bluuebunny/crossref_metadata_2025 huggingface dataset:
Xanthomonas protegens sp. nov., a novel rice seed-associated bacterium, provides in vivo protection against X. oryzae pv. oryzae, the bacterial leaf blight pathogen
Authors: Rana Rekha , Sharma Anushika , Madhavan Vishnu Narayanan , Korpole Suresh , Sonti Ramesh V , Patel Hitendra K , Patil Prabhu B
Published: November 2024

Historically, Xanthomonas species are primarily known for their pathogenicity against plants, but recently, there have been more findings of non-pathogenic xanthomonads. In the present study, we report isolates from healthy rice seeds that belong to a new species, Xanthomonas protegens, a protector of the rice plants against a serious pathogenic counterpart, i.e. X. oryzae pv. oryzae upon leaf clip co-inoculation. The new member species is non-pathogenic to rice and lacks a type III secretion system. The pangenome investigation revealed a large number of unique genes, including a novel lipopolysaccharide biosynthetic gene cluster, that might be important in its adaptation. The phylo-taxonogenomic analysis revealed that X. protegens is a taxonomic outlier species of X. sontii, a core, vertically transmitted rice seed endophyte with numerous probiotic properties. Interestingly, X. sontii is also reported as a keystone species of healthy rice seed microbiome. The findings and resources will help in the development of unique gene markers and evolutionary studies of X. sontii as a successful symbiont and X. oryzae as a serious pathogen. Here, we propose X. protegens sp. nov. as a novel species of the genus Xanthomonas with PPL118 = MTCC 13396 = CFBP 9164 = ICMP 25181 as the type strain. PPL117, PPL124, PPL125, and PPL126 are other strains of the species.
Usability Testing of the PACE-App to Support Family Caregivers in Managing Pain for People With Dementia
Authors: Chi Nai-Ching , Nguyen Kristy , Shanahan Angela , Demir Ibrahim , Fu Ying-Kai , Chi Chih-Lin , Perkhounkova Yelena , Hein Maria , Buckwalter Kathleen , Wolf Michael , Williams Kristine , Herr Keela
Published: November 2024

Background and Objectives

Pain management is often suboptimal in individuals with dementia, and their family caregivers are tasked with supporting pain management despite limited preparation. The web-based PACE-app (PAin Control Enhancement) was designed to assist caregivers in managing pain for individuals with dementia. This study aimed to evaluate the usability of the PACE-app.

Research Design and Methods

A convergent parallel mixed-methods design was used to evaluate the PACE-app’s usability with 16 family caregivers and 6 healthcare professionals. Quantitative data were collected using the Post-Study System Usability Questionnaire (PSSUQ), and qualitative data were gathered through guided-app reviews and semistructured interviews. Quantitative data were analyzed descriptively, and qualitative data were thematically coded.

Results

The PSSUQ results indicated that both family caregivers and healthcare professionals had a highly positive experience with the PACE-app: overall scores (2.01 vs 1.68), system usefulness (1.76 vs 1.68), information quality (1.98 vs 1.80), interface quality (2.30 vs 1.60), and satisfaction (2.00 vs 1.60) were rated on a 1–7 scale (with lower scores indicating better usability). Qualitative findings supported these results, with participants endorsing the PACE-app’s usefulness, ease of use, learnability, effective information presentation, aesthetics, clear layout, and overall satisfaction. Participants also provided valuable feedback for improving information quality (enhancing clarity) and interface quality (real-time coaching on pain management).

Discussion and Implications

The study demonstrated favorable usability and strong satisfaction among family caregivers and healthcare professionals using the PACE-app. Incorporating participants’ suggestions will guide enhancements to the app’s information and interface, ensuring it better meets users’ needs.
“Voiceless”: the procedural gap in algorithmic justice
Authors: Kinchin Niamh
Published: November 2024

Conversations about algorithms and fairness can overlook the bifurcation of justice. Whilst distributive justice is integral to accountability for algorithmic bias and related harms, without procedural justice and ‘voice’, defined as consent, transparency, and a right to be heard, algorithmic decisions will fail to find legitimacy and acceptance. Fairness metrics respond better to distributive justice because algorithmic bias is primarily framed in such terms. The potential of AI Ethics Guidelines and formal regulation to address voice is compromised by ambiguous concepts of fairness, rigidity, and competing market demands. The scope of a right to a fair trial limits the potential of human rights impact assessments to address procedural rights. Jurisdictional issues of reviewability, interpretation, and applicability challenge judicial review. In examining the capacity of these accountability mechanisms to ensure ‘voice’, a ‘procedural gap’ emerges in algorithmic decision-making.
Isotonic subgroup selection
Authors: Müller Manuel M , Reeve Henry W J , Cannings Timothy I , Samworth Richard J
Published: November 2024

Given a sample of covariate–response pairs, we consider the subgroup selection problem of identifying a subset of the covariate domain where the regression function exceeds a predetermined threshold. We introduce a computationally feasible approach for subgroup selection in the context of multivariate isotonic regression based on martingale tests and multiple testing procedures for logically structured hypotheses. Our proposed procedure satisfies a non-asymptotic, uniform Type I error rate guarantee with power that attains the minimax optimal rate up to poly-logarithmic factors. Extensions cover classification, isotonic quantile regression, and heterogeneous treatment effect settings. Numerical studies on both simulated and real data confirm the practical effectiveness of our proposal, which is implemented in the R package ISS.
Masculinity contest cultures and organizational outcomes in police organizations
Authors: Buhrig Ryan
Published: November 2024

As a male-dominated occupation that has historically valued strength, risk-taking, and control, policing may be particularly susceptible to masculinity contest cultures (MCC), characterized by social norms that valorize physical ability, avoid weakness, prioritize work, and promote dominance. Through surveys of patrol officers from five Canadian police agencies (n = 238), this study explored the existence of MCCs and their relationship with organizational outcomes. The study suggested that an officer’s perception of their work within an MCC can predict job engagement (b = −0.48, P < .001), work meaning (b = −0.35, P < .001), self-reported performance (b = −0.07, P < .001), and turnover intention (b = 0.07, P < .001) when controlling for gender, supervisory status, years of police service, and university education. Additionally, university degrees were a significant positive predictor of MCC scores (b = 2.40, P < .01), indicating that university-educated police officers perceive their workplace cultures as more masculine. As the first study that related MCCs to university education, job engagement, and work meaning in policing, it advances our understanding and provides insights into how these cultures relate to organizational outcomes. The results also have implications for policy and police administration.
Auctioning Long-Term Projects under Financial Constraints
Authors: Arve M , Martimort D
Published: November 2024

We consider a procurement auction for the provision of a basic service to which an add-on must later be appended. Potential providers are symmetric, have private information on their cost for the basic service and the winning firm must also implement the add-on. To finance value-enhancing activities related to the add-on, this firm may need extra funding by outside financiers. Nonverifiable effort related to these activities creates a moral hazard problem which makes the firm’s payoff function for the second period concave in returns over the relevant range. Concavity has two effects. First, it makes it more attractive to backload payments to facilitate information revelation. Second, uncertainty on the cost of the add-on introduces a background risk which requires a risk premium. In this context, we characterize the optimal intertemporal structure of payments to the winning firm, equilibrium bidding behaviour and reserve prices for a first-price auction.
Adaptation and innovation in darter fish cranial musculature (Etheostomatinae: Percidae): insights from diceCT
Authors: Arbour J H , Ramazan S , Clark S
Published: November 2024

Fish skulls are often highly kinetic, with multiple linkage and lever systems powered by a diverse suite of muscles. Comparative analysis of the evolution of soft-tissue structures in the fish skull is often limited under traditional approaches, while new imaging techniques like diceCT (diffusible iodine-based contrast-enhanced computed tomography) allow for high-resolution imaging of muscles in situ. Darters (Percidae: Etheostomatinae) are a diminutive and species-rich clade of lotic freshwater fishes, which show diverse head shapes believed to be associated with different foraging strategies. We used diceCT to sample all major cranial adductors and abductors responsible for movement of the jaw, hyoid, operculum, and suspensorium from 29 species. We applied comparative phylogenetic approaches to analyse the evolutionary trends in muscle size across the clade. We found two major patterns: (i) darter cranial muscles show fundamental trade-offs relating to investment in musculature, as well as buccal expansion vs. biting attributes; early divergence in muscle size appears to be associated with shifts in habitat use and foraging; (ii) darter adductor mandibulae show high variation in architecture (fibre orientation, divisions). This study highlights how new imaging techniques can provide novel insights into the anatomy of even well-sampled/represented clades.
Expansion of the Host Range of Xanthomonas euroxanthea: First Occurrence in Sunflower in Bulgaria
Authors: Garcia Eva , Soares Fabiana , Rodrigues Cristiana Oliveira , Trovão João , Pothier Joël F. , Camelo Alexandra , Santo Christophe Espirito , Dragnev Dian , Petrova Eli , Costa Joana , Bobev Svetoslav Ganchev
Published: November 2024

Sunflower is a short-season crop of the Asteraceae family and the Helianthus genus and is the fourth most important oilseed crop in the world. During a field campaign, unusual symptoms (necrosis and longitudinal cracking of the petiole) were observed in a sunflower crop grown in the region of Kavarna (Dobrich district, Bulgaria) and strains of the genus Xanthomonas were isolated. Results based on phylogenetic and phylogenomic analyses showed that they clustered with Xanthomonas euroxanthea CPBF 424T species, a pathogenic strain isolated from walnut buds in Portugal and responsible for causing walnut bacterial blight (WBB). The sunflower strain showed five out of eight X. euroxanthea-specific markers (XEA4-XEA8), a pattern also observed in some strains isolated from Solanum lycopersicum, Phaseolus vulgaris and rainwater sources, reinforcing the emergence of a recent lineage-driven by evolutionary adaptations to new plant hosts. This is the first report of X. euroxanthea in sunflower crops in Bulgaria, which represents a potential threat to production and its distribution should be monitored.
Evaluation of a Faculty-Led Clinical Model to Meet Pediatric Preventive Care Competencies Through a Pediatric Mobile Clinic
Authors: Quinones Saribel G. , Foronda Cynthia L.
Published: November 2024

Limited pediatric primary care clinical placement sites and preceptors have made it difficult for family nurse practitioner (FNP) students to meet pediatric preventive clinical competencies. The purpose of this project was to evaluate a faculty-led clinical model to meet pediatric preventive care competencies through a pediatric mobile clinic. A pre-post evaluation design was used to evaluate student perceptions of their achievement of competencies. Students demonstrated improvement in all seven competencies. A faculty-led clinical model through a pediatric mobile clinic may be an effective way to improve pediatric clinical competencies for FNP students.
Chest computed tomography-based artificial intelligence-aided latent class analysis for diagnosis of severe pneumonia
Authors: Chu Caiting , Guo Yiran , Lu Zhenghai , Gui Ting , Zhao Shuhui , Cui Xuee , Lu Siwei , Jiang Meijiao , Li Wenhua , Gao Chengjin
Published: November 2024

Background:

There is little literature describing the artificial intelligence (AI)-aided diagnosis of severe pneumonia (SP) subphenotypes and the association of the subphenotypes with the ventilatory treatment efficacy. The aim of our study is to illustrate whether clinical and biological heterogeneity, such as ventilation and gas-exchange, exists among patients with SP using chest computed tomography (CT)-based AI-aided latent class analysis (LCA).

Methods:

This retrospective study included 413 patients hospitalized at Xinhua hospital diagnosed with SP from June 1, 2015 to May 30, 2020. AI quantification results of chest CT and their combination with additional clinical variables were used to develop LCA models in an SP population. The optimal subphenotypes were determined though evaluating statistical indicators of all the LCA models, and clinical implications of them such as guiding ventilation strategies were further explored by statistical methods.

Results:

The two-class LCA model based on AI quantification results of chest CT can describe the biological characteristics of the SP population well and hence yielded the two clinical subphenotypes. Patients with subphenotype-1 had milder infections (P <0.001) than patients with subphenotype-2 and had lower 30-day (P <0.001) and 90-day (P <0.001) mortality, and lower in-hospital (P = 0.001) and 2-year (P <0.001) mortality. Patients with subphenotype-1 showed a better match between the percentage of non-infected lung volume (used to quantify ventilation) and oxygen saturation (used to reflect gas exchange), compared with patients with subphenotype-2. There were significant differences in the matching degree of lung ventilation and gas exchange between the two subphenotypes (P <0.001). Compared with patients with subphenotype-2, those with subphenotype-1 showed a relatively better match between CT-based AI metrics of the non-infected region and oxygenation, and their clinical outcomes were effectively improved after receiving invasive ventilation treatment.

Conclusions:

A two-class LCA model based on AI quantification results of chest CT in the SP population particularly revealed clinical heterogeneity of lung function. Identifying the degree of match between ventilation and gas-exchange may help guide decisions about assisted ventilation.
Growing burden of inflammatory bowel disease in China: Findings from the Global Burden of Disease Study 2021 and predictions to 2035
Authors: Yu Ziqing , Ruan Gechong , Bai Xiaoyin , Sun Yinghao , Yang Hong , Qian Jiaming
Published: November 2024

Background:

Inflammatory bowel disease (IBD) imposes a significant economic and social burden in China. We aim to assess the epidemiological trends of IBD in China, and to predict the burden in the near future.

Methods:

The incidence, mortality, prevalence, and disability-adjusted life year (DALYs) of IBD from 1990 to 2021 were obtained from Global Burden of Disease Study 2021. Estimated annual percentage change (EAPC), average annual percent change, total percent change, and age-period-cohort model were used to access trends. Bayesian age–period–cohort model was utilized to predict the risk of incidence and mortality.

Results:

In 2021, IBD affected 168,077 people in China, with 24,941 new cases and 5640 deaths. The age-standardized rate (ASR) of incidence and death was 1.4 and 0.3, respectively. The incidence and prevalence in China were lower than the global and high socio-demographic index (SDI) regions, but the ASR of incidence and prevalence (EAPC: 2.93 and 2.54, respectively) had rapidly increased from 1990 to 2021. The ASR of death and DALYs had significantly decreased (EAPC: −3.05 and −2.93, respectively). Middle-aged and elderly populations faced a severe burden of incidence and prevalence, while the elderly population faced a severe mortality burden. It is projected that by 2035, the ASR of incidence will continue to rise, whereas the death rate will continue to decline.

Conclusions:

The burden of IBD in China is serious and increasingly severe. Establishing a comprehensive disease management system in China will help better control the medical burden of IBD.
Research Progress on Epicardial Repair After Myocardial Injury
Authors: Li Guohua , Yan Zongquan , Han Lei , Wu Sipeng , Wang Meiling , Qi Anning , Zhou Zhenxian , Wang Ne , Sun Ruolan , Zhou Xiaohui
Published: November 2024

Myocardial Injuries, such as myocardial infarction, trigger complex biological responses. The epicardium, known for its regenerative capabilities, plays a pivotal role in cardiac repair by undergoing activation and subsequent cellular transformations. This review examines the mechanisms of epicardial activation after myocardial injury, focusing on epithelial-mesenchymal transition, cell proliferation, and cell migration. It underscores the significance of the epicardium in heart repair processes and discusses potential implications for developing novel cardiac therapies. These insights may pave the way for leveraging epicardial cell dynamics to enhance cardiac regeneration, ultimately reducing the morbidity associated with heart disease.
Accuracy of intraocular lens power calculation in patients with endothelial dystrophy without edema
Authors: Shemer Asaf , Fradkin Maayan , Dubinsky-Pertzov Biana , Reitblat Olga , Simaan Francis , Sella Ruti , Pras Eran , Einan-Lifshitz Adi
Published: November 2024

Purpose:

To evaluate the accuracy of several intraocular lens (IOL) formulas for patients with endothelial dystrophy (ED) without edema treated with cataract surgery alone.

Setting:

1 academic, tertiary referral center.

Design:

Comparative retrospective cohort study.

Methods:

The predicted refractive results of patients with ED who underwent cataract surgery were assessed and compared with a matched control group. The accuracy of 5 different IOL formulas, Haigis, Holladay 1, Barrett Universal II (BUII), SRK/T, and Kane, was evaluated and compared between the groups. The SDs of the prediction error (PE) of all formulas were compared.

Results:

221 eyes were included in this study. 50 (23%) eyes of patients with ED and 171 (77%) control eyes. There was no significant difference between the 2 groups in clinical and demographical characteristics (P > .05). The postoperative spherical equivalent was −0.37 diopters (D) in the ED group and −0.30 D in the control group (P = .8). Overall, both groups had a comparable SD of the PE and absolute PE in all formulas (P > .05). In the ED group, absolute PE was 0.34 D for Haigis, 0.32 D for Holladay 1, 0.32 D for BUII, 0.38 D for SRK/T, and 0.32 D for Kane formulas. No statistically significant difference between formulas was found.

Conclusions:

The prediction accuracy of IOL power calculation in patients with ED was found comparable both between formulas and in comparison with healthy controls. This suggests that in patients with guttate without edema, the IOL power calculations are as effective and accurate as in healthy eyes.
Duration of dual antiplatelet treatment after percutaneous coronary intervention in patients with chronic kidney disease: a systematic review and meta-analysis
Authors: Apostolos Anastasios , Bozika Maria , Nastouli Kassiani-Maria , Chlorogiannis Dimitrios-David , Dimitriadis Kyriakos , Toutouzas Konstantinos , Tsioufis Konstantinos , Davlouros Periklis , Tsigkas Grigorios
Published: November 2024

Patients suffering from chronic kidney disease (CKD) have higher ischemic and bleeding risk compared with patients with normal renal function. The aim of our systematic review and meta-analysis is to compare shortened (≤3 months) dual antiplatelet therapy (DAPT) with longer DAPT in patients with CKD undergoing percutaneous coronary interventions. We systematically screened three major databases (Medline, Cochrane Central Register of Controlled Trials, and Scopus) searching for randomized-controlled trials or subanalyses of them, which compared shortened (S-DAPT) to longer (L-DAPT) regimens of DAPT in patients with CKD. The primary endpoint is the net adverse clinical events (NACE) and the secondary is major adverse cardiac events (MACE), and bleedings. Subgroup analyses included studies using only P2Y12 monotherapy, ticagrelor-based regimens, 1- and 3-month duration of DAPT. A total of 10 studies and 6688 patients were included in our analysis. No significant differences regarding NACE (RR: 0.97, 95% CI: 0.84–1.12, I
2 = 0%), MACE (RR: 1.00, 95% CI: 0.85–1.117, I
2 = 0%), and bleedings (RR: 0.78, 95% CI: 0.59–1.03, I
2 = 25%) were observed between S-DAPT and L-DAPT in our meta-analysis. The findings from the subgroup analyses were in accordance with total findings; bleedings were significantly reduced in S-DAPT when only studies with 3-month duration of DAPT were analyzed (RR: 0.58, 95% CI: 0.40–0.85, I
2 = 0%). Our systematic review and meta-analysis showed that no significant differences were observed between patients treated with S-DAPT or L-DAPT in the terms of MACE, NACE, and bleedings in patients with CKD. When it is required, S-DAPT could be considered in patients with CKD.
Acute kidney injury subphenotyping and personalized medicine
Authors: Meersch Melanie , Mayerhöfer Timo , Joannidis Michael
Published: November 2024

Purpose of review

This review discusses novel concepts of acute kidney injury (AKI), including subphenotyping, which may facilitate the development of target treatment strategies for specific subgroups of patients to achieve precision medicine.

Recent findings

AKI is a multifaceted syndrome with a major impact on morbidity and mortality. As efforts to identify treatment strategies have largely failed, it is becoming increasingly apparent that there are different subphenotypes that require different treatment strategies. Various ways of subphenotyping AKI have been investigated, including the use of novel renal biomarkers, machine learning and artificial intelligence, some of which have already been implemented in the clinical setting. Thus, novel renal biomarkers have been recommended for inclusion in new definition criteria for AKI and for the use of biomarker bundled strategies for the prevention of AKI. Computational models have been explored and require future research.

Subphenotyping of AKI may provide a new understanding of this syndrome and guide targeted treatment strategies in order to improve patient outcomes.
New ultrasound techniques for acute kidney injury diagnostics
Authors: McDonald Rory , Watchorn James , Hutchings Sam
Published: November 2024

Purpose of review

Acute kidney injury (AKI) is common in critical illness and associated with adverse outcomes. Imaging, specifically ultrasound, is increasingly finding a role in AKI diagnostics. This includes the assessment of arterial and venous blood flow, tissue perfusion and the condition of the renal parenchyma. This review provides an update on ultrasound techniques and their application to AKI in critical care.

Recent findings

Advances have been made in arterial and venous Doppler, contrast enhanced ultrasound (CEUS) and shear wave elastography (SWE). Doppler and CEUS techniques offer benefit in terms of AKI diagnosis and in identifying patients at risk. In addition, through the demonstration of altered flow or impaired perfusion, these techniques provide information on the pathophysiology of AKI, offering potential for targeted intervention. Renal SWE, an emerging technique, assesses tissue stiffness potentially allowing exploration of the role of venous congestion in the pathogenesis of AKI.

Ultrasound continues to demonstrate great promise in the diagnosis and management of AKI, offering a noninvasive means to diagnose perfusion deficits and assess response to treatments. Further research, with standardization of techniques, may allow multifaceted renal ultrasound assessment in the critically ill for more accurate diagnosis and tailored intervention in AKI.
Erythromycin disrupts Acinetobacter baumannii biofilms through destruction of the quorum sensing system
Authors: Dong Hang , Sun Jianguo , Liu Yiling , Li Qin , Huang Jianglong , Xu Panfeng , Wang Yuanqing
Published: November 2024

Background:

This study was conducted to explore the effects of erythromycin on biofilms comprising Acinetobacter baumannii (A baumannii).

Methods:

To clarify the effect of erythromycin on the biofilms of A baumannii, we collected pure Ab strains isolated and identified from a variety of sample types extracted from patients in the microbiological laboratory of our hospital from April to August 2023, and divided them into an experimental group (treated with erythromycin) and a control group (without erythromycin). The morphology and quantity of A baumannii biofilm were observed at 24h, 48h, 72h, and 5d post-treatment, respectively, and the expression of quorum sensing (QS) system gene (abaI, abaR) mRNA was detected by fluorescence quantitative PCR.

Results:

The results showed that A baumanniis are prone to form multiple drug-resistant (MDR) bacteria, against which the most commonly used clinical antibiotics are ineffective. Overall, we found that the number of bacteria, the number of bacteria in the biofilm, and the number of biofilms formed gradually increased over time, with a statistical difference (P < .05). After the addition of erythromycin, significant improvements in biofilm formation were achieved, indicating that erythromycin can destroy A baumannii biofilms, inhibiting bacterial growth to a certain extent. The expression levels of abaI and abaR gradually increased over time, indicating that the role of the QS system became more apparent over time. Biofilm formation is related to the QS system of A baumanniis. After erythromycin treatment, abaI and abaR mRNA expression was downregulated in the experimental group.

Conclusion:

Erythromycin disrupts A baumannii biofilms by destroying the quorum sensing system.
Autonomic dysfunction as manifestation of ICANS: A case report
Authors: Rochate Dina , González-García Antonio Manuel , Santos Marcos Carmen , Pérez-López Estefanía , Martín-López Ana-África , Alaña Mónica , Martín Martín Lourdes , López Parra Miriam , Sánchez Guijo Fermín , López Corral Lucía
Published: November 2024

Rationale:

Anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy is a successful treatment for B-cell malignancies associated with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Cardiovascular toxicities have also been reported in this setting. However, there is scarce data regarding development of autonomic disorders after CAR-T cell therapy.

Patient concerns:

We report a case with a patient with non-Hodgkin B-cell lymphoma, refractory to 2 prior lines of immunochemotherapy, treated with CAR-T therapy.

Diagnoses:

Orthostatic hypotension secondary to autonomic dysfunction was diagnosed as manifestation of ICANS.

Interventions:

The patient received metilprednisolone 1000 mg IV daily for 3 days and anakinra 100 mg IV every 6h.

Outcomes:

The vast majority of autonomic symptoms ceased and 4 months after CAR-T therapy, autonomic dysfunction was resolved.

Lessons:

New-onset autonomic dysfunction can occur as manifestation of ICANS in patients who experience persistent neurologic and cardiovascular symptoms after resolution of acute neurotoxicity and should be early recognized. Differences in differential diagnosis, mechanisms and treatment approaches are discussed.
Cutaneous manifestations of infective endocarditis as presenting signs of left atrial myxoma in a patient with acute ischemic stroke: A case report
Authors: Shen Ying-Chi , Chang Kai-Chun , Su Jen-Jen
Published: November 2024

Rationale:

Approximately one-fifth ischemic stroke are attributed to cardioembolism. Patients with cardioembolic stroke often develop a more severe disability and a higher risk of stroke recurrence. Cardiac myxoma, although uncommon, can serve as a potentially curable cause of acute embolic strokes.

Patient concerns:

A 55-year-old male patient presented to the emergency department with acute vertigo and unsteady gait, accompanied by left upper limb numbness. Concurrently, purple-like lesions on the left hand were noticed.

Diagnoses:

Brain magnetic resonance imaging showed multiple infarctions in the posterior circulation. Additionally, skin examination showed Janeway lesions, Osler nodes and splinter hemorrhages. There was no evidence of systemic infection. Subsequently, transthoracic echocardiogram revealed a left atrial myxoma.

Intervention:

Early surgical resection of cardiac myxoma was performed.

Outcomes:

The patient recovered well from the surgery. No recurrent embolic event was reported at 3-month postoperatively.

Lessons:

Clinicians should be vigilant for skin manifestations of cardiac embolism. In patients with acute ischemic strokes, the presence of cutaneous embolic phenomena could serve as a warning sign of cardioembolism.
Switching hemophilia A patients to rVIII-SingleChain: The Iberian experience
Authors: Calvo-Villas José Manuel , Núñez-Vázquez Ramiro , Benítez-Hidalgo Olga , García-Díaz Covadonga , Galmés Bernat , Carvalho Manuela , Serrano-Torres Pilar , Aznar-Salatti José , Álvarez-Román María Teresa
Published: November 2024

The real-world outcomes of lonoctocog alfa (rVIII-SingleChain), a long-acting factor VIII (FVIII) with a favorable safety and efficacy profile in trials, were assessed in patients with hemophilia A in Iberian (Spain and Portugal). This was a retrospective study involving patients switching to rVIII-SingleChain from other FVIIIs in 7 Spanish and Portuguese hospitals. The efficacy and safety of replacement therapies were compared between 12 months before switching and the period from switching to the end of the study. Twenty-nine patients (median age 25 years; severe hemophilia A, 37.9%) were recruited. Before switching, 12 were on prophylaxis and were followed-up for a median of 12 months. After switching, 17 received prophylaxis with rVIII-SingleChain and were followed-up for a median of 41 months. Those with ≤2 weekly infusions increased from 37.5% before switching to 60.7% after switching to rVIII-SingleChain. The median monthly consumption was 312 IU/kg with prior FVIIIs and 273 IU/kg with rVII-SingleChain. Six spontaneous bleeds were reported in each period in the prophylaxis patients. In the entire cohort, 50 bleeds were reported with prior FVIIIs and 33 were reported after switching to rVIII-SingleChain. Patients requiring ≤1 dose for hemostasis increased from 44.0% with prior FVIIIs to 60.6% with rVIII-SingleChain. Responses were rated good/excellent in 95.4% of cases. No safety concerns were reported. Patients who switched to rVIII-SingleChain prophylaxis had excellent bleeding control and reduced infusion frequency in regular clinical practice, with the subsequent increase in quality-of-life.
Construction of a prognostic risk model based on pyroptosis-related genes and comprehensive analysis of key genes and tumor immune microenvironment for colon cancer
Authors: Liu Mengxi , Zhang Jin , Zhao Yu , Zhang Xiaoyi
Published: November 2024

Pyroptosis-related genes have great potential for prognosis, an accurate prognostic model based on pyroptosis genes has not been seen in Colorectal adenocarcinoma (COAD). Furthermore, understanding the mechanisms of gene expression characteristics and the Tumor Immune Microenvironment associated with the prognosis of COAD is still largely unknown. Constructing a prognostic model based on pyroptosis-related genes, and revealing prognosis-related mechanisms associated with the gene expression characteristics and tumor microenvironment. 59 pyroptosis-related genes were collected. The gene expression data and clinical data of COAD were downloaded from The Cancer Genome Atlas. External validation datasets were downloaded from the Gene Expression Omnibus database. 10 characteristic genes with prognostic values were obtained using univariate and LASSO Cox. 10-gene Riskscore prognostic model was constructed. Both gene set enrichment analysis and network propagation methods were used to find pathways and key genes leading to different prognostic risks. The area under the ROC curves were used to evaluate the performance of the model to distinguish between high-risk and low-risk patients, the results were 0.718, 0.672, and 0.669 for 1-, 3-, and 5-year survival times. A nomogram based on Riskscore and clinical characteristics showed the probability of survival at 1, 3, and 5 years, and the calibration curves showed good agreement between the predicted and actual observations, its C-index is 0.793. The decision curves showed that the net benefit of the nomogram was significantly superior to that of the other single variables. Four key pathways leading to different prognostic risks were obtained. Six key genes with prognostic value, significant expression differences (P < .05) and significant survival differences (P < .05) between high/low risk groups were obtained from the gene set of all 4 key pathways. This study constructed a prognostic model for COAD using 10 pyroptosis-related genes with prognostic value. This study also revealed significant differences in specific pathways and the tumor immune microenvironment (TME) between the high-risk group and the low-risk group, highlighted the roles of ALDH5A1 and Wnt signaling in promoting COAD and the suppressive effects of the IL-4/IL-13 pathway and RORC on COAD. The study will be helpful for precision therapy.
The effect of dexmedetomidine on emergence delirium of postanesthesia events in pediatric department: A systematic review and meta-analysis of randomized controlled trials
Authors: Tang Sunyu , Liu Jikai , Ding Zheng , Shan Ting
Published: November 2024

Background:

Emergence delirium (ED) is a common occurrence in pediatric postanesthesia events, leading to negative outcomes. Dexmedetomidine (DEX), as an anesthesia adjuvant, has shown promise in preventing ED in adult surgeries, and it has been increasingly used in pediatric surgical settings. However, its effectiveness in other postanesthesia events, such as MRI examinations and ambulatory surgery centers, remains unclear. This meta-analysis aims to assess the safety and efficacy of DEX in preventing ED in various pediatric postanesthesia events beyond surgery.

Methods:

Prospective randomized controlled trials were searched in Pubmed, Web of Science, and EBSCO until October 13, 2023. Comparisons were made between DEX and other sedatives or analgesics in different postanesthesia events (including surgery operations, the examination of MRI, day surgery, and invasive action). Subgroup analyses were conducted based on drug delivery methods, medication timing, DEX dosages, use of analgesics, event types, and recovery time.

Results:

A total of 33 trials involving 3395 patients were included. DEX significantly reduced the incidence of ED (odds ratios [OR] = 0.23, 95% confidence interval [CI]: 0.19–0.27, I2 = 37%, P < .00001). Intranasal delivery of DEX was the most effective (OR 0.18, 95% CI: 0.10–0.32, P < .00001, I2 = 0%). DEX also showed benefits in day surgery and mask insertion events (OR 0.30, 95% CI: 0.14–0.26, P = .001, I2 = 0%).

Conclusion:

DEX demonstrates superior efficacy in preventing ED in pediatric postanesthesia events compared to other sedatives and analgesics. Its use is recommended in various settings for its safety and effectiveness in managing ED.
Recent advances in Del Nido cardioplegia: A comprehensive analysis of randomized clinical trials in adult cardiac surgery
Authors: Ahmed Muhammad , Raja Adarsh , Virwani Vikash , Raja Sandesh , Hussain Syed Yawar , Moeed Abdul , Bai Shanta , Abbas Johar , Fadelallah Eljack Mohammed Mahmmoud , Asghar Muhammad Sohaib
Published: November 2024

Background:

Del Nido cardioplegia (DNC) has extensively been used for pediatric population undergoing cardiac surgery. However, its use in adult cardiac surgeries have been limited thus, its benefits are not yet fully known. This analysis was performed to evaluate the impact of DNC versus any other type of cardioplegia in adult patients who are undergoing cardiac surgery.

Methods:

We systematically searched PubMed, Cochrane Library, and Scopus from database inception till March 2023, and moderate to high-quality randomized controlled trials were included which compared DNC to other cardioplegia. The primary outcome was postoperative stroke and/or transient ischemic attack (TIA). Secondary outcomes included spontaneous rhythm return, postoperative myocardial infarction, all-cause mortality, postoperative atrial fibrillation, defibrillation after coronary reperfusion, postoperative intra-aortic balloon pump, postoperative kidney injury, postoperative low cardiac output syndrome, inotropic support, cardiopulmonary bypass time, cross-clamp time, blood transfusion, cardioplegia volume, hospital stay, intensive care unit stay, mechanical ventilation stay, postoperative left ventricular ejection fraction, and cardiac markers.

Results:

In this meta-analysis, 13 studies were included with a patient population of 2207. Stroke and/or TIA studies (risk ratio [RR]: 0.54, 95% CI [0.29, 1.00]) and all-cause mortality studies (RR: 1.30, 95% CI [0.66, 2.56]) were insignificant. From the secondary outcomes, spontaneous rhythm return (RR: 1.58, 95% CI [1.02, 2.45]), defibrillation after coronary reperfusion (RR: 0.49, 95% CI [0.30, 0.79]), inotropic support (RR: 0.70, 95% CI [0.57, 0.85]), composite risk of stroke and/or TIA and/or acute kidney injury and mortality (RR: 0.72, 95% CI [0.53, 0.99]), cross-clamp time (mean difference [MD]: −6.01, 95% CI [−11.14, −0.89]), blood transfusion (RR: 0.73, 95% CI [0.60, 0.90]), cardioplegia volume (MD: −537.17, 95% CI [−758.89, −315.45]), troponin T (MD: −1.71, 95% CI [−2.11, −1.32]), creatine phosphokinase-MB (MD: −2.96, 95% CI [−5.84, −0.07]) were significant. Whereas all other secondary outcomes were found to be insignificant.

Conclusion:

No significant difference was observed between patients undergoing Del Nido administration in comparison to other cardioplegia solutions for the primary outcome, stroke or/and TIA.
Hypoglycemia and hyperglycemia in neonatal encephalopathy: A narrative review
Authors: Asif Sughra , Shaukat Maryam , Khalil Kashaf , Javed Hadiya , Safwan Muhammad , Alam Khadija , Fatima Sabahat , Chohan Prishotam , Muhammad Hanif Huraim , Mahmmoud Fadelallah Eljack Mohammed , Bin Zafar Muhammad Daim , Hasanain Muhammad
Published: November 2024

Neonatal encephalopathy (NE) is a serious condition with various neurological dysfunctions in newborns. Disruptions in glucose metabolism, including both hypoglycemia and hyperglycemia, are common in NE and can significantly impact outcomes. Hypoglycemia, defined as blood glucose below 45 mg/dL, is associated with increased mortality, neurodevelopmental disabilities, and brain lesions on MRI. Conversely, hyperglycemia, above 120 to 150 mg/dL, has also been linked to heightened mortality, hearing impairment, and multiorgan dysfunction. Both aberrant glucose states appear to worsen prognosis compared to normoglycemic infants. Therapeutic hypothermia is the standard of care for NE that provides neuroprotection by reducing metabolic demands and inflammation. Adjunct therapies like glucagon and continuous glucose monitoring show promise in managing dysglycemia and improving outcomes. Glucagon can enhance cerebral blood flow and glucose supply, while continuous glucose monitoring enables real-time monitoring and personalized interventions. Maintaining balanced blood sugar levels is critical in managing NE. Early detection and intervention of dysglycemia are crucial to improve outcomes in neonates with encephalopathy. Further research is needed to optimize glycemic management strategies and explore the potential benefits of interventions like glucagon therapy.
Causal association of immune effector proteins with sepsis: A Mendelian randomization study
Authors: Wang Yongsheng , Xu Chuchu , Zhang Yao , Zhou Lijuan , Zhang Ting , Yin Xiaona , Wang Xi , Jiang Yinling , Du Fangbing , Wang Xiaoqiong
Published: November 2024

Sepsis is an infection-induced systemic inflammatory response syndrome. Immune regulation plays a crucial role in sepsis. We looked into the link between immune effector–related proteins and sepsis in this study by using both univariate and multivariate Mendelian randomization (MR) analyses. We accessed and collected data from the Integrative Epidemiology Unit’s Open About Sepsis genome-wide association study database. The 6 immune effector–associated proteins each contained 10,534,735 single-nucleotide polymorphisms from 3301 samples. Using the weighted median, MR-Egger, simplex, inverse-variance weighting, and weighted mode methods, univariate MR then investigated the link between complement factor H-related protein-5 (CFHR5), Fc epsilon receptor II (FCER2), granzyme B (GZMB), major histocompatibility complex, class II, DQ alpha (HLA-DQA2), mannose-binding lectin 2 (MBL2), or myeloperoxidase (MPO) and sepsis. In the inverse-variance weighted results, the P values of all 6 immune effector–related proteins were <0.05, suggesting a possible causal relationship between them and sepsis. MBL2 (odds ratio [OR] = 1.046) was a risk factor for sepsis, while the other proteins (FCER2: OR = 0.922; GZMB: OR = 0.908; CFHR5: OR = 0.858; HLA-DQA2: OR = 0.896; MPO: OR = 0.875) were safety factors. By revealing a causal link between sepsis and CFHR5, FCER2, GZMB, HLA-DQA2, MBL2, or MPO, our study offers an essential resource for additional investigations on the subject.
Bibliometric and visual analyses of research on the links between stroke and exosomes from 2008 to 2023
Authors: Song Jiaqi , Zhan Kaihan , Li Jiayu , Cheng Saiqi , Li Xiaohong , Yu Li
Published: November 2024

Exosomes, which are extracellular vesicles secreted and released from specific cells, exist widely in cell culture supernatants and various body fluids. This study aimed to analyze the research status of exosomes in stroke, and predict developmental trends via bibliometric analyses. The related literature from January 1, 2008 to January 1, 2024 was searched in the Web of Science Core Collection and 943 articles were retrieved. VOSviewer was used to visualize national cooperation and institutional cooperation. Cluster analysis of keywords and Citespace were applied for mutation analysis. Results: The analysis of 943 works of literature showed that the number of published articles has been steadily increasing since 2015. It is predicted that nearly 211 articles will be published in 2024 and 220 annually by 2028. China has the largest number of publications (473), followed by the United States (234), and Germany (61). The institution with the most publications is Henry Ford Hospital (Detroit, MI). In the keyword cluster “Exosomes and the Mechanism of Stroke: Inflammation and Apoptosis,” exosomes and inflammation were identified as hotspots. “Functional recovery” was a new trend in the keyword cluster of “Angiogenesis and Functional Recovery after Stroke.” China and the United States are the main forces in this field, and both countries focusing on drug treatments. The studies have been published mainly in China and United States. The findings of our bibliometric analyses of the literature may enable researchers to choose appropriate institutions, collaborators, and journals.
Non-alcoholic fatty liver disease is associated with coronary flow reserve impairment: A pilot meta-analysis
Authors: Jain Hritvik , Pervez Neha , Dey Debankur , Raza Fatima Ali , Jain Jyoti , Ahmed Mushood , Goyal Aman , Odat Ramez M. , Jha Mayank , Tariq Muhammad Daoud , Fox Sebastian , Yadav Rukesh , Ahmed Raheel
Published: November 2024

Background:

Non-alcoholic fatty liver disease (NAFLD) is estimated to affect approximately 25% of the global population. Both, coronary artery disease and NAFLD are linked to underlying insulin resistance and inflammation as drivers of the disease. Coronary flow reserve parameters, including coronary flow reserve velocity (CFRV), baseline diastolic peak flow velocity (DPFV), and hyperemic DPFV, are noninvasive markers of coronary microvascular circulation. The existing literature contains conflicting findings regarding these parameters in NAFLD patients.

Methods:

A comprehensive systematic search was conducted on major electronic databases from inception until May 8, 2024, to identify relevant studies. We pooled the standardized mean differences (SMD) with 95% confidence intervals (CI) using the inverse-variance random-effects model. Statistical significance was set at P < .05.

Results:

Four studies with 1139 participants (226 with NAFLD and 913 as controls) were included. NAFLD was associated with a significantly lower CFRV (SMD: −0.77; 95% CI: −1.19, −0.36; P < .0002) and hyperemic DPFV (SMD: −0.73; 95% CI: −1.03, −0.44; P < .00001) than the controls. NAFLD demonstrated a statistically insignificant trend toward a reduction in baseline DPFV (SMD: −0.09; 95% CI: −0.38, 0.19; P = .52) compared to healthy controls.

Conclusion:

Patients with NAFLD are at a higher risk of coronary microvascular dysfunction, as demonstrated by reduced CFRV and hyperemic DPFV. The presence of abnormal coronary flow reserve in patients with NAFLD provides insights into the higher rates of cardiovascular disease in these patients. Early aggressive targeted interventions for impaired coronary flow reserve in subjects with NAFLD may lead to improvement in clinical outcomes.
COVID-19 positive woman presented with major fetal congenital anomalies: A case report with literature review
Authors: Erciyestepe Sezgi Güllü , Pata Özlem
Published: November 2024

Rationale:

Pregnancy is a special term in life with physiological changes in both cardiorespiratory and immune systems; that is why severe acute respiratory syndrome coronavirus 2 infection in pregnancy may result in an altered response. With this, we present a case report of a young pregnant lady who was exposed to severe acute respiratory syndrome coronavirus 2 infection just before pregnancy and ended up with an affected fetus. The impact of coronavirus disease 2019 (COVID-19) exposure on neonatal outcomes has not yet been fully evaluated; by this article, we aim to find if COVID-19 exposure is linked to congenital anomalies.

Patient concerns:

A 25-year-old woman who has no history of genetic or chronic diseases applied to our clinic for routine control of pregnancy. She does not have a consanguineous marriage or any other potential risk factors for pregnancy.

Diagnoses and interventions:

She had a history of COVID-19 polymerase chain reaction positivity 2 days before the first day of the last menstruation period and hospitalization for 7 days. After 7 days of treatment with favipiravir and levofloxacin, enoxaparin sodium, famotidine, paracetamol, budesonide, dornaz alfa, and vitamin C; her general situation gets better, and discharged from the hospital on the seventh day of hospitalization without any further treatment prescription.

Outcomes:

During her routine controls for pregnancy at first-trimester evaluation ultrasonography; there was right forearm aplasia and deformities at both feet and legs.

Lessons:

In the literature, there is conflicting evidence about the impact of COVID-19 in pregnancy especially if the patient is confronted with the virus in the first trimester. Despite the increasing number of published studies on COVID-19 in pregnancy, there are insufficient good quality unbiased studies about the issue. Risk factors for COVID-19 overlap with the risk factors for pregnancy complications and the risk factors of the treatment prescribed. The impact of COVID-19 exposure on neonatal outcomes has not yet been fully evaluated; in this article, we aim to find if COVID-19 exposure is linked to congenital anomalies. Further research is needed to ascertain neonatal outcomes.