bluuebunny/crossref_metadata_2025 huggingface dataset:
Practice Versus Potential: The Impact of the BioFire FilmArray Pneumonia Panel on Antibiotic Use in Children
Authors: Plattner Alexander S , Lockowitz Christine R , Dumm Rebekah , Banerjee Ritu , Newland Jason G , Same Rebecca G
Published: February 2024

Background

The BioFire FilmArray Pneumonia Panel (BFPP), a multiplex PCR panel for the diagnosis of lower respiratory tract infections, has been proposed as a tool for antimicrobial stewardship. Few studies evaluate real-world implementation of the BFPP and no studies focus exclusively on children. Our institution implemented BFPP testing without restrictions.

Methods

We conducted a retrospective cohort study in children hospitalized at St. Louis Children’s Hospital to (1) characterize the use of the BFPP in pediatric patients and (2) assess how results impacted antibiotic use. We included all BFPP tests obtained during the first year after the introduction of the test, September 2021 through August 2022. The primary outcome was change in antibiotic therapy within 24 hours of results, which was compared to the potential change in antibiotic therapy determined by two infectious diseases clinicians.

Results

One hundred sixty-nine tests from 126 patients were included. Nine patients were immunocompromised and 19 had chronic tracheostomy. The majority of tests were sent from tracheal aspirate specimens (92%) and from patients in an intensive care unit (94%). Only 51% of tests were obtained due to respiratory failure or suspected pneumonia. For 80% of test results, there was potential to change antibiotics, but change occurred in only 46% of tests in practice. Antibiotic escalation was more common (26%) than de-escalation (15%) or discontinuation (4.1%).

Conclusions

In a cohort of pediatric patients tested with the BFPP, the majority of tests were sent from tracheal aspirates and less than half of tests were associated with a change in antibiotics.
Circumferential tracheal replacement with silicone stent supported, cryopreserved aortic homograft
Authors: Hauptmann Edward , Dhar Shumon , Harirah Omar , Chandra Raghav , Reznik Scott , Waters John
Published: February 2024

Treatment of long-segment tracheal defects remains a challenge in thoracic surgery with no standard surgical option. Aortic allografts have been used for this purpose with varying degrees of success. In a patient that suffered anastomotic dehiscence after tracheal resection with primary anastomosis, we performed complete tracheal resection and replacement using a stented circumferential aortic allograft. Currently, this patient is able to breathe normally without tracheostomy assistance 22 months postoperatively. Our report is the first in the English literature of long-term survival without tracheostomy dependence and close interval follow-up after circumferential tracheal resection and replacement with a cryopreserved aortic allograft.
Reamer irrigator aspirator (RIA) reduces risk of fat embolism in bilateral pediatric femur shaft fractures: a case report
Authors: Jacobson Erik , Schieve Bailey C , Klahs Kyle J , Macias Reuben A , Abdelgawad Amr , Thabet Ahmed M
Published: February 2024

A 14-year-old male patient was successfully treated with the reamer irrigator aspirator for femur intramedullary rod preparation after sustaining right and left closed femur fractures because of an all-terrain vehicle accident. In patients already categorized as high risk for fat embolism syndrome, such as those with bilateral femur fractures, reaming both femora greatly increases the likelihood of this complication. The reamer irrigator aspirator provides an effective tool that potentially mitigates the risk of fat embolism syndrome in pediatric patients with this type of orthopedic trauma.
Approaching the ‘Social Context of Writing Practices in Late Bronze Age Ugarit’
Authors: Burlingame Andrew
Published: February 2024

This review article discusses points raised in Philip Boyes's 2021 monograph Script and Society: The Social Context of Writing Practices in Late Bronze Age Ugarit. The arguments of the book are summarized, contextualized, and evaluated from an Ugaritological disciplinary perspective; remarks on method and opportunities for future research are presented; and a series of specific comments is offered as a supplementary resource for readers and researchers interested in further pursuing the topics Boyes addresses.
Time-lapse confocal microscopy to study in vitro Streptococcus mutans surface colonization
Authors: Wing Jason T F , Hayashi Michael A L , Redissi Aneesa F , Vickerman M Margaret , Tenuta Livia M A , Fenno J Christopher , Rickard Alexander H
Published: February 2024

The cariogenicity of Streptococcus mutans relates to its ability to form biofilms on dental surfaces. The aim of this work was to develop a flowcell system compatible with time-lapse confocal microscopy to compare the adhesion and accumulation of S. mutans cells on surfaces in unsupplemented media against media containing sucrose or sucralose (a non-metabolized sweetener) over a short period of time. Fluorescent S. mutans 3209/pVMCherry was suspended in unsupplemented media or media supplemented with 1% sucrose or 1% sucralose and passed through a 3D-printed flowcell system. Flowcells were imaged over 60 minutes using a confocal microscope. Image analysis was performed, including a newly developed object-movement-based method to measure biomass adhesion. Streptococcus mutans 3209/pVMCherry grown in 1% sucrose-supplemented media formed small, dense, relatively immobile clumps in the flowcell system measured by biovolume, surface area, and median object centroid movement. Sucralose-supplemented and un-supplemented media yielded large, loose, mobile aggregates. Architectural metrics and per-object movement were significantly different (P < 0.05) when comparing sucrose-supplemented media to either unsupplemented or sucralose-supplemented media. These results demonstrate the utility of a flowcell system compatible with time-lapse confocal microscopy and image analysis when studying initial biofilm formation and adhesion under different nutritional conditions.
Light and Electron Microscopy Study of Opportunistic Free-Living Nematodes Scavenging and Thriving within Buried Dinosaur Bones
Authors: Armitage Mark H
Published: February 2024

Nematode worms are the most abundant multicellular organism on Earth. They thrive in every habitat known, and they are voracious feeders within the top 70 cm of soils. Their sturdy cuticle protects them from environmental factors and predators. Nematodes play a significant role in the decomposition of vertebrate remains in soil and serve as indicators of nutrients that enter soils during decomposition. Certain parasitic nematodes have been identified in fossil remains, but reports of fossil worms are rare. We demonstrate the abundant presence of opportunistic nematodes feeding within dinosaur bones from the Hell Creek formation, MT. The presence of visible worm ultrastructure indicates that they were alive when preserved within the dinosaur bones. Our findings are identical to worms characterized as “blood parasites” in a dinosaur bone from Brazil, demonstrating that there is sufficient soft tissue within dinosaur bone canals to sustain large populations of nematodes post-mortem.
A refined search for high-velocity gas in the Cygnus Loop supernova remnant
Authors: Ritchey Adam M , Federman S R , Lambert David L
Published: February 2024

We present the results of a sensitive search for high-velocity gas in interstellar absorption lines associated with the Cygnus Loop supernova remnant (SNR). We examine high-resolution high signal-to-noise ratio optical spectra of six stars in the Cygnus Loop region with distances greater than ∼700 pc. All stars show low-velocity Na i and Ca ii absorption. However, only one star, HD 198301, exhibits high-velocity Ca ii absorption components, at velocities of +62, +82, and  +96 km s−1. The distance to this star of ∼870 pc helps to constrain the distance to the receding edge of the Cygnus Loop’s expanding shock front. One of our targets, HD 335334, was previously thought to exhibit high positive and high negative velocity interstellar Na i and Ca ii absorption. This was one factor leading Fesen et al. to derive a distance to the Cygnus Loop of 725 ± 15 pc. However, we find that HD 335334 is in fact a double-line spectroscopic binary and shows no evidence of high-velocity interstellar absorption. As such, the distance to HD 335334 cannot be used to constrain the distance to the Cygnus Loop. Our detection of Ca ii absorption approaching 100 km s−1 toward HD 198301 is the first conclusive detection of high-velocity absorption from a low-ionization species associated with the Cygnus Loop SNR. A large jump in the Na i column density toward BD+31 4218, a star located beyond the northwestern boundary of the Cygnus Loop, helps to constrain the distance to a large molecular cloud complex with which the Cygnus Loop is evidently interacting.
Transport-driven super-Jeans fragmentation in dynamical star-forming regions
Authors: Li Guang-Xing
Published: February 2024

The Jeans criterion is one cornerstone in our understanding of gravitational fragmentation. A critical limitation of the Jeans criterion is that the background density is assumed to be a constant, which is often not true in dynamic conditions such as star-forming regions. For example, during the formation phase of the high-density gas filaments in a molecular cloud, a density increase rate $\dot{\rho }$ implies a mass accumulation time of $t_{\rm acc}= \rho / \dot{\rho }= - \rho (\nabla \cdot (\rho \vec{v}))^{-1}$. The system is non-stationary when the mass accumulation time becomes comparable to the free-fall time $t_{\rm ff} = 1 / \sqrt{G \rho }$. We study fragmentation in non-stationary settings, and find that accretion can significantly increase in the characteristic mass of gravitational fragmentation (λJeans, aac = λJeans(1 + tff/tacc)1/3, $m_{\rm Jeans,\, acc} = m_{\rm Jeans} (1 + t_{\rm ff} / t_{\rm acc})$). In massive star-forming regions, this mechanism of transport-driven super-Jeans fragmentation can contribute to the formation of massive stars by causing order-of-magnitude increases in the mass of the fragments.
Studying the nulling, subpulse drifting, and moding in PSR J1921+1948 with the FAST
Authors: Shang Lunhua , Bai Juntao , Xu Xin , Dang Shijun , Wang Shuangqiang , Dong Aijun , Pang Lijun , Yu Yan , Li Qingying
Published: February 2024

We reported the observations of nulling, subpulse drifting, and moding of radio radiation in pulsar (PSR) B1918+19 at 1250 MHz with the Five-hundred-meter Aperture Spherical radio Telescope. The nulling fraction is 2.6 ± 0.1 per cent and no periodicity of nulling can be seen. We confirmed the existence of three different drift modes (A, B, C) and a disordered mode (N) at 1250 MHz. Unlike the other three modes where the second component of the average pulse profile dominates, the first component of the average pulse profile in mode C is brighter than the other components, the second component shifts forward and the fourth component shifts backward. The bidrifting phenomenon is observed in PSR B1918+19, the drifting of the first and second components is positive, and the drift direction of the fourth component is negative. The drifting rate of the drift bands composed of the first and second components has an obvious evolutionary trend. Mode B has a short duration and no clear trend can be seen. But for mode A, the drift rate of each drift band starts relatively fast, then slows down to a steady state, and finally increases slowly until it enters either null or mode N. Further analysis shows that the emergence and significant variation in the drifting period of multidrifting subpulse emission modes for PSR B1918+19 may be due to the aliasing effect. The interesting subpulse emission phenomenon of PSR B1918+19 at different frequencies provides a unique opportunity to understand the switching mechanism of the multidrift mode of the pulsars.
The SAMI galaxy survey: predicting kinematic morphology with logistic regression
Authors: Vaughan Sam P , van de Sande Jesse , Fraser-McKelvie A , Croom Scott , McDermid Richard , Liquet-Weiland Benoit , Barsanti Stefania , Cortese Luca , Brough Sarah , Sweet Sarah , Bryant Julia J , Goodwin Michael , Lawrence Jon
Published: February 2024

We use the SAMI (Sydney-AAO Multi-object Integral field spectrograph) galaxy survey to study the the kinematic morphology–density relation: the observation that the fraction of slow rotator galaxies increases towards dense environments. We build a logistic regression model to quantitatively study the dependence of kinematic morphology (whether a galaxy is a fast or slow rotator) on a wide range of parameters, without resorting to binning the data. Our model uses a combination of stellar mass, star formation rate (SFR), r-band half-light radius, and a binary variable based on whether the galaxy’s observed ellipticity (ϵ) is less than 0.4. We show that, at fixed mass, size, SFR, and ϵ, a galaxy’s local environmental surface density (log10(Σ5/Mpc−2)) gives no further information about whether a galaxy is a slow rotator, that is, the observed kinematic–morphology density relation can be entirely explained by the well-known correlations between environment and other quantities. We show how our model can be applied to different galaxy surveys to predict the fraction of slow rotators which would be observed and discuss its implications for the formation pathways of slow rotators.
Resolution of the incongruency of dipole asymmetries within various large radio surveys – implications for the Cosmological Principle
Authors: Singal Ashok K
Published: February 2024

We investigate dipole asymmetries in four large radio surveys, each spanning more than 75 per cent of the sky. Two of them, the Very Large Array Sky Survey (VLASS) and the Rapid ASKAP Continuum Survey (RACS), have recently yielded dipoles that appear incongruent with each other as well as seem inconsistent with previous radio survey dipoles and the cosmic microwave background (CMB) dipole. Because these radio surveys have large overlaps in sky coverage, comprising hence large majority of common radio sources, one would not expect significant differences between their radio dipoles, irrespective of their underlying source of origin. We examine here in detail these radio dipoles, to ascertain the source of incongruency among them. We find the VLASS and RACS data to be containing some declination-dependent systematics, seemingly in the vicinity of the declination limit of each survey. We show that the effects of such systematics can be mitigated by restricting the declination limits of the respective survey during the dipole determination. A weighted mean of the sky coordinates of thus derived dipoles from the four radio surveys lies within 1.2σ of the CMB dipole direction. However, the amplitude appears significantly larger, 3.7 ± 0.6 times or more than the CMB dipole. This puts in doubt not only the conventional wisdom that the genesis of all these dipoles, including that of the CMB dipole, is due to the Solar peculiar motion, it also raises uncomfortable questions about the Cosmological Principle, the basis of the standard ΛCDM cosmological model.
Sardinia Radio Telescope observations of the Coma cluster
Authors: Murgia M , Govoni F , Vacca V , Loi F , Feretti L , Giovannini G , Melis A , Concu R , Carretti E , Poppi S , Valente G , Bernardi G , Bonafede A , Boschin W , Brienza M , Clarke T E , de Gasperin F , Enßlin T A , Ferrari C , Gastaldello F , Girardi M , Gregorini L , Johnston-Hollitt M , Orrù E , Parma P , Perley R A , Taylor G B , Marchegiani P
Published: February 2024

We present deep total intensity and polarization observations of the Coma cluster at 1.4 and 6.6 GHz performed with the Sardinia Radio Telescope. By combining the single-dish 1.4 GHz data with archival Very Large Array observations, we obtain new images of the central radio halo and of the peripheral radio relic where we properly recover the brightness from the large-scale structures. At 6.6 GHz, we detect both the relic and the central part of the halo in total intensity and polarization. These are the highest frequency images available to date for these radio sources in this galaxy cluster. In the halo, we find a localized spot of polarized signal, with fractional polarization of about 45 per cent. The polarized emission possibly extends along the north-east side of the diffuse emission. The relic is highly polarized, up to 55 per cent, as usually found for these sources. We confirm the halo spectrum is curved, in agreement with previous single-dish results. The spectral index is α = 1.48 ± 0.07 at a reference frequency of 1 GHz and varies from α ≃ 1.1, at 0.1 GHz, up to α ≃ 1.8, at 10 GHz. We compare the Coma radio halo surface brightness profile at 1.4 GHz (central brightness and e-folding radius) with the same properties of the other haloes, and we find that it has one of the lowest emissivities observed so far. Reanalysing the relic’s spectrum in the light of the new data, we obtain a refined radio Mach number of M = 2.9 ± 0.1.
Effects of optogenetic silencing the anterior cingulate cortex in a delayed non-match to trajectory task
Authors: Cruz Ana S , Cruz Sara , Remondes Miguel
Published: February 2024

Working memory is a fundamental cognitive ability, allowing us to keep information in memory for the time needed to perform a given task. A complex neural circuit fulfills these functions, among which is the anterior cingulate cortex (CG). Functionally and anatomically connected to the medial prefrontal, retrosplenial, midcingulate and hippocampus, as well as motor cortices, CG has been implicated in retrieving appropriate information when needed to select and control appropriate behavior. The role of cingulate cortex in working memory-guided behaviors remains unclear due to the lack of studies reversibly interfering with its activity during specific epochs of working memory. We used eNpHR3.0 to silence cingulate neurons while animals perform a standard delayed non-match to trajectory task, and found that, while not causing an absolute impairment in working memory, silencing cingulate neurons during retrieval decreases the mean performance if compared to silencing during encoding. Such retrieval-associated changes are accompanied by longer delays observed when light is delivered to control animals, when compared to eNpHR3.0+ ones, consistent with an adaptive recruitment of additional cognitive resources.
Gut–liver microphysiological systems revealed potential crosstalk mechanism modulating drug metabolism
Authors: Kurniawan Dhimas Agung , Leo Sylvia , Inamatsu Mutsumi , Funaoka Sohei , Aihara Taichi , Aiko Mizuno , Rei Inoue , Sakura Takeshi , Arakawa Hiroshi , Kato Yukio , Matsugi Tomoaki , Esashika Katsuhiro , Shiraki Nobuaki , Kume Shoen , Shinha Kenta , Kimura Hiroshi , Nishikawa Masaki , Sakai Yasuyuki
Published: February 2024

The small intestine and liver play important role in determining oral drug's fate. Both organs are also interconnected through enterohepatic circulation, which imply there are crosstalk through circulating factors such as signaling molecules or metabolites that may affect drug metabolism. Coculture of hepatocytes and intestinal cells have shown to increase hepatic drug metabolism, yet its crosstalk mechanism is still unclear. In this study, we aim to elucidate such crosstalk by coculturing primary human hepatocytes harvested from chimeric mouse (PXB-cells) and iPSc-derived intestinal cells in a microphysiological systems (MPS). Perfusion and direct oxygenation from the MPS were chosen and confirmed to be suitable features that enhanced PXB-cells albumin secretion, cytochrome P450 (CYP) enzymes activity while also maintaining barrier integrity of iPSc-derived intestine cells. Results from RNA-sequencing showed significant upregulation in gene ontology terms related to fatty acids metabolism in PXB-cells. One of such fatty acids, arachidonic acid, enhanced several CYP enzyme activity in similar manner as coculture. From the current evidences, it is speculated that the release of bile acids from PXB-cells acted as stimuli for iPSc-derived intestine cells to release lipoprotein which was ultimately taken by PXB-cells and enhanced CYP activity.
Rails and responsibilities: Perspectives of railroad police officers in China
Authors: Xu Haoran
Published: February 2024

In policing practices, railway policing has an essential role to ensure the public security of extensive railway network. However, limited attention has been given to understanding the perspectives of police officers involved in this specialized field. This study aims to fill this gap by exploring the perspectives of railway police officers. Through in-depth interviews with 31 railway police officers from different regions, this research examines their experiences, challenges, and perceptions regarding their roles and responsibilities. The findings reveal that conflicts of interest within the railway police department pose potential risks to its internal cohesion. These officers used different strategies for response to violent attacks in ordinary and high-speed trains, highlighted instances of avoidance of duties due to internal conflicts, suggesting deficiencies in the evaluation mechanism employed. This study not only contributes to our understanding of railway policing in China but also provides insights for global railway policing and criminal investigation coordination.
Variation in Utilization of Physical Therapist and Occupational Therapist Services After Rotator Cuff Repair: A Population-Based Study
Authors: Stern Brocha Z , Zubizarreta Nicole , Anthony Shawn G , Gladstone James N , Poeran Jashvant
Published: February 2024

Objective

The objective of this study was to describe the utilization of physical therapist and occupational therapist services after rotator cuff repair (RCR) and examine variation in rehabilitation characteristics by profession.

Methods

This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters database. Eligible patients were 18 to 64 years old and had undergone outpatient RCR between 2017 and 2020. Physical therapist and occupational therapist services were identified using evaluation and treatment codes with profession-specific modifiers (“GP” or “GO”). Factors predicting utilization of formal rehabilitation and physical therapist versus occupational therapist services were examined; and univariable and multivariable analyses of days to initiate therapy, number of visits, and episode length by profession were completed.

Results

Among 53,497 patients with an RCR, 81.2% initiated formal rehabilitation (93.8% physical therapist, 5.2% occupational therapist, 1.0% both services). Patients in the Northeast and West (vs the South) were less likely to receive rehabilitation (odds ratio [OR] = 0.67 to 0.70) and less likely to receive occupational therapist services (OR = 0.39). Patients living in the Midwest (versus the South) were less likely to receive rehabilitation (OR = 0.79) but more likely to receive occupational therapist services (OR = 1.51). Similarly, those living in a rural (versus urban) area were less likely to utilize rehabilitation (OR = 0.89) but more likely to receive occupational therapist services (OR = 2.21). Additionally, receiving occupational therapist instead of physical therapist services was associated with decreased therapist visits (−16.89%), days to initiate therapy (−13.43%), and episode length (−13.78%).

Conclusion

Most patients in our commercially insured cohort utilized rehabilitation services, with a small percentage receiving occupational therapist services. We identified profession-specific variation in utilization characteristics that warrants further examination to understand predictors and associated outcomes.

Impact

Variation in rehabilitation utilization after RCR, including profession-specific and regional differences, may indicate opportunities to improve standardization and quality of care.
Connectome-based predictive modeling of Internet addiction symptomatology
Authors: Feng Qiuyang , Ren Zhiting , Wei Dongtao , Liu Cheng , Wang Xueyang , Li Xianrui , Tie Bijie , Tang Shuang , Qiu Jiang
Published: February 2024

Internet addiction symptomatology (IAS) is characterized by persistent and involuntary patterns of compulsive Internet use, leading to significant impairments in both physical and mental well-being. Here, a connectome-based predictive modeling approach was applied to decode IAS from whole-brain resting-state functional connectivity in healthy population. The findings showed that IAS could be predicted by the functional connectivity between prefrontal cortex with the cerebellum and limbic lobe and connections of the occipital lobe with the limbic lobe and insula lobe. The identified edges associated with IAS exhibit generalizability in predicting IAS within an independent sample. Furthermore, we found that the unique contributing network, which predicted IAS in contrast to the prediction networks of alcohol use disorder symptomatology (the range of symptoms and behaviors associated with alcohol use disorder), prominently comprised connections involving the occipital lobe and other lobes. The current data-driven approach provides the first evidence of the predictive brain features of IAS based on the organization of intrinsic brain networks, thus advancing our understanding of the neurobiological basis of Internet addiction disorder (IAD) susceptibility, and may have implications for the timely intervention of people potentially at risk of IAD.
Identification of Pathogen-Specific Novel Sources of Genetic Resistance Against Ascochyta Blight and Identification of Their Underlying Genetic Control
Authors: Rawale Kanwardeep S. , Gutierrez-Zamora Gemini R. , Venditto Noah A. , Gill Kulvinder S.
Published: February 2024

Global chickpea production is restricted by Ascochyta blight caused by the necrotrophic fungi Ascochyta rabiei. Developing locally adapted disease-resistant cultivars is an economically and environmentally sustainable approach to combat this disease. However, the lack of genetic variability in cultivated chickpeas and breeder-friendly markers poses a significant challenge to Ascochyta blight-resistant breeding efforts in chickpeas. In this study, we screened the mini-core germplasm of Cicer reticulatum against a local pathotype of A. rabiei. A modified mini-dome screening approach resulted in the identification of five accessions showing a high level of resistance. The mean disease score of resistant accessions ranged between 1.75 ± 0.3 and 2.88 ± 0.4 compared to susceptible accessions, where the mean disease score ranged between 3.59 ± 0.62 and 8.86 ± 0.14. Genome-wide association study revealed a strong association on chromosome 5, explaining ∼58% of the phenotypic variance. The underlying region contained two candidate genes (Cr_14190.1_v2 and Cr_14189.1_v2), the characterization of which showed the presence of a DNA-binding domain (cl28899 and cd18793) in Cr_14190.1_v2 and its orthologs in C. arietinum, whereas Cr_14190.1_v2 carried an additional N-terminal domain (cl31759). qPCR expression analysis in resistant and susceptible accessions revealed ∼3- and ∼110-fold higher transcript abundance for Cr_14189.1 and Cr_14190.1, respectively.
Induction of lung progenitor cell‐like organoids by porcine pluripotent stem cells
Authors: Yang Xinchun , Wu Xiaolong , Wang Yuqi , Li Wenhao , Wu Xiaojie , Yuan Liming , Yu Taiyong , Li Na , Zhang Shiqiang , Hua Jinlian
Published: February 2024

Organoids are in vitro 3D models that are generated using stem cells to study organ development and regeneration. Despite the extensive research on lung organoids, there is limited information on pig lung cell generation or development. Here, we identified five epithelial cell types along with their characteristic markers using scRNA‐seq. Additionally, we found that NKX2.1 and FOXA2 acted as the crucial core transcription factors in porcine lung development. The presence of SOX9/SOX2 double‐positive cells was identified as a key marker for lung progenitor cells. The Monocle algorithm was used to create a pseudo‐temporal differentiation trajectory of epithelial cells, leading to the identification of signaling pathways related to porcine lung development. Moreover, we established the differentiation method from porcine pluripotent stem cells (pPSCs) to SOX17+FOXA2+ definitive endoderm (DE) and NKX2.1+FOXA2+CDX2− anterior foregut endoderm (AFE). The AFE is further differentiated into lung organoids while closely monitoring the differentiation process. We showed that NKX2.1 overexpression facilitated the induction of lung organoids and supported subsequent lung differentiation and maturation. This model offers valuable insights into studying the interaction patterns between cells and the signaling pathways during the development of the porcine lung.
The Aging Care 5Ms Competencies: A Modified Delphi Study to Revise Medical Student Competencies for the Care of Older Adults
Authors: Yogaparan Thirumagal , Burrell Alishya , Talbot-Hamon Catherine , Sadowski Cheryl A. , Grief Cindy , MacDonald Elizabeth , Thain Jenny , Ng Karen A. , Khoury Lara , Moran Martin , Feldman Sid , Lustgarten Sylvia , Bach Tammy V.
Published: February 2024

Purpose

To revise the 2009 Canadian Geriatrics Society (CGS) Core Competencies in the Care of Older Persons for Canadian Medical Students by applying current frameworks and using a modified Delphi process.

Method

The working group chose the Geriatric 5Ms model and CanMEDS framework to develop and structure the competencies. National (i.e., Canadian) Delphi participants were recruited, and 3 Delphi survey rounds were conducted from 2019 to 2021. Each survey round collected quantitative data using a 7-point Likert scale (LS) and qualitative data using free-text comments. The purpose of the first round was to establish the importance of the components of the proposed competencies (categorized into 13 subsections) and identify additional themes. The second round assessed agreement with 31 proposed competencies organized into 7 themes: aging, caring for older adults, mind, mobility, medications, multicomplexity, and matters the most. The third survey-rated agreement levels after further revisions to the competencies were applied. The final 33 competencies were shared with survey participants for feedback and other stakeholders for external validation.

Results

Mean LSs for the importance of the 13 competency component subsections on the first survey varied from 5.11 to 6.54, with an agreement level of 73%–93%. New themes emerged from the qualitative comments. Mean LSs for the 31 competencies on the second survey ranged from 5.57 to 6.81, with an agreement level of 80%–97%. Mean LSs for the revised competencies on the third survey ranged from 5.83 to 6.65, with an agreement level of 83%–95%.

Conclusions

The authors developed the 33 Aging Care 5Ms Competencies for Canadian medical students using a consensus process. The competencies fulfill an important need in medical education, and ultimately, society. The authors strongly believe that the competencies can be woven into existing undergraduate medical curricula through purposeful integration and collaboration, including with other specialties.
A Case Series of Patients With Complex Airway Disease and Large Thyroid Tumors Anterior to the Trachea Precluding Tracheostomy
Authors: Imran Saira , Chen Leon L. , Rausen Michelle , Morris Luc G.T. , Patel Snehal , Halpern Neil A.
Published: February 2024

BACKGROUND:

This case series explores the management of respiratory failure in patients with large anterior tracheal thyroid tumors where tracheostomy is not an option. To our knowledge, this study is the first to address the challenges associated with caring for such patients.

CASE SUMMARY:

We present the clinical courses of four intubated adults with advanced thyroid cancer and complex airway issues that preclude surgical tracheostomy. Interventions included custom airway stents, long-term intubation, and oncological therapies. Ethical quandaries around patient autonomy and capacity emerged, exacerbated by the absence of viable exit strategies for prolonged intubation, notably the performance of a tracheostomy, causing emotional distress in patients, families, and staff.

CONCLUSIONS:

This study showcases the multifaceted challenges in medical, ethical, and emotional domains associated with managing intubated patients with complex disease precluding tracheotomies. We advocate for a nuanced, multidisciplinary, and personalized approach to confront unique issues in airway management, ethical considerations, and disposition.
Liver Elastography in Acute Liver Failure: A Pilot Study
Authors: Trovato Francesca M. , Artru Florent , Miquel Rosa , Pirani Tasneem , McPhail Mark J.W.
Published: February 2024

OBJECTIVES:

We aimed to assess the feasibility and reliability of sequential ultrasonographic and elastographic monitoring in acute liver failure (ALF).

DESIGN:

Observational study.

SETTING:

ALF is a rare, life-threatening disease that requires intensive care admission and often liver transplant, where the accurate selection of patients is crucial. Liver elastography is a noninvasive tool that can measure hepatic stiffness, but previous results have been inconclusive in ALF.

PATIENTS:

Patients admitted between October 2021 and March 2023 to the Liver Intensive Therapy Unit at King’s College Hospital with ALF were recruited, with healthy control (HC) individuals and acute-on-chronic liver failure (ACLF) used as controls.

INTERVENTION:

None.

MEASUREMENTS:

Average shear wave velocity was recorded with ElastPQ on the right and left liver lobes and the spleen. Portal vein flow, hepatic artery resistive index, and peak systolic velocity were also recorded. Physiologic and histologic data were used for comparison.

MAIN RESULTS:

Forty patients with ALF, 22 patients with ACLF, and 9 HC individuals were included in the study. At admission, liver stiffness measurement (LSM) of the right lobe was statistically different between HC individuals (5.6 ± 2 kPa), ALF (31.7 ± 17 kPa), and ACLF (76.3 ± 71 kPa) patients (ALF vs. ACLF, p = 0.0301). Spleen size and stiffness discriminated between ALF (10.4 ± 2 cm and 21.4 ± 16.6 kPa) and ACLF (14 ± 2.3 cm and 42.6 ± 26 kPa). At admission, LSM was not different between ALF patients who spontaneously survived versus patients who died or were transplanted in the following 90 days. However, the trend over the first 10 days of admission was different with a peak of LSM at day 5 in spontaneous survivors followed by reduction during the recovery phase. ALF patients with poor prognosis showed a persistently increased LSM.

CONCLUSIONS:

In ALF stiffness peaks at day 5 of admission with subsequent reduction in patients spontaneously surviving, showing significant difference according to the prognosis at day 7 of admission. LSM might be useful in distinguishing acute from acute-on-chronic liver failure together with spleen volume and stiffness.
Assessing Fuchs Corneal Endothelial Dystrophy Using Artificial Intelligence–Derived Morphometric Parameters From Specular Microscopy Images
Authors: Prada Angelica M. , Quintero Fernando , Mendoza Kevin , Galvis Virgilio , Tello Alejandro , Romero Lenny A. , Marrugo Andres G.
Published: February 2024

Purpose:

The aim of this study was to evaluate the efficacy of artificial intelligence–derived morphometric parameters in characterizing Fuchs corneal endothelial dystrophy (FECD) from specular microscopy images.

Methods:

This cross-sectional study recruited patients diagnosed with FECD, who underwent ophthalmologic evaluations, including slit-lamp examinations and corneal endothelial assessments using specular microscopy. The modified Krachmer grading scale was used for clinical FECD classification. The images were processed using a convolutional neural network for segmentation and morphometric parameter estimation, including effective endothelial cell density, guttae area ratio, coefficient of variation of size, and hexagonality. A mixed-effects model was used to assess relationships between the FECD clinical classification and measured parameters.

Results:

Of 52 patients (104 eyes) recruited, 76 eyes were analyzed because of the exclusion of 26 eyes for poor quality retroillumination photographs. The study revealed significant discrepancies between artificial intelligence–based and built-in microscope software cell density measurements (1322 ± 489 cells/mm2 vs. 2216 ± 509 cells/mm2, P < 0.001). In the central region, guttae area ratio showed the strongest correlation with modified Krachmer grades (0.60, P < 0.001). In peripheral areas, only guttae area ratio in the inferior region exhibited a marginally significant positive correlation (0.29, P < 0.05).

Conclusions:

This study confirms the utility of CNNs for precise FECD evaluation through specular microscopy. Guttae area ratio emerges as a compelling morphometric parameter aligning closely with modified Krachmer clinical grading. These findings set the stage for future large-scale studies, with potential applications in the assessment of irreversible corneal edema risk after phacoemulsification in FECD patients, as well as in monitoring novel FECD therapies.
Concurrent and lagged associations among pain medication use, pain, and negative affect: a daily diary study of people with chronic low back pain
Authors: Burns John W. , Gerhart James , Smith David A. , Porter Laura , Rye Bonny , Keefe Francis
Published: February 2024

People with chronic pain often attempt to manage pain and concurrent emotional distress with analgesic substances. Habitual use of such substances—even when not opioid-based—can pose side effect risks. A negative reinforcement model has been proposed whereby relief of pain and emotional distress following medication consumption increases the likelihood that the experience of elevated pain and distress will spur further medication use. People with chronic low back pain (N = 105) completed electronic diary assessments 5 times/day for 14 consecutive days. Lagged and cross-lagged analyses focused on links between time 1 pain and negative affect (NA) and time 2 analgesic medication use and vice versa. Sex differences were also explored. Primary results were as follows: (1) participants on average reported taking analgesic medication during 41.3% of the 3-hour reporting epochs (29 times over 14 days); (2) time 1 within-person increases in pain and NA predicted time 2 increases in the likelihood of ingesting analgesic medications; (3) time 1 within-person increases in medication use predicted time 2 decreases in pain and NA; and (4) lagged associations between time 1 pain/NA and time 2 medication use were strongest among women. Findings suggest that the use of analgesic medications for many people with chronic pain occurs frequently throughout the day. Results support the validity of a negative reinforcement model where pain and distress lead to pain medication use, which in turn leads to relief from pain and distress.
Bilateral deficiency of Meissner corpuscles and papillary microvessels in patients with acute complex regional pain syndrome
Authors: Mehling Katharina , Becker Juliane , Chen Jeremy , Scriba Sabrina , Kindl Gudrun , Jakubietz Rafael , Sommer Claudia , Hartmannsberger Beate , Rittner Heike L.
Published: February 2024

Complex regional pain syndrome (CRPS) presents postinjury with disproportionate pain and neuropathic, autonomic, motor symptoms, and skin texture affection. However, the origin of these multiplex changes is unclear. Skin biopsies offer a window to analyze the somatosensory and vascular system as well as skin trophicity with their protecting barriers. In previous studies, barrier-protective exosomal microRNAs were altered in CRPS. We here postulated that tissue architecture and barrier proteins are already altered at the beginning of CRPS. We analyzed ipsilateral and contralateral skin biopsies of 20 fully phenotyped early CRPS patients compared with 20 age- and sex-matched healthy controls. We established several automated unbiased methods to comprehensively analyze microvessels and somatosensory receptors as well as barrier proteins, including claudin-1, claudin-5, and claudin-19. Meissner corpuscles in the skin were bilaterally reduced in acute CRPS patients with some of them lacking these completely. The number of Merkel cells and the intraepidermal nerve fiber density were not different between the groups. Dermal papillary microvessels were bilaterally less abundant in CRPS, especially in patients with allodynia. Barrier proteins in keratinocytes, perineurium of dermal nerves, Schwann cells, and papillary microvessels were not affected in early CRPS. Bilateral changes in the tissue architecture in early CRPS might indicate a predisposition for CRPS that manifests after injury. Further studies should evaluate whether these changes might be used to identify risk patients for CRPS after trauma and as biomarkers for outcome.
Inability to Access Needed Medical Care Among Asian American, Native Hawaiian, and Pacific Islander Medicaid Enrollees
Authors: Nguyen Kevin H. , Oronce Carlos Irwin A. , Adia Alexander C. , Yeh Jih-Cheng , Ponce Ninez
Published: February 2024

We examined self-reported inability to access to needed medical care and reasons for not accessing medical care among US-representative adult Medicaid enrollees, disaggregated across 10 Asian American, Native Hawaiian, and Pacific Islander ethnic groups. Chinese (−4.54 percentage points [PP], P < .001), Other Asian (−4.42 PP, P < .001), and Native Hawaiian (−4.36 PP, P < .001) enrollees were significantly less likely to report being unable to access needed medical care compared with non-Hispanic White enrollees. The most common reason reported was that a health plan would not approve, cover, or pay for care. Mitigating inequities may require different interventions specific to certain ethnic groups.
Effects of kidney tonic herbs for primary osteoporosis: A systematic review and meta-analysis
Authors: Li Wei , Ye Baisheng , Huang Zhen , Zhou Hang , Feng Jie , Chen Qi , Huang Hai , Meng Shilong , Qie Fengqing , Shi Xiaolin
Published: February 2024

Background:

Primary osteoporosis (POP) is one of the most common orthopedic conditions with a high risk of fractures. Effective treatment of POP is crucial for reducing disability rates and improving quality of life. Kidney tonic therapy is a classical traditional Chinese medicine approach for treating POP. This study aims to provide a comprehensive and reliable assessment of the clinical evidence of kidney tonic herbs (KTH) in treating POP patients.

Methods:

An extensive literature search was conducted in 8 electronic databases from their inception through September 30, 2022, to evaluate the efficacy and safety of KTH for POP. We included 43 randomized controlled trials with 4349 participants. The qualified studies will be chosen and evaluated separately by 2 researchers. The primary outcome measure was bone mineral density (BMD) of lumbar. RevMan 5.3 and Stata 16 were used to carry out the meta-analyses.

Results:

Our meta-analysis showed 29 studies with significantly increased lumbar BMD (mean difference [MD] = 0.06; 95% confidence interval [CI]; I
2 = 98%, P = .003), 18 studies with noticeably higher femoral neck BMD (MD = 0.08; 95% CI; I
2 = 98%, P = .0005), 6 studies with significantly increased femoral trochanter BMD (MD = 0.10; 95% CI; I
2 = 97%, P = .002), 4 studies with noticeably higher ward’s triangle BMD (MD = 0.13; 95% CI; I
2 = 100%, P = .04), and 3 studies with noticeably higher distal radius BMD (MD = 0.06; 95% CI; I
2 = 86%, P = .009). One study showed 12 falls and 8 fallers in the intervention group, 28 falls and 17 fallers in the control group at 36 months. 3 studies showed a significant difference in fracture incidence between the intervention group and the control group (95% CI: 0.15-0.81; I
2 = 0%, P = .01). Additionally, the meta-analysis demonstrated that KTH offered superior pain relief (8 trials, n = 980; 95% CI: −1.05 to −0.74; I
2 = 94%, P < .00001). Besides, KTH found no serious harmful effects.

Discussion:

KTH may increase BMD and decrease the likelihood of fractures in POP patients. However, further research is necessary to investigate the effectiveness of KTH in reducing falls and fractures.
Identification of immune-related hub genes contributing to the pathogenesis, diagnosis, and remission of ulcerative colitis by integrated bioinformatic analyses
Authors: Zhou Lingna , Gu Qianru , Huang Aihua , Fu Guoxiang , Hu Xiaotong , Jiang Zhinong
Published: February 2024

The inflammatory disease ulcerative colitis (UC) is multifaceted, immune-mediated, chronic, and relapsing, which is considered to be mainly driven by dysregulated mucosal immune response. The remission of the inflammatory response is a marker of mucosal healing, relating to the low risk of hospitalizations, colorectal cancer, and colectomy. In spite of this, it is still unclear what the key immunological mechanism is which contributes to UC. Here, we explored the immune mechanism and related key genes underlying the state of inflammation in UC. Co-expression networks were constructed based on the expression profiles of immune-related genes in GSE179285. Using Weighted Gene Co-expression Network Analysis and Protein-protein interactions analysis, common hub genes were identified in the module of interest. Then, screening of real hub genes, significantly differentially expressing in inflamed UC, was carried out by Differential Expression Genes Analysis of GSE75214, GSE53306, and GSE6731datasets and immunohistochemistry of clinical samples. The diagnosis Capacity of the hub gene was identified by “glm” function in R. The potential key immune-related mechanisms were investigated using functional enrichment analysis and gene set enrichment analysis (GSEA). Bioinformatics tools were used to predict potential upstream transcription factors (TF), including the UCSC genome browser, correlation analyses, and JASPAR browser. The analysis revealed the blue module, consisting of 227 immune-related genes, showed the highest correlation with inflamed UC. And then, forty-three common candidates were distinguished. S100A9 was identified within the key module as a real hub gene with good diagnostic performance. The immune genes in the blue module were markedly enriched in the Cytokine-Cytokine receptor interaction. S100A9 most likely gets involved NOD-like receptor (NLR) signaling pathway. SPI1 showed the strongest likelihood to be the regulator. S100A9 was identified as the real immune-related hub gene for inflamed UC. Both diagnosis and remission may be aided by its high expression in the inflamed UC.