bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Breast MRI: Current Evidence and Patient Selection
Authors: Christensen Diana M , Shehata Mariam N , Javid Sara H , Rahbar Habib , Lam Diana L
Published: February 2023

Breast MRI is the most sensitive imaging modality for the assessment of newly diagnosed breast cancer extent and can detect additional mammographically and clinically occult breast cancers in the ipsilateral and contralateral breasts. Nonetheless, appropriate use of breast MRI in the setting of newly diagnosed breast cancer remains debated. Though highly sensitive, MRI is less specific and may result in false positives and overestimation of disease when MRI findings are not biopsied prior to surgical excision. Furthermore, improved anatomic depiction of breast cancer on MRI has not consistently translated to improved clinical outcomes, such as lower rates of re-excision or breast cancer recurrence, though there is a paucity of well-designed studies examining these issues. In addition, current treatment paradigms have been developed in the absence of this more accurate depiction of disease span, which likely has limited the value of MRI. These issues have led to inconsistent and variable utilization of preoperative MRI across practice settings and providers. In this review, we discuss the history of breast MRI and its current use and recommendations with a focus on the preoperative setting. We review the evidence surrounding the use of preoperative MRI in the evaluation of breast malignancies and discuss the data on breast MRI in the setting of specific patient factors often used to determine breast MRI eligibility, such as age, index tumor phenotype, and breast density. Finally, we review the impact of breast MRI on surgical outcomes (re-excision and mastectomy rates) and long-term breast recurrence and survival outcomes.
Impact of Patient Navigation on Reducing Breast Imaging Disparities and Applications in the COVID-19 Era
Authors: Gong Anna J , Lee Emerson E , Visvanathan Kala , Oluyemi Eniola T
Published: February 2023

The coronavirus (COVID-19) pandemic has impacted breast cancer screening with concerns that this may lead to increased overall breast cancer mortality and worsened racial and ethnic disparities in breast cancer survival. As pandemic recovery efforts are underway, we must be prepared to address barriers to timely access of breast imaging services, including those that existed prior to the pandemic, as well as any new barriers that may arise as a result of the pandemic. Patient navigation is an important tool that has been shown to address barriers to timely breast imaging access and help reduce disparities. Patient navigation programs can serve as a key part of the strategy to mitigate the impact of the COVID-19 pandemic on timely breast cancer diagnosis. These programs have been shown to be successful in promoting adherence to breast cancer screening guidelines as well as encouraging timely diagnostic follow-up, particularly in underserved communities. Further research is needed to explore the role of using a telehealth platform for patient navigation and evaluate the cost-effectiveness of patient navigator programs as well as more randomized controlled trials to further explore the impact of patient navigation programs.
The Political Economy Consequences of China’s Export Slowdown
Authors: Campante Filipe R , Chor Davin , Li Bingjing
Published: February 2023

We study how adverse economic shocks influence political outcomes in strong authoritarian regimes, by examining the export slowdown in China during the mid-2010s. We first show that prefectures that experienced a more severe export slowdown witnessed a significant increase in incidents of labor strikes, using a shift-share instrumental variables strategy. The prefecture party secretary was subsequently more likely to be replaced by the central government, particularly if the rise in strikes was greater than in other prefectures that saw comparable export slowdowns. These patterns are consistent with a simple framework we develop, where the central government makes strategic use of a turnover decision to induce effort from local officials in preserving social stability, and to screen them for retention. In line with the framework’s predictions, we find a heightened emphasis by local party secretaries—particularly younger officials whose career concerns are stronger—on upholding stability following negative export shocks. This is evident in both words (from textual analysis of official speeches) and deeds (from expenditures on public security and social spending).
Accessory After the Fact at the International Criminal Court?
Authors: Ventura Manuel J
Published: February 2023

It has generally been understood that international criminal law recognizes ex post facto aiding and abetting as a mode of liability but not the standalone offence commonly known, in many states, as accessory after the fact. However, as this article reveals, the authentic Spanish text of Article 25(3)(c) of the Rome Statute of the International Criminal Court (‘ICC Statute’) includes the word ‘encubridor’ which — as a comparative analysis of the Criminal Codes of Spanish-speaking countries confirms — is the Spanish language legal equivalent of a person that is an accessory after the fact. Yet, nothing in the authentic English text of Article 25(3)(c) — the version that most of the international criminal law scholarship and the International Criminal Court (‘ICC’) have focused on — alludes to this. To resolve this substantive discrepancy, Article 25(3)(c) is considered across all authentic languages (Arabic, Chinese, English, French, Russian, and Spanish) and in light of Articles 31–33 of the 1969 Vienna Convention on the Law of Treaties in a manner consistent with the rights of the accused. This article concludes that the mentioned discrepancy is unique to Article 25(3)(c) in the authentic Spanish language, most likely the result of an error, and that the concept of ‘accessory after the fact’ should not be applied at the ICC. That Article 25(3), a provision that has featured in so many ICC decisions and judgments and spawned so much academic writing, has contained such a glaring and seemingly undetected error for over 24 years ought to compel commentators, academics, and practitioners to look beyond the working languages of the ICC — English and French — when analysing, interpreting, and applying the ICC Statute.
Modal structures in groups and vector spaces
Authors: van Benthem Johan , Bezhanishvili Nick
Published: February 2023

Vector spaces contain a number of general structures that invite analysis in modal languages. The resulting logical systems provide an interesting counterpart to the much better-studied modal logics of topological spaces. In this programmatic paper, we investigate issues of definability and axiomatization using standard techniques for modal and hybrid languages. The analysis proceeds in stages. We first present a modal analysis of commutative groups that establishes our main techniques, next we introduce a new modal logic of linear dependence and independence in vector spaces and, finally, we study a modal logic for describing full-fledged vector spaces. While still far from covering every basic aspect of linear algebra, our discussion identifies several leads for more systematic research.
Clinical and imaging characteristics of pulmonary cryptococcosis: a comparative analysis of 118 non-AIDS patients in China
Authors: Xiong Ping , Huang Chaowen , Zhong Liandi , Huang Liebin
Published: February 2023

The accurate diagnosis of pulmonary cryptococcosis (PC) is an important guarantee for the selection of reasonable treatment methods. In this paper, the clinical and imaging manifestations of PC in non-AIDS patients were retrospectively analyzed, and according to whether there was an underlying disease, a comparative analysis was carried out to deepen the understanding of PC, and improve the accuracy of its diagnosis. Both clinical and CT imaging data of 118 PC patients were analyzed retrospectively. The clinical manifestations of PC patients were not specific, and 61 patients had no apparent symptoms. A total of 49 patients (49/118) were treated with antifungal agents alone, 46 of them had follow-up records after treatment, and 91.3% (42/46) of them achieved a good outcome. The most common imaging sign was the subpleural nodule or mass. Other main imaging signs include bronchial air sign (50/118), halo sign (32/118), ring target sign (65/118), lobulation sign (72/118), and necrosis (76/118). In terms of age, halo sign, and ring target sign, there were significant differences between the group with underlying disease and the group without underlying disease (P < .05). The CT manifestations of PC have some characteristics, and using antifungal agents can achieve good outcomes.
Binary asteroid scattering around white dwarfs
Authors: McDonald Catriona H , Veras Dimitri
Published: February 2023

Increasing observations of white dwarf atmospheric pollution and disrupting planetesimals is driving increased studies into the fate of exo-asteroids around post-main-sequence stars. Planetesimal populations in the Solar System that are most likely to survive the violent post-main-sequence evolution, such as the Kuiper Belt, display a large binary fraction with a propensity for near equal-mass components and provide a previously unexplored population of planetesimals that are likely to exist around white dwarfs. Here, we simulate the dynamical evolution of equal-mass binary asteroid systems around white dwarfs using the N-body integrator REBOUND for 1 Gyr. We confirm that giant planets are efficient at dissociating and ejecting binary asteroid systems on eccentric orbits, while Earth-mass planets are better at keeping planetesimals in their planetary systems. We find binary systems can be dissociated and ejected from their systems across Myr time-scales, producing interstellar objects. We do not expect a population of free-floating binary asteroid systems as all ejected planetesimals are gravitationally unbound from each other. Further, we discuss the influence of asteroid binarity on the white dwarf pollution process and find there is little to no impact on how close a body can get to a star. However, the orbital evolution of binary asteroids changes the distribution of planetesimals available in a white dwarf planetary system to be further scattered onto white dwarf polluting orbits.
Inferring neutron star properties with continuous gravitational waves
Authors: Lu Neil , Wette Karl , Scott Susan M , Melatos Andrew
Published: February 2023

Detection of continuous gravitational waves from rapidly spinning neutron stars opens up the possibility of examining their internal physics. We develop a framework that leverages a future continuous gravitational wave detection to infer a neutron star’s moment of inertia, equatorial ellipticity, and the component of the magnetic dipole moment perpendicular to its rotation axis. We assume that the neutron star loses rotational kinetic energy through both gravitational wave and electromagnetic radiation, and that the distance to the neutron star can be measured, but do not assume electromagnetic pulsations are observable or a particular neutron star equation of state. We use the Fisher information matrix and Monte Carlo simulations to estimate errors in the inferred parameters, assuming a population of gravitational-wave-emitting neutron stars consistent with the typical parameter domains of continuous gravitational wave searches. After an observation time of 1 yr, the inferred errors for many neutron stars are limited chiefly by the error in the distance to the star. The techniques developed here will be useful if continuous gravitational waves are detected from a radio, X-ray, or gamma-ray pulsar, or else from a compact object with known distance, such as a supernova remnant.
The ALMOND survey: molecular cloud properties and gas density tracers across 25 nearby spiral galaxies with ALMA
Authors: Neumann Lukas , Gallagher Molly J , Bigiel Frank , Leroy Adam K , Barnes Ashley T , Usero Antonio , den Brok Jakob S , Belfiore Francesco , Bešlić Ivana , Cao Yixian , Chevance Mélanie , Dale Daniel A , Eibensteiner Cosima , Glover Simon C O , Grasha Kathryn , Henshaw Jonathan D , Jiménez-Donaire María J , Klessen Ralf S , Kruijssen J M Diederik , Liu Daizhong , Meidt Sharon , Pety Jérôme , Puschnig Johannes , Querejeta Miguel , Rosolowsky Erik , Schinnerer Eva , Schruba Andreas , Sormani Mattia C , Sun Jiayi , Teng Yu-Hsuan , Williams Thomas G
Published: February 2023

We use new HCN(1–0) data from the ACA Large-sample Mapping Of Nearby galaxies in Dense gas (ALMOND) survey to trace the kpc-scale molecular gas density structure and CO(2–1) data from the Physics at High Angular resolution in Nearby GalaxieS–Atacama Large Millimeter/submillimeter Array (PHANGS–ALMA) to trace the bulk molecular gas across 25 nearby star-forming galaxies. At 2.1 kpc scale, we measure the density-sensitive HCN/CO line ratio and the star formation rate (SFR)/HCN ratio to trace the star formation efficiency in the denser molecular medium. At 150 pc scale, we measure structural and dynamical properties of the molecular gas via CO(2–1) line emission, which is linked to the lower resolution data using an intensity-weighted averaging method. We find positive correlations (negative) of HCN/CO (SFR/HCN) with the surface density, the velocity dispersion, and the internal turbulent pressure of the molecular gas. These observed correlations agree with expected trends from turbulent models of star formation, which consider a single free-fall time gravitational collapse. Our results show that the kpc-scale HCN/CO line ratio is a powerful tool to trace the 150 pc scale average density distribution of the molecular clouds. Lastly, we find systematic variations of the SFR/HCN ratio with cloud-scale molecular gas properties, which are incompatible with a universal star formation efficiency. Overall, these findings show that mean molecular gas density, molecular cloud properties, and star formation are closely linked in a coherent way, and observations of density-sensitive molecular gas tracers are a useful tool to analyse these variations, linking molecular gas physics to stellar output across galaxy discs.
Supernova connection of unidentified ultra-high-energy gamma-ray source LHAASO J2108+5157
Authors: De Sarkar Agnibha
Published: February 2023

We present a simple phenomenological model of hadronic interaction between protons accelerated in an old supernova remnant (SNR) and cold protons situated within the associated molecular clouds (MCs). The accelerated protons from the old SNR escaped the SNR shock front, and got injected into the MCs at an earlier time, producing ultra-high-energy gamma-rays and neutrinos through inelastic proton–proton interaction. We also take into account the acceleration and subsequent escape of electrons from the SNR shock front. The escaped electrons produce gamma-rays through various radiative cooling mechanisms, after getting injected into the MCs. We use the model discussed in this letter to explain the multiwavelength spectral energy distribution of unidentified Galactic ultra-high-energy gamma-ray source LHAASO J2108+5157. We also discuss the feasibility of applying this model in other cases as well. Future observations can test the viability of the model discussed in this letter, which will in turn confirm that the SNRs can, in fact, accelerate particles up to PeV energies.
How to include and recognize the work of ornithologists based in the Neotropics: Fourteen actions forOrnithological Applications,Ornithology, and other global-scope journals
Authors: Ruelas Inzunza Ernesto , Cockle Kristina L , Núñez Montellano María Gabriela , Fontana Carla S , Cuatianquiz Lima Cecilia , Echeverry-Galvis María A , Fernández-Gómez Ronald A , Montaño-Centellas Flavia A , Bonaccorso Elisa , Lambertucci Sergio A , Cornelius Cintia , Bosque Carlos , Bugoni Leandro , Salinas-Melgoza Alejandro , Renton Katherine , Freile Juan F , Angulo Fernando , Mugica Valdés Lourdes , Velarde Enriqueta , Cuadros Sandra , Miño Carolina Isabel
Published: February 2023

Global-scope scientific journals have played an important role in upholding a colonial legacy of north-south inequities in ornithology, and they now have a key role to play in increasing equity in scientific publishing. We explore common barriers faced by ornithologists in the Neotropics (Latin America and the Caribbean) and suggest priority actions that Ornithological Applications, Ornithology, and other global-scope ornithological journals can take to increase equity in publication and research uptake. Among the most important problems, we identified (1) restrictive (and north-biased) criteria for assessing research “importance” and “novelty,” (2) the high publication costs of the Author Pay (Gold) Open Access model, (3) language hegemony, (4) under-representation of ornithologists from the Neotropics on editorial boards and as lead authors on invited articles, and (5) lack of attention to ethics of collaboration and citation. We recommend that Ornithological Applications, Ornithology, and other global-scope ornithological journals (1) adjust their criteria for publication with the aim to publish all scientifically robust and ethically rigorous ornithology research submitted by first authors based in the Neotropics, including negative results and articles on basic biology; (2) maintain or create options for free or low-cost publication; (3) offer the option of a submission and review process in Spanish (and possibly other languages in the future); (4) increase the representation of ornithologists based in the Neotropics (especially women and those belonging to other marginalized groups) in core editorial teams and on editorial boards; and (5) introduce structured reflexivity statements, in which authors declare how local scientists were involved in the research and how equity was promoted in the collaboration that resulted in the manuscript. For these changes to be broadly effective in the long term, ornithologists across the Global South, and Indigenous, Brown, and Black ornithologists globally, should play lead roles in designing, implementing, and assessing the effectiveness of journal policies and programs. Spanish and Portuguese translations are available in the supplementary material.
Trading in the era of carbon standards: how can trade, standard setting, and climate regimes cooperate?
Authors: Lim Aik Hoe , Holzer Kateryna
Published: February 2023

Regulatory cooperation is indispensable for increasing the quality of carbon-related product regulations and standards (CPRS), reducing trade tensions over them, facilitating their alignment, and, eventually, promoting the convergence of different national emission reduction levels towards a universal carbon price. In this article, we explore how trade and trade-related arrangements and institutions can be used to intensify regulatory cooperation on CPRS. We focus on the following questions: when, where, and how does regulatory cooperation on CPRS take place within the international trading system, and what are the ways to strengthen regulatory cooperation on CPRS? While admitting the key role of market forces and the large market factor in the alignment of carbon standards, we argue that this de facto trade-driven alignment requires a steering from state-to-state regulatory cooperation, as well as cooperation of government agencies with private certification schemes in helping producers, especially from developing countries, to comply. Moreover, the potential for more systematic collaboration between the multilateral institutions for climate change and trade should be explored. This could include the establishment of a joint UNFCCC–WTO forum for the exchange of policy-relevant technical and scientific information on key issues surrounding CPRS and consolidation of the relevant database.
From theory to practice: determining emissions in traded goods under a border carbon adjustment
Authors: Mehling Michael A , Ritz Robert A
Published: February 2023

As part of its Green Deal, the European Union has advanced a ‘Carbon Border Adjustment Mechanism’ (CBAM). Reflective of a trend towards greater use of coercive trade measures to advance environmental and other policy objectives, the CBAM would extend carbon pricing to imported goods with the aim of limiting carbon leakage. Theoretical enquiry into this type of policy approach—known as border carbon adjustments (BCAs)—suggests economic and environmental benefits, but typically discounts the role of legal and practical constraints on BCA design and implementation. In this paper, we show why the BCA design commonly featured in past research—basing the adjustment level on default carbon intensities—runs counter to the economic logic of carbon pricing by distorting the incentives for emissions abatement. Requiring producers to demonstrate their actual carbon intensity captures additional economic benefits of carbon pricing and improves the overall legal prospects of a BCA, but adds to its administrative complexity and creates risk of avoidance practices such as ‘resource shuffling’. What emerges is a more nuanced understanding of BCAs that highlights the challenges when transitioning from theory to practice.
PAT1-type GRAS-domain proteins control regeneration by activating DOF3.4 to drive cell proliferation in Arabidopsis roots
Authors: Bisht Anchal , Eekhout Thomas , Canher Balkan , Lu Ran , Vercauteren Ilse , De Jaeger Geert , Heyman Jefri , De Veylder Lieven
Published: February 2023

Plant roots possess remarkable regenerative potential owing to their ability to replenish damaged or lost stem cells. ETHYLENE RESPONSE FACTOR 115 (ERF115), one of the key molecular elements linked to this potential, plays a predominant role in the activation of regenerative cell divisions. However, the downstream operating molecular machinery driving wound-activated cell division is largely unknown. Here, we biochemically and genetically identified the GRAS-domain transcription factor SCARECROW-LIKE 5 (SCL5) as an interaction partner of ERF115 in Arabidopsis thaliana. Although nonessential under control growth conditions, SCL5 acts redundantly with the related PHYTOCHROME A SIGNAL TRANSDUCTION 1 (PAT1) and SCL21 transcription factors to activate the expression of the DNA-BINDING ONE FINGER 3.4 (DOF3.4) transcription factor gene. DOF3.4 expression is wound-inducible in an ERF115-dependent manner and, in turn, activates D3-type cyclin expression. Accordingly, ectopic DOF3.4 expression drives periclinal cell division, while its downstream D3-type cyclins are essential for the regeneration of a damaged root. Our data highlight the importance and redundant roles of the SCL5, SCL21, and PAT1 transcription factors in wound-activated regeneration processes and pinpoint DOF3.4 as a key downstream element driving regenerative cell division.
Proteasomal degradation of MaMYB60 mediated by the E3 ligase MaBAH1 causes high temperature-induced repression of chlorophyll catabolism and green ripening in banana
Authors: Wei Wei , Yang Ying-ying , Lakshmanan Prakash , Kuang Jian-fei , Lu Wang-jin , Pang Xue-qun , Chen Jian-ye , Shan Wei
Published: February 2023

Banana (Musa acuminata) fruits ripening at 30 °C or above fail to develop yellow peels; this phenomenon, called green ripening, greatly reduces their marketability. The regulatory mechanism underpinning high temperature-induced green ripening remains unknown. Here we decoded a transcriptional and post-translational regulatory module that causes green ripening in banana. Banana fruits ripening at 30 °C showed greatly reduced expression of 5 chlorophyll catabolic genes (CCGs), MaNYC1 (NONYELLOW COLORING 1), MaPPH (PHEOPHYTINASE), MaTIC55 (TRANSLOCON AT THE INNER ENVELOPE MEMBRANE OF CHLOROPLASTS 55), MaSGR1 (STAY-GREEN 1), and MaSGR2 (STAY-GREEN 2), compared to those ripening at 20 °C. We identified a MYB transcription factor, MaMYB60, that activated the expression of all 5 CCGs by directly binding to their promoters during banana ripening at 20 °C, while showing a weaker activation at 30 °C. At high temperatures, MaMYB60 was degraded. We discovered a RING-type E3 ligase MaBAH1 (benzoic acid hypersensitive 1) that ubiquitinated MaMYB60 during green ripening and targeted it for proteasomal degradation. MaBAH1 thus facilitated MaMYB60 degradation and attenuated MaMYB60-induced transactivation of CCGs and chlorophyll degradation. By contrast, MaMYB60 upregulation increased CCG expression, accelerated chlorophyll degradation, and mitigated green ripening. Collectively, our findings unravel a dynamic, temperature-responsive MaBAH1–MaMYB60–CCG module that regulates chlorophyll catabolism, and the molecular mechanism underpinning green ripening in banana. This study also advances our understanding of plant responses to high-temperature stress.
Anisotropic cell growth at the leaf base promotes age-related changes in leaf shape in Arabidopsis thaliana
Authors: Tang Hong-Bo , Wang Juan , Wang Long , Shang Guan-Dong , Xu Zhou-Geng , Mai Yan-Xia , Liu Ye-Tong , Zhang Tian-Qi , Wang Jia-Wei
Published: February 2023

Plants undergo extended morphogenesis. The shoot apical meristem (SAM) allows for reiterative development and the formation of new structures throughout the life of the plant. Intriguingly, the SAM produces morphologically different leaves in an age-dependent manner, a phenomenon known as heteroblasty. In Arabidopsis thaliana, the SAM produces small orbicular leaves in the juvenile phase, but gives rise to large elliptical leaves in the adult phase. Previous studies have established that a developmental decline of microRNA156 (miR156) is necessary and sufficient to trigger this leaf shape switch, although the underlying mechanism is poorly understood. Here we show that the gradual increase in miR156-targeted SQUAMOSA PROMOTER BINDING PROTEIN-LIKE transcription factors with age promotes cell growth anisotropy in the abaxial epidermis at the base of the leaf blade, evident by the formation of elongated giant cells. Time-lapse imaging and developmental genetics further revealed that the establishment of adult leaf shape is tightly associated with the longitudinal cell expansion of giant cells, accompanied by a prolonged cell proliferation phase in their vicinity. Our results thus provide a plausible cellular mechanism for heteroblasty in Arabidopsis, and contribute to our understanding of anisotropic growth in plants.
Tomato APETALA2 family member SlTOE1 regulates inflorescence branching by repressing SISTER OF TM3
Authors: Sun Shuai , Wang Xiaotian , Liu Zhiqiang , Bai Jingwei , Song Jia , Li Ren , Cui Xia
Published: February 2023

Inflorescence architecture directly impacts yield potential in most crops. As a model of sympodial plants, tomato (Solanum lycopersicum) inflorescence exhibits highly structural plasticity. However, the genetic regulatory network of inflorescence architecture in tomato remains unclear. Here, we investigated a modulator of inflorescence branching in tomato, TARGET OF EAT1 (SlTOE1), an APETALA2 (AP2) family member found to be predominantly expressed in the floral meristem (FM) of tomato. sltoe1 knockout mutants displayed highly branched inflorescences and defective floral organs. Transcriptome analysis revealed that SISTER OF TM3 (STM3) and certain floral development-related genes were upregulated in the flower meristem of sltoe1. SlTOE1 could directly bind the promoters of STM3 and Tomato MADS-box gene 3 (TM3) to repress their transcription. Simultaneous mutation of STM3 and TM3 partially restored the inflorescence branching of the sltoe1cr mutants, suggesting that SlTOE1 regulates inflorescence development, at least in part through an SlTOE1STM3/TM3 module. Genetic analysis showed that SlTOE1 and ENHANCER OF JOINTLESS 2 (EJ2) additively regulate tomato inflorescence branching; their double mutants showed more extensive inflorescence branching. Our findings uncover a pathway controlling tomato inflorescence branching and offer deeper insight into the functions of AP2 subfamily members.
Advanced Point-of-care Bedside Monitoring for Acute Respiratory Failure
Authors: Cammarota Gianmaria , Simonte Rachele , Longhini Federico , Spadaro Savino , Vetrugno Luigi , De Robertis Edoardo
Published: February 2023

Advanced respiratory monitoring involves several mini- or noninvasive tools, applicable at bedside, focused on assessing lung aeration and morphology, lung recruitment and overdistention, ventilation–perfusion distribution, inspiratory effort, respiratory drive, respiratory muscle contraction, and patient–ventilator asynchrony, in dealing with acute respiratory failure. Compared to a conventional approach, advanced respiratory monitoring has the potential to provide more insights into the pathologic modifications of lung aeration induced by the underlying disease, follow the response to therapies, and support clinicians in setting up a respiratory support strategy aimed at protecting the lung and respiratory muscles. Thus, in the clinical management of the acute respiratory failure, advanced respiratory monitoring could play a key role when a therapeutic strategy, relying on individualization of the treatments, is adopted.
Resuscitation in the First 3 Hours of Sepsis-Induced Hypotension Varies by Patient and Hospital Factors
Authors: Chen Jen-Ting , Roberts Russel J. , Sevransky Jonathan Eliot , Gong Michelle Ng ,   on behalf of the VOLUME-CHASERS Study Group, Discovery Network, Society of Critical Care Medicine
Published: February 2023

IMPORTANCE:

Patient and hospital factors affects how we resuscitate patients in the first 3 hours of sepsis-induced hypotension.

OBJECTIVES:

To evaluate variability in compliance to the 3-hour surviving sepsis campaign (SSC) bundle and explore the association of early compliance with subsequent shock and in-hospital mortality.

DESIGN:

Retrospective cohort study between September 2017 and February 2018.

SETTING:

Thirty-four academic medical centers.

PARTICIPANTS:

A subgroup sepsis-induced hypotensive patients from a larger shock cohort study.

MAIN OUTCOMES AND MEASURES:

Compliance to SSC bundle that was defined as receiving appropriate antibiotics, 30 mL/kg of crystalloid or initiation of vasopressors, and lactate, obtained in the first 3 hours following sepsis-induced hypotension.

RESULTS:

We included 977 patients with septic-induced hypotension. Bundle compliance was 43.8%, with the lowest compliance to fluid or vasopressor components (56%). Patients with high Sequential Organ Failure Assessment scores and physiologic assessments were more likely to receive compliant care, as were patients with sepsis-induced hypotension onset in the emergency department (ED) or admitted to mixed medical-surgical ICUs. SSC compliance was not associated with in-hospital mortality (adjusted odds ratio, 0.72; 95% CI, 0.47–1.10). The site-to-site variability contributed to SSC compliance (intraclass correlation coefficient [ICC], 0.15; 95% CI, 0.07–0.3) but not in-hospital mortality (ICC, 0.02; 95% CI, 0.001–0.24). Most patients remained in shock after 3 hours of resuscitation (SSC compliant 81.1% and noncompliant 53.7%). Mortality was higher among patients who were persistently hypotensive after 3 hours of resuscitation for both the SSC compliant (persistent hypotension 37% vs not hypotensive 27.2%; p = 0.094) and noncompliant (30.1% vs 18.2%; p = 0.001, respectively).

CONCLUSIONS AND RELEVANCE:

Patients with a higher severity of illness and sepsis-induced hypotension identified in the ED were more likely to receive SSC-compliant care. SSC compliance was not associated with in-hospital mortality after adjusting for patient- and hospital-level differences. Higher mortality is seen among those who remain in shock after initial resuscitation, regardless of SSC compliance.
Individualised flow-controlled versus pressure-controlled ventilation in a porcine oleic acid-induced acute respiratory distress syndrome model
Authors: Abram Julia , Martini Judith , Spraider Patrick , Putzer Gabriel , Ranalter Manuela , Wagner Julian , Glodny Bernhard , Hell Tobias , Barnes Tom , Enk Dietmar
Published: February 2023

BACKGROUND

A continuous gas flow provided by flow-controlled ventilation (FCV) facilitates accurate dynamic compliance measurement and allows the clinician to individually optimise positive end-expiratory and peak pressure settings accordingly.

OBJECTIVE

The aim of this study was to compare the efficiency of gas exchange and impact on haemodynamics between individualised FCV and pressure-controlled ventilation (PCV) in a porcine model of oleic acid-induced acute respiratory distress syndrome (ARDS).

DESIGN

Randomised controlled interventional trial conducted on 16 pigs.

SETTING

Animal operating facility at the Medical University Innsbruck.

INTERVENTIONS

ARDS was induced in lung healthy pigs by intravenous infusion of oleic acid until moderate-to-severe ARDS at a stable Horowitz quotient (PaO2 FiO2
−1) of 80 to 120 over a period of 30 min was obtained. Ventilation was then either performed with individualised FCV (n = 8) established by compliance-guided pressure titration or PCV (n = 8) with compliance-guided titration of the positive end-expiratory pressure and peak pressure set to achieve a tidal volume of 6 ml kg−1 over a period of 2 h.

MAIN OUTCOME MEASURES

Gas exchange parameters were assessed by the PaO2
FiO2
−1 quotient and CO2 removal by the PaCO2 value in relation to required respiratory minute volume. Required catecholamine support for haemodynamic stabilisation was measured.

RESULTS

The FCV group showed significantly improved oxygenation [149.2 vs. 110.4, median difference (MD) 38.7 (8.0 to 69.5) PaO2 FiO2
−1; P = 0.027] and CO2 removal [PaCO2 7.25 vs. 9.05, MD −1.8 (−2.87 to −0.72) kPa; P = 0.006] at a significantly lower respiratory minute volume [8.4 vs. 11.9, MD −3.6 (−5.6 to −1.5) l min−1; P = 0.005] compared with PCV. In addition, in FCV-pigs, haemodynamic stabilisation occurred with a significant reduction of required catecholamine support [norepinephrine 0.26 vs. 0.86, MD −0.61 (−1.12 to −0.09) μg kg−1 min−1; P = 0.037] during 2 ventilation hours.

CONCLUSION

In this oleic acid-induced porcine ARDS model, individualised FCV significantly improved gas exchange and haemodynamic stability compared with PCV.

TRIAL REGISTRATION

Protocol no.: BMBWF-66.011/0105-V/3b/2019)
Impact of a Dedicated Outpatient Parenteral Antimicrobial Therapy Program on Peripherally Inserted Central Catheter Removal at a Large Academic Medical Center
Authors: Drwiega Emily , Rab Saira , Schechter Marcos C. , Andruski Rebecca , Maxam Meshell , Kundu Suprateek , Zheng Ziduo , Patel Manish
Published: February 2023

Background

Outpatient parenteral antimicrobial therapy (OPAT) is a strategy to administer parenteral antibiotics in the outpatient setting through a vascular access device, such as a peripherally inserted central catheter (PICC). Prompt PICC removal after OPAT completion can minimize potential complications of phlebitis, catheter-associated infections, and venous thrombosis. There is no literature evaluating the impact of a dedicated OPAT clinic on PICC removal.

Methods

This was a single-center, retrospective observational study. Patients 18 years or older discharged on OPAT were included. In March 2018, Grady Health System implemented a multidisciplinary OPAT clinic. The pre-OPAT clinic group included patients referred from January 1, 2017, through March 31, 2018, and the post-OPAT clinic group included patients referred from April 1, 2018, through June 30, 2019. The primary outcome was the rate of documented PICC removal before and after implementation of a dedicated OPAT clinic. Secondary outcomes included difference in rates and reasons for emergency department (ED) visits and readmissions, and difference in rates of OPAT follow-up visits between the 2 groups. The PICC removal rates were fitted in linear regression models for pre- and post-OPAT clinic groups, and the slopes of the 2 regression models were compared.

Results

A total of 450 patients were included: 230 and 220 in the pre- and post-OPAT clinic groups, respectively. In the pre-OPAT group, 180 patients (73.8%) had a documented PICC removal compared with 213 patients (86.6%) in the post-OPAT group (P < 0.001). There were significantly more patients who visited the ED for a PICC-related reason in the pre-OPAT clinic group (62 vs 44, P = 0.006).

Conclusions

The proportion of patients with documented PICC removal increased and the proportion of patients with a PICC-related ED visit decreased after the establishment of a dedicated OPAT clinic.
Dietary interventions using Facebook: a systematic review
Authors: Cunha Vera , Montenegro Susana , Padrão Patrícia
Published: February 2023

Introduction:

Facebook has been used to change food behaviors. The aim of this review was to synthesize the knowledge about the effect of nutritional interventions delivered through Facebook in dietary intake, food and nutritional knowledge and behavior, and weight management.

Methods:

PubMed, Web of Science, Ovid, Scopus, and Cochrane electronic databases were searched for intervention studies that were published from 2013 to 2019. This systematic review protocol was formulated based on Cochrane Guidelines for Systematic Reviews of Health Promotion and Public Health Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

Results:

Of the 4824 identified studies, 116 were considered for eligibility and 18 met the inclusion criteria of this review. Of these, 13 were randomized controlled trials, 2 were quasiexperimental studies, 2 were case studies, and 1 was a nonrandomized controlled trial. Interventions had a positive nutritional-related impact in most of the studies (78%).

Discussion:

Positive changes in dietary intake, food and nutritional knowledge and behavior, and weight management were observed in studies that used Facebook as a component of intervention. Facebook effectiveness by its own was difficult to evaluate considering that is frequently a component of intervention. The heterogeneity of the outcome variables between studies did not allow concluding about the effectiveness of this tool.
Comparison of intramedullary versus extramedullary alignment technique in total knee arthroplasty: A PRISMA-compliant meta-analysis
Authors: Li Ming , Li Jun , Hu Shuai , Jia Bingshen
Published: February 2023

Background:

This meta-analysis aimed to compare the efficacy of intramedullary and extramedullary femoral alignment technique in treating total knee arthroplasty (TKA) patients.

Methods:

PubMed, Embase, Cochrane library, Chinese National Knowledge Infrastructure, and Weipu databases were electronically searched. Potential clinical studies that investigated the effect and safety of intramedullary versus extramedullary femoral alignment technique in TKA patients were searched. The primary outcome was lower limb coronal alignment. Stata 12.0 was used for meta-analysis.

Results:

This meta-analysis included 12 prospective randomized controlled studies that reported data on 935 TKA patients. No significant difference was noted in lower limb coronal alignment, coronal alignment of femoral component, sagittal alignment of femoral component and tibial slope between intramedullary and extramedullary alignment techniques (P > .05). Further, extramedullary alignment technique significantly decrease the total blood loss than intramedullary alignment technique (weighted mean difference: −86.52; 95% confidence interval: −115.05–−57.99; P = .000) and subsequently transfusion rate (risk ratio: 0.57; 95% confidence interval: 0.41–0.79; P = .000). Finally, there was no significant difference between intramedullary and extramedullary alignment techniques in terms of the total complications (P > .05).

Conclusions:

The present meta-analysis showed that intramedullary and extramedullary femoral alignment technique had comparable precise profiles. And extramedullary femoral alignment technique could reduce blood loss and blood transfusion. Total complications were comparable between the groups. More randomized controlled trials with large samples are required to verify the comparison of intramedullary and extramedullary femoral alignment technique in TKA patients.
Exploring the mechanism of astragalus membranaceus in the treatment of multiple system atrophy based on network pharmacology and molecular docking
Authors: Yang Ni , Qi Xianghua , Hu Jing , Teng Jing , Wang Yuangeng , Li Chunlin
Published: February 2023

Multiple system atrophy (MSA) is a fatal neurodegenerative disease, it causes functional degradation of multiple organs and systems throughout the body. Astragalus membranaceus (AM), a well-known traditional Chinese medicine, has been used to improve muscle wasting-related disorders for a long history. In this study, we used network pharmacology and molecular docking to predict the mechanism underlying AM for the treatment of MSA. We screened the active compounds of AM and its related targets, as well as the target proteins of MSA. We made a Venn diagram to obtain the intersecting targets and then constructed a protein-protein interaction network to find the core targets and build an active ingredient-target network map. After subjecting the intersecting targets to gene ontology and Kyoto encyclopedia of genes and genomes analysis, the binding ability of core compounds and core target proteins were validated by molecular docking. A total of 20 eligible compounds and 274 intersecting targets were obtained. The core components of treatment are quercetin, kaempferol, and isorhamnetin, and the core targets are TP53, RELA, and TNF. The main biological processes are related to cellular responses and regulation. Molecular functions are mainly associated with apoptosis, inflammation, and tumorigenesis. Molecular docking results show good and standard binding abilities. This study illustrates that AM treats MSA through multiple targets and pathways, and provides a reference for subsequent research.
Successful haploidentical hematopoietic stem cell transplantation for activated phosphoinositide 3-kinase δ syndrome: Case report and literature review
Authors: Yang Xiaolan , Xi Rui , Bai Jiaofeng , Pan Yaozhu
Published: February 2023

Rationale:

Activated phosphoinositide 3-kinase δ syndrome (APDS), a recently described primary immunodeficiency,is caused by autosomal dominant mutation in the phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit delta(PIK3CD) gene encoding the p110δ catalytic subunit of PI3Kδ (APDS1) or the PIK3R1 gene that encodes the p85α regulatory subunit of PI3Kδ (APDS2). Gain-of-function mutation of PIK3CD in APDS1 leads to p110δ hyperactivity, with the result of the hyperphosphorylation of downstream mediators of Akt and mammalian target of rapamycin that cause a series of clinical symptoms. Few cases with APDS were reported in Asia.

Patient concerns:

We report a 6-year-old patient with a recurrent respiratory infection, cryptosporidium enteritis, lymphoproliferation, high serum immunoglobulin-M level, anemia, and inverted CD4+/CD8+ ratio. The whole exome sequencing confirmed a heterozygous missense mutation c.3061G>A（p.E1021K）in patient and her mother. Her mutant gene is inherited from her mother, but her mother has not any clinical symptoms.

Diagnoses:

Activated phosphoinositide 3-kinase δ syndrome.

Interventions:

The patient was received immunoglobulin (Ig) replacement therapy, antibiotics, and rapamycin treatment. Through effectively controlling infection and optimal timing of transplantation by adjusting the conditioning regimen, haploidentical Hematopoietic Stem Cell Transplantation(haplo-HSCT) from her brother was successfully performed.

Outcomes:

The patient is in good condiion with a good quality of life after 20 months of follow-up.

Lessons:

We reported a rare APDS1 case with PIK3CDE1021K gene mutation, Successfully treated with haplo-HSCT. This case provided a reference for treating APDS with haplo-HSCT.
Investigation of the efficacy and pharmacological mechanism of Danhong injections for treating chronic obstructive pulmonary disease: A PRISMA-compliant meta-analysis and network pharmacology analysis
Authors: Gao Xiaoyu , Gao Jinsong
Published: February 2023

Background:

Accumulating evidence supported the clinical efficacy of Danhong injection (DHI) on chronic obstructive pulmonary disease (COPD). It is urgent to summarize the effects of DHI on various outcomes in COPD patients and to elucidate the molecular mechanisms of DHI in treating COPD.

Methods:

Eligible studies were retrieved from 6 databases including China national knowledge infrastructure, Wangfang, VIP, web of science, PubMed, and Embase. The heterogeneity across studies was tested using the I
2 statistic and the quality of studies was assessed. The pooled evaluation of outcomes was calculated using a fix- or random-effect model according to the heterogeneity. The underlying mechanism of DHI in treating COPD was analyzed using network pharmacology.

Results:

A total of 34 eligible studies with a general medium quality were included in the meta-analysis. The pooled data showed that DHI intervention significantly increased clinical efficacy as compared to routine treatment. Meanwhile, our data also revealed that the addition of DHI markedly improved hemorheological indicators, lung function index, arterial blood gas index, and as well as blood coagulation functions. However, the current meta-analysis lacked sufficient data to support the significant effect of DHI on prothrombin time and activated partial thromboplastin time. Network pharmacology found 59 candidate targets of DHI in treating COPD, and enrichment analysis found these targets were associated with lymphocyte proliferation and activation, glucocorticoid receptor signaling, TREM1 signaling, IL-12 signaling and production in macrophages, and aryl hydrocarbon receptor signaling. Multiple core targets including AKT1, TNF, and IL1B, etc. Were identified and might play an important role in the action of DHI against COPD.

Conclusion:

Taken together, this study suggested that DHI could ameliorate hemorheological indicators, lung function, arterial blood gas, and as well as coagulation functions of COPD patients and elucidate the underlying mechanism of DHI against COPD.
Urinary insulin signaling pathway related proteins may serve as potential biomarkers for monitoring diabetes mellitus without hypertension and hyperlipidemia
Authors: Zhao Man , Meng Qian , Zhang Man
Published: February 2023

The insulin signaling pathway plays an important role in the development of diabetes mellitus. The expression of insulin signaling pathway related proteins in the urine of diabetic patients has not been reported. The aim of this study was to analyze and verify the expression of insulin signaling pathway related proteins in the urine of diabetic patients without hypertension and hyperlipidemia, and to explore their clinical application value. Based on data-independent acquisition proteomics technology and bioinformatics, the urinary protein expression profile of diabetic patients without hypertension and hyperlipidemia was established. Western blot and enzyme-linked immunoassay were performed to verify the expression of insulin signaling pathway related proteins in the urine of diabetic patients. Sixteen proteins related to the insulin signaling pathway were screened in urine, and 7 of them were differentially expressed in the urine of diabetic patients without hypertension and hyperlipidemia. Further quantitative analysis showed that the downregulation of protein kinase CAMP-dependent type II regulatory subunit α, growth factor receptor bound protein 2, and guanine nucleotide-binding protein G(s) in the urine of diabetic patients without hyperlipidemia and hypertension was consistent with the preliminary screening results. In this exploratory study, we detected the expression of insulin signaling pathway related proteins in the urine of diabetic patients without hypertension and hyperlipidemia. protein kinase CAMP-dependent type II regulatory subunit α, growth factor receptor bound protein 2, and guanine nucleotide-binding protein G(s) in the urine of diabetic patients were downregulated, which was associated with diabetes. They may be promising noninvasive biomarkers for monitoring diabetes.