bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP40: Enhanced Team Communication Improves Door to Device Times
Authors: Richardson Melissa
Published: February 2024

Background:
Patients experiencing acute ischemic stroke benefit from early reperfusion. The American Heart Association set a goal for hospitals performing mechanical thrombectomy to achieve ‘door to device’ (DTD) time of less than 90 minutes for 50% of eligible patients. In 2021, only 23% of patients were meeting this time target. These patients require complex care and timely communication between various practitioners. It was noted that these practitioners were working in silos, which resulted in unnecessary delays. The need for enhanced communication was identified as an intervention to improve performance.

Methods:
Key team members are equipped with a dedicated phone using an artificial intelligence application, which provides an early signal when large vessel occlusion is detected. This allows for earlier mobilization of resources. This is particularly important for emergency department and interventional radiology nurses who are the ones driving transition of care between departments. In addition, the anesthesia department uses closed loop communication to notify the team of their readiness to receive the patient. Lastly, timely debriefs for all practitioners involved in the case provide a forum for constructive, thoughtful feedback about ways to be more efficient.

Results:
After enhanced communication strategies were implemented in quarter 2 of 2022, DTD times improved to 43% in quarter 3 of 2022, 50% in quarter 4 of 2022, 67% in quarter 1 of 2023 and 75% in quarter 2 of 2023.

Conclusions:
Providing tools to enhance communication amongst various practitioners has resulted in sustained improvement in DTD times. Future data collection should focus on associating these improved DTD times with long term functional outcomes.
Abstract WP47: Creation of a Pediatric Stroke Alert Protocol
Authors: Garza Ashley M , Figueroa Jeanette
Published: February 2024

Background:
In 2021, our Comprehensive Stroke Center (CSC) in San Antonio (SA), Texas received 7 pediatric patients suffering from signs and symptoms of stroke. These patients ranged in age from 4-17 and approximately 57% were positive for an acute ischemic stroke (AIS). During the month of March, 2 patients were brought in via EMS and both MRIs were positive for AIS, prompting our stroke team to evaluate our adult processes. We concluded that an Emergency Department (ED) Pediatric Stroke Alert Protocol was needed in order for our hospital to have the capability to care for this patient population, and also appropriately triage and offer acute therapies to give these patients the best chance possible.

Purpose:
Develop an ED Pediatric Stroke Alert Protocol in order to provide rapid triage and advanced therapies if warranted. The ED Pediatric Stroke Alert protocol was developed with our same stroke alert time frame in mind, 0-6 hours, and with the age range of 2-17 years.

Methods:
An interdisciplinary team consisting of Vascular neurology, Pediatric Neurology, Pediatric Hematology/Oncology, Pediatric Critical Care nursing, Pediatric / Adult ED nursing & Faculty, Neuro Critical Care, Pharmacy, and our Stroke Team met to discuss how to implement a pediatric protocol. It was decided that modeling it after the Adult ED Stroke Alert Protocol would be best to limit confusion and triage errors. The Cincinnati Stroke Scale was used as the tool of choice in order for our ED team to identify stroke symptoms, also a time frame of less than 6 hours from onset of symptoms AND a blood glucose between 60 and 600. This would then prompt the activation of the Pedi ED Stroke Alert Protocol. Triage on the protocol includes inclusion and exclusion criteria for IV tPA, which was also tailored to the pediatric population with the help of Pediatric Hematology/Oncology.

Results:
The ED Pedi SA Protocol has since been revised to meet the needs of our changing pediatric stroke population. The CSC continues to treat pediatric patients and continues to develop other tools to meet the needs of this population.

Conclusion:
Our CSC has been categorized by EMS as one of the only CSCs in SA, Texas that is capable of providing complete stroke care to the pediatric population.
Abstract WP66: Increases in Emergency Department Utilization of CT Angiography Brain and CT Perfusion in the Transferred Patient Population Across the Endovascular Therapy Era
Authors: Mamer Lauren E , Kocher Keith E , Cranford James A , Meurer William J , Scott Phillip A
Published: February 2024

Background:
With the advent of endovascular therapy as a treatment modality for LVO stroke, the importance of stroke networks has become increasingly clear. We sought to understand the way advanced neuroimaging is utilized in transferred emergency department (ED) encounters using a large national dataset.

Methods:
Retrospective cohort study of adult ED encounters, comparing ED transfers (to other acute care hospitals) to discharged patients. Data from the 2013-2018 National Emergency Department Sample (NEDS), an AHRQ dataset containing a weighted 20% sample of US ED encounters were analyzed. CTA Head, CTP, MRI Brain, and Non-contrast CT Head imaging use was determined from Common Procedural Terminology (CPT) codes. ICD10 Codes I60-I69 were used to indicate cerebrovascular disease. Statistical comparisons used 95% CI for rate per 100,000 ED visits.

Results:
ED utilization of advanced neuroimaging was higher in transferred patients than discharged patients in all years studied (Fig). Between 2013 and 2018, utilization of CTA and CTP increased 8-fold and 20-fold, respectively in the transferred population. Noncontrast head CT and MRI were relatively stable but more frequent in transferred encounters. Between 2013 and 2018, encounters associated with a transfer came disproportionately from smaller hospitals (45% from hospitals with <=20,000 ED visits per year, and 24% from ED visits at hospitals with between 20,000 and 40,000 ED visits per year). In 2018 transferred encounters with a CTA Head or CTP, 75% (72-77) and 76%(70-83), respectively had a diagnosis code associated with cerebrovascular disease.

Conclusions:
Utilization of CTA and CTP increased substantially between 2013-2018 in the ED transfer population, and most of these encounters are associated with a cerebrovascular disease diagnosis. Detailed diagnosis and hospital demographic data to be presented. These results have implications for the design and optimization of stroke systems of care.
Abstract WP68: National Database Demonstrates Substantial Delays Between Non-Contrast CT and CT Angiography in Suspected Stroke Patients in 2023
Authors: Mijalski Sells Christina M , Loube Deanne , Phan Allan Q , Albers Gregory W
Published: February 2024

Background:
Prompt identification of large vessel occlusions (LVOs) leads to shorter door to thrombectomy times and better outcomes. In most stroke centers, both a non-contrast CT (CT) and CT angiography (CTA) are ordered simultaneously in patients suspected to have acute stroke. In some centers, a CT is performed first, and CTA is subsequently obtained if vessel imaging is deemed necessary.

Methods
: Data on 23,925 patients from 717 hospitals who underwent both CT and CTA imaging processed with Rapid software in the United States from Jan 1, 2023 to June 30, 2023 were queried to determine the time delay between CT and CTA. Rapid software is typically used to evaluate suspected stroke patients for occlusions of major brain arteries and salvageable tissue.

Results
: A delay greater than 15 minutes between CT and CTA occurred in 4,365 patients (18%). Among the 717 hospitals, 595 (83%) had a median delay of less than 15 minutes, 77 (11%) had 15-30 minute delays and 45 (6%) had greater than 30 minute median delays. Among the 595 high performing hospitals, 57% had greater than 15 minute delays in 10% or fewer patients, 33% of the hospitals had 11-33% of their patients with greater than 15 minute delays, and 10% had 34-50% of patients with greater than 15 minute delays.

Conclusion
: Nearly 20% of patients have a delay greater than 15 minutes between CT and CTA. Seventeen percent of hospitals had a median delay of greater than 15 minutes and 6% had more than a 30 minute median delay. Even among high performing hospitals, a substantial number of patients had more than 15 minutes delay suggesting these patients were moved off the scanner between scans. Education on reducing CT to CTA time in suspected stroke patients should be targeted to hospitals with substantial delays. Software to identify LVOs on non-contrast CT could significantly reduce the door to diagnosis time for LVOs.
Abstract WP75: Interprofessional Medical Education in a Stroke Escape Room to Improve Stroke Education and Communication Skills
Authors: Djakovic Mirjana , Wadina Adam , Rainey Joy , De Lauriea Margaret , Rasmussen Teresa R , Thuruthumaly Elizabeth
Published: February 2024

Purpose:
Acute stroke care requires a foundation of clinical knowledge to quickly recognize symptoms and facilitate rapid, safe treatment. Effective care requires a complex network of communication in a stroke response team. Simulation-based training provides a multimodal approach to learning that reinforces clinical knowledge of stroke and affords the opportunity to demonstrate effective communication skills in critical situations. An interprofessional scenario allows all participants to learn about the different roles required for effective care.

Methods:
Fifty new graduate nurses participated in a pilot model of a traditional didactic session on stroke knowledge, followed by an “escape room” incorporating this knowledge to solve puzzles. The second iteration was expanded to include incoming neurology PGY-2 residents, registered nurses, and pharmacy residents. After the lecture, participants formed teams including equal numbers of all provider roles. The teams were tasked to complete a timed version of the escape room by solving stroke-based puzzles. The escape room was followed by a debrief of communication skills modeled by TeamSTEPPS. Finally, the same teams were exposed to a simulated “stroke code," which included a focused assessment, interpretation of labs and imaging, and management of barriers to treatment with an end goal of collectively managing a suspected stroke.

Results:
A 5-point scale was used to assess level of comfort with leadership in initial stroke assessment, management, treatment, and communicating concerns. The average increase in numeric level of comfort was 0.9 (range 0.6 - 1.4). The benefit did appear greater for incoming neurology PGY-2 residents (average increase 1.3, range 0.6 - 1.6) compared to registered nurses (average increase 0.45, range 0.25 to 0.75).

Conclusions:
Use of an escape room during training for incoming neurology PGY-2 residents, registered nurses, and pharmacy residents provided a novel opportunity to facilitate application of clinical knowledge, leadership, teamwork, shared decision-making, and prioritization of patient safety. Providing interactive sessions in between didactic instruction increased participant engagement and level of comfort with roles in a stroke response team.
Abstract WP76: Utilization Rate and Predictors Utilization of Transcranial Doppler Ultrasound Amongst Stroke Population of USA - A Nationwide Study
Authors: Andreev Alexander , Patil Karishma , Jain Aagam , Sreeni Nishitha , Thomas Anchu , Patel Urvish K , Arora Rohan
Published: February 2024

Introduction:
Transcranial Doppler Ultrasound (TCD) has proven to be useful in monitoring vasospasm after intracerbral hemorrhage (ICH), predicting delayed ischemic stroke (AIS) (sensitivity 91.2%, specificity 80.8%), and assessing recanalization post-thrombolysis for AIS. (91%, 93%). Findings were limited by small sample size and non-nationwide representation for the USA. We aimed to evaluate the utilization and predictors of utilization of TCD in ICH and AIS hospitalizations of the USA.

Methods:
A retrospective cross-sectional study on the Nationwide Inpatient Sample was analyzed using the year 2003-2014. Hospitalizations with ICH, AIS, and TCD were identified using the ICD-9-CM codes 431 and 433-437.XX as a primary diagnosis and 88.71 respectively. Univariate and multivariate logistic regression analysis were performed to find out utilization rate and predictors of utilization in ICH and AIS.

Results:
We found 715,516 ICH and 4,224,924 AIS hospitalizations of those 4,405(0.62%) in ICH and 93,673(2.22%) in AIS had TCD utilization. Utilization trend has declined in ICH(0.99% in 2003 to 0.71% in 2014, pTrend<0.0001) and AIS (3.84% in 2003 to 1.34% in 2014, pTrend<0.0001). In regression analysis of AIS hospitalizations, age group 65 and above(1.7, 1.3-2.2), African American(1.5, 1.5-1.6), Hispanic(1.63, 1.6-1.7), income 76-100th percentile(1.2, 1.2-1.3), hypertensives(1.05, 1.01-1.1), hypercholesterolemia (1.2, 1.2-1.3), alcohol abuse(1.1, 1.00-1.2) and anticoagulant users(1.5; 1.4-1.6), had higher odds of TCD utilization. Amongst ICH, TCD utilization was higher in African-American/Hispanic; medium to large size/urban-teaching hospital, drug abusers(6.5, 1.6-25.5), hypercholesterolemia(1.8, 1.4-2.3), and those with external ventricular drain(2.1, 1.1-4.2).

Conclusion:
Despite the proven higher sensitivity and accuracy of TCD in ICH and AIS, its utilization has declined. This is concerning, especially given the potential benefits for specific patient populations like African Americans and hypertensives who may have higher needs for stroke monitoring. To address this disparity, it is imperative that more comprehensive studies be conducted to thoroughly examine the outcomes and cost-utility of TCD.
Abstract WP9: Ischemic Stroke Progression After Witnessed Onset in Daytime vs Night-Time
Authors: Pariona-Vargas Fatima , Mun Katherine T , Starkman Sidney , Sanossian Nerses , Lo Eng , Bahr Hosseini Mersedeh , Stratton Samuel , Eckstein Marc , Conwit Robin A , Liebeskind David S , Rao Neal M , Shkirkova Kristina , Avila Gilda , Kim-Tenser May A , Saver Jeffrey L ,   FAST-MAG Investigators
Published: February 2024

Introduction:
Early neurologic deterioration (END) and poor functional outcomes are more frequent with night than daytime onset of ischemic stroke. This variation may be related to: 1) circadian variation endogenous bodily rhythms and/or 2) extrinsic environmental time cues.

Methods:
To assess the contribution of extrinsic environmental time to ischemic stroke course, we evaluated patients with acute cerebral ischemia (ACI) onset within last 2h, enrolled in the NIH FAST-MAG trial of prehospital neuroprotection, consisting of patients with witnessed/wake onset.

Results:
Among 1235 ACI patients (ischemic stroke 1033, TIA 202), age was 70.8 [±13.2], 45.3% female, initial NIHSS 7 (IQR 2-15), LKW to randomization 59 mins (IQR 46-80), and 473 (38%) treated with IV lytics. Onset occurred during clock daytime (07:00-22:59) in 1147 (92.9%) and night-time (23:00-06:59) in 88 (7.1%). Patients were similar in 18 baseline characteristics, but night-onset had higher initial SBP (162 vs 155, p=0.01) and longer onset to paramedic times (33m vs 23m, p = 0.0002). Among non-lytic patients, both unadjusted and adjusted clinical outcomes were similar in night vs daytime patients, including END (13.6% vs 16.4%), 90d mRS 0-2 (63.6% vs 58.5%), and 90d mortality (10.2% vs 12.8%). Among lytic patients, clinical outcomes were also similar in night vs daytime onset patients, including unadjusted END (36% vs 21.7%), 90d mRS 0-2 (52% vs 46.9%), and 90d mortality (12% vs 17.4%). Night vs daytime onset did not modify the effect of magnesium vs placebo on outcome among either non-thrombolytic or thrombolytic-treated patients (Figure).

Conclusion:
Among acute cerebral ischemia patients, efficacy, safety, and neuroprotective agent response outcomes were not modified by witnessed onset during active versus inactive phase clock times. These findings suggest biological wake-sleep state rather than chronologic clock time is the driver of known circadian rhythmicity in stroke course.
Abstract WP91: Stroke Tracking: Improving Core Measure Compliance Tracking & Efficiency
Authors: Stein Laura A , Spahr Melissa , Scavicchio Karlie , Owens Karrima C , Hoey Colin , Rothstein Aaron , Yellareddigari Megan , Sellers Michele , Pomeroy Jon , Tambe Ujwala , Cristancho Daniel , Blum Christina
Published: February 2024

Background:
Stroke program development and expansion requires excellent patient care and continued quality improvement via ongoing data collection. Substantial time and effort are required to identify patient records and manually assess metrics within charts. While real-time assessment of this data is ideal, achieving this is challenging.

Purpose:
We sought to create a real-time, electronic medical record (EMR) derived patient tracking list to improve accuracy, efficiency, and timeliness of stroke patient data collection.

Methods:
Ischemic stroke patient identification was optimized utilizing current patient lists, which over capture, and applying filters based on EMR entries applicable to stroke patients. Patient capture was reviewed to ensure adequate sensitivity and specificity. Subsequently, key stroke quality data points were identified. Custom columns were created to pull data from across the EMR into a central list. Column data was validated to ensure accuracy and confirm improved efficiency via timed chart reviews. A Mann-Whitney test was used to compare means pre and post-review. Of note, different reviewers performed pre and post reviews.

Results:
A stroke tracking list was successfully implemented. Chart review in the previous process averaged 173.2 seconds (STD 40.6) vs. 121.3 seconds (STD 17.8) in the new process (p<0.05). Patient identification times were not compared, though identifying charts in the old workflow ranged from 12 to 15 minutes per chart.

Conclusions:
Creation of a central tracking list within the electronic medical record is feasible and can improve patient identification, coordination of critical data sharing, and data collection efficiency. Utilization decreased data collection times and prompted creation of similar tracking lists for other core measure data. While sample sizes were small and pre and post reviewers were different, this work demonstrates feasibility and early foundational work.
Abstract WP98: Variability of Perioperative Anticoagulation Strategies in Patients With Atrial Fibrillation
Authors: Kearse Tiffany , Moncaleano Daniela , Schachter Maria Micaela , Saba Ramsey , TSENG VICTOR , Dolia Jay , Antzoulatos Eleni , Schachter Daniel
Published: February 2024

Introduction:
In patients with atrial fibrillation (AFib) whose anticoagulation (AC) requires being held prior to non-emergent surgery, ischemic stroke is an unfortunately familiar event. Current practices in the holding of anticoagulation pre-op and the use of bridging therapy are heterogeneous, the guidelines for which are often underutilized.

Methodology:
We surveyed cardiologists, general practitioners and surgical specialists across a single large academic-based healthcare institution regarding periprocedural AC practices in patients with AFib. Data were organized by provider type and experience. Chi-square, Fisher exact, and Student's t-tests were used to analyze differences in anticoagulation practices.

Results:
Of 2,604 surveys emailed, 14 cardiologist, 53 general practitioners and 70 procedural/surgical specialists participated. Average number of days surgical specialists required holding AC were 2.6 (SD = 1.2) for direct oral anticoagulant (DOAC) and 4.6 (SD=1.6) for warfarin. INR goal averaged 1.6 (SD 0.3). Surgical specialists required bridging therapy for DOAC significantly less often than they did for warfarin, 15.5% vs 44.3%,

X
2

= 14.0, p < 0.001. Timing of DOAC held and warfarin held did not differ between attendings and trainees, nor did threshold goal INR. In contrast, practices between non-surgical specialists widely differed. Cardiologists trended roughly 4 times less likely than general practitioners to prescribe bridging therapy while DOAC was held,

X
2

= 3.3, p = 0.06, yet they also trended toward prescribing bridging therapy more often for patients who had history of ischemic stroke. Significantly, attendings were 5 times less likely than residents to prescribe bridging therapy for DOACs and 3x times less likely to do so for warfarin,

X
2

= 14.9, p = 0.0001 and

X
2

= 5.5, p = 0.01, respectively.

Conclusion:
Our data indicate that significant differences exist in pre-op anticoagulation recommendations across provider type as well as training level. These differences are most stark in the use of bridging therapy while anticoagulation is held. Surgeons demonstrated more consistency in their anticoagulation strategies than did non-surgical providers.
Joint Exposure to Ambient Air Pollutants, Genetic Risk, and Ischemic Stroke: A Prospective Analysis in UK Biobank
Authors: Li Panlong , Wang Ying , Tian Dandan , Liu Min , Zhu Xirui , Wang Yanfeng , Huang Chun , Bai Yan , Wu Yaping , Wei Wei , Tian Shan , Li Yuna , Qiao Yuan , Yang Junting , Cao Shanshan , Cong Chaohua , Zhao Lei , Su Jingjing , Wang Meiyun
Published: February 2024

BACKGROUND:

Our primary objective was to assess the association between joint exposure to various air pollutants and the risk of ischemic stroke (IS) and the modification of the genetic susceptibility.

METHODS:

This observational cohort study included 307 304 British participants from the United Kingdom Biobank, who were stroke-free and possessed comprehensive baseline data on genetics, air pollutant exposure, alcohol consumption, and dietary habits. All participants were initially enrolled between 2006 and 2010 and were followed up until 2022. An air pollution score was calculated to assess joint exposure to 5 ambient air pollutants, namely particulate matter with diameters equal to or <2.5 µm, ranging from 2.5 to 10 µm, equal to or <10 µm, as well as nitrogen oxide and nitrogen dioxide. To evaluate individual genetic risk, a polygenic risk score for IS was calculated for each participant. We adjusted for demographic, social, economic, and health covariates. Cox regression models were utilized to estimate the associations between air pollution exposure, polygenic risk score, and the incidence of IS.

RESULTS:

Over a median follow-up duration of 13.67 years, a total of 2476 initial IS events were detected. The hazard ratios (95% CI) of IS for per 10 µg/m
3
increase in particulate matter with diameters equal to or <2.5 µm, ranging from 2.5 to 10 µm, equal to or <10 µm, nitrogen dioxide, and nitrogen oxide were 1.73 (1.33–2.14), 1.24 (0.88–1.70), 1.13 (0.89–1.33), 1.03 (0.98–1.08), and 1.04 (1.02–1.07), respectively. Furthermore, individuals in the highest quintile of the air pollution score exhibited a 29% to 66% higher risk of IS compared with those in the lowest quintile. Notably, participants with both high polygenic risk score and air pollution score had a 131% (95% CI, 85%–189%) greater risk of IS than participants with low polygenic risk score and air pollution score.

CONCLUSIONS:

Our findings suggested that prolonged joint exposure to air pollutants may contribute to an increased risk of IS, particularly among individuals with elevated genetic susceptibility to IS.
Association Between Hematoma Volume and Risk of Subsequent Ischemic Stroke: A MISTIE III and ATACH-2 Analysis
Authors: Harris William , Kaiser Jed H. , Liao Vanessa , Avadhani Radhika , Iadecola Costantino , Falcone Guido J. , Sheth Kevin N. , Qureshi Adnan I. , Goldstein Joshua N. , Awad Issam A. , Hanley Daniel F. , Kamel Hooman , Ziai Wendy C. , Murthy Santosh B.
Published: February 2024

BACKGROUND:

Nontraumatic intracerebral hemorrhage (ICH) is independently associated with a long-term increased risk of major arterial ischemic events. While the relationship between ICH location and ischemic risk has been studied, whether hematoma volume influences this risk is poorly understood.

METHODS:

We pooled individual patient data from the MISTIE III (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase 3) and the ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage-2) trials. The exposure was hematoma volume, treated as a continuous measure in the primary analysis, and dichotomized by the median in the secondary analyses. The outcome was a symptomatic, clinically overt ischemic stroke, adjudicated centrally within each trial. We evaluated the association between hematoma volume and the risk of an ischemic stroke using Cox regression analyses after adjustment for demographics, vascular comorbidities, and ICH characteristics.

RESULTS:

Of 1470 patients with ICH, the mean age was 61.7 (SD, 12.8) years, and 574 (38.3%) were female. The median hematoma volume was 17.3 mL (interquartile range, 7.2–35.7). During a median follow-up of 107 days (interquartile range, 91–140), a total of 30 ischemic strokes occurred, of which 22 were in patients with a median ICH volume of ≥17.3 mL and a cumulative incidence of 4.6% (95% CI, 3.1–7.1). Among patients with a median ICH volume <17.3 mL, there were 8 ischemic strokes with a cumulative incidence of 3.1% (95% CI, 1.7–6.0). In primary analyses using adjusted Cox regression models, ICH volume was associated with an increased risk of ischemic stroke (hazard ratio, 1.02 per mL increase [95% CI, 1.01–1.04]). In secondary analyses, ICH volume of ≥17.3 mL was associated with an increased risk of ischemic stroke (hazard ratio, 2.5 [95% CI, 1.1–7.2]), compared with those with an ICH volume <17.3 mL.

CONCLUSIONS:

In a heterogeneous cohort of patients with ICH, initial hematoma volume was associated with a heightened short-term risk of ischemic stroke.
American crocodile nesting in sediment-nourished habitats on Crocodile Lake National Wildlife Refuge, Florida, USA
Authors: Briggs-Gonzalez Venetia , Godahewa Avishka , Balaguera-Reina Sergio , Dixon Jeremy , Mazzotti Frank
Published: February 2024

The American crocodile (Crocodylus acutus) is the most widely distributed New World crocodile. However, the species has experienced severe declines due to overexploitation. In South Florida, loss of nesting habitat, with coastal degradation from sea level rise and urban development has prompted American crocodiles to nest in novel habitats. Crocodile Lake National Wildlife Refuge (CLNWR) serves as an important nesting site for the South Florida population of American crocodiles and more recently nesting habitat has been supplemented to manage coastal erosion. The goal of this study was to investigate the internal nest biology of American crocodile nests laid in sediment nourished sand mounds on CLNWR. We monitored internal nest temperature and volumetric water content of five live and two control sand nests in 2021 (N = 73 eggs) and 2022 (N = 84 eggs). The metabolic heat generated by incubating eggs in internal nest temperatures ranged from 0.8°C to 2.0°C warmer and more stable than ambient temperatures and reflecting a seasonal pattern. Average clutch size was 31.4 ± 7.09 eggs and incubation period ranged from 78 to 114 days until hatching. These data provide the first insight into thermal regimes of nests laid in novel/supplemented nesting habitat as is the case for a significant proportion of nests in the South Florida population of American crocodiles. Here we provide an opportunity to evaluate the importance of creating artificial nesting habitat for American crocodiles where habitat degradation from climate change threatens species survival.
Aloe burgersfortensis (Asphodelaceae subfam. Alooideae): a distinctive, winter-flowering maculate aloe endemic to the southeastern Limpopo and northwestern Mpumalanga provinces of South Africa
Authors: SMITH GIDEON F. , FIGUEIREDO ESTRELA , KLOPPER RONELL R.
Published: February 2024

Aloe burgersfortensis (Asphodelaceae subfam. Alooideae), which generally has been included in the synonymy of A. parvibracteata since 2000, is formally reinstated as an accepted species that is endemic to the southeastern Limpopo and northwestern Mpumalanga provinces of South Africa. Aloe burgersfortensis differs from A. parvibracteata in several vegetative and reproductive morphological characters so warranting its recognition at the rank of species; the differences are quantified and discussed. The typification of the name A. burgersfortensis is reinterpreted and corrected. Both A. burgersfortensis and A. parvibracteata are illustrated and an amplified description is provided for A. burgersfortensis.
Volvariella lanata (Pluteaceae, Agaricales), a new species from the Middle Volga Region, Russia
Authors: MALYSHEVA EKATERINA , MALYSHEVA VERA
Published: February 2024

One new species of Volvariella (V. lanata) is described based on a combination of morphological and molecular evidence. The species is characterized by rather large basidiomata with grey-brown, fibrillose to pubescent pileus, pubescent stipe and brownish trilobate volva, cheilocystidia with long apical appendages, utriform or fusiform pleurocystidia, and basidiospores 5.9–7.4 × 3.7–5.0 µm. Sequences of nrITS and nrLSU of the studied specimens were generated, and the phylogenetic analyses were performed with Maximum likelihood and Bayesian inference methods for nrITS+nrLSU dataset. The analyses showed that the new species is clustered within the genus Volvariella, forming a distinct phylogenetic lineage with V. krizii as its sister taxon.
Morpho-phylogenetic characterizations reveal a new species of Coccomyces on Cunninghamia lanceolata from China
Authors: ZHENG LU , TANG MINGXIA , LI YINLONG , LI XINYUAN , WANG SHIJUAN
Published: February 2024

Specimen of Coccomyces collected on Cunninghamia lanceolata, from Huangshan Mountain in Anhui Province, China, was identified as a new species, named here as Coccomyces cunninghamiae. Although multi-gene (ITS, nrLSU, mtSSU) phylogenetic analysis showed that the new species was closely related to C. anhuiensis, it differs significantly from C. anhuiensis in morphology by intraepidermal or subepidermal ascomata, well-developed paraphyses forming epithecium and shape of ascospores. Moreover, the ITS sequence similarity between them is only 87.86%. Specimens studied are deposited in the Reference Collection of Forest Fungi of Anhui Agricultural University, China (AAUF).
Pinanga curioi, a new mottled-leaved Pinanga (Arecaceae) from Panay Island, Philippines
Authors: ADORADOR JIRO T. , CALLADO JOHN REY C. , FERNANDO EDWINO S.
Published: February 2024

A new mottled-leaved species of Pinanga, P. curioi, is described from Panay Island, Philippines. This species exhibits an admixture of morphological traits of the Maculata group, but can be circumscribed with the following combination of characters: abaxially subglaucescent subfalcate-sigmoid middle leaflets with an inconspicuously narrowed base and non-pendulous shallow apical incisions, 3–5 greenish to orangish yellow rachillae, each bearing large obovoid-ellipsoid fruits which are only distally or partially spirally-arranged, and an elongate embryo. Relevant morphological and ecological notes and an updated key for the Maculata group are also included. P. curioi is endemic to Panay Island and exhibits the least mottling in the group when fully matured. It is hereby assessed as Endangered following the IUCN guidelines.
Another new species of Dibamus Duméril & Bibron, 1839 (Squamata: Dibamidae) from Nui Chua National Park, Ninh Thuan Province, Vietnam
Authors: KLIUKIN NIKITA S. , BRAGIN ANDREY M. , NGUYEN TAN VAN , LE SON XUAN , TRAN TIN TRONG VO , GORIN VLADISLAV A. , POYARKOV NIKOLAY A.
Published: February 2024

A new species of dibamid lizard, Dibamus deimontis sp. nov., is described based on eight specimens collected from the highlands of Nui Chua Mountain within Nui Chua National Park, Ninh Thuan Province, southern Vietnam. Dibamus deimontis sp. nov. co-occurs with the recently described Dibamus tropcentr, but is recorded at higher elevations (670–700 m a.s.l. vs. 200–280 m a.s.l.), and in a different habitat and microhabitats than the previous species. Our study represents the first report on the near sympatric occurrence of two Dibamus species. The new species can be distinguished from other congeners by the following combination of characters: rostral, labial and nasal sutures incomplete; two to three postoculars; three to five scales on the posterior edge of infralabial; 22–25 midbody scale rows; 193–225 ventral scales; 47–55 subcaudal scales; 115 presacral and 27 tail vertebrae (in a single male specimen examined); and maximum snout-vent length 136.2 mm. We suggest this species should be considered as Vulnerable (VU) following the IUCN’s Red List categories. Our study brings the number of species in the genus Dibamus to 26; Dibamus deimontis sp. nov. is the eighth species of Dibamus recorded in Vietnam, and underlines the importance of the country as a local center of reptilian diversity in Southeast Asia.
Extracellular CIRP induces CD4CD8αα intraepithelial lymphocyte cytotoxicity in sepsis
Authors: Akama Yuichi , Murao Atsushi , Aziz Monowar , Wang Ping
Published: February 2024

Background

In sepsis, intestinal barrier dysfunction is often caused by the uncontrolled death of intestinal epithelial cells (IECs). CD4CD8αα intraepithelial lymphocytes (IELs), a subtype of CD4+ T cells residing within the intestinal epithelium, exert cytotoxicity by producing granzyme B (GrB) and perforin (Prf). Extracellular cold-inducible RNA-binding protein (eCIRP) is a recently identified alarmin which stimulates TLR4 on immune cells to induce proinflammatory responses. Here, we hypothesized that eCIRP enhances CD4CD8αα IEL cytotoxicity and induces IEC death in sepsis.

Methods

We subjected wild-type (WT) and CIRP−/− mice to sepsis by cecal ligation and puncture (CLP) and collected the small intestines to isolate IELs. The expression of GrB and Prf in CD4CD8αα IELs was assessed by flow cytometry. IELs isolated from WT and TLR4−/− mice were challenged with recombinant mouse CIRP (eCIRP) and assessed the expression of GrB and Prf in CD4CD8αα by flow cytometry. Organoid-derived IECs were co-cultured with eCIRP-treated CD4CD8αα cells in the presence/absence of GrB and Prf inhibitors and assessed IEC death by flow cytometry.

Results

We found a significant increase in the expression of GrB and Prf in CD4CD8αα IELs of septic mice compared to sham mice. We found that GrB and Prf levels in CD4CD8αα IELs were increased in the small intestines of WT septic mice, while CD4CD8αα IELs of CIRP−/− mice did not show an increase in those cytotoxic granules after sepsis. We found that eCIRP upregulated GrB and Prf in CD4CD8αα IELs isolated from WT mice but not from TLR4−/− mice. Furthermore, we also revealed that eCIRP-treated CD4CD8αα cells induced organoid-derived IEC death, which was mitigated by GrB and Prf inhibitors. Finally, histological analysis of septic mice revealed that CIRP−/− mice were protected from tissue injury and cell death in the small intestines compared to WT mice.

Conclusion

In sepsis, the cytotoxicity initiated by the eCIRP/TLR4 axis in CD4CD8αα IELs is associated with intestinal epithelial cell (IEC) death, which could lead to gut injury.
Cirscan: a shiny application to identify differentially active sponge mechanisms and visualize circRNA–miRNA–mRNA networks
Authors: Fraboulet Rose-Marie , Si Ahmed Yanis , Aubry Marc , Corre Sebastien , Galibert Marie-Dominique , Blum Yuna
Published: February 2024

Background

Non-coding RNAs represent a large part of the human transcriptome and have been shown to play an important role in disease such as cancer. However, their biological functions are still incompletely understood. Among non-coding RNAs, circular RNAs (circRNAs) have recently been identified for their microRNA (miRNA) sponge function which allows them to modulate the expression of miRNA target genes by taking on the role of competitive endogenous RNAs (ce-circRNAs). Today, most computational tools are not adapted to the search for ce-circRNAs or have not been developed for the search for ce-circRNAs from user’s transcriptomic data.

Results

In this study, we present Cirscan (CIRcular RNA Sponge CANdidates), an interactive Shiny application that automatically infers circRNA–miRNA–mRNA networks from human multi-level transcript expression data from two biological conditions (e.g. tumor versus normal conditions in the case of cancer study) in order to identify on a large scale, potential sponge mechanisms active in a specific condition. Cirscan ranks each circRNA–miRNA–mRNA subnetwork according to a sponge score that integrates multiple criteria based on interaction reliability and expression level. Finally, the top ranked sponge mechanisms can be visualized as networks and an enrichment analysis is performed to help its biological interpretation. We showed on two real case studies that Cirscan is capable of retrieving sponge mechanisms previously described, as well as identifying potential novel circRNA sponge candidates.

Conclusions

Cirscan can be considered as a companion tool for biologists, facilitating their ability to prioritize sponge mechanisms for experimental validations and identifying potential therapeutic targets. Cirscan is implemented in R, released under the license GPL-3 and accessible on GitLab (https://gitlab.com/geobioinfo/cirscan_Rshiny). The scripts used in this paper are also provided on Gitlab (https://gitlab.com/geobioinfo/cirscan_paper).
Identification of Campylobacter jejuni and Campylobacter coli genes contributing to oxidative stress response using TraDIS analysis
Authors: Stoakes Emily , Chen Xuanlin , Kalmar Lajos , Baker Dave , Evans Rhiannon , Rudder Steven , Grant Andrew J.
Published: February 2024

Background

Campylobacter jejuni and Campylobacter coli are the major causative agents of bacterial gastroenteritis worldwide and are known obligate microaerophiles. Despite being sensitive to oxygen and its reduction products, both species are readily isolated from animal food products kept under atmospheric conditions where they face high oxygen tension levels.

Results

In this study, Transposon Directed Insertion-site Sequencing (TraDIS) was used to investigate the ability of one C. jejuni strain and two C. coli strains to overcome oxidative stress, using H2O2 to mimic oxidative stress. Genes were identified that were required for oxidative stress resistance for each individual strain but also allowed a comparison across the three strains. Mutations in the perR and ahpC genes were found to increase Campylobacter tolerance to H2O2. The roles of these proteins in oxidative stress were previously known in C. jejuni, but this data indicates that they most likely play a similar role in C. coli. Mutation of czcD decreased Campylobacter tolerance to H2O2. The role of CzcD, which functions as a zinc exporter, has not previously been linked to oxidative stress. The TraDIS data was confirmed using defined deletions of perR and czcD in C. coli 15-537360.

Conclusions

This is the first study to investigate gene fitness in both C. jejuni and C. coli under oxidative stress conditions and highlights both similar roles for certain genes for both species and highlights other genes that have a role under oxidative stress.
Safety and efficacy of low-dose esketamine in laparoscopic cholecystectomy: a prospective, double-blind randomized controlled trial
Authors: Zhao Lu , Li Zhengyu , Jin Bi , Hou Nina , Yang Heng
Published: February 2024

Background

Esketamine, recognized for its analgesic, sedative, and anti-inflammatory qualities, is integral in multimodal analgesia. However, the potential opioid-sparing effects of intravenous esketamine, along with its impact on inflammatory responses, and cognitive function during laparoscopic surgery, remain unexplored.

Methods

In this study, 90 patients scheduled for laparoscopic cholecystectomy were equally randomized into three groups: a normal saline control group (NS), a low-dose esketamine group (LS) and a high-dose esketamine group (HS). Subsequently, we monitored several parameters: hemodynamics, levels of stress and inflammatory responses, intraoperative doses of sufentanil, remifentanil, and propofol, and 24-hour postoperative sufentanil requirements. We also evaluated alterations in cognitive function, perioperative indicators, and potential adverse reactions among the three groups.

Results

Compared to their levels 5 minutes prior to anesthesia (T0) and 30 minutes post-operation (T4), the NS group exhibited a more significant decrease in Mean Arterial Pressure (MAP) and Heart Rate (HR) at various time intervals: 5 minutes after the skin incision (T1), 30 minutes post-incision (T2), and at the conclusion of the operation (T3), compared to the LS and HS groups(P < 0.05). Furthermore, the NS group exhibited a greater increase in levels of adrenaline (AD), noradrenaline (NE), endothelin (ET), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) at T1, T2, and T3, more so than the other two groups(P < 0.05). 24 hours after the surgery, patients in the LS group and HS group had significantly higher Montreal Cognitive Assessment (MoCA) scores than those in the NS group(P < 0.05). The LS and HS groups required lower doses of propofol, remifentanil, and sufentanil during surgery (P < 0.05), experienced shorter postoperative recovery times, and had lower incidences of nausea, vomiting, and respiratory depression compared to the NS group (P < 0.05).

Conclusion

The administration of low-dose esketamine has been shown to be safe, effective, and dependable in the context of laparoscopic gallbladder surgery. It has the capacity to stabilize hemodynamic responses, ameliorate both stress and inflammatory reactions from surgery, and hastens anesthesia recovery. Furthermore, it fosters the restoration of postoperative cognitive function. Notably, when combined with nalbuphine, it exhibits opioid-sparing effects, reducing postoperative adverse outcomes.

Trial registration

The trial is registered with the China Clinical Trials Registry Registration Number: ChiCTR2300067596. Retrospectively registered (date of registration: 12/01/2023).
A modified Michaelis-Menten equation estimates growth from birth to 3 years in healthy babies in the USA
Authors: Walters William A. , Ley Catherine , Hastie Trevor , Ley Ruth E. , Parsonnet Julie
Published: February 2024

Background

Standard pediatric growth curves cannot be used to impute missing height or weight measurements in individual children. The Michaelis–Menten equation, used for characterizing substrate-enzyme saturation curves, has been shown to model growth in many organisms including nonhuman vertebrates. We investigated whether this equation could be used to interpolate missing growth data in children in the first three years of life and compared this interpolation to several common interpolation methods and pediatric growth models.

Methods

We developed a modified Michaelis–Menten equation and compared expected to actual growth, first in a local birth cohort (N = 97) then in a large, outpatient, pediatric sample (N = 14,695).

Results

The modified Michaelis–Menten equation showed excellent fit for both infant weight (median RMSE: boys: 0.22 kg [IQR:0.19; 90% < 0.43]; girls: 0.20 kg [IQR:0.17; 90% < 0.39]) and height (median RMSE: boys: 0.93 cm [IQR:0.53; 90% < 1.0]; girls: 0.91 cm [IQR:0.50;90% < 1.0]). Growth data were modeled accurately with as few as four values from routine well-baby visits in year 1 and seven values in years 1–3; birth weight or length was essential for best fit. Interpolation with this equation had comparable (for weight) or lower (for height) mean RMSE compared to the best performing alternative models.

Conclusions

A modified Michaelis–Menten equation accurately describes growth in healthy babies aged 0–36 months, allowing interpolation of missing weight and height values in individual longitudinal measurement series. The growth pattern in healthy babies in resource-rich environments mirrors an enzymatic saturation curve.
Associations between self-care advice and healing time in patients with venous leg ulcer– a Swedish registry-based study
Authors: Rosenburg Marcus , Tuvesson Hanna , Lindqvist Gunilla , Brudin Lars , Fagerström Cecilia
Published: February 2024

Background

Venous leg ulcers take time to heal. It is advocated that physical activity plays a role in healing, and so does the patient’s nutritional status. Additionally, malnutrition influences the inflammatory processes, which extends the healing time. Therefore, the staff’s advising role is important for patient outcomes. Thus, this study aimed to investigate the associations between given self-care advice and healing time in patients with venous leg ulcers while controlling for demographic and ulcer-related factors.

Methods

The sample consisted of patients registered in the Registry of Ulcer Treatment (RUT) which includes patient and ulcer-related and healing variables. The data was analyzed with descriptive statistics. Logistic regression models were performed to investigate the influence of self-care advice on healing time.

Results

No associations between shorter healing time (less than 70 days) and the staff´s self-care advice on physical activity was identified, whilst pain (OR 1.90, CI 1.32–2.42, p < 0.001) and giving of nutrition advice (OR 1.55, CI 1.12–2.15, p = 0.009) showed an association with longer healing time.

Conclusions

Neither self-care advice on nutrition and/or physical activity indicated to have a positive association with shorter healing time. However, information and counseling might not be enough. We emphasize the importance of continuously and systematically following up given advice throughout ulcer management, not only when having complicated ulcers.
Patterns of psychotropic drug prescriptions and general practice consultations among community-dwelling older people with dementia during the first two years of the COVID-19 pandemic
Authors: Du Jiamin , Burger Huibert , Kupers Thijmen , Sulim Karina , Homburg Maarten T. , Muris Jean W. M. , olde Hartman Tim C. , Zuidema Sytse U. , Peters Lilian L. , Janus Sarah I. M.
Published: February 2024

Background

The COVID-19 pandemic and subsequent lockdown measures had serious implications for community-dwelling older people with dementia. While the short-term impacts of the pandemic on this population have been well studied, there is limited research on its long-term impacts. Quantifying the long-term impacts may provide insights into whether healthcare adaptations are needed after the acute phase of the pandemic to balance infection prevention measures with healthcare provision. This study aims to examine patterns of psychotropic drug prescriptions and general practice consultations in community-dwelling older people with dementia during the first two years of the pandemic.

Methods

We utilised routine electronic health records from three Dutch academic general practice research networks located in the North, East, and South, between 2019 and 2021. We (1) compared the weekly prescription rates of five groups of psychotropic drugs and two groups of tracer drugs, and weekly general practice consultation rates per 1000 participants, between the first two years of the pandemic and the pre-pandemic phase, (2) calculated changes in these rates during three lockdowns and two relaxation phases relative to the corresponding weeks in 2019, and (3) employed interrupted time series analyses for the prescription rates. Analyses were performed for each region separately.

Results

The study population sizes in the North, East, and South between 2019 and 2021 were 1726 to 1916, 93 to 117, and 904 to 960, respectively. Data from the East was excluded from the statistical analyses due to the limited sample size. During the first two years of the pandemic, the prescription rates of psychotropic drugs were either lower or similar to those in the pre-pandemic phase, with differences varying from -2.6‰ to -10.2‰. In contrast, consultation rates during the pandemic were higher than in the pre-pandemic phase, increasing by around 38‰.

Conclusions

This study demonstrates a decrease in psychotropic drug prescriptions, but an increase in general practice consultations among community-dwelling older people with dementia during the first two years of the pandemic. However, reasons for the decrease in psychotropic drug prescriptions are unclear due to limited information on the presence of neuropsychiatric symptoms and the appropriateness of prescribing.