bluuebunny/crossref_metadata_2025 huggingface dataset:
MedBot vs RealDoc: efficacy of large language modeling in physician-patient communication for rare diseases
Authors: Weber Magdalena T , Noll Richard , Marchl Alexandra , Facchinello Carlo , Grünewaldt Achim , Hügel Christian , Musleh Khader , Wagner Thomas O F , Storf Holger , Schaaf Jannik
Published: February 2025

Objectives

This study assesses the abilities of 2 large language models (LLMs), GPT-4 and BioMistral 7B, in responding to patient queries, particularly concerning rare diseases, and compares their performance with that of physicians.

Materials and Methods

A total of 103 patient queries and corresponding physician answers were extracted from EXABO, a question-answering forum dedicated to rare respiratory diseases. The responses provided by physicians and generated by LLMs were ranked on a Likert scale by a panel of 4 experts based on 4 key quality criteria for health communication: correctness, comprehensibility, relevance, and empathy.

Results

The performance of generative pretrained transformer 4 (GPT-4) was significantly better than the performance of the physicians and BioMistral 7B. While the overall ranking considers GPT-4’s responses to be mostly correct, comprehensive, relevant, and emphatic, the responses provided by BioMistral 7B were only partially correct and empathetic. The responses given by physicians rank in between. The experts concur that an LLM could lighten the load for physicians, rigorous validation is considered essential to guarantee dependability and efficacy.

Discussion

Open-source models such as BioMistral 7B offer the advantage of privacy by running locally in health-care settings. GPT-4, on the other hand, demonstrates proficiency in communication and knowledge depth. However, challenges persist, including the management of response variability, the balancing of comprehensibility with medical accuracy, and the assurance of consistent performance across different languages.

Conclusion

The performance of GPT-4 underscores the potential of LLMs in facilitating physician-patient communication. However, it is imperative that these systems are handled with care, as erroneous responses have the potential to cause harm without the requisite validation procedures.
Disparity analysis: a tale of two approaches
Authors: Opacic Aleksei , Wei Lai , Zhou Xiang
Published: February 2025

To understand patterns of social inequality, social science research has typically relied on statistical models linking the conditional mean of an outcome variable to a set of explanatory factors. A prime example of this approach is the Kitagawa-Oaxaca-Blinder (KOB) method. By fitting two linear models separately for an advantaged group and a disadvantaged group, the KOB method decomposes the between-group outcome disparity into two parts: a part explained by group differences in background characteristics, and an unexplained part often dubbed ‘residual inequality’. In this article, we explicate, contrast, and extend two distinct approaches to studying group disparities, which we term the descriptive approach, as epitomized by the KOB method and its variants, and the prescriptive approach, which focuses on how a disparity of interest would change under a hypothetical intervention to one or more manipulable treatments. For the descriptive approach, we propose a generalized nonparametric KOB decomposition that considers multiple explanatory variables sequentially. For the prescriptive approach, we introduce a variety of stylized interventions, such as lottery-type and affirmative-action-type interventions that close between-group gaps in treatment. We illustrate the two approaches to disparity analysis through an application to the Black-White gap in college completion rates in the U.S.
An Optically Led Search for Kilonovae to z∼0.3 with the Kilonova and Transients Program (KNTraP)
Authors: Van Bemmel Natasha , Zhang Jielai , Cooke Jeff , Rest Armin , Möller Anais , Andreoni Igor , Auchettl Katie , Dobie Dougal , Gendre Bruce , Goode Simon , Freeburn James , Jones David O , Kilpatrick Charles D , Lien Amy , Rau Arne , Spitler Lee , Suhr Mark , Valdes Fransisco
Published: February 2025

Compact binary mergers detectable in gravitational waves can be accompanied by a kilonova, an electromagnetic transient powered by radioactive decay of newly synthesised r-process elements. A few kilonova candidates have been observed during short gamma-ray burst follow-up, and one found associated with a gravitational wave detection, GW170817. However, robust kilonova candidates are yet to be found in un-triggered, wide-field optical surveys; a search not requiring an initial gravitational wave or gamma-ray burst trigger. Here we present the first observing run for the Kilonova and Transients Program (KNTraP) using the Dark Energy Camera. The first KNTraP run ran for 11 nights, covering 31 fields at a nightly cadence in two filters. The program is non-disruptive, can detect transients beyond the LIGO/Virgo/KAGRA horizon, is agnostic to the merger orientation, avoids the Sun and/or Galactic plane, and produces high cadence multi-wavelength light curves. The data were processed nightly in real-time for rapid identification of transient candidates, allowing for follow-up of interesting candidates before they faded away. Three fast-rising candidates were identified in real-time, however none had the characteristics of the kilonova AT2017gfo associated with GW170817 or with the expected evolution for kilonovae from our fade-rate models. After the run, the data were reprocessed, then subjected to stringent filtering and model fitting to search for kilonovae offline. Multiple KNTraP runs (3+) are expected to detect kilonovae via this optical-only search method. No kilonovae were detected in this first KNTraP run using our selection criteria, constraining the KN rate to R < 1.8 × 105 Gpc−3 yr−1.
Regulation of CRISPR trans-cleavage activity by an overhanging activator
Authors: Yin Na , Yu Hongyan , Zhang Li , Luo Fei , Wang Weitao , Han Xiaole , He Yu , Zhang Yiqi , Wu You , Pu Jiu , Feng Tong , Yang Gang , Chen Tingmei , Xie Guoming
Published: February 2025

The clustered regularly interspaced short palindromic repeats (CRISPR)/Cas12a system exhibits extraordinary capability in the field of molecular diagnosis and biosensing, attributed to its trans-cleavage ability. The precise modulation of performance has emerged as a significant challenge in advancing CRISPR technology to the next stage of development. Herein, we reported a CRISPR/Cas12a regulation strategy based on an overhanging activator. The presence of overhanging domains in activators creates steric hindrances that have a substantial impact on the trans-cleavage activity and activation timing of Cas12a. The trans-cleavage activity of Cas12a can be finely tuned by adjusting the position, length, and complementarity of the overhanging domains. Moreover, specific structures exhibit characteristics of automatic delayed activation. The presence of overhanging domains enables precise and timely activation of Cas12a, facilitating multifunctional applications. This system effectively accomplishes dynamic regulation, programmable release of cargo, logical operations, and multi-enzyme detection. The flexibility and versatility of this simple and powerful CRISPR regulatory strategy will pave the way for expanded applications of CRISPR/Cas in biotechnology, bioengineering, and biomedicine.
Nitrogen stable isotope fractionation by biological nitrogen fixation reveals cellular nitrogenase is diffusion limited
Authors: Han Eunah , Kopf Sebastian H , Maloney Ashley E , Ai Xuyuan Ellen , Sigman Daniel M , Zhang Xinning
Published: February 2025

Biological fixation of dinitrogen (N2), the primary natural source of new bioavailable nitrogen (N) on Earth, is catalyzed by the enzyme nitrogenase through a complex mechanism at its active site metal cofactor. How this reaction functions in cellular environments, including its rate-limiting step, and how enzyme structure affects functioning remain unclear. Here we investigated cellular N2 fixation through its N isotope effect (15εfix), measured as the difference between the 15N/14N ratios of diazotroph net new fixed N and N2 substrate. The value of 15εfix underpins N cycle reconstructions and differs between diazotrophs using molybdenum-containing and molybdenum-free nitrogenases. By examining 15εfix for Azotobacter vinelandii strains with natural and mutated nitrogenases, we determined if 15εfix reflects enzyme-scale isotope effects and, thus, N2 use efficiency. Distinct and relatively stable 15εfix values for wild-type molybdenum- and vanadium-nitrogenase isoforms (2.5‰ and 5.8–6.6‰, respectively), despite changing cellular growth rate and electron availability, support 15εfix as a proxy for isoform type among extant nitrogenases. Structural mutation of active site N2 access altered molybdenum-nitrogenase 15εfix (3.0–6.8‰ for α-70VI mutant). Structure-function and isotopic modeling results indicated cellular N2 reduction is rate-limited by N2 diffusion inside nitrogenase due to highly efficient catalysis by the active site cofactor, exemplifying 15εfix as a tool to probe N2 fixation mechanisms. Diffusion-constrained reactions could reflect structural tradeoffs that protect the oxygen-sensitive cofactor from oxygen inactivation. This suggests that nitrogenase function is optimized for modern oxygenated environments and that pre-Great Oxidative Event nitrogenases were less diffusion limited and potentially exhibited larger 15εfix values.
Multi-objective cooperative control of junction-temperature oriented three-level traction converter
Authors: Liu Haitao , Xiang Chaoqun , Du Jingrun , Zhang Xinan
Published: February 2025

IGBT (Insulated-Gate Bipolar Transistor) module is the core of three-level (3 L) traction converter. In order to improve the lifetime of traction converter, a model predictive torque control (MPTC) based on junction temperature constraint is proposed. Firstly, the optimization range is reduced by judging the sector where the reference voltage vector locates, as the traditional MPTC needs to be optimized 27 times in each sampling period, which requires a large amount of calculation. Secondly, by simplifying the calculation of IGBT power loss and dynamically constraining it in the cost function, the performance of optimal voltage vector balancing control can be balanced with power loss. Simulation results show that the proposed method reduces the junction temperature of the power semiconductor and prolonging the converter lifetime compared with the traditional strategy.
Where flowers bloom, so do downy mildews: new species and new records of Hyaloperonospora, Peronospora and Plasmopara species on ornamental and wild plants in the United States
Authors: Salgado-Salazar Catalina , Rodriguez Salamanca Lina , Romberg Megan K. , Davis William J. , McConnell Megan , Havan Ambrosia E. , Peduto Hand Francesca
Published: February 2025

Downy mildews are biotrophic plant pathogens of low and high value crops which can cause significant damage and economic losses. The floral and nursery crops industries are particularly susceptible to downy mildews, especially when annuals, herbaceous perennials, and woody plants are growing in protected environments. Downy mildews are also a common but poorly documented occurrence on wild relatives, or non-cultivated plant hosts. The role these play, however, as pathogen reservoirs and on the emergence or re-emergence of downy mildew epidemics is still unknown. In this study, we report downy mildew observations on several annual, herbaceous perennial and woody shrub plants in several states in the Eastern U.S. Based on morphological observations and phylogenetic analyses of two nuclear loci (ITS, rnLSU) and two mitochondrial loci (cox2, cox1), we report Peronospora and Plasmopara occurrences on frost grape (Ohio), Lenten rose (North Carolina, Virginia), mock strawberry (Maryland), redbud (North Carolina), snapdragon (Virginia), viburnum (North Carolina) and Virginia creeper (Maryland, Ohio). The phylogenetic analysis indicated that the Peronospora isolates on snapdragon (Antirrhinum majus) from Virginia were clearly separated from other P. antirrhini isolates collected on Misopates orontium, indicating they constitute a separate species here described as Pe. ceperoae. The phylogenetic analyses also supported the combination of Peronospora matthiolae, a pathogen of Matthiola incana (stock), into Hyaloperonospora, based on specimens collected in Ohio. Collectively, our results suggest a wider geographic distribution for the downy mildew species reported, highlighting the need for continuous surveillance of these pathogens to prevent outbreaks and their introduction to naïve environments.
Sore throat or severe threat? The teleconsultation that uncovered neutropenic sepsis
Authors: Chandrakanthan Chanceeth , Ritsema Tamara S.
Published: February 2025

This case report describes a telemedicine visit by a patient with fever, sore throat, and odynophagia. The patient had recently started taking propylthiouracil (PTU) for Graves disease. She was referred to the ED, where a complete blood cell count revealed agranulocytosis with a neutrophil count of 200 cells/mm3. PTU was promptly discontinued, and she received treatment with IV piperacillin-tazobactam, resulting in an improvement in her condition. With the rise of telemedicine, clinicians must prioritize thorough history-taking to detect uncommon complications of medications and to ensure patient safety.
Internal vs external fixation of the anterior ring in unstable pelvic fractures was associated with discharge to home.
Authors: Patterson Joseph T. , Hasegawa Ian G. , Sakka Brandan , Collins Andrew P. , Shabani Soroush , Duong Andrew M. , Ding Li , Wong Monica D. , Firoozabadi Reza , Gary Joshua L.
Published: February 2025

OBJECTIVE:

To determine if anterior internal or definitive external fixation combined with posterior internal fixation of unstable pelvic fractures was associated with frequency of discharge to home.

METHODS:

Design: Retrospective cohort study.

Setting:

Two Level 1 Trauma Centers and one academic tertiary referral center.

Patient Selection Criteria:

Patients aged ≥16 years with unstable OTA/AO 61B/C pelvis fractures treated with operative fixation of the anterior and posterior pelvic ring by three fellowship-trained orthopaedic trauma surgeons from October 2020 to November 2022.

Outcome Measures and Comparisons:

The primary outcome was the adjusted odds of discharge to home with internal fixation compared with definitive external fixation of the anterior pelvic ring on multivariable analysis considering patient, injury, and treatment characteristics. Secondary outcomes included bivariable associations between anterior fixation type and intensive care unit (ICU) days, ventilator days, hospital length of stay, and hospital charges.

RESULTS:

Seventy-nine patients (65%) who were treated with internal fixation presented with higher mean Glasgow Coma Scale scores (13.5±3.6 vs 10.5±5.4, p<0.01) than 43 patients treated with definitive external fixation, but were otherwise similar to with regard to age (mean 48.1±19.9 vs 41.2±15.8, range (16-96) vs (19-77), p=0.07), sex (36.7% vs 44.2% female, p=0.42193), mean, body mass index (28.4±6.2 vs 28.7±7.4 kg/m2, p=0.93), any medical comorbidities (50.6% vs 44.2%, p=0.62), substance use ((13.9% vs 27.9%, p=0.09884), insurance type (p=0.97), mean Injury Severity Score (24.8±12.0 vs 29.5±14.0, range 5-57 vs 10-57, p=0.14), pelvis fracture pattern (p=0.12187), and preinjury living environment(p=0.67695). On multivariable analysis, patients treated with internal fixation were more frequently discharged to home (53.2% vs 27.9%, odds ratio 3.39, 95% confidence interval 1.29-9.84, p=0.0198). Patients treated with anterior internal fixation also experienced fewer mean ICU days (6.0±8.8 vs 9.8±16.3, p=0.0213), ventilator days (3.5±8.2 vs 6.9±15.9, p<0.0081), and hospital days (18.7±16.2 vs 31.2±26.7, p<0.01); and incurred less hospital charges ($278,563.29±$261,602.35 vs $580,625.98±$503,067.98, p<0.01).

CONCLUSIONS:

Patients who received anterior and posterior internal fixation of their unstable pelvis fractures were more likely to discharge to home than patients treated with anterior definitive external fixation and posterior internal fixation. Anterior internal fixation was also associated with fewer ICU, ventilator, and hospital days, as well as less hospital charges.

LEVEL OF EVIDENCE:

Therapeutic Level III.
Comparative study of time-restricted eating on body composition and metabolic parameters in climacteric women with obesity: analysis of a pre-post intervention
Authors: de Morais Araújo Nathália Cavalcanti , Paixão Júlia Acioli , de Oliveira Freitas Fabiane , de Araújo Gonçalves Daniel Nunes , de Araujo Fernando Wesley Cavalcanti , da Silva Silvia Alves , do Nascimento Elizabeth
Published: February 2025

Objective

The physiological changes inherent to the climacteric period can trigger or aggravate overweight/obesity, among several other health disorders. This study aimed to evaluate the effects of time-restricted eating (TRE) on body composition and cardiometabolic parameters in climacteric women with obesity submitted to caloric restriction (CR) through a hypocaloric diet.

Methods

We conducted an analysis of a clinical trial in a pre-post design that included adult climacteric women with obesity. Participants were divided into two groups: hypocaloric diet control group (n = 30) — with hypocaloric diet and free meal times, and hypocaloric diet and time-restricted eating group (HTRE) (n = 27) — with hypocaloric diet and TRE (fasting from 7 pm to 7 am), for 10 weeks. Anthropometric and biochemical parameters were evaluated before and after the intervention period. A significance level of P < 0.05 was considered for all cases.

Results

Both groups showed a reduction in all anthropometric parameters, but without significant difference (P = 0.34) between groups. However, some metabolic parameters were significantly highlighted in the HTRE such as cholesterol level normalization (HTRE, 181.76 ± 34.20 mg/dL) and a decrease in plasma atherogenicity (P = 0.02), glycated hemoglobin (P < 0.001), estimated mean glucose (P = 0.02), and alanine aminotransferase (P = 0.02), unlike the hypocaloric diet control group, which did not show such significance.

Conclusions

In this study, from the perspective of body composition, similar changes were observed between the group subjected to CR alone and the group subjected to CR combined with a 12-hour overnight fast. However, there was an indication of superior improvement in glycemic and lipid parameters in the group subjected to the 12-hour overnight fast. These findings suggest the potential for TRE, as implemented, to have positive effects on reducing cardiovascular risk and other chronic metabolic diseases.
The transition to menopause for autistic individuals in the US: a qualitative study of health care challenges and support needs
Authors: Cusano Julia L. , Erwin Val , Miller Debra , Rothman Emily F.
Published: February 2025

Objective

The goal of the current study was to better understand autistic people's experiences with the menopause transition, by focusing on their symptoms, healthcare interactions, and receipt of informal support.

Methods

This was a qualitative research study. We conducted one-on-one videotelephone interviews with 21 autistic adults who had experienced, or were currently experiencing, perimenopause in the United States. Data were coded by two independent coders. We used a thematic analysis approach.

Results

The analysts derived several overarching themes related to perimenopausal symptoms, barriers to healthcare, and informal support networks. Participants reported increased sensory sensitivities during perimenopause and reported that these severely impacted their quality of life. These sensory sensitivities also compounded vasomotor symptoms of perimenopause causing an extreme and overwhelming confluence of symptoms and difficulties. Despite this, many participants felt that their healthcare providers supported them insufficiently. Participants felt unprepared for the intensification of sensory sensitivities during the menopause transition due to a lack of information about perimenopause from healthcare providers and because their social support network members lacked information about perimenopause.

Conclusions

Autistic people face unique challenges during the menopause transition, which may include managing sensory sensitivities and navigating healthcare systems. Results highlight the need for education about menopause earlier in life for autistic people. Findings further demonstrate the need for holistic approaches to perimenopausal symptom management and better training for providers on the unique needs of perimenopausal autistic people.
Cardiac phenotypes in LMNA mutations
Authors: Rouhi Leila
Published: February 2025

Purpose of review

This review highlights the diverse cardiac manifestations of LMNA mutations, focusing on their underlying molecular mechanisms and clinical implications. As LMNA mutations are implicated in cardiomyopathies, such as dilated cardiomyopathy (DCM), arrhythmogenic cardiomyopathy (ARVC), and conduction system diseases, understanding these phenotypes is critical for advancing diagnosis and management strategies.

Recent findings

Recent studies reveal that LMNA mutations disrupt nuclear envelope stability, activating the DNA damage response (DDR) and compromising chromatin organization and mechanotransduction. Mouse models have elucidated pathways linking LMNA dysfunction to fibrosis, arrhythmias, and myocardial remodeling. Emerging evidence demonstrates that fibroblasts play a crucial role in cardiac phenotypes. Advances in genetic screening have also underscored the importance of early identification and risk stratification, particularly for arrhythmias and sudden cardiac death.

The diverse spectrum of LMNA-related cardiac phenotypes, from isolated conduction defects to severe DCM and ARVC, underscores the necessity of personalized care strategies. Bridging insights from molecular studies and clinical research paves the way for targeted therapies to slow disease progression and improve patient outcomes. Future efforts should prioritize translational research on molecular mechanisms with potential in mouse models, alongside a deeper exploration of genotype–phenotype correlations, to refine and implement effective therapeutic interventions.
β-Catenin regulates distinct pathways from YAP and suppresses ONECUT1 to drive hepatoblastoma development in mice and humans
Authors: Liao Weiting , Zhang Yi , Wang Jingxiao , Cui Guofei , Evert Matthias , Xu Meng , Wu Yanhui , Wang Xue , Deng Shanshan , Song Xinhua , Monga Satdarshan P. , Zhao Jinqiu , Li Qiu , Calvisi Diego F. , Chen Xin
Published: February 2025

Background & aims:

Hepatoblastoma (HB) is the predominant primary malignant liver tumor in childhood. Concomitant YAP and β-Catenin activation occurs in most HB. However, the signaling pathways distinctively regulated by YAP and β-Catenin protooncogenes in HB remain unexplored.

Approach and results:

We engineered an inducible HB murine model using hydrodynamic injection to deliver transposon plasmids encoding constitutive YAP and doxycycline (Dox)-inducible ΔN90-β-Catenin(YAP/TRE-β-Catenin). Gene expression patterns in mouse HB lesions upon short-term Dox withdrawal, i.e., tumors still existed, but ΔN90-β-Catenin was turned OFF, were analyzed. Mice rapidly developed aggressive HB lesions when fed doxycycline. However, upon Dox withdrawal, HB regressed, although tumors did not completely disappear over a long time. At the molecular level, YAP and β-Catenin were found to regulate distinct gene expression programs in HB. Specifically, YAP controls the Hippo and metabolism-related pathways, whereas β-Catenin modulates immune-related pathways contributing to immune exclusion in the tumor microenvironment. Furthermore, we identified the transcription factor ONECUT1 as a tumor suppressor gene downregulated by activated β-Catenin in HB. Low ONECUT1 expression also characterizes human HB, and co-expression of ONECUT1 strongly suppressed YAP/β-Catenin-driven HB formation in mice. Mechanistically, ONECUT1 functions downstream of activated β-Catenin and negatively regulates tumor cell glycolysis.

Conclusions:

We show that suppressing activated β-Catenin could hamper HB progression in vivo by affecting pathways distinct from those regulated by YAP in HB. Inhibition of ONECUT1 expression by β-Catenin might represent a critical molecular event leading to HB formation.
Assessing Quality of Vision in Cataract Surgery: A Randomized Trial of Digital vs. Paper-Based Questionnaires
Authors: Rein Adi Porat , Lundström Mats , Dickman Mor M. , Rosen Matan , Finkelman Yaron , Semionov Anastasia , Zadok David , Abulafia Adi
Published: February 2025

Purpose:

To introduce a newly developed digital platform and compare its reliability and agreement with paper-based questionnaires for assessing quality of vision before and after cataract surgery.

Setting:

University-affiliated ophthalmology department and private clinic.

Design:

Prospective, randomized trial with parallel design of 1:1 allocation ratio without masking.

Methods:

Between 11/2021 and 6/2023, patients from a preoperative cataract clinic, aged ≥21 years, with cataracts in both eyes and internet access were randomly assigned by “ALEA” software to complete Catquest-9SF and Quality-of-Vision (QoV) questionnaires before surgery and after second eye surgery via paper or a newly developed digital European Registry of Quality Outcomes in Cataract and Refractive Surgery (EUREQUO) platform. Statistical analyses evaluated agreement between methods, and validation was by Rasch analysis.

Results:

Half (183/364, 50.3%) of the enrolled patients were allocated to digital questionnaires. After exclusion due to technical issues, missing questions, and withdrawal, 307/364 patients remained, of whom 159 (51.8%) filled in digital questionnaires. Half of all patients (n=154) underwent sequential surgeries on both eyes after a minimum one-month interval. Seventy-two (72/154, 46.8%) completed postoperative questionnaires. Comparative analysis found no significant differences between paper and digital methods. Catquest-9SF and QoV questionnaires demonstrated good precision and reliability (Rasch analysis). Postoperative vision improved at an average of 2.82 logits.

Conclusion:

The newly developed digital EUREQUO platform for patient assessment of quality of vision before and after cataract surgery with the Catquest-9SF and QoV questionnaires, offers a reliable alternative to traditional paper-based questionnaires, enhancing convenience for patients and providers.
Implications of portal vein/superior mesenteric vein involvement in pancreatic cancer: a comprehensive correlation from preoperative radiological assessment to resection, pathology, and long-term outcomes: a retrospective cohort study
Authors: Kim Hyeong Seok , Chae Hochang , Lim Soo Yeun , Jeong HyeJeong , Yoon So Jeong , Shin Sang Hyun , Han InWoong , Heo Jin Seok , Kim Hongbeom
Published: February 2025

Background:

The incidence of portal vein/superior mesenteric vein (PV/SMV) resection during pancreatoduodenectomy is increasing in clinical practice. This study investigated the clinical significance of preoperative PV/SMV assessment and intraoperative resection and their correlation with pathological results and long-term survival outcomes.

Methods:

We analyzed 443 patients undergoing pancreatoduodenectomy at a tertiary center from 2012 to 2017 based on PV/SMV resection. Subgroup analyses were performed based on preoperative PV/SMV involvement, resection, and margin status.

Results:

Total of 441 patients were analyzed; 175 had PV/SMV involvement on preoperative radiological assessments and 128 underwent PV/SMV resection. True pathological invasion was observed in 78 patients (60.9%), with 34.3% showing no invasion and negative margins. The positive predictive value for preoperative PV/SMV involvement was 61.7%, with a false-negative value of 28.9%. Overall survival of patients who underwent PV/SMV resection was worse than those who did not (2-year survival rate, 38.1% vs 54.9%, P < 0.001). Patients without PV/SMV resection with an rR1/R1 margin showed no decrease in survival compared to those with PV/SMV resection and R0 margins (54.9% vs 40.3%, P = 0.029). Prognostic factors included hypertension, PV/SMV resection, PV/SMV R2 margin, T stage, N stage, cell differentiation, adjuvant treatment, and recurrence.

Conclusion:

PV/SMV resection could ensure R0 resection but may lead to unnecessary resection. Careful consideration is essential in determining the need for PV/SMV resection. Poor survival in such patients highlights the need for tailored treatments, including neoadjuvant therapy, for those who are expected to undergo PV/SMV resections.
Predictors of Short and Long-term Rebleeding in Patients With Overt Gastrointestinal Bleeding
Authors: Rizk Chantal , Kerbage Anthony , Tamim Hani , El Sheikh Walaa G. , Sharara Ala I. , Mourad Fadi , Shaib Yasser , Daniel Fady , Soweid Assaad , Rockey Don C. , Barada Kassem
Published: February 2025

Background:

We aimed to identify predictors of rebleeding in patients with overt gastrointestinal bleeding (GIB) and to develop a rebleeding index.

Methods:

This was a prospective study of patients admitted with GIB from 2013 to 2023 at a tertiary care center. Rebleeding was defined as the recurrence of visible bleeding after initial stabilization, endoscopic evaluation, and/or hemostatic therapy, accompanied by a change in vital signs or a hemoglobin (Hgb) decrease of ≥2 g/dL. Independent predictors were determined after adjusting for confounders.

Results:

Seven hundred ninety-seven patients with GIB were recruited between 2013 and 2023 and were followed up until death or January 2023. In-hospital, 1-month, 1-year, and end of follow-up rebleeding rates were: 5.3%, 8.9%, 16.2%, and 21.8%, respectively. Sources of rebleeding were different from the original sources in 36% of patients. Predictors of 1-month rebleeding included need for ≥3 packed red blood cell (PRBC) units (HR=1.86; p=0.041), endoscopic stigmata of recent hemorrhage (SRH) (HR=1.99; p=0.007), and Hgb level (HR=0.82; p=0.018; lower Hgb predicts higher rebleeding risk). A rebleeding index based on SRH, Hgb level, and ≥3 PRBC units showed modest performance (AUC=0.68), with higher scores indicating increased rebleeding risk. At the end of follow-up, SRH remained a predictor (HR=1.61; p=0.003), whereas antiplatelets on admission or discharge appeared protective against rebleeding (HR=0.66; p=0.021; HR=0.63; p=0.026).

Conclusion:

Predictors of rebleeding after GIB were SRH, PRBC transfusion, and lowest Hgb. The novel index based on these predictors performed favorably compared with the GBS, Rockall systems for UGUB and ABC scores. These data will help guide management and risk stratification of patients with GIB.
Integration of Virtual Technology and Artificial Intelligence Improves Satisfaction, Patient Safety, and Nursing Workforce Efficiency
Authors: Tyransky Cassandra E. , Paulus Kasey , Langmead Erin , Miller David M. , Smith Carol R. , Hughes Fallon , Buchko Barbara L. , Saconi Bruno
Published: February 2025

Background:

Virtual care technology including artificial intelligence (AI) may augment nursing functions creating flexibility in staffing that reduces workforce shortages and enhances patient safety.

Local problem:

A health system experienced nursing workforce shortages and patient safety concerns.

Methods:

Quality improvement methodology was used to evaluate the impact of implementing virtual care technology with AI.

Interventions:

Virtual patient observation (VPO) with AI and virtual nurse (VN) technology were implemented. Nursing assistants served as virtual observers, while registered nurses functioned as VNs, managing patient admissions, discharges, and education.

Results:

Unwitnessed in-room patient fall rates decreased 59% and median sitter hours were reduced by 91%. Patient experience and nurse perceptions of patient safety, workforce flexibility, and well-being improved. The program saved 63 hours per month of bedside nurse time.

Conclusions:

Nurse leader sponsorship of VPO with AI and VN to augment nursing functions offers a solution to improve patient safety and workforce flexibility.
Addressing Patient Learning Myopia in Multiple Sclerosis Through A Thermodynamic Approach
Authors: Cegarra-Sánchez Jorge , Cegarra-Navarro Juan-Gabriel , Martinez-Martinez Aurora
Published: February 2025

Background:

Multiple sclerosis (MS) is a chronic and unpredictable condition requiring continuous learning and self-management. Since learning myopia involves a tendency to focus on immediate concerns at the expense of long-term goals, it can hinder disease management.

Problem:

Patients with MS often prioritize short-term symptom relief over proactive disease education and adherence to disease-modifying therapies. This focus on the immediate challenges complicates efforts to foster sustained learning, further compounded by widespread misinformation about MS management.

Approach:

This article applies a thermodynamic framework integrating rational, emotional, and spiritual capacities to overcome learning myopia.

Outcomes:

The article demonstrates how nurses can facilitate informed decision-making, resilience, and long-term adherence, mitigating the impacts of learning myopia.

Conclusions:

Addressing learning myopia through the thermodynamic approach empowers patients to manage MS effectively, improving quality of life.
Minnesota Public Health Corps: A Qualitative Assessment of AmeriCorps’ Members Experiences
Authors: Stabler Henry , Kirkland Chelsey , Frank Jaclyn , Price Rachel , Leider Jonathon
Published: February 2025

Context:

Long-standing gaps in public health capacity exist due to extensive workforce shortages, particularly in governmental public health (GPH); these gaps were worsened during and after the COVID-19 pandemic. In response, the federal government established Public Health AmeriCorps (PHA), which supported the integration of AmeriCorps members in public health systems. Minnesota Public Health Corps (MNPHC) prioritized placing members in GPH agencies to increase GPH capacity. Initial evaluation results (2022-2023) suggest that program members were well-integrated into agencies. This article reports on the contextual information offered by MNPHC members throughout their service, including the specific programs and activities members implemented, to better explain how members were successful at extending agencies’ capacity.

Objectives:

Activities, challenges, and successes of members during their service are described to better explain how members were successful at extending their sites’ capacity.

Design:

Descriptive qualitative methods using data reported each month by 60 members.

Setting:

GPH agencies with at least one AmeriCorps member.

Participants:

MNPHC members and GPH agencies.

Intervention:

MNPHC members at GPH agencies across Minnesota who implemented service plans.

Main Outcome Measure:

Outcomes of interest included salient themes within MNPHC members’ (1) activities, (2) encountered challenges and barriers, (3) successes.

Results:

MNPHC members implemented public health activities that helped bolster the capacity at host sites. The most common activities were related to public health communications, community engagement, and data analysis. Reported successes were largely concerned with progress made on the different activities being implemented by members. Members also reported few challenges; however, most reported challenges related to common issues encountered in public health, such as difficulty working with community partners or finding available data.

Conclusions:

MNPHC offers a compelling model that provides support to the GPH workforce while also offering those considering a career in GPH an opportunity to experience a range of public health activities.
Using machine learning to predict poor adherence to antiretroviral therapy among adolescents living with HIV in low resource settings
Authors: Najjuuko Claire , Brathwaite Rachel , Xu Ziqi , Kizito Samuel , Lu Chenyang , Ssewamala Fred M
Published: February 2025

Objectives:

Achieving optimal adherence to antiretroviral therapy (ART) and viral suppression is still insufficient for attaining the UNAIDS 95-95-95 target of 2030, especially among adolescents living with HIV (ALWHIV). This study sought to develop a model to predict poor adherence risk among ALWHIV and identify associated risk factors.

Design:

We utilized machine learning (ML) to predict future ART adherence among ALWHIV leveraging its ability to analyze complex, multidimensional data.

Methods:

We leveraged a dataset from a 6-year (2012-2018) longitudinal randomized control trial (RCT) with 635 ALWHIV in Uganda. We evaluated six ML models and retained one with the highest Area Under Receiver Operating Characteristic (AUROC), and Area Under Precision-Recall Curve (AUPRC). We further identified principal factors associated with ART adherence based on the best model.

Results:

The random forest model outperformed others, with mean AUROC: 0·71 (BC 95% CI: [0·69–0·72]) and AUPRC: 0·55 (BC 95% CI: [0·53–0·58]). The principal risk factors of poor adherence were poor adherence history; poverty; biological relationship to caregiver; self-concept; savings confidence; duration on ART; frequency discussing sensitive topics with caregivers; household size; economic group assignment; and school enrollment.

Conclusions:

Our findings support potential use of ML methods and socio-behavioral data for predicting poor ART adherence risk among ALWHIV. The predictive tool can help identify ALWHIV at the highest risk of treatment failure, and enable early targeted interventions. However, the tool is still preliminary and its accuracy could be improved by incorporating HIV phenotypic and clinical data.

Clinical Trial Number:

ClinicalTrials.gov ID:NCT01790373
Patient-Reported Outcome (PROMIS) Scores Improve After Gender-Affirming Mastectomy
Authors: Sweitzer Keith R. , Milek David , Escandón Joseph M. , Sanderson Derrick , Christiano Jose G.
Published: February 2025

Background

Ad hoc and patient-reported outcome measures not specific to transgender surgery limit assessment of the impact of gender-affirming procedures. Patient-Reported Outcomes Measurement Information System (PROMIS) was developed as an objective and validated instrument to measure patient-related outcomes. In our study, we aimed to describe and analyze mean T-score changes in PROMIS before and after gender-affirming mastectomy.

Methods

A single-institution retrospective review of a prospectively maintained database was conducted on patients undergoing gender-affirming mastectomy (GAM) between October 2016 and July 2023. Along with demographic data, PROMIS T-scores for different health domains related to gender dysphoria were collected preoperatively and at postoperative months 1, 3, and 6. Tukey-Kramer adjustment statistical analysis and linear mixed-effect model were employed to accommodate both fixed and random effects from nonindependence in the data with adjusted P < 0.05 being considered statistically significant.

Results

A total of 185 patients were included. The average age was 23.7 years. Seven percent of patients were identified as nonbinary; 91% received preoperative hormonal therapy. Furthermore, 87.7% completed the survey on postoperative month 1 (POM1), 68.3% on POM3, and 47.5% on POM6. Baseline anxiety was found significantly worse (T-score, 60.4) compared to general US population. Satisfaction with social roles, anxiety, depression, social isolation, and anger demonstrated significantly improved T-scores after GAM on POM1, 3, and 6 compared to preoperative values.

Conclusions

Female-to-male transgender patients undergoing GAM demonstrated lasting improvements in satisfaction with social roles, anxiety, depression, social isolation, and anger over the period of 6 months postoperatively. PROMIS represents a relevant and useful tool to measure patient-reported outcomes in patients undergoing gender-affirming surgery.
Long-Term Outcome of Nasal Base Tripod in Patients With Unilateral Cleft
Authors: Saito Takafumi , Fukuyama Sotatsu , Tu Junior Chun-Yu , Lo Lun-Jou
Published: February 2025

Background

Primary rhinoplasty is gaining popularity in cleft care. However, for a comprehensive reconstruction of 3-dimensional nasal morphology, an emphasis on lip muscle repair is essential to achieve nasal symmetry. Surgeons aiming to improve outcomes need to extend their understanding of the interrelationships among the alar bases, columellar base, and the underlying skeletal structure in primary condition and up to skeletal maturity.

Methods

This study analyzed imaging data from 192 skeletally matured patients, dividing them into unilateral complete, incomplete, and noncleft groups. Both cone-beam computed tomography and 3D photographs were utilized to investigate the 3-dimensional relationships among bilateral alare and subnasale, including underlying structures (soft-tissue thickness and skeletal asymmetry). Statistical comparisons were performed. Through stepwise multiple linear regression analysis, the study identified significant interrelationships among the nasal bases.

Results

The data revealed that despite the asymmetry in the underlying skeletal foundation, the current surgical methods have been successful in reconstructing the alar bases in a 3-dimensional aspect. However, columellar base deviation was observed when compared to the noncleft patients. The regression analysis revealed a notable correlation between the depression of the cleft-side alar base and columellar base deviation.

Conclusions

This study provides an insight for evaluating the cleft lip repair. Correcting the anteroposterior depression on cleft side alar base, in addition to adequate muscle reconstruction, could possibly reduce the columellar base deviation.
An Artificial Intelligence Model for Vascularity Monitoring of Postoperative Flap
Authors: Lu Ming , Zhang Aijie , Wang Yao , Lim Rebecca Qian Ru , Chen Wei , Yi Zhe , Wang Ziquan , Zhang Yan , Qian Zhen , Wang Guangzhi , Liu Bo
Published: February 2025

Background:

Postoperative flap monitoring is a labor-intensive task that relies heavily on the subjective judgment of skin color change by both medical and nursing staff. Human errors, such as misinterpretation of visual cues, may result in flap failure due to missed or delayed detection of vascular compromise.

Objective:

To simulate clinical situations of vascular compromise and investigate the feasibility of using an artificial intelligence (AI) model with skin color monitoring algorithms (SCMAs) and pulse wave monitoring algorithms (PWMAs) in identifying changes to site vascularity.

Materials and Methods:

A tourniquet machine was used on human participants to simulate clinical conditions of venous and arterial obstruction by applying 6 different pressure conditions (0, 40, 70, 100, 160, and 200 mm Hg). The tourniquet was placed 10 cm above each participant’s elbow crease, and each pressure condition was maintained for 3 minutes. The color changes of the participant’s forearm and arm were assessed by 5 clinical specialists of level 2 according to the Tang and Giddins classification, and the SCMAs and PWMAs were recorded as well with their respective algorithms. The results from the SCMAs were then compared with the manual assessments, while the results from the PWMAs were compared with the pulse oximeter readings.

Results:

The 100 mm Hg pressure condition simulated a clinical venous blockage, while the 200 mm Hg pressure condition simulated an arterial blockage. The results from the SCMAs and PWMAs correlated with manual assessments of skin color changes and pulse oximetry readings, respectively. The simulation of a venous compromise showed a gradual deepening of skin color, whereas an arterial obstruction demonstrated decreased peripheral oxygen saturation instead of significant changes to skin color.

Conclusion:

These AI algorithms are comparable with manual assessment and contact-based devices in identifying vascular compromise, which portends feasibility in future research and development of such technology.
The Anterior Mandibular Alveolar Bone Augmentation With Sticky Bone in Periodontally Accelerated Osteogenic Orthodontics
Authors: Lou Qun , Yuan Hao , Sun Qi , Wang Bixia
Published: February 2025

Objective:

Sticky bone, a composite of porcine-derived xenograft bone material and serum components obtained from autologous blood centrifugation, was implanted into the anterior mandibular alveolar bone during periodontally accelerated osteogenic orthodontics (PAOO) in a patient with skeletal Class III malocclusion. The augmentation and stability of the alveolar bone in the grafted area were evaluated over a one-year follow-up period.

Methods:

A patient with skeletal Class III malocclusion underwent PAOO surgery as part of presurgical orthodontic treatment. During the procedure, sticky bone was used as a substitute for traditional granular bone, while autologous blood components were centrifuged to form barrier membranes. Cone-beam computed tomography (CBCT) scans were taken before treatment, and at 6 months and 1 year post-PAOO surgery. The height and thickness of the bone graft in the anterior mandibular region were measured using Blue Sky Plan software.

Results:

The measurements showed that, although minor absorption of the bone graft occurred one year after surgery, CBCT scans at the completion of orthodontic treatment revealed a 1–3 mm layer of exogenous bone still covering the middle and upper thirds of the root in the mandibular anterior region. This bone grafting technique effectively corrected bone dehiscence.

Conclusions:

In this case, sticky bone, a combination of heterologous bone material and autologous blood barrier membranes, successfully preserved the bone height and thickness one year after PAOO surgery. The use of sticky bone for bone augmentation proved to be an economical and reliable method with long-term stability. Future controlled studies with larger sample sizes are needed to further validate the clinical applicability of this approach in treating anterior mandibular alveolar defects.