bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploration of Indigenous Actinomycetes as Biocontrol Agents of Purple Blotch Diseases at Onion
Authors: Yanti Y , Hamid H , Nurbailis  , Dzulfahmi M D , Selviana S , Rahmanda Putra I
Published: August 2023

Purple blotch disease caused by Alternaria porri is an essential disease in shallot plants. Actinomycetes microorganisms have potential as A. porri biological control agents because they produce bioactive compounds. The research aimed to select actinomycetes isolates that can suppress the growth of A. porri, stimulate growth, and increase the production of shallots. The study consisted of four stages: isolation, selection, characterization, and identification of potential actinomycetes isolates. The isolation results obtained 35 indigenous isolates, and as many as 16 isolates were successfully selected based on the results of the biosafety test. The antagonism test showed that 12 isolates produced suppression to A. porri by 4.87–63.77%. From 16 selected isolates, 13 isolates could produce chitinase enzymes with a chitinolytic index of 0.61-2.58. Nine selected isolates: AMSN23, AMSN10 AMBP7, AMSP10, AMSR21, AMTE2, AMDK6, AMTD 14, and AMPL24, could dissolve phosphate and produce Indole Acetic Acid (IAA) with a concentration of 34.82–85.98 ppm, but only six isolates were able to fix nitrogen. In the results of the 16S rRNA gene sequence, nine isolates were selected and potentially identified as Streptomyces rameus, S. lydicus, S. panaciradicis, S. seoulensis,S. fuscichromogenes, Streptomyces sp, S. nigrescens, S. viridaris, and S. griseus
Production of drip bag coffee filled with blended arabica and robusta coffee beans by ohmic fermentation technology
Authors: Nur Nadiah , Asfar Muhammad , Reta  , Nurmiah Sitti , Darmawan  , Thamrin Syahruni , Sumule Ophirtus
Published: August 2023

To produce the highest quality brewed coffee based on consumer preferences, it is required to conduct a cupping test before to determining the ideal blending formula. The greatest blended formulations created by ohmic fermentation technology and the use of a drip bag filter during the brewing process can produce a high-quality coffee fragrance and flavor. The purpose of this study was to identify the optimal blending formulation based on the results of the cupping test and to assess the caffeine content, pH value, and organoleptic test results of Arabica and Robusta ohmic drip bag coffee. Fully Randomized Design (CRD) was employed for the study with four treatment ratios of Arabica: Robusta coffee blending (20%:80%; 40%:60%; 60%:40%; 80%:20%). Based on the findings of the cupping test, the optimal ratio of Arabica to Robusta was 80%:20%. The variance analysis revealed that the mixing of Arabica and Robusta coffee had a highly significant (P0.05) effect on the overall. The variance analysis of brewing coffee with the best treatment revealed that the treatment had no significant influence (P>0.05) on the overall. The average caffeine concentration measured using UV-Vis spectrophotometry was 0.25. The second test resulted in the lowest caffeine value, 0.16, whereas the first test resulted in the highest caffeine value, 0.31. The mean pH level was 0.93. The first test yielded the lowest pH value, which was 4.86, whereas the third test yielded the highest pH value. The organoleptic test results for the blended ohmic drip bag coffee based on the cupping test yielded a cupping score of o>84, which corresponds to an overall score of 85 for a ratio of 80% Arabica: 20% Robusta (cup of excellence coffee). In contrast, the cupping score of 15 grams of coffee powder without a drip bag filter was greater than 80, totaling 84.06 points (specialty coffee).
Improvement of Flexible Polyurethane Foam Characteristics of Palm Oil Polyols with the Addition Of Polyethylene Glycol-400
Authors: Neswati  , Nazir N , Arief S , Yusniwati
Published: August 2023

Palm oil polyol-based foams have inflexible and brittle properties. Palm oil polyols have a lower molecular weight. Polyols with a high molecular weight and a primary OH group, such as polyethylene glycol (PEG)-400, can provide the flexible properties of polyurethane foam. This study aimed to examine the optimum concentration of PEG-400, which can produce flexible polyurethane foam made from palm oil polyols with the best characteristics based on mechanical properties. This study compared palm oil polyol and PEG-400 treatment of 80%:20%, 70%:30%, 60%:40%, 50%:50%. Flexible polyurethane foam was characterized, including FTIR analysis, SEM, tensile strength, yield strength, elongation at break, and TGA. The results showed that the use of PEG-400 at an optimum concentration of 40% resulted in flexible polyurethane foam with a greater number of open cells and increased flexible properties but decreased the value of tensile strength and yield strength, as well as decreased the foam’s stability to heat. However, tensile strength and elongation at break of PEG-based palm oil polyurethane obtained from this study followed the flexible polyurethane foam requirements.
Asphalt concrete mix analysis using volcanic ash filler
Authors: Asfiati Sri , Dewi Irma , Prafanti Sri , Siregar Zulkifli
Published: August 2023

Asphalt mixture is a combination of a mixture of aggregate and asphalt. Sinabung eruption volcanic ash produced many negative impact on health and the environment. So that needs to be done in order to study the volcanic ash can be used in road pavement, especially on Asphalt Concrete pavement, the purpose of this study to determine the effect comparison of volcanic ash filler sinabung on Asphalt Concrete - Binder Course. This research was laboratory experimental in nature with asphalt level variation of 5%, 5.5%, 6%, 6.5%, 7% and volcanic filler level of 1, 2 and 3% in each asphalt level variation. There were 5 samples used the examination was done using marshall test instrument. The test used to determine the graph of asphalt content with value stability, flow, bulk density, VIM, VMA, VFB. The results of the over all addition of volcanic ash in the petroleum asphalt. Asphalt Concrete Binder Course Marshall stability values indicate that the better that showed that a mixture of aggregate is very good. If the flow value is lower, the VIM value is getting lower, then the VMA value and VFB value have a value that is more than the minimum value.
Determination of Optimum Conditions for Nitrate Anion (NO3
−) Desorption on Mesoporous Silica Modified with Dimethylamine (DMA)
Authors: Retno Dipnorita , Oktavia Budhi , Dewata Indang , Khair Miftahul
Published: August 2023

Mesoporous silica is an inorganic material that has high potential to be applied in various industrial fields, one of its applications is the adsorption method. To maximize the adsorption of mesoporous silica, modification of the silica surface was carried out by adding amine compounds. The amine compound used as a modifier is dimethylamine (DMA), using glycidoxypropyltrimethoxysilane (GPTMS) as a linking compound. The column method uses mesoporous silica, modified with dimethylamine, in the nitrate anions adsorption process. The adsorption capacity of the nitrate anion is 0.0917 mg/g. After adsorbed, the desorption process was carried out to release the adsorbed nitrate anions. The desorption process found that HCl was the best desorption agent used on nitrate anions. The optimum concentration of HCl was 0.15 M, with the number of nitrate anions desorbed as much as 0.0459 mg with a 100% desorption percentage.
Nutritional and therapeutic aspects of fermented buffalo milk produced by Lactiplantibacillus pentosus HBUAS53657
Authors: Susmiati S , Khairina I , Melia S , Alzahra H
Published: August 2023

Lactiplantibacillus pentosus strain HBUAS53657 was used as a starter in the production of fermented buffalo milk, with citrus added as a prebiotic to improve taste and antioxidant levels. Fermented milk products containing 6% starter L. pentosus HBUAS53657 and 20% orange juice produced the best results in physicochemical, microbiological, and organoleptic tests. This fermented milk product will also be used for intervention testing research to overcome children’s nutritional problems. This is a descriptive study. This study aimed to analyse the composition of macro (protein, fat, carbohydrate, fibre and total energy) and micronutrients (Ca, Na, K, Zn and phosphorus) content of fermented milk Lactiplantacillus pentosus strain HBUAS53657 with 20% orange juice. The data on the characteristics of macro and micronutrients were analysed quantitatively with descriptive analysis, presenting the data from the study using tables and graphs. The result shows the fermented milk served contains macro and micronutrients. Plain fermented milk has a high protein and calorie content compared to fermented milk with the addition of orange juice, while the mineral content is almost the same. Plain fermented milk is more recommended to overcome nutritional deficiencies.The findings of this study can be used to promote increased consumption or fermentation of milk
Systematic investigation of the homology sequences around the human fusion gene breakpoints in pan-cancer – bioinformatics study for a potential link to MMEJ
Authors: Kim Pora , Kumar Himansu , Yang Chengyuan , Luo Ruihan , Liu Jiajia , Zhou Xiaobo
Published: August 2023

Microhomology-mediated end joining (MMEJ), an error-prone DNA damage repair mechanism, frequently leads to chromosomal rearrangements due to its ability to engage in promiscuous end joining of genomic instability and also leads to increasing mutational load at the sequences flanking the breakpoints (BPs). In this study, we systematically investigated the homology sequences around the genomic breakpoint area of human fusion genes, which were formed by the chromosomal rearrangements initiated by DNA double-strand breakage. Since the RNA-seq data is the typical data set to check the fusion genes, for the known exon junction fusion breakpoints identified from RNA-seq data, we have to infer the high chance of genomic breakpoint regions. For this, we utilized the high feature importance score area calculated from our recently developed fusion BP prediction model, FusionAI and identified 151 K microhomologies among ~24 K fusion BPs in 20 K fusion genes. From our multiple bioinformatics studies, we found a relationship between sequence homologies and the immune system. This in-silico study will provide novel knowledge on the sequence homologies around the coded structural variants.
Long-term efficacy and safety of lerodalcibep in heterozygous familial hypercholesterolaemia: the LIBerate-HeFH trial
Authors: Raal Frederick , Fourie Nyda , Scott Russell , Blom Dirk , De Vries Basson Matthys , Kayikcioglu Meral , Caldwell Kate , Kallend David , Stein Evan ,   LIBerate-HeFH Investigators, Turner Traci , Bergeron Jean , Caku Artuela , Elis Avishay , Durst Ronen , Yalim Zafer , Kayikcioglu Meral , Kirilmaz Bahadir , Celik Atac , Duzen Irfan , Oguzhan Abdurraham , Basarici Ibrahim , Raal Frederick , Blom Dirk , Abelson Marc , Basson Matthys , Burgess Lesley , Fourie Nyda , Heggen Eli , Asprusten Emil , Mehta Vimal , Puri Raman , Mehta Ashwani , Gupta Preeti , Chag Milan , Pradhan Akshyaya , Jimenez Francisco Fuentes , Murillo Fernando Civeira , Sala Xavier Pinto , Scott Russell
Published: August 2023

Background and Aims

Lerodalcibep, a novel small recombinant fusion protein of a proprotein convertase subtilisin/kexin type 9 gene–binding domain (adnectin) and human serum albumin, demonstrated highly effective low-density lipoprotein cholesterol (LDL-C) reduction with monthly 300 mg in 1.2 mL subcutaneous dosing in Phase 2. In this global Phase 3 trial, the safety and efficacy of lerodalcibep were evaluated in heterozygous familial hypercholesterolaemia patients requiring additional LDL-C lowering.

Methods

Patients were randomized 2:1 to monthly subcutaneous injections of either lerodalcibep 300 mg or placebo for 24 weeks. The primary efficacy endpoints were the per cent change from baseline in LDL-C at Week 24 and the mean of Weeks 22 and 24.

Results

In 478 randomized subjects [mean age (range); 53 (18–80) years, 51.7% female, mean (SD) baseline LDL-C 3.88 (1.66) mmol/L], lerodalcibep reduced LDL-C, compared with placebo by an absolute amount of 2.08 (0.11) mmol/L [LS mean (SE); 95% confidence interval −2.30 to −1.87] with a percentage difference of −58.61 (3.25)% at Week 24 and by 2.28 (0.10) mmol/L (95% confidence interval −2.47 to −2.09) with a percentage difference of −65.0 (2.87)% at the mean of Weeks 22 and 24 (P < .0001 for all). With lerodalcibep, 68% of subjects achieved both a reduction in LDL-C ≥ 50% and the recommended European Society of Cardiology LDL-C targets during the study. Except for mild injection site reactions, treatment-emergent adverse events were similar between lerodalcibep and placebo.

Conclusions

Lerodalcibep, a novel anti-proprotein convertase subtilisin/kexin type 9 gene small binding protein dosed monthly as an alternative to monoclonal antibodies, significantly reduced LDL-C in subjects with heterozygous familial hypercholesterolaemia with a safety profile similar to placebo.
Rocky rule: the idiosyncrasy of spatial and temporal size variation in mammals
Authors: Crandall Kirsten E , Olson Link E , Millien Virginie
Published: August 2023

Mammals are predicted to vary in body size following Bergmann’s rule, with individuals found at higher latitudes in colder temperatures being larger in size compared to conspecifics occurring at lower latitudes in warmer temperatures. Body size is similarly expected to vary temporally, with a decrease in size through time due to recent climate warming. While Bergmann’s rule is well-supported in mammals, there is increasing evidence of exceptions to the rule. Here, we present patterns of size variation in 17 North American mammal species using five morphological traits (condylobasal skull length, skull width, maxillary toothrow length, body weight, and head-and-body length) to determine if size varies predictably for each species in space and time. We found little support for a widespread Bergmannian pattern for these species at a broad spatial scale (across North America) and a contemporary temporal scale (the past 120 years). The effects of latitude or year on each trait were highly variable with three types of responses: an increase, a decrease, or no change in size across space or through time. Spatial size trends were detected more often than temporal size trends, as the temperature range was significantly larger in space than through time. Body weight (the most variable trait) and head-and-body length were more likely to conform to Bergmann’s rule than craniodental measurements. We did not detect any changes in size variability with latitude, and our study species either increased or decreased in size variability over time. Our findings demonstrate that size variation in mammals is highly context-dependent. As such, caution is needed when using rules of body size variation to predict the future response of species to climate warning while valid in theory, it is likely too simplistic of an approach.
Correlative Atomic Force Microscopy and Raman Spectroscopy in Acid Erosion of Dentin
Authors: Doss Bryant L , Konkol Jakub A , Liu Yangxi , Brinzari Tatiana V , Pan Long
Published: August 2023

Physical properties and chemical composition are fundamentally defining and interconnected surface characteristics. However, few techniques are able to capture both in a correlative fashion at the same sample location and orientation. This is especially important for complex materials such as dentin, which is an inner tooth structure and is a heterogeneous, composite inorganic–organic material with open channels (tubules) that extend toward the tooth pulp. Here, a combined microscope system consisting of an atomic force microscope and a confocal Raman spectrometer was used to study the correlative physical and chemical properties of human dentin. The local hardness of dentin was highly correlated with the Raman signal ratio of inorganic to organic material, and this was enhanced in the peritubular regions of dentin. When the samples were etched with citric acid, Young's modulus, hardness, and inorganic-to-organic material ratio decreased significantly, collagen fibrils on the surface were exposed, the peritubular regions were removed, and the tubule diameters increased. Thus, the combined atomic force microscopy (AFM)–Raman approach allows for comprehensive and correlative physical–chemical analysis of material surfaces and will be invaluable for evaluating oral therapeutic strategies.
A possible role for the merger of clusters/voids in the cosmological expansion
Authors: Mohammadi S , Yusofi E , Mohsenzadeh M , Salem M K
Published: August 2023

In this study, we use the merger process of clusters/voids in the role of variable dark energy fluid to alleviate the Hubble tension, which can lead to a balance in the cosmological expansion rate. To reach this target, we will introduce a modified form of energy density for cosmic fluid with the quadratic equation of state, and then we obtain Hubble, deceleration parameters, and luminosity distance for this fluid. To obtain the merger factor and other parameters of our model, we utilize the NONLINEARMODELFIT function within MATHEMATICA. By consideration of the local and global measurements of $\rm H_0$, and the equation of state parameter w as the priory values, and fitting our model with observational Hubble data measurements, we will show that the merger of clusters/voids plays the role of balancing the cosmic expansion rate. Also, it will be shown that the model is more compatible than wCDM with the standard model to describe the accelerating Universe
Filament fragmentation: density gradients suppress end-dominated collapse
Authors: Hoemann Elena , Heigl Stefan , Burkert Andreas
Published: August 2023

The onset of star formation is set by the collapse of filaments in the interstellar medium. From a theoretical point of view, an isolated cylindrical filament forms cores via the edge effect. Due to the self-gravity of a filament, the strong increase in acceleration at both ends leads to a pile-up of matter which collapses into cores. However, this effect is rarely observed. Most theoretical models consider a sharp density cut-off at the edge of the filament, whereas a smoother transition is more realistic and would also decrease the acceleration at the ends of the filament. We show that the edge effect can be significantly slowed down by a density gradient, although not completely avoided. However, this allows perturbations inside the filament to grow faster than the edge. We determine the critical density gradient for which the time-scales are equal and find it to be of the order of several times the filament radius. Hence, the density gradient at the ends of a filament is an essential parameter for fragmentation and the low rate of observed cases of the edge effect could be naturally explained by shallow gradients.
Domain collapse and active site ablation generate a widespread animal mitochondrial seryl-tRNA synthetase
Authors: de Potter Bastiaan , Vallee Ingrid , Camacho Noelia , Filipe Costa Póvoas Luís , Bonsembiante Aureliano , Pons i Pons Alba , Eckhard Ulrich , Gomis-Rüth Francesc-Xavier , Yang Xiang-Lei , Schimmel Paul , Kuhle Bernhard , Ribas de Pouplana Lluís
Published: August 2023

Through their aminoacylation reactions, aminoacyl tRNA-synthetases (aaRS) establish the rules of the genetic code throughout all of nature. During their long evolution in eukaryotes, additional domains and splice variants were added to what is commonly a homodimeric or monomeric structure. These changes confer orthogonal functions in cellular activities that have recently been uncovered. An unusual exception to the familiar architecture of aaRSs is the heterodimeric metazoan mitochondrial SerRS. In contrast to domain additions or alternative splicing, here we show that heterodimeric metazoan mitochondrial SerRS arose from its homodimeric ancestor not by domain additions, but rather by collapse of an entire domain (in one subunit) and an active site ablation (in the other). The collapse/ablation retains aminoacylation activity while creating a new surface, which is necessary for its orthogonal function. The results highlight a new paradigm for repurposing a member of the ancient tRNA synthetase family.
Practical overview of the ICRP Publication 145 phantoms for use with MCNP
Authors: Hetrick Lucas , Douglas Jordan , Poudel Deepesh
Published: August 2023

This paper provides a practical overview of the mesh-type reference phantoms (MRCPs) published by the ICRP by providing supplementary guidance on the proper implementation of using the MRCPs in computational codes, such as Monte Carlo N-Particle. Various validation scenarios for photon and neutron exposures were also examined where published values were reproduced using the MRCPs for both external and internal exposures. Generally, the MRCPs performed well in the validation scenarios with the values reproduced being within 10% of the published values.
Shoot Maturation Strengthens FLS2-Mediated Resistance toPseudomonas syringae
Authors: Hu Lanxi , Kvitko Brian , Severns Paul M. , Yang Li
Published: August 2023

Temporospatial regulation of immunity components is essential for properly activating plant defense response. Flagellin-sensing 2 (FLS2) is a surface-localized receptor that recognizes bacterial flagellin. The immune function of FLS2 is compromised in early stages of shoot development. However, the underlying mechanism for the age-dependent FLS2 signaling is not clear. Here, we show that the reduced basal immunity of juvenile leaves against Pseudomonas syringae pv. tomato DC3000 is independent of FLS2. The flg22-induced marker gene expression and reactive oxygen species activation were comparable in juvenile and adult stages, but callose deposition was more evident in the adult stage than the juvenile stage. We further demonstrated that microRNA156, a master regulator of plant aging, does not influence the expression of FLS2 and FRK1 ( Flg22-induced receptor-like kinase 1) but mildly suppresses callose deposition in juvenile leaves. Our experiments revealed an intrinsic mechanism that regulates the amplitude of FLS2-mediated resistance during aging.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
PNEUMATIC RETINOPEXY WITH FOCAL LASER PHOTOCOAGULATION FOR MYOPIC FOVEOSCHISIS WITH MACULAR DETACHMENT
Authors: Anderson David R. , Vrabec Tamara R.
Published: August 2023

Purpose:

To describe the clinical course and imaging of a case of myopic foveoschisis with macular detachment (MD), microbreak and epiretinal membrane managed with pneumatic retinopexy, and focal laser photocoagulation of the microbreak.

Methods:

Retrospective case review of a highly myopic, phakic White man who developed vision loss due to myopic foveoschisis with MD.

Results:

A 66-year-old phakic man with a refractive error of −13.25 to 2.25 × 150 in his left eye and 1 month visual loss who was diagnosed with myopic foveoschisis with MD, microbreak, and epiretinal membrane developed recurrent, isolated, posterior, partial MD 1 month after pneumatic retinopexy. Central macular thickness was 901 μm. Repeat pneumatic retinopexy with supplemental focal laser photocoagulation surrounding the inferior macular periarteriolar microbreak achieved reattachment and improvement in the retinoschisis with return of visual acuity from 20/150 to baseline 20/40+ at 18-month follow-up.

Conclusion:

Pneumatic retinopexy with focal laser photocoagulation may provide an alternative to vitrectomy and MP for the repair of myopic foveoschisis with MD and epiretinal membrane.
Prospective evaluation of the ESCRS online calculator for calculation of a multifocal intraocular lens
Authors: Lwowski Christoph , Kohnen Thomas
Published: August 2023

Purpose:

To evaluate a recently introduced ESCRS online calculator for intraocular lens (IOL) calculation of a multifocal IOL in refractive lens exchange and cataract surgery in a prospective setting.

Setting:

Department of Ophthalmology, Goethe University Frankfurt, Germany.

Design:

Prospective, consecutive case series.

Methods:

Eyes that received lens extraction and multifocal IOL implantation were included. The mean prediction error, mean absolute error, and median absolute prediction error (MedAE) provided by the ESCRS online calculator were compared, as were the number of eyes within ±0.5 diopters (D), ±1.0 D, ±2.0 D of target refraction. The SRK/T formula was also included for comparison. Postoperative spherical equivalent was measured at 3 months. 1 eye per patient was included.

Results:

88 eyes from 88 patients with a mean age of 62 ± 9.5 years were included. The MedAE was low for all formulas and ranged from 0.26 D (Kane), Hill-RBF (0.27 D), Hoffer Q Savini/Taroni (Hoffer QST) (0.27 D), Barrett Universal II (BUII) (0.28 D), Emmetropia Verifying Optical (EVO) (0.29 D), Cooke K6 (0.27 D), 0.30 D (Postoperative spherical Equivalent prediction using Artificial intelligence and Linear algorithms, by Debellemaniére, Gatinel, and Saad [Pearl DGS]) to 0.31 D (SRK/T). No statistically significant difference was found (P= .627). Considering the number of eyes within ±0.5 D of the calculated refraction the best performing was again the Hill-RBF (84%, 74 eyes), again followed by Kane (71, 81%), EVO, Pearl DGS, Hoffer QST, BUII (each 80%, 70 eyes), Cooke K6 (78%, 69 eyes), and SRK/T (74%). Again, no statistically significant difference was found (P= .39).

Conclusions:

Using a recently introduced ESCRS online IOL calculator in multifocal IOLs leds to a high number of eyes reaching target refraction and low prediction errors. All formulas performed similarly well. Hill-RBF showed the highest number of eyes within ±0.5 D, but no significance was found.
“Seeing the light in the shade of it”: primary caregiver and youth perspectives on using an inpatient portal for pain care during hospitalization
Authors: Pope Nicole , Jones Sophie , Crellin Dianne , Palmer Greta , South Mike , Harrison Denise
Published: August 2023

Studies from multiple countries report that most hospitalized children, especially the youngest and sickest, experience pain that is often severe yet inadequately treated. Evidence suggests this can lead to immediate and lifelong consequences affecting children, families, and communities. Partnership and shared decision-making by children, families, and clinicians is the ideal pediatric healthcare model and can improve care quality and safety, including pain care. A growing evidence base demonstrates that inpatient portals (electronic personal health record applications linked to hospital electronic medical or health records) can improve child and family engagement, outcomes, and satisfaction during hospitalization. This study examined the perspectives of caregivers of hospitalized children and of hospitalized youth about using an inpatient portal to support their engagement in pain care while in hospital. A qualitative descriptive study design was used and 20 participants (15 caregivers and 5 youth) with various painful conditions in one pediatric hospital participated in semistructured interviews. The authors applied a reflexive content analysis to the data and developed 3 broad categories: (1) connecting and sharing knowledge about pain, (2) user-centred designs, and (3) preserving roles. These findings outlined caregiver and youth recommendations for portal configurations that deeply engage and empower children and families in pain care through multidirectional knowledge sharing, supporting caregiver and clinicians' roles without burdening, or replacing human interaction implicit in family-centered pain care. Further research should measure the impact of portals on pain-related outcomes and explore the perspectives of clinicians.
Are Physical and Depressive Symptoms Different Between Women and Men With Heart Failure?
Authors: Roberts Davis Mary C. , Dieckmann Nathan F. , Hansen Lissi , Gupta Nandita , Hiatt Shirin , Lee Christopher , Denfeld Quin E.
Published: August 2023

Background

Adults with heart failure (HF) experience a constellation of symptoms; however, understanding of gender differences in HF symptoms remain elusive. The aim of this study was to determine whether there are gender differences in physical and depressive symptoms and symptom patterns in HF using 2 different analytic techniques.

Methods

We performed a secondary analysis of combined data from 6 studies of adults with HF. Physical symptoms were measured with the HF Somatic Perception Scale, and depressive symptoms were measured with the Patient Health Questionnaire-9. First, we performed propensity matching with the nearest neighbor to examine the average treatment effect for HF Somatic Perception Scale and Patient Health Questionnaire-9 in the matched sample of women and men. Next, we used the entire data set in a latent class mixture model to determine patterns of symptoms. Finally, we calculated predictors of class membership with multinomial logistic regression.

Results

The sample (n = 524, 86.5% systolic HF) was 37% women with a mean age of 58.3 ± 13.9 years and mean number of years with HF of 6.9 ± 6.9. Three hundred sixty-six participants were matched on propensity scores; there were no significant gender differences in symptom scores between matched women (n = 183) and men (n = 183). Among all 524 participants, 4 distinct latent classes of symptom patterns indicate that many patients with HF are fatigued, some have more depressive symptoms, and others have significantly more edema or cough. Gender did not predict membership to any symptom pattern.

Conclusions

There were significant gender differences in sociodemographics, health behaviors, and clinical characteristics, but not HF symptoms or symptom patterns, using either analytic technique.
Prophylactic Management of Women With Bipolar Disorder During Pregnancy and the Perinatal Period
Authors: Uguz Faruk , Sharma Verinder , Boyce Philip , Clark Crystal T. , Galbally Megan , Koukopoulos Alexia , Marsh Wendy , Stevens Anja , Viguera Adele
Published: August 2023

Many women with bipolar disorder experience episodes of illness or relapses over the perinatal period, especially in the immediate postpartum period. Risks associated with treated/untreated psychopathologies and fetal exposure to bipolar medications make the management of bipolar disorder during these periods challenging for clinicians and patients. In light of the available effectiveness and reproductive safety data, the current clinical update based on the opinions of a group of international perinatal psychiatry authors recommends general considerations and specific management strategies for each possible clinical scenario, including mixed features, predominant polarity, diagnosis of subtypes of bipolar disorder, severity of previous episodes, and risk of recurrence of mood episodes.
Pancreatic tuberculosis misdiagnosed for surgical treatment: clinical analysis of 3 cases and literature review
Authors: Zhou Bin , Wang Zusen , Yu Caiyan , Jin Shuxiang , Qu Tengfei
Published: August 2023

The incidence rate of pancreatic tuberculosis (PT) is low, and it is difficult to distinguish from pancreatic malignant tumor before operation. We present 3 patients diagnosed after surgical treatment. All 3 cases involved female patients who were admitted due to primary manifestation of abdominal pain. These patients did not exhibit symptoms such as jaundice or back pain, and their tumor markers were within normal range. The surgical interventions employed included partial resection of the tumor in 1 case, mass resection in another, and pancreaticoduodenectomy in the third. Preoperative puncture biopsy is essential for diagnosing PT, and it should be actively conducted on patients with suspected cases. We summarize several common manifestations of PT to find the possibility of tuberculosis during preoperative evaluation and avoid misdiagnosis and unnecessary surgery.
Clinical Neurology in Practice
Authors: Mathis Stéphane , Solé Guilhem , Damon-Perrière Nathalie , Rouanet-Larrivière Marie , Duval Fanny , Prigent Julia , Nadal Louis , Péréon Yann , Le Masson Gwendal
Published: August 2023

Background:

The tongue is an essential organ for the development of certain crucial functions such as swallowing and speech. The examination of the tongue can be very useful in neurology, as the various types of lingual alterations can lead to certain specific diagnoses, the tongue being a kind of ‘mirror’ of some neurological function.

Review Summary:

To discuss the elements of clinical examination of the tongue in relation to neurological disorders. After reviewing the different superficial lesions of the tongue, we deal with various movement disorders of the tongue (fasciculations/myokimia, orolingual tremor, choreic movements of the tongue, dystonia of the tongue, lingual myoclonus, and psychogenic movements), disorders of taste and lingual sensitivity and lingual pain.

Conclusions:

Examination of the tongue should not be limited to studying its motility and trophicity. It is equally important to check the sensory function and understand how to interpret abnormal movements involving the tongue. This study also aimed to demonstrate the importance of nonmotor tongue function in neurological practice.
Mental Health Provision in PICU: An Analysis of Referrals to an Embedded Psychologist Over 20 Years at a Single Center*
Authors: Colville Gillian A.
Published: August 2023

OBJECTIVES:

The main aim of this study was to illustrate the type of mental health provision possible on PICU by describing the nature of referrals of child patients and their parents to an embedded psychologist over a 20-year period, adding to the literature on intervention and service development.

DESIGN:

Retrospective evaluation of anonymized departmental database.

SETTING:

Twelve-bed PICU at a teaching hospital in a major urban center.

PATIENTS:

Five hundred forty-five consecutive referrals for support for parent and/or child by PICU staff between 1998 and 2017.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Referrals increased from seven of 288 (2.4%) in 1998 to 85 of 643 (13.2%) in 2017. The majority were for parent support initially (456/545, 84%). Mean (sd) number of contacts was 4.5 (10.2), range 1 to 143, and mode was 1. Patient gender and age typical of the total PICU population, but referrals were more common where children had an oncology or trauma diagnosis (p< 0.001). Comparisons with other inpatient referrals at the same hospital revealed a higher proportion of requests were made for parent support on PICU (456/545 [84%] vs 789/1,997 [40%];p< 0.001) and that nurses were more likely to initiate referrals on PICU than on the other wards (437/543 [80%] vs 1,190/1,993 [60%];p< 0.001). In other respects, the two groups were similar in terms of number of sessions, waiting times, and attendance rates.

CONCLUSIONS:

Growing appreciation of the psychological impact of a child’s admission to PICU has been associated with increasing referral to an embedded psychologist over a 20-year period, at this center. Clinical and service implications are outlined in the context of the latest research on the mitigation of post-intensive care syndrome in this population.
Successful Transjugular Portosystemic Shunt Treatment of Pediatric Sinusoidal Obstruction: Case Report and Review of Literature
Authors: Ramic Lana , Speckert Matthew , Ramphal Raveena , Ling Simon C. , Temple Michael , Kehar Mohit
Published: August 2023

Background:

In adults with medically refractory sinusoidal obstruction syndrome (SOS), a transjugular intrahepatic portosystemic shunt (TIPS) has been used successfully to improve portal hypertension and symptoms such as ascites. There is limited data on the use of TIPS for SOS in pediatric patients.

Methods:

The index case was reviewed retrospectively. PubMed and Medline databases were searched to identify other cases.

Results:

A 4-year-old male with high-risk neuroblastoma, developed SOS after tandem autologous stem cell transplant. He was medically managed with defibrotide, diuretics, and peritoneal drainage, but, due to refractoriness, he underwent TIPS day +54 following bone marrow transplant. Hepatic venous pressure gradient improved from 17 to 8 mm Hg following TIPS placement with significant improvement in the patient’s clinical status and ascites. However, 15 months later, his shunt remained patent, and he remains clinically well with stable liver enzymes. A literature review identified 13 pediatric cases of TIPS for SOS due to varied causes. TIPS caused a median hepatic venous pressure gradient of 9 mmHg (range, 2–38 mm Hg). The mortality following the procedure was 15%, with 2 cases who died at 2- and 11-days post-TIPS. At the time of the last follow-up (range 8–25 months), 5 patients were alive, and 8 were lost to follow-up.

Conclusion:

We present here a pediatric case of SOS due to stem cell transplant treated successfully with TIPS with a review of the literature. A timely, individualized application of TIPS can be effective in treating children with medication-refractory SOS.
Superior Mesenteric Artery Syndrome and Nutcracker Syndrome as the Presentation of Crohn’s Disease in a Young Patient: A Case Report and Review of Literature
Authors: Lao Breanna Belle , Pitts Anna Margaret , Thomas Aby , Camacho Sandra M.
Published: August 2023

Superior mesenteric artery syndrome and nutcracker syndrome are rare vascular complications most often seen after marked weight loss caused by compression of the duodenum and left renal vein between the superior mesenteric artery and the aorta, respectively. The coexistence of superior mesenteric artery syndrome and nutcracker syndrome has been rarely reported. Herein, we present the case of a 16-year-old male with intermittent periumbilical abdominal pain, bilious vomiting, and weight loss who was found to have both of these vascular complications of significant weight loss as the initial presentation of Crohn’s disease. This report provides insight into the diagnosis and treatment of these syndromes while highlighting the importance for practitioners to keep vascular complications on their differential diagnosis of vomiting and abdominal pain in patients with Crohn’s disease.
Concomitant Reconstruction of Multiple Scalp Defects With One Rotational Flap
Authors: Seretis Konstantinos , Bounas Nikolaos , Lykoudis Efstathios G.
Published: August 2023

The cornerstones of scalp reconstruction are provisions of adequate skin paired with a satisfactory cosmetic outcome without hairline distortion. Several techniques have been described over the years to reconstruct sizable defects. Currently, an individualized approach, based on the patient’s medical status and needs, the defect characteristics, and the local tissue quality and availability, should be considered for an optimal outcome. The reconstruction of multiple scalp defects, by means of a well-planned rotational flap, is proposed as a viable option with many advantages. It enables concurrent reconstruction of the defects, obviates further surgical incisions, and elaborates surgical maneuvers, minimizing operative time and complications risk. A satisfactory esthetic outcome can be achieved.
Custom 3D-Printed External Cranial Orthotic for Prevention and Treatment of Syndrome of the Trephined
Authors: Leach Garrison A. , Dean Riley A. , Cleary Daniel R. , Steinberg Jeffrey A. , Gosman Amanda A.
Published: August 2023

Syndrome of the Trephined (SoT) is a frequently misunderstood and underdiagnosed outcome of decompressive craniectomy, especially in cases of trauma. The pressure gradient between atmospheric pressure and the sub-atmospheric intracranial pressure results in a sinking of the scalp overlying the craniectomy site. This gradually compresses the underlying brain parenchyma. This parenchymal compression can disrupt normal autoregulation and subsequent metabolism, yielding symptoms ranging from headaches, dizziness, altered behavior to changes in sensation, and difficulty with ambulation, coordination, and activities of daily living. We present a case of SoT treated with a 3D-printed custom polycarbonate external cranial orthotic that allowed us to re-establish this pressure gradient by returning the cranium to a closed system. The patient demonstrated subjective improvement in quality of life and his symptoms. This was consistent with the re-expanded brain parenchyma on CT imaging.
Anatomic Study of Petrous Bone and Its Surrounding Structures in the Extended Anterior Transpetrosal Approach
Authors: Cheng Ye , Cao Jun , Chen Zhenlin , Geng Homing , Wu Xiaolong , Zhang Lei , Bai Jie , Xiao Xinru
Published: August 2023

Extended anterior transpetrosal approach (ATPA) includes drilling the petrous bone to achieve maximal exposure of the petroclival region. Injuring of surrounding neurovascular structures, such as the internal carotid artery (ICA), during the procedure may result in severe complications. In this study, we aimed to use computer topographic images to provide comprehensive anatomic information on the petrous bone and surrounding structures to help surgeons during the extended ATPA. Computer topographic angiography images of 110 individuals were reviewed, and measurements were performed on coronal, sagittal, and axial planes following multiplanar reformation. The petrous apex and sagittal midline were used to locate the anterior, middle, and posterior parts of the petrous bone and petrosal segment of the ICA during the ATPA. The thicknesses of the petrous bone were 3.28±0.71, 3.53±0.88, and 7.02±1.11 mm at the petrous apex, trigeminal impression, and internal opening of internal auditory canal (IAC) positions, respectively. The distances between the petrous apex to the trigeminal impression, internal opening of the IAC, auris interna, and labyrinth were 7.39±1.62, 15.95±2.48, 17.39±2.39, and 29.00±3.18 mm, respectively. Furthermore, the petrosal segment of the ICA was located at the above landmarks on the petrous bone. Our findings provide anatomic information on the petrous bone and surrounding structures during the extended ATPA procedure based on fixed anatomic landmarks so as to achieve maximal exposure and reduce the number of complications.
Impact of Neighborhood Disadvantage on High-Risk Oncotype DX Recurrence Scores and Breast Cancer Survival
Authors: Goel Neha , Hernandez Alexandra , Kwon Deukwoo , Antoni Michael H. , Cole Steve
Published: August 2023

Objective:

Evaluate the association between neighborhood disadvantage and Oncotype DX score, a surrogate for tumor biology, among a national cohort.

Summary Background Data:

Women living in disadvantaged neighborhoods have shorter breast cancer (BC) survival, even after accounting for individual-level, tumor, and treatment characteristics. This suggests unaccounted social and biological mechanisms by which neighborhood disadvantage may impact BC survival.

Methods:

This cross-sectional study included Stage I and II, ER+ /HER2- BC patients with Oncotype DX score data from the National Cancer Database from 2004-2019. Multivariate regression models tested the association of neighborhood-level income on Oncotype DX score controlling for age, race/ethnicity, insurance, clinical stage, and education. Cox regression assessed overall survival.

Results:

Of the 294,283 total BC patients selected, the majority were non-Hispanic White (n=237,197, 80.6%) with 7.6% non-Hispanic Black (n=22,495) and 4.5% Other (n=13,383). 27.1% (n=79,7254) of the population lived in the most disadvantaged neighborhoods with an annual neighborhood-level income of <$48,000 while 59.62% (n=175,305) lived in neighborhoods with a median-level income of >$48,000. On multivariate analysis controlling for age, race/ethnicity, insurance status, neighborhood-level education, and pathologic stage, patients in disadvantaged neighborhoods had a greater risk of high- versus low-risk Oncotype DX scores compared to those in advantaged neighborhoods [OR=1.04 (1.01-1.07), P=0.0067].

Conclusion and Relevance:

This study takes a translational epidemiologic approach to identify that women living in the most disadvantaged neighborhoods have more aggressive tumor biology, as determined by the Oncotype DX score.
Development and Internal Validation of a Questionnaire Assessing Predisposition to Nonadherence to Immunosuppressive Medication in Kidney Pretransplant Patients
Authors: Oliveira Luana Cristina Lins de Medeiros , Tavares Raquel Padilha Martins , Moreira Francisca Sueli Monte , Nóbrega Ítala Morgânia Farias da , Nogueira Telma Cristiane Cavalcanti , Oliveira Alene Barros de , Batista Lorena de Medeiros , Martins Rand Randall , Oliveira Antonio Gouveia
Published: August 2023

Background.

After kidney transplant, nonadherence to immunosuppressive therapy is the main cause of impaired kidney function and graft loss. The objective of this study was the development and internal validation of a clinical questionnaire for assessing the predisposition to adherence to immunosuppressive therapy in kidney pretransplant patients.

Methods.

Multicenter prospective study conducted in 7 kidney hemodialysis and 6 kidney transplant centers of 3 Brazilian state capitals. Kidney transplant candidate patients of both sexes and >18-y-old were included. Retransplanted patients were excluded. A 72-item pilot version of the questionnaire, created through literature review complemented with a focus group of 8 kidney pretransplant patients, was administered to 541 kidney transplant candidate patients. Factor analysis with varimax rotation was used for questionnaire development. Internal validity evaluation used Cronbach’s alpha and test–retest reliability. Construct validity was assessed by differentiation by known groups.

Results.

The final questionnaire, named Kidney AlloTransplant Immunosuppressive Therapy Adherence (KATITA) Questionnaire, consisting of 25 items in 3 dimensions, presented good internal consistency reliability (Cronbach’s alpha 0.81). The 3 dimensions and respective Cronbach’s alpha were “Carelessness” (14 items, 0.81), “Skepticism” (6 items, 0.57), and “Concern” (5 items, 0.62). The interdimension correlation matrix showed low correlation coefficients (<0.35). Test–retest reliability, evaluated with 154 patients, showed an intraclass correlation coefficient of 0.62 (moderate agreement). The scale showed construct validity.

Conclusions.

The KATITA-25 questionnaire is the first psychometric instrument for evaluation of predisposition to nonadherence to immunosuppressive medication in candidate patients for kidney transplant in the pretransplant setting.
Current avenues of gene therapy in Pompe disease
Authors: Leon-Astudillo Carmen , Trivedi Prasad D. , Sun Ramon C. , Gentry Matthew , Byrne Barry J. , Corti Manuela
Published: August 2023

Purpose of the review

Pompe disease is a rare, inherited, devastating condition that causes progressive weakness, cardiomyopathy and neuromotor disease due to the accumulation of glycogen in striated and smooth muscle, as well as neurons. While enzyme replacement therapy has dramatically changed the outcome of patients with the disease, this strategy has several limitations. Gene therapy in Pompe disease constitutes an attractive approach due to the multisystem aspects of the disease and need to address the central nervous system manifestations. This review highlights the recent work in this field, including methods, progress, shortcomings, and future directions.

Recent findings

Recombinant adeno-associated virus (rAAV) and lentiviral vectors (LV) are well studied platforms for gene therapy in Pompe disease. These products can be further adapted for safe and efficient administration with concomitant immunosuppression, with the modification of specific receptors or codon optimization. rAAV has been studied in multiple clinical trials demonstrating safety and tolerability.

Gene therapy for the treatment of patients with Pompe disease is feasible and offers an opportunity to fully correct the principal pathology leading to cellular glycogen accumulation. Further work is needed to overcome the limitations related to vector production, immunologic reactions and redosing.