Previous research has established AGamous-Like62 (AGL62) activation and auxin biosynthesis in the endosperm as key events following fertilization in Arabidopsis (Arabidopsis thaliana) and wild strawberry (Fragaria vesca). To test the hypothesis that epigenetic mechanisms are critical in mediating the effect of fertilization on the activation of AGL62 and auxin biosynthesis in the endosperm, we first identified and analyzed imprinted genes from the endosperm of wild strawberries. We isolated endosperm tissues from F1 seeds of 2 wild strawberry F. vesca subspecies, generated endosperm-enriched transcriptomes, and identified candidate Maternally Expressed and Paternally Expressed Genes (MEGs and PEGs). Through bioinformatic analyses, we identified 4 imprinted genes that may be involved in regulating the expression of FveAGL62 and auxin biosynthesis genes. We conducted functional analysis of a maternally expressed gene FveMYB98 through CRISPR-knockout and over-expression in transgenic strawberries as well as analysis in heterologous systems. FveMYB98 directly repressed FveAGL62 at stage 3 endosperm, which likely serves to limit auxin synthesis and endosperm proliferation. These results provide an inroad into the regulation of early-stage seed development by imprinted genes in strawberries, suggest the potential function of imprinted genes in parental conflict, and identify FveMYB98 as a regulator of a key transition point in endosperm development.
The microRNA399d-PHOSPHATE2 module alters rice sensitivity to rice ragged stunt virus by manipulating phosphate uptake
Authors: Lü Shaoyuan , Yu Xiyuan , Wu Xiaoqing , Hu Qiong , Zhu Xiao , Wu Ming , Hu Qun , Zhao Shanshan , Hu Jie , Wu Jianguo , Zhang Shuai
Published: September 2024

Rice (Oryza sativa L.) production frequently faces threats from biotic and abiotic stressors, with rice ragged stunt virus (RRSV) as a substantial biotic factor. The relationship between inorganic phosphorus content and susceptibility to RRSV is crucial yet poorly understood. This study investigates how phosphorus metabolism influences rice resistance to RRSV, focusing on genetic manipulations that modulate this relationship. The RRSV infection increased phosphate (Pi) content in the aerial parts of rice plants by enhancing Pi uptake and transport. Furthermore, the upregulation of microRNA399d (miR399d) and the suppression of its target gene OsPHOSPHATE2 (OsPHO2) enhanced Pi accumulation, increasing rice susceptibility to RRSV infection. Additionally, elevated Pi levels, which are associated with altered reactive oxygen species (ROS) dynamics, reduced ROS activity and potentially dampened the plant's innate immune response to viral infection. The miR399d-PHOSPHATE2 module was identified as pivotal in mediating phosphate uptake and influencing susceptibility to RRSV through modulations in the phosphorus and ROS pathways. This study shed light on the regulatory mechanisms of phosphorus nutrition in rice, revealing a critical interaction between phosphorus metabolism, ROS dynamics, and viral defense. The findings suggest potential strategies for manipulating Pi levels to enhance plant resistance against viruses, opening avenues for agricultural improvements and disease management in rice.
Positivity and Entanglement of Polynomial Gaussian Integral Operators
Authors: Balka Richárd , Csordás András , Homa Gábor
Published: September 2024

Positivity preservation is an important issue in the dynamics of open quantum systems: positivity violations always mark the border of validity of the model. We investigate the positivity of self-adjoint polynomial Gaussian integral operators $\widehat{\kappa }_{\operatorname{PG}}$; i.e. the multivariable kernel $\kappa _{\operatorname{PG}}$ is a product of a polynomial $P$ and a Gaussian kernel $\kappa _G$. These operators frequently appear in open quantum systems. We show that $\widehat{\kappa }_{\operatorname{PG}}$ can only be positive if the Gaussian part is positive, which yields a strong and quite easy test for positivity. This has an important corollary for the bipartite entanglement of the density operators $\widehat{\kappa }_{\operatorname{PG}}$: if the Gaussian density operator $\widehat{\kappa }_G$ fails the Peres–Horodecki criterion, then the corresponding polynomial Gaussian density operators $\widehat{\kappa }_{\operatorname{PG}}$ also fail the criterion for all $P$; hence they are all entangled. We prove that polynomial Gaussian operators with polynomials of odd degree cannot be positive semidefinite. We introduce a new preorder $\preceq$ on Gaussian kernels such that if $\kappa _{G_0}\preceq \kappa _{G_1}$ then $\widehat{\kappa }_{\operatorname{PG}_0}\ge 0$, implying that $\widehat{\kappa }_{\operatorname{PG}_1}\ge 0$ for all polynomials $P$. Therefore, deciding the positivity of a polynomial Gaussian operator determines the positivity of a lot of other polynomial Gaussian operators having the same polynomial factor, which might improve any given positivity test by carrying it out on a much larger set of operators. We will show an example that this really can make positivity tests much more sensitive and efficient. This preorder has implications for the entanglement problem, too.
The Impact of Crisis-Period Interest Rate Declines on Distressed Borrowers
Authors: Gabriel Stuart , Lutz Chandler
Published: September 2024

We measure the causal impact of reductions in benchmark interest rates on the renegotiation and performance of distressed loans, using 2000s subprime mortgages as a laboratory. Subprime borrowers treated with larger benchmark rate reductions benefited from increased debt-renegotiation probabilities and lower debt-service payments. Modification rates were similar among current and delinquent borrowers but higher for real estate investors, highlighting the role of financial acumen in renegotiation. Renegotiations also reduced longer-run foreclosures, but treated borrowers who lingered in delinquency offset these benefits. Findings suggest monetary easing can spur debt renegotiation but alone may not lead to longer-run curative outcomes.
Efficacy and safety of filgotinib in patients with moderately active rheumatoid arthritis and an inadequate response to methotrexate
Authors: Buch Maya H , Walker David , Edwards Christopher J , Barry Jane , Akroyd Laura , Ekoka Omoruyi Edmund V , Taylor Peter C
Published: September 2024

Objectives

Clinical trials restricted to moderately active RA are limited. Filgotinib is approved for treating moderate to severe active RA. This post hoc analysis assessed the efficacy and safety of filgotinib in moderately active RA.

Methods

In FINCH 1, patients with active moderate to severe RA and inadequate response to methotrexate received filgotinib 200 mg or 100 mg (FIL200/FIL100) once daily, adalimumab 40 mg every 2 weeks or placebo, all with methotrexate (N = 1755). This subgroup analysis was conducted in patients with a moderate baseline Disease Activity Score in 28 joints using C-reactive protein [DAS28-CRP; >3.2 to ≤5.1; n = 425 (24.2%)].

Results

A higher proportion of patients achieved DAS28-CRP <2.6, Clinical Disease Activity Index (CDAI) remission (≤2.8), low disease activity (LDA) (DAS28-CRP ≤3.2 or CDAI ≤10) and American College of Rheumatology (ACR20/50/70) responses with FIL200 and FIL100 vs placebo at weeks 12 and 24. Week 12 ACR20 response rates (primary end point) were 77.9%, 67.8% and 43.8%, respectively. A total of ∼75% of patients achieved DAS28-CRP LDA by week 24 with either filgotinib dose. FIL200 and FIL100 elicited greater improvements in patient-reported outcomes than placebo. The efficacy of filgotinib, maintained through week 52, was comparable to that of adalimumab. Frequency of adverse events (AEs) was similar with filgotinib and adalimumab. Infections were the most common AEs; incidence rates were 40–53% in active treatment groups.

Conclusion

In this subpopulation with moderately active RA, the efficacy and safety of filgotinib were similar to those in the overall FINCH 1 population (patients with active moderate to severe RA).

Trial registration

ClinicalTrials.gov, http://clinicaltrials.gov, NCT02889796.
Vessel wall MRI in giant cell arteritis: standardized protocol and scoring approach developed by an international working group
Authors: Rhee Rennie L , Bathla Girish , Rebello Ryan , Kurtz Robert M , Junek Mats , Warrington Kenneth J , Khalidi Nader , Merkel Peter A , Guggenberger Konstanze V , Tamhankar Madhura A , Bley Thorsten A ,   for the Vasculitis Clinical Research Consortium, Cuthbertson David , Borchin Renée L , Grayson Peter C , Khalidi Nader , Krischer Jeffrey P , Langford Carol A , McAlear Carol A , Merkel Peter A , Pagnoux Christian , Specks Ulrich , Warrington Kenneth J
Published: September 2024

Objectives

There are an increasing number of centres performing research on high-resolution vessel wall magnetic resonance imaging (VW-MRI) in GCA. However, harmonized approaches to VW-MRI in GCA are lacking and are essential to performing multicentre studies. Using a data-driven, consensus-based approach, an international expert group developed a standardized MRI protocol and scoring system to advance multi-centred research in cranial GCA.

Methods

A targeted literature review of VW-MRI in cranial GCA was conducted. A working group comprised of radiologists, rheumatologists and ophthalmologists with expertise in VW-MRI and GCA reviewed the results of the literature search, presented relevant data and images from their respective centres, and then reached consensus on recommendations related to key MRI structures, MRI sequences, scoring system and other important considerations.

Results

A total of 21 relevant articles were identified and reviewed. Based on published literature, structures to be evaluated on MRI were categorized based on anatomic location (extradural cranial, intradural cranial and orbits) and prioritization (core vs elective). Essential and elective sequences to comprehensively image cranial and orbital structures while minimizing scan time were determined along with scoring systems to grade contrast enhancement.

Conclusion

This report describes a standardized approach to facilitate research of VW-MRI in cranial GCA that is the result of a multidisciplinary, international collaboration of experts in VW-MRI and/or GCA.
Effects of mixed metal exposure on MRI metrics in basal ganglia
Authors: Kim Juhee , Kim Byoung-Gwon , Hong Young-Seoub , Lee Eun-Young
Published: September 2024

Welding fumes contain various metals. Past studies, however, mainly focused on Manganese (Mn)-related neurotoxicity. This study investigated welding-related mixed metal exposure effects on MRI metrics in the basal ganglia (BG) and their dose–response relationship. Subjects with (N = 23) and without (N = 24) a welding exposure history were examined. Metal exposure was estimated with an exposure history questionnaire and whole blood metal levels. T1 (weighted-intensity and relaxation time; estimates of brain Mn accumulation), diffusion tensor imaging (axial [AD], mean [MD], radial diffusivity, and fractional anisotropy [FA]; estimates of microstructural differences) metrics in BG (caudate nucleus, putamen, and globus pallidus [GP]), and voxel-based morphometry (for volume) were examined and related with metal exposure measures. Compared with controls, welders showed higher GP R1 (1/T1; P = 0.034) but no differences in blood metal and T1-weighted (T1W) values in any ROIs (P’s > 0.120). They also had higher AD and MD values in the GP (P’s < 0.033) but lower FA values in the putamen (P = 0.039) with no morphologic differences. In welders, higher blood Mn and Vanadium (V) levels predicted higher BG R1 and T1W values (P’s < 0.015). There also were significant overall metal mixture effects on GP T1W and R1 values. Moreover, GP AD and MD values showed nonlinear associations with BG T1W values: They increased with increasing T1W values only above certain threshold of T1 values. The current findings suggest that Mn and V individually but also metal mixtures jointly predict GP T1 signals that may in turn contribute to altered DTI metrics in the BG after certain exposure threshold levels.
Dormancy characteristics of lammas-growth seedlings of subtropical trees and their phenological responses to experimental warming
Authors: Zheng Jinbin , He Yi , Wang Fucheng , Zheng Rujing , Wu Jiasheng , Hänninen Heikki , Zhang Rui
Published: September 2024

Lammas growth of trees means the additional growth of the shoot after the growth cessation and bud set in late summer. In temperate tree species, lammas growth occurs irregularly and is often regarded as abnormal, disturbed growth. In subtropical tree species, however, lammas growth is a prevalent phenomenon, possibly due to the prolonged occurrence of high temperatures in the autumn. The occurrence of lammas growth extends the growing season of trees, but its influence on subsequent dormancy phenomena and bud burst phenology remains largely unexplored. By comparing seedlings showing lammas growth with others not showing it, we carried out an experimental study of how lammas growth affects the bud burst phenology and the underlying dormancy phenomena under both ambient and controlled chilling, forcing and warming conditions in four subtropical tree species: Carya illinoinensis, Cinnamomum japonicum, Phoebe chekiangensis and Torreya grandis. With the exception of C. illinoinensis, lammas growth delayed bud burst in all the species under ambient conditions. In the chilling experiment, the delayed bud burst appeared to be due to higher minimum forcing requirement, higher dormancy depth, and in T. grandis, also due to lower chilling sensitivity in the lammas-growth seedlings than in the non-lammas-growth ones. However, a spring warming experiment showed that the sensitivity of bud burst to spring temperatures was higher in the lammas-growth seedlings than in the non-lammas-growth ones. Because of this, the difference between the two phenotypes in the timing of bud burst vanished with increasing warming. Our findings elucidate the significant impact of lammas growth on the dormancy dynamics of subtropical tree species, highlighting the necessity to better understand how the physiological phenomena causing lammas growth change the trees’ subsequent environmental responses under changing climatic conditions.
Timing of Radiographic Healing for Distal Femur Fractures Treated With Intramedullary Nails
Authors: Brodke Dane , Devana Sai , Hernandez Adolfo , O'Hara Nathan , Burke Cynthia , Gupta Jayesh , McKibben Natasha , O'Toole Robert , Morellato John , Gillon Hunter , Walters Murphy , Barber Colby , Perdue Paul , Dekeyser Graham , Steffenson Lillia , Marchand Lucas , Fairres Marshall James , Black Loren , Roddy Erika , El Naga Ashraf , Hogue Matthew , Gulbrandsen Trevor , Atassi Omar , Mitchell Thomas , Shymon Stephen , Working Zachary , Lee Christopher
Published: September 2024

OBJECTIVES:

The aim of this study was to profile modified Radiographic Union Scale for Tibia (mRUST) scores over time in distal femur fractures treated with intramedullary nails and identify predictors of radiographic union timing and delayed progression.

METHODS:

Design:

Multicenter retrospective cohort study.

Setting:

Ten Level I Trauma Centers.

Patient Selection Criteria:

The inclusion criteria were patients with distal femur fractures (OTA/AO 33A and 33 C) treated with intramedullary nails, with a minimum follow-up of 1 year or until radiographic union or reoperation. The exclusion criteria were fractures treated with combination nail-plate constructs, pathologic fractures, and patients younger than 18 years old.

Outcome Measures and Comparisons:

The primary outcome was the mRUST score at 3, 6, and 12 months postoperatively. Receiver operating characteristic curve analysis identified the optimal 3-month mRUST score predicting reoperation. Multivariable models were used to identify predictors of radiographic union timing and delayed progression.

RESULTS:

The study included 155 fractures in 152 patients, with a mean patient age of 51 and a mean follow-up of 17 months. A 3-month mRUST score of ≤8 predicted reoperation with a PPV of 25% and a NPV of 99%. The timing of radiographic union was associated with tobacco use (1.2 months later; P = 0.04), open fracture (1.4 months later; P = 0.04), and the use of topical antibiotics (2.1 months longer; 95% CI, 0.33–3.84; P = 0.02); however, topical antibiotics were at high risk of being confounded by injury severity. Delayed progression to fracture healing, wherein the most rapid radiographic healing occurs more than 3 months postoperatively, was predicted by chronic kidney disease (P < 0.01).

CONCLUSIONS:

A 3-month mRUST score >8 suggests a very high likelihood of avoiding reoperation for nonunion. Tobacco use and open fractures were associated with a longer time to radiographic union. Chronic kidney disease is associated with a delayed radiographic progression, suggesting a need for adjusted expectations and management strategies in these patients.

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Geospatial Data Aggregation Methods for Novel Geographies: Validating Congressional District Life Expectancy Estimates
Authors: Schnake-Mahl Alina , Anfuso Giancarlo , Hernandez Stephanie M. , Bilal Usama
Published: September 2024

Background:

Place is a critical determinant of health. Recent novel analyses have explored health outcome estimation for small geographies, such as census tracts, as well as health outcome aggregation to geopolitical geographies with accountable political representatives, such as congressional districts. In one such application, combining these approaches, researchers aggregated census tract estimates of life expectancy at the congressional district level to derive local estimates, but such an approach has not been validated.

Methods:

Here, we compared two sources and approaches to calculating life expectancy data for Pennsylvania congressional districts. We used 2010–2015 census tract life expectancy estimates from the US Small-area Life Expectancy Estimates Project and dasymetric methods to compute population-weighted life expectancy aggregated to the congressional district level. Using georeferenced Vital Statistics data, we aggregated age-specific census tract death and population counts to congressional districts and used abridged life tables to estimate life expectancy. To validate the dasymetric aggregated estimates we compared absolute differences, assessed the correlation, and created Bland–Altman plots to visualize the agreement between the two measures.

Results:

We found strong agreement between congressional district estimates of life expectancy at birth derived using the dasymetric Life Expectancy Estimates Project model–based approach and the Vital Statistics direct estimates approach, though life expectancy at older ages (75 years and older) showed weak correlations.

Conclusions:

This validation contributes to our understanding of geospatial aggregation methods for novel geographies including congressional districts. Health outcome data aggregated to the congressional district geography can support congressional policymaking aimed at improving population health outcomes.
Differential Receipt of Genetic Services Among Patients With Gynecologic Cancer and Their Relatives: A Review of Challenges to Health Equity
Authors: Kanbergs Alexa , Rauh-Hain J. Alejandro , Wilke Roni N.
Published: September 2024

Up to 14% of endometrial cancers and 23% of epithelial ovarian cancers are associated with genetic predispositions. Referral for genetic testing and counseling can significantly impact a patient’s oncologic outcomes. However, significant disparities in genetic referral and testing exist within medically underserved and minority populations in the United States. These disparities in care and access to care are multifactorial, often involving patient-level, health care-level, and system-level factors. In this review, we focus on disparities in genetic testing among patients with ovarian and uterine cancer, and the missed opportunities for primary cancer prevention among their relatives.
Implementing a Phase II Quality Control Protocol for a High Precision 137Cs Dosimetry Calibration Irradiator
Authors: Noey Jordan D. , Stewart Colin J. , Kearfott Kimberlee J.
Published: September 2024

In medical physics, rigorous quality assurance and quality control protocols are vital for precise dose delivery applications. In many health physics applications, the allowable uncertainty for various processes is often greater than that of medical physics due to looser safety ties. This results in less demand for quality control and uncertainty analyses, since these may not be needed. However, certain applications can benefit from a comprehensive quality control program, as it may yield important insights, such as air kerma monitoring in dosimetry calibrations for environmental and low-dose applications. By implementing a thorough quality control program tailored to specific contexts and needs, uncertainties associated with dose measurements can be quantified with greater accuracy and reliability. This proactive approach not only ensures the integrity of data collected but also enhances understanding of the measured doses. For these reasons, a comprehensive quality control initiative was implemented following documented failures in a 137Cs dosimetry calibration irradiator. This involved systematic charge collection using NIST-traceable ion chambers to observe long-term changes. A Phase I quality control protocol was previously implemented, which employed Shewhart control charts and Nelson’s rules to analyze various datasets subgrouped under different conditions. This study addresses the development of a Phase II protocol, which focuses more on uncertainty quantification of systematic errors and irradiator changes, and air kerma precision for dosimetry calibrations. A designed experiment was performed to identify how much systematic errors influence the air kerma. Emphasis was placed on stricter quality assurance protocols, continuous data collection, and additional control charts to monitor short-term changes, such as exponentially weighted moving average control charts. A pre-irradiation control process was implemented to verify that the total air kerma met the measurement quality objective and to show how various uncertainties were applied before calibration. This study indicates how uncertainty is applied given observed air kerma measurements from the irradiator. Ongoing efforts aim to streamline the quality control procedure, ensure consistent data collection, and assess its impact on dosimetry applications.
Psychometric Properties of Vestibular and Ocular Measures Used for Concussion Assessments: A Scoping Review
Authors: Barnes Keely , Sveistrup Heidi , Karimijashni Motahareh , Bayley Mark , Marshall Shawn
Published: September 2024

Background:

Concussions most commonly affect the vestibular and ocular systems. Clinical measures used in the assessment of vestibular and ocular deficits should contain strong psychometric properties so that clinicians can accurately detect abnormality to guide treatment interventions.

Objectives:

The aim of this scoping review was: (1) to identify the measures used to evaluate the vestibular and ocular domains postconcussion and (2) to document the psychometric properties of the measures.

Methods:

Two databases (Medline (Ovid) and Embase) were searched from inception to May 2023. An updated search was completed in January 2024 using the same databases and search terms. Studies were screened and data were extracted independently by 2 reviewers. Measures were categorized into vestibular, ocular, or both (vestibular and ocular) domains, and relevant psychometric properties were documented.

Results:

Fifty-two studies were included in this review. 28 studies explored the use of vestibular measures, 12 explored ocular measures, and 12 explored both vestibular and ocular measures or explored the use of vestibulo-ocular reflex measures. Most studies explored the properties associated with balance measures, particularly the balance error scoring system. Diagnostic accuracy (sensitivity and specificity metrics) of the associated measures was the most frequently documented characteristic in the literature.

Conclusion:

Identification of clinical measures used to evaluate vestibular and ocular deficits postconcussion is needed to understand the evidence supporting their use in practice. Documenting the psychometric properties will allow clinicians and researchers to understand the status of the current literature and support for the use of certain measures in practice in terms of their ability to appropriately detect deficits in people with concussion when deficits are truly present.
Identifying Barriers and Implementation Strategies to Inform TBI Screening Adoption in Behavioral Healthcare Settings
Authors: Hyzak Kathryn A. , Bunger Alicia C. , Bogner Jennifer A. , Davis Alan K.
Published: September 2024

Objective: Identify barriers to the adoption of the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) in behavioral healthcare organizations and match these barriers to implementation strategies to inform future implementation efforts. Participants: Twenty behavioral health providers. Design: Qualitative study involving individual, semi-structured interviews regarding barriers to adopting the OSU TBI-ID. Data were thematically analyzed around constructs from the Consolidated Framework for Implementation Research (CFIR). Results were matched to strategies using the Expert Recommendations for Implementing Change (CFIR/ERIC) matching tool. Results: Ten barriers were identified across 4 CFIR domains. Inner-Setting barriers were inadequate leadership engagement, priorities, resources, and organizational incentives. Individual-Characteristics barriers were insufficient knowledge about the connection between TBI and behavioral health and how to conduct the OSU TBI-ID with fidelity, low self-efficacy to conduct screening, and inadequate motivation and buy-in to conduct screening. Outer-Setting barriers were lack of state-level mandates and inadequate incentives to conduct screenings. The Process domain barrier was an insufficient engagement of key personnel. Strategy recommendations include: identify and prepare champions; alter incentive and allowance structures; inform local opinion leaders; build a coalition; access new funding; conduct local consensus discussions; involve executive boards; capture/share local knowledge; conduct educational meetings; assess for readiness and identify determinants; identify early adopters; fund and contract for the clinical innovation; create a learning collaborative; and conduct a local needs assessment. Conclusions: This is the first study to examine barriers to adopting the OSU TBI-ID in real-world practice settings. Our results suggest that multilevel implementation strategies addressing mechanisms of change are necessary at the provider, organizational, and systems levels to overcome the complex barriers affecting TBI screening adoption and implementation. Future research is needed to test these strategies and their mechanisms of action on the adoption, implementation, and sustainment of TBI screening, as well as their effect on client-level outcomes.
Limbal Subconjunctival Abscess: A Rare Complication of Acanthamoeba Keratitis
Authors: Sibley Daniel , de Benito Llopis Laura
Published: September 2024

Purpose:

Acanthamoeba keratitis (AK) is a rare infection affecting the cornea. Immune-mediated sclerokeratitis is a well-documented late complication often requiring systemic immunosuppression. We present an alternative clinical presentation of subconjunctival abscesses caused by direct invasion of the Acanthamoeba and a proposed management strategy.

Methods:

This study was a single case report performed at a tertiary care center in the United Kingdom.

Results:

A 42-year-old contact lens wearer with a history of swimming in contact lenses presented with 2 days of pain, redness, and photophobia. There was clinical suspicion for AK that was later confirmed on confocal microscopy and cultures. Four months into treatment with polyhexamethylene biguanide 0.06% monotherapy, they experienced a relapse of symptoms and developed multiple subconjunctival limbal abscesses with associated scleritis. These were drained in the office, and topical treatment changed to chlorhexidine 0.2%. The aspirate was culture-positive Acanthamoeba. Despite initially improving, the abscess reoccurred within a month. Repeat drainage was performed, and topical and oral voriconazole was added to the treatment regime. The abscess resolved leaving an area of scleromalacia.

Conclusions:

Despite immune-mediated sclerokeratitis being a more common complication of AK, infectious scleritis can also occur. Correct identification of the cause of scleritis is required to prevent mistreatment of infectious scleritis with systemic immunosuppression. The abscess resolved with repeated drainage and the use of topical and systemic voriconazole.
Chinese expert consensus on imaging assessment of Pancreatic ductal adenocarcinoma (PDAC) resectability
Authors: Xue Huadan , He Ming , Liu Zaiyi , Du Yang , Dai Menghua , Liang Zhiyong , Zhao Xinming , Chen Min , Jin Zhengyu ,   on behalf of Group of Abdomen, Chinese Society of Radiology
Published: September 2024

Evaluation of PDAC resectability plays an important role in the workflow of diagnosis and treatment of PDAC including the decision of surgery or not, the selection of surgery methods, evaluation the adopting of neoadjuvant therapy or not. Imaging examination is an important tool to evaluate the resectability of PDAC, and various imaging examination should be used rationally and appropriately. This expert consensus summarized and discussed the key issues in imaging assessment of the resectability of PDAC, such as the selection of examination methods, key points of imaging assessment, and the application of new technologies, in order to better serve and guide the diagnosis and treatment of PDAC patients.
Efficacy of Rituximab in Autoimmune-Mediated IgG4 Pancreaticobiliary Disease
Authors: Loganathan Priyadarshini , Siby Ninette , Mohan Babu P. , Gajendran Mahesh , Chandan Saurabh , Echavarria Juan , Saligram Shreyas , Adler Douglas G.
Published: September 2024

Background and Aims:

IgG4 pancreaticobilliary disease (IgG4-PBD) typically shows a rapid improvement with glucocorticoid treatment, yet most patients experience a recurrence. Rituximab (RTX) has emerged as a hopeful approach to prevent relapses in IgG4-PBD. Nevertheless, there is a lack of data on the efficacy and safety of RTX in IgG4-PBD. In this study, we aim to perform a systematic review and meta-analysis to study the pooled efficacy of RTX in this patient population.

Methods:

Multiple databases, including MEDLINE, SCOPUS, and Embase, were searched (in March 2024) using specific terms for studies evaluating the efficacy and safety of RTX in IgG4 pancreatic biliary disease. Outcomes of interest were relapse, remission, partial remission rates, and adverse events. Standard meta-analysis methods were used using the random-effects model.I2% heterogeneity was used to assess the heterogeneity.

Results:

Twelve studies were included in the study (257 patients). The pooled rate of complete remission was 68% (54% to 80%),I2=53%, respectively. The pooled relapse rate was 23% (13% to 36%),I2=64%. The pooled rate of total adverse events was 21% (12% to 35%),I2=52%. The pooled partial remission rate is 16% (7% to 32%),I2=25%. The pooled rate of complete and partial remission was 81% (66% to 90%),I2=75%. The pooled infusion reaction and infection were 12% (7% to 18%),I2=0% and 14% (8% to 22%),I2=16%, respectively.

Conclusion:

RTX therapy appears effective in inducing and maintaining remission of pancreaticobiliary disease with a low rate of side effects. RTX presents as a promising treatment option for patients grappling with recurrent or unresponsive IgG4-related ailments. In addition, RTX emerges as an attractive alternative for individuals intolerant to steroids or experiencing IgG4-related disease relapses. Future studies comparing RTX with other immunomodulators will offer deeper insights into relapse factors and elucidate the appropriateness of utilizing this maintenance treatment following the initial flare.
Racial and Ethnic Disparities in Emergency Department Use Among Older Adults With Asthma and Primary Care Nurse Practitioner Work Environments
Authors: Poghosyan Lusine , Liu Jianfang , Turi Eleanor , Flandrick Kathleen , Robinson Marcia R. , George Maureen , Martsolf Grant R. , Carthon J. Margo Brooks , O’Reilly-Jacob Monica
Published: September 2024

Background

Older adults from specific racial and ethnic minoritized groups experience disproportionately higher asthma prevalence, morbidity, and mortality. They also often use emergency departments (EDs) to manage their asthma. High-quality primary care can improve asthma control and prevent ED use. Nurse practitioners (NPs) provide an increasing proportion of primary care to minoritized patients, yet often, they work in poor work environments that strain NP care.

Objectives

We examined whether racial and ethnic health disparities in ED visits among older adults with asthma are moderated by the NP work environment in primary care practices.

Methods

In 2018–2019, we used a cross-sectional design to collect survey data on NP work environments from 1,244 NPs in six geographically diverse states (i.e., Arizona, California, New Jersey, Pennsylvania, Texas, and Washington). We merged the survey data with 2018 Medicare claims data from 46,658 patients with asthma to assess the associations of all-cause and ambulatory care-sensitive conditions, ED visits with NPs’ work environment, and race and ethnicity using logistic regression.

Results

More than one third of patients with asthma visited the ED in 1 year, and a quarter of them had an ambulatory care-sensitive condition ED visit. Black and Hispanic patients were more likely than White patients to have all-cause and ambulatory care-sensitive condition ED visits. NP work environment moderated the association of race with all-cause and ambulatory care-sensitive condition ED visits among patients with asthma. Greater standardized NP work environment scores were associated with lower odds of all-cause and ambulatory care-sensitive condition ED visits between Black and White patients.

Discussion

Disparities in ED visits between Black and White patients with asthma decrease when these patients receive care in care clinics with more favorable NP work environments. Preventing unnecessary ED visits among older adults with asthma is a likely benefit of favorable NP work environments. As the NP workforce grows, creating favorable work environments for NPs in primary care is vital for narrowing the health disparity gap.
Experiences and Health Outcomes of Emerging Adults with Type 1 Diabetes: A Mixed Methods Study
Authors: Al Bayrakdar Amani , Puzantian Houry , Noureddine Samar , Abu-Saad Huijer Huda , Nasrallah Mona , Joiner Kevin L. , Martyn-Nemeth Pamela , Tfayli Hala
Published: September 2024

Background

Emerging adults with type 1 diabetes are at risk of poorer diabetes-related health outcomes than other age groups. Several factors affecting the health and experiences of the emerging adults are culture and healthcare specific.

Objectives

The aim of this study was to explore the experience of emerging adults living with type 1 diabetes in Lebanon, describe their diabetes self-care and diabetes-related health outcomes (HbA1c and diabetes distress), and identify the predictors of these outcomes.

Methods

A convergent mixed methods design was used with 90 participants aged 18-29 years. Sociodemographic, clinical data, and measures of diabetes distress, social support, and self-care were collected. Fifteen emerging adults participated in individual semi-structured interviews. Multiple linear regression was used to determine predictors of diabetes outcomes. Thematic analysis was used to analyze qualitative data. Data integration was used to present the mixed methods findings.

Results

The study sample had a mean HbA1c of 7.7% (SD = 1.36) and 81.1 % reported moderate to severe diabetes distress levels. The participants had good levels of diabetes self-care and high levels of social support. HbA1c was predicted by insulin treatment type, age at diagnosis, and diabetes self-care; while diabetes distress was predicted by diabetes knowledge, blood glucose monitoring approach, and diabetes self-care. “Living with type 1 diabetes during emerging adulthood: the complex balance of a chemical reaction” was the overarching theme of the qualitative data, with three underlying themes: “Breaking of bonds: changes and taking ownership of their diabetes”, “The reactants: factors affecting the diabetes experience”, and “Aiming for equilibrium”. The integrated mixed methods results revealed one divergence between the qualitative and quantitative findings related to the complexity of the effect of received social support.

Discussion

The suboptimal health of the emerging adults despite good self-care highlights the importance of addressing cultural and healthcare specific factors such as diabetes knowledge and public awareness, social support, and availability of technology to improve diabetes health. Findings of this study can guide future research, practice, and policy development.
Increased risk of hospitalization among children who were HIV-exposed and uninfected compared to population controls
Authors: Brochon Jeanne , Ducruet Thierry , Taillefer Suzanne , Lamarre Valérie , Renaud Christian , Metras Marie-Elaine , Karatzios Christos , Puyat Joseph H. , Singer Joel , Valois Silvie , Soudeyns Hugo , Boucoiran Isabelle , Kakkar Fatima
Published: September 2024

Objectives:

While studies have demonstrated increased morbidity and mortality risk in infancy among children who are HIV-exposed and uninfected (CHEU), longitudinal data are limited. The objective of this study was to assess long-term risk of hospitalization among CHEU compared to children who are HIV-unexposed and uninfected (CHUU), and determine risk factors for hospitalization among CHEU.

Design:

A longitudinal cohort study (1988–2015) linking the Centre maternel et infantile sur le SIDA cohort (Montreal, Quebec) to administrative data from the Régie de l’assurance maladie du Québec (RAMQ), a universal health insurance provider in the province of Quebec.

Methods:

CHEU from the CMIS cohort were matched 1 : 3 by age, sex, and postal code with CHUU controls from the RAMQ database. Incidence and causes of hospitalization between CHEU and CHUU were compared using Poisson regression.

Results:

Seven hundred twenty-six CHEU were matched to 2178 CHUU. Risk of first hospitalization was significantly higher among CHEU at 1 year (incidence rate ratio [IRR] 2.22 [1.86–2.66]), 5 years (IRR 1.62 [1.39–1.90]), and over the lifespan (IRR 1.55 [1.33–1.81]). Among CHEU, significant risk factors for hospitalization on univariate regression analysis included birth year before 2005, prematurity, small for gestational age (SGA), detectable maternal viral load (dVL) at delivery, and maternal hepatitis C co-infection. In the adjusted analysis, small for gestational age and dVL remained significant risk factors.

Conclusion:

CHEU had a higher rate of hospitalization than CHUU controls across their lifespan. Significant risk factors included SGA and detectable maternal dVL, suggesting a need for enhanced pediatric care for these children.
Optimizing Lower Extremity Local Flap Reconstruction in Peripheral Vascular Disease
Authors: Li Karen R. , Rohrich Rachel N. , Lava Christian X. , Akbari Cameron M. , Attinger Christopher E.
Published: September 2024

Background

Local flaps remain a valuable reconstructive tool as a means for limb salvage for patients with advanced arterial disease. Our single-center, retrospective cohort study aims to compare the outcomes of different patterns of blood flow affected by vascular disease to pedicles in local flap reconstruction of the foot and ankle.

Methods

A retrospective review of 92 patients and 103 flaps was performed. On angiograms, pattern of blood flow to the flap pedicle was determined to be direct inline flow (DF) or indirect flow (IF). Patterns of IF were either by arterial-arterial connections (AC) or unnamed randomized collaterals (RC). Primary outcomes were immediate flap success and limb salvage. Comparative analyses were performed using the χ2 and Fisher tests for categorical variables.

Results

Among all flaps, 73.8% (n = 76/103) had DF and 26.2% (n = 27/103) had IF. Both groups experienced similar rates of immediate flap success (DF = 97.3% vs IF = 92.6%, P = 0.281) and limb salvage (DF = 75.% vs IF = 66.7%, P = 0.403). However, the rate of contralateral amputation was significantly higher in the IF group (26.9% vs 5.3%, P = 0.006). When comparing the 3 distinct patterns of blood flow (DF vs AC vs RC), pedicled flaps were more commonly supplied by DF and AC, while random pattern flaps were more commonly supplied by RC (P = 0.042).

Conclusions

Alternative routes of revascularization can maintain local flap viability and achieve similar rates of limb salvage but risks contralateral amputation. We found that pedicled and local muscle flaps require inline blood flow or blood supply by ACs. Meanwhile, random pattern flap can be supported by random collaterals.
A quality assessment tool for focused abdominal sonography for trauma examinations using artificial intelligence
Authors: Cull John , Morrow Dustin , Manasco Caleb , Vaughan Ashley , Eicken John , Smith Hudson
Published: September 2024

BACKGROUND

Current tools to review focused abdominal sonography for trauma (FAST) images for quality have poorly defined grading criteria or are developed to grade the skills of the sonographer and not the examination. The purpose of this study is to establish a grading system with substantial agreement among coders, thereby enabling the development of an automated assessment tool for FAST examinations using artificial intelligence (AI).

METHODS

Five coders labeled a set of FAST clips. Each coder was responsible for a different subset of clips (10% of the clips were labeled in triplicate to evaluate intercoder reliability). The clips were labeled with a quality score from 1 (lowest quality) to 5 (highest quality). Clips of 3 or greater were considered passing. An AI training model was developed to score the quality of the FAST examination. The clips were split into a training set, a validation set, and a test set. The predicted scores were rounded to the nearest quality level to distinguish passing from failing clips.

RESULTS

A total of 1,514 qualified clips (1,399 passing and 115 failing clips) were evaluated in the final data set. This final data set had a 94% agreement between pairs of coders on the pass/fail prediction, and the set had a Krippendorff α of 66%. The decision threshold can be tuned to achieve the desired tradeoff between precision and sensitivity. Without using the AI model, a reviewer would, on average, examine roughly 25 clips for every 1 failing clip identified. In contrast, using our model with a decision threshold of 0.015, a reviewer would examine roughly five clips for every one failing clip — a fivefold reduction in clips reviewed while still correctly identifying 85% of passing clips.

CONCLUSION

Integration of AI holds significant promise in improving the accurate evaluation of FAST images while simultaneously alleviating the workload burden on expert physicians.

LEVEL OF EVIDENCE

Diagnostic Test/Criteria; Level II.
Does early transfusion of cold-stored whole blood reduce the need for component therapy in civilian trauma patients? A systematic review
Authors: Risha Mohamad , Alotaibi Abdullah , Smith Shane , Priestap Fran , Iansavitchene Alla , Laverty Colin , Hilsden Rich , Beckett Andrew , Spurrell David , Vogt Kelly , Ball Ian
Published: September 2024

BACKGROUND

Civilian acute trauma care has advanced in recent decades; however, traumatic injury remains the leading cause of death in individuals aged 15 to 29 years in the United States and worldwide. Uncontrolled hemorrhage is the leading preventable cause of death in trauma patients, with up to half of these deaths occurring before reaching a medical facility. The timely application of hemorrhage control measures is critical to enhance the survivability of trauma patients and is one of the major challenges faced by medical providers in austere environments. The purpose of this review is to explore if early resuscitation with cold-stored whole blood therapy reduces the need for component therapy in the first 24 hours postinjury in the civilian population.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic literature search in Medline, EMBASE, and Transfusion Evidence Library for studies reporting data on 24-hour blood product usage in trauma patients in hemorrhagic shock receiving initial therapy with whole blood. Two reviewers independently performed the selection of eligible studies.

RESULTS

Of a total of 2,150 identified studies, 11 studies (n = 4,792) met the inclusion criteria. There was heterogeneity in the study design, interventions, and outcomes. Seven studies reported a statistically significant decrease in 24-hour transfusion requirements in the whole blood intervention group in comparison with the control component therapy group. Three studies reported no significant difference between the two groups. One of the studies reported an increase in 24-hour transfusion requirements in the whole blood group.

CONCLUSION

Overall, there appears to be a decrease in component therapy use following initial resuscitation with whole blood in trauma patients with hemorrhagic shock. However, further research is needed to address this important practical question (PROSPERO registration no. CRD42023422173).

LEVEL OF EVIDENCE

Systematic Review; Level IV.