bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomical considerations regarding a high-flow arteriovenous fistula below the conus medullaris in a patient with hereditary hemorrhagic telangiectasia: Case report
Authors: Schmolling Ángela H , Bodani Vivek , Jaroenngarmsamer Tanaporn , Andrade-Barazarte Hugo , Radovanovic Ivan , Krings Timo
Published: August 2023

Background and Importance

Cauda equina radicular arteriovenous fistulas are rare “low flow” shunting lesions characterized by direct communication between the radicular artery and vein of a cauda equina nerve root. None have been associated with hereditary hemorrhagic telangiectasia and a high-flow cauda equina radicular arteriovenous fistula has never been reported. We present a unique case of a high-flow cauda equina radicular arteriovenous fistula in a patient with hereditary hemorrhagic telangiectasia. Marked flow-induced vascular remodeling posed significant diagnostic and therapeutic challenges which will be highlighted in this report.

Clinical Presentation

A 39-year-old female with genetically confirmed hereditary hemorrhagic telangiectasia presented with progressive thoracic myelopathy secondary to a high-flow single-hole arteriovenous fistula below the conus. The feeding artery, arising from the anterior spinal artery, and draining vein had a paramedian course, favoring the diagnosis of a cauda equina radicular arteriovenous fistula (supplied by a proximal radicular artery) over a filum terminale arteriovenous fistula. Transarterial embolization was attempted but significant elongation and tortuosity of the anterior spinal artery precluded microcatheter access to the fistulous point. Surgical disconnection was successfully performed. The intraoperative findings supported the diagnosis of cauda equina radicular arteriovenous fistula. Delayed neurologic deterioration secondary to overshooting venous thrombosis was observed. She recovered after the initiation of therapeutic anticoagulation.

Conclusion

To the best of our knowledge, we hereby report the first high-flow cauda equina radicular arteriovenous fistula. The accurate differentiation of cauda equina radicular arteriovenous fistula from filum terminale arteriovenous fistulas, while challenging, is important to avoid treatment-related complications. Careful preoperative planning, the use of specialized endovascular and surgical techniques, and meticulous postoperative care can ensure the safe and complete disconnection of high-flow cauda equina radicular arteriovenous fistulas.
Design, analysis, and experiment of an innovative embedded compact continuously variable transmission with flexible metal V-belt
Authors: Liu Jinfu , Chen Shouqi , Xu Linsen , Jiang Zhengyan , Li Hui
Published: August 2023

The existing deceleration systems in industrial robots often employ rotate vector (RV) or harmonic reducers to augment torque and decrease speed, yet achieving the motor’s peak power proves challenging. Given the extremely high space-size demands for reduction systems in robotic applications, an innovative compact continuously variable transmission is suggested, leveraging the transmission characteristics of spatial gear trains and metallic V-belts. The proposed system utilizes the input of an eccentric shaft to drive the planetary pulley’s rotation around the sun pulley. The pinhole, in cooperation with the eccentric shaft of the planetary pulley, achieves coaxial output of the transmission power. The article primarily explores the transmission and speed change mechanisms, then dissects the relationships between the transmission ratio and the effective radius of the pulley, the axial adjustment distance, and the factors influencing the pulley’s wrapping angle. Further, we use the Lagrange equation to derive the input equation, establishing the correlation between the planetary pulley’s rotation angle and system inertia, angular acceleration, angular velocity, and effective working radius over time. Finally, we simulate the continuously variable transmission’s motion to examine speed changes in forward, reverse, and neutral states. A continuously variable transmission prototype and a testing platform are also constructed to assess performance parameters, specifically input and output torque, and rotational speed.
Intravenous ustekinumab maintenance treatment in patients with loss of response to subcutaneous dosing
Authors: Argüelles-Arias Federico , Valdés Delgado Teresa , Maldonado Pérez Belén , González Antuña Jaime , Castro Laria Luisa
Published: August 2023

Background:

Ustekinumab (UST) is indicated for the treatment of Crohn’s disease (CD) and Ulcerative Colitis (UC). Despite having shown clinical effectiveness in the real world, some patients may lose response over time or need a higher dose to achieve it. In this context, UST intravenous (IV) maintenance has been proposed.

Objectives:

The primary endpoint of our study was to evaluate the efficacy and safety of maintenance IV UST treatment in Inflammatory Bowel Disease (IBD) patients who present with partial response or loss of response to subcutaneous (SC) UST.

Design:

We performed a monocentric observational retrospective study including patients with active IBD on maintenance treatment with IV UST.

Methods:

The clinical response and remission was analyzed at week 12, defined as either Harvey–Bradshaw Index ⩽ 4 for CD or partial Mayo Score ⩽ 2 for UC. The reduction of objective markers of disease activity, fecal calprotectin, and C-reactive protein was evaluated. Moreover, UST trough levels were measured pre- and post-UST IV maintenance and any adverse events were assessed.

Results:

We included 23 patients. Clinical remission at week 12 was achieved by 43.5% of the patients. The proportion of patients in clinical response after 12 weeks on UST IV maintenance was 82.6%. After a median follow-up of 9.3 months all patients remained on IV UST maintenance. No adverse events were recorded in any patient for the duration of the study.

Conclusions:

IV UST maintenance treatment was able to recapture response in most of the patients who had lost response to SC maintenance.
Patient-reported outcomes following selpercatinib treatment in Chinese patients with advanced RET fusion-positive non-small-cell lung cancer and thyroid cancer, and RET-mutant medullary thyroid cancer in the phase II LIBRETTO-321 trial
Authors: Lu Shun , Zheng Xiangqian , Sun Yuping , Huang Dingzhi , Wu Lin , Ji Qinghai , Zhou Chengzhi , Zhou Jianying , Guo Ye , Ge Minghua , Ding Ding , Shao Jingxin , Zhang Wanli , Gao Ming , Cheng Ying
Published: August 2023

Background:

Patient-reported outcomes (PROs) are increasingly becoming an important part of clinical trials as they are helpful in analyzing the safety and efficacy of treatment in chronic diseases like cancer.

Objectives:

We report PROs and health-related quality of life (HRQoL) with selpercatinib treatment among Chinese patients with rearranged in transfection ( RET) fusion-positive non-small-cell lung cancer (NSCLC), RET fusion-positive thyroid cancer (TC), and RET-mutant medullary TC (MTC) as an exploratory analysis of the LIBRETTO-321 trial.

Design:

A total of 77 patients (47 RET fusion-positive NSCLC, 1 RET fusion-positive TC, and 29 RET-mutant MTC) were enrolled. Compliance for European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) was 100% at baseline and >90% at each time point.

Methods:

PROs were assessed using the EORTC QLQ-C30, and a bowel diary assessment for MTC patients with baseline diarrhea using the Systemic Therapy-Induced Diarrhea Assessment Tool. Data were collected at pre-dose; every 8 weeks from cycle 3; and every 12 weeks after cycle 13. A >10-point change from baseline was considered clinically meaningful. PRO changes were summarized through cycle 13.

Results:

Most patients with NSCLC or MTC showed improvement or remained stable on the global health status and functional subscales. For global health status, 47.4% of NSCLC and MTC patients showed definite improvement with only 19.7% showing definite worsening. For functional subscales, less than 30% of the patients showed definite worsening. For symptom subscales, more than 64% of the patients either improved or remained stable for the symptoms. For MTC patients with bowel diary assessment ( n = 5), there was no severity or worsening from baseline in the diarrheal episodes observed during treatment with selpercatinib.

Conclusion:

The study demonstrated favorable PROs in Chinese patients with RET fusion-positive NSCLC, TC, and RET-mutant MTC treated with selpercatinib. HRQoL was improved or stable as assessed by EORTC QLQ-30.

Trail registration:

This study was registered at ClinicalTrials.gov ( https://clinicaltrials.gov/ct2/show/NCT04280081 ) ClinicalTrials.gov Identifier: NCT04280081.
Dysfunctional high-density lipoprotein in chronic inflammatory rheumatic diseases
Authors: Waldecker-Gall Sabina , Seibert Felix , Bertram Sebastian , Doevelaar Adrian , Braun Jürgen , Baraliakos Xenofon , Babel Nina , Waldecker Christoph , Scharow Linda , Pagonas Nikolaos , Westhoff Timm H.
Published: August 2023

Background:

The mechanism explaining low cholesterol concentrations in chronic inflammatory rheumatic disease (CIRD) is incompletely understood. We hypothesized that chronic inflammation impairs the functionality of high-density lipoprotein (HDL), for example, by oxidative processes.

Objectives:

Assessment of oxidized HDL (HDLox), a marker of dysfunctional HDL, in newly diagnosed patients with CIRD before and after initiation of immunosuppressive therapy and comparison of HDLox values of patients with CIRD to non-CIRD controls.

Design:

Prospective observational trial.

Methods:

The study was conducted on 44 newly diagnosed CIRD patients, who were initiated on immunosuppressive therapy (baseline). A total of 136 patients without CIRD served as control. Lipid profiles including HDLox levels and C-reactive protein (CRP) were measured in both groups at baseline. In CIRD patients, measurements were repeated 12 weeks after baseline. Validated outcome tools for disease activity and function were assessed at baseline and 12 weeks.

Results:

A total of 33 (75%) patients with rheumatoid arthritis, 7(16%) with axial spondyloarthritis, and 4 (9%) with systemic lupus erythematosus were included. Groups were comparable for age and BMI. CIRD patients had higher HDLox concentrations (1.57 versus 0.78, p = 0.02) and tended to have lower low-density lipoprotein cholesterol, HDL cholesterol, and cholesterol concentrations compared to controls. HDLox (1.57 versus 1.4, p = 0.26) and CRP levels (2.1 versus 0.7 mg/dl, p < 0.01) decreased in CIRD patients from baseline to follow-up.

Conclusion:

CIRD is associated with an impairment of the anti-inflammatory properties of HDL as reflected by an increase in HDLox concentrations. This effect may contribute to the increased cardiovascular risk in chronic inflammatory diseases.
An optimized 1.5 Tesla MRI protocol of the brachial plexus
Authors: Felisaz Paolo Florent , Napolitano Angela , Terrani Simone , Parisi Carmelo , Toto-Brocchi Marco , Cè Maurizio , Alessandrino Francesco , Oliva Giancarlo , Cellina Michaela , Gerevini Simonetta
Published: August 2023

Purpose

Creating an effective MRI protocol for examining the brachial plexus poses significant challenges, and despite the abundance of protocols in the literature, there is a lack of reference standards for basic sequences and essential parameters needed for replication. The aim of this study is to establish a reproducible 1.5 T brachial plexus imaging protocol, including patient positioning, coil selection, imaging planes, and essential sequence parameters.

Methods

We systematically investigated MRI sequences, testing each parameter through in vivo experiments, examining their effects on signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), visual quality scores, and acquisition time. Sequences were refined based on optimal quality and timing scores. The final protocol was tested on scanners from two other vendors for reliability.

Results

The final protocol included a combination of 2D turbo-spin-echo and 3D SPACE T1, SPACE STIR, and VIBE DIXON sequences. Recommendations for imaging planes, phase encoding, field of view, TR, TE, resolution, number of slices, slice thickness, fat and blood suppression, and acceleration strategies are provided. The protocol was successfully translated to other vendor's scanners with comparable quality.

Conclusion

We present an optimized protocol detailing the essential parameters for reproducibility. Our comprehensive list of experiments describes the impact of each parameter on image quality and scan time, addressing common artifacts and potential solutions. This protocol can benefit both young radiologists new to the field and experienced professionals seeking to refine their existing protocols.
Unsettling relatonality: Attachment after the ‘relational turn’
Authors: Anderson Ben
Published: August 2023

In this response, I place the concept of attachment in the context of debates about the ontological commitments and political-ethical value of relational thinking today. Reading the four commentaries in this forum as emerging from and enacting a fraying of the promise and hold of relational thinking, I explore how, together, they pose a series of questions to my account of attachments as trajectories that ‘bring closer’ a promissory ‘object’: how do some objects become promissory, what, if anything, is the outside of attachment, and what accompanies attachments? The terms through which the commentaries pose these questions and complement the concept of attachment – economies, desire, problem, detachment – revise and supplement my vocabulary and research agenda for a cultural geography of attachment. Simultaneously, they question and challenge relational thinking more broadly.
Stability and change in the opinion–policy relationship: Evidence from minimum wage laws
Authors: Simonovits Gabor , Bor Alexander
Published: August 2023

Recent studies have documented large discrepancies between mass preferences and policies in U.S. states consistent with theories that highlight the oversized influence of affluent Americans on policymaking. In this note, we replicate and extend a recent such study (Simonovits, Guess, and Nagler, 2019) to assess how policy bias evolves in time. Specifically, relying on novel data and methods, we construct measures of minimum wage preferences and compare them to observed policies in each state for the years of 2014, 2016, 2019, and 2021. We demonstrate that, averaged across states, policy change closely tracked a pronounced increase in preferences for higher minimum wages, but the size of policy bias remained relatively stable. However, this national pattern hides an increasingly polarized policy landscape: in many states, insufficient responsiveness led to an increasing deviation between preferences and policies, while in other states policy changes—larger than preference changes—closed initial policy bias.
Ten postulates of a media imperialism framework: For critical research on China’s media power and influence in the Global South
Authors: Mirrlees Tanner
Published: August 2023

This article considers the growing media power and influence of China in the global South through the lens of a critical media imperialism framework derived from the geopolitical economy of communications research tradition. While extensive research exists on US media imperialism and the challenge to it posed by China’s global media rise, the idea of China as a media imperialist in its own right has received limited attention. This article addresses this gap in the field by summarizing ten key postulates of a media imperialism framework for critical research on China’s media power and influence in the global South. This article study does not seek to prove China’s status as a new media imperialist power or provide a detailed case study of China’s media imperialism in a specific country. Instead, it synthesizes the ten postulates of a media imperialism framework, examines China’s corporate and state media organizations in relation to these, and draws from relevant scholarship, evidence, and anecdotes. The article argues that each postulate can serve as a foundation for future case studies of different facets of China’s media power and influence in countries across the global South. These postulates can be refined, disproven, or expanded through further research. By considering China’s media power and influence through the lens of the media imperialism framework, this article aims to stimulate further meta-theory, empirical research, and scholarly debates on this pivotal topic, which while contentious, is significant to the future of the global South, and the wider world system.
The Effectiveness, Accessibility, and Feasibility of Price Policy Mechanism in India: Evidence from the Situation Assessment Survey 2018–2019
Authors: Roy Ranjana
Published: August 2023

India’s agricultural price policy came under serious criticism in the past for its inefficiencies and the financial burden that it puts on the state exchequer. Using the household-level Situation Assessment Survey, published by the National Statistical Office (NSO), this study inspects the effectiveness, accessibility, and feasibility of price policy mechanisms in India. It is found that farmers’ income in India has been increasing at a slower rate and the share of income from crop cultivation has been declining over the years. However, farmers who have received the benefits of minimum support price (MSP) and procurement mechanism, reported having a better income as compared to farmers who sell to the local market right after harvest. Indian agriculture is dominated by small and marginal farmers operating on less than two hectares of land. They are more vulnerable to shocks, such as climate change, price crashes, and post-harvest loss. This study critically evaluates the operation of price policy with special reference to the landholding classes of the farmers. It finds that MSP played an important role in keeping the market prices high and ensuring a better return. However, the reach of MSP has been limited to a few crops and in selected states.
Prospective Multicenter Randomized Controlled Trial of Surgical Versus Nonsurgical Treatment for Acute Rockwood Type 3 Acromioclavicular Injury
Authors: Tauber Mark , Hoffelner Thomas , Lehmann Lars , Kraus Natascha , Scheibel Markus , Moroder Philipp
Published: August 2023

Background:

Evidence for the superiority of surgical versus nonsurgical treatment of Rockwood type 3 acromioclavicular joint (ACJ) dislocation is still lacking.

Hypothesis:

It was hypothesized that surgical treatment will outperform nonsurgical treatment.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

A prospective randomized trial involving 4 study centers was performed from January 1, 2011, to March 31, 2016. A total of 85 patients with acute Rockwood type 3 ACJ dislocations were allocated randomly to receive either nonsurgical or surgical treatment. A total of 70 patients were treated as allocated, and 8 patients made an early crossover from nonsurgical to surgical treatment, leaving 47 patients treated surgically and 31 patients nonsurgically. All patients were followed up longitudinally, including clinical evaluation using the Constant score and standardized radiographic evaluation, with final follow-up after 2 years.

Results:

At no follow-up time point was there a significant difference in Constant score between the surgically and nonsurgically treated patients. Radiographic analysis showed not only an inferior coracoclavicular distance at all follow-up points for surgical treatment but also a higher incidence of posttraumatic osteoarthritis and heterotopic ossifications, without any negative clinical correlation. With regard to complications, 1 patient (3%) in the nonsurgical group underwent secondary surgical ACJ stabilization. The revision rate after surgical treatment was 17% ( P < .001). Neither primary horizontal instability nor younger age were associated with inferior clinical outcomes after nonsurgical treatment.

Conclusion:

Surgical treatment of ACJ Rockwood type 3 injuries did not lead to superior functional outcomes. Neither younger age nor horizontal instability were associated with inferior outcomes after nonsurgical treatment. Surgical treatment led to a slower recovery and to higher complication and revision rates.

Registration:

ISRCTN registry (study ID: ISRCTN92265154).
Prophylactic Knee Bracing in Offensive Linemen of the National Football League: A Retrospective Analysis of Usage Trends, Player Performance, and Major Knee Injury
Authors: Ackerman Devon R. , Ptasinski Anna M. , Edmond Travis , Dunleavy Mark L. , Gallo Robert A.
Published: August 2023

Background:

Offensive linemen in American football are prone to high-energy valgus forces to the knee, leading to associated injuries. Some offensive linemen in the National Football League (NFL) wear prophylactic knee braces (PKB) to prevent ligamentous injury.

Purpose/Hypothesis:

This purpose of the study was to compare injury rates and performance between NFL offensive linemen who wear PKB and those who do not. It was hypothesized that brace wear would be associated with fewer major knee injuries and no difference in gameplay performance.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

For the 2014 through 2020 NFL seasons, offensive linemen with at least 200 game snaps per regular season were identified. Players were grouped by PKB status (bracers vs nonbracers) based on visualization of bilateral, dual-hinged metal knee braces as part of gameday uniforms on publicly available imaging databases and/or game videos. Major knee injuries, defined as those requiring the missing of games, were identified using publicly available data. Performance was assessed with Pro Football Focus grades for each season. Rates of major knee injury were compared between groups with the 2-sample Z test for proportions, and performance grades were compared with the unpaired t test.

Results:

For the cumulative study period, bracers demonstrated a significantly lower rate of major knee injuries than nonbracers (0.013 vs 0.049 injuries per player, respectively; P = .04). Isolated MCL injury was the most common injury for nonbracers. There was no group difference in performance for the cumulative study period or during most individual seasons. Yearly prevalence of PKB usage declined steadily from 16.3% in 2014 to 5.6% in 2020. A subgroup analysis of rookie players demonstrated an overall downtrend in usage during the study period as well.

Conclusion:

Results indicated that knee brace prophylaxis by NFL offensive linemen was associated with a reduced risk of major knee injury without a significant difference in performance when compared with nonbracers. Despite this, the prevalence of PKB declined over the study period.
Medial Femoral Condyle Free Flap for Persistent Osseous Nonunion of the First Metatarsophalangeal Joint: A Preliminary Report of a New Surgical Indication for the Medial Femoral Condyle Free Flap
Authors: Kaiser Dominik , Levin L. Scott
Published: August 2023

Background:

Recalcitrant or persistent nonunions of the metatarsophalangeal (MTP) joint occur following failed MTP surgery for MTP fusion, failed MTP prosthesis, for hallux rigidus or due to infection and erosion. A deficient soft tissue envelope and compromised vascular supply of tissues in this region compound further attempts to salvage the great toe and preserve function. The medial femoral condyle (MFC) free flap provides vascularized corticocancellous bone and periosteum and has been successfully used for a variety of complex hindfoot and ankle pathologies. We present an additional indication with a small cohort study demonstrating its use in persistent nonunions of the first MTP joint.

Methods:

A retrospective review was completed of all MFC flaps used for revision of failed first MTP joint fusion from January 2019 to November 2022. Demographic information, comorbidities, as well as clinical and radiologic follow-up was obtained from the patient charts.

Results:

Three patients were included with MTP nonunion and an average of 7.5 (range, 5-11) failed prior surgeries. Mean age at index surgery was 50 (range, 46-57) years. An osseous union was achieved in all patients after 82 (range, 75-88) days. Hardware removal was possible after 81 (range, 55-98) days. Mean follow-up was 17 (range, 5-31) months. We note a 100% flap success rate without returns to the operating room. The lengths of the bone flaps were 2 to 4 cm, the volumes were 8 to 12 cm3. Fixation was performed with 1 intramedullary K-wire. The recipient vessel in all patients was the dorsalis pedis artery or a tributary thereof. All arterial anastomoses were performed under the operating microscope.

Conclusion:

The MFC free flap is a reasonable option for salvage of complex recalcitrant or persistent nonunions of the first MTP joint. More prospective long-term studies with functional outcomes are necessary to confirm these findings.

Level of Evidence:

Level IV, retrospective case series.
A Systematic Review of Follicular Psoriasis: A Unique but Under-Recognized Entity
Authors: Jablon Kelli , Ho Jonathan D. , Chung Hye Jin
Published: August 2023

Background

Follicular psoriasis (FP) is a rare and under-recognized subtype of psoriasis that affects hair follicles and can be frequently misdiagnosed due to its unique presentation.

Objective

We aimed to analyze the frequently reported clinical, histological, and dermatoscopic features of FP, as well as their treatment options.

Methods

We conducted a systematic review of the PubMed/MEDLINE database using the search terms “follicular” and “psoriasis.” Fourteen studies were included yielding information on 44 patients (27 adults [61.4%] and 17 children [38.6%]).

Results

Adult FP showed a female predominance (M:F = 1:2.7), frequent involvement of lower extremities (81.5%), association with metabolic syndrome including diabetes mellitus (22.2%), and a predilection for skin of color (SOC:White = 8:1). On the contrary, juvenile FP revealed male predominance (M:F = 1:0.6), frequent involvement of the trunk (41.2%), and exclusive involvement in skin of color (SOC:White = 11:0). In addition to its unique presentation, FP tends to be misdiagnosed due to its low incidence of concomitant psoriasis (31.8%), and rare personal (18.2%) or family history (6.8%) of psoriasis. Reported histopathological features include keratotic plugging, follicular parakeratosis with or without neutrophils, psoriasiform acanthosis, hypogranulosis, and neutrophilic infiltration of follicular epithelium. Dermatoscopic findings include folliculocentric lesions with normal appearing terminal hairs, perifollicular white scale, and various vascular structures.

Conclusion

Once correctly diagnosed, patients with FP showed improvement or resolution of symptoms with various combinations of topical and systemic therapies. Understanding the demographic features and clinical presentations of FP can help address under-recognition of this clinical variant of psoriasis.
Neural production networks: AI’s infrastructural geographies
Authors: Ferrari Fabian
Published: August 2023

It is commonly argued that a handful of technology firms own the infrastructure that underpins the proliferation of artificial neural networks. But little is known about how this concentration of computational resources manifests itself in new geographies of production. To address this disparity, this article introduces the theoretical framework of neural production networks: geographically dispersed but computationally enveloped production arrangements powered by artificial neural networks. The article substantiates this framework by probing the role of Amazon, Google and Microsoft as lead firms in neural production networks. By reconsidering three key categories of production network scholarship – value, embeddedness and power – in light of those lead firms, the article opens a space for economic–geographical research on artificial neural networks.
Assessing the Potential for Error in Investigating Intraneural Vascularity: A Need for a Standardized Imaging Protocol
Authors: Yao Buwen , Evans Kevin D. , Roll Shawn C.
Published: August 2023

Objective:

This study examined the implementation of a Doppler sonography imaging protocol to assess intraneural blood flow, within the median nerve, in healthy individuals.

Materials and Methods:

A total of 176 participants were examined, and this involved 717 retrospective observations of the images collected. The implemented imaging protocol was assessed, and the data that were collected were cleaned and checked for fidelity and validity.

Results:

A large percentage of missing evidence (11%–35%) across proximal, mid, and distal carpal tunnel locations. Only a quarter of cases with evidence of intraneural blood flow had the strongest evidence of a power Doppler video clip, of which only three-quarters were valid. The study identified potential areas for improving the imaging protocol to reduce missing data and improve data quality.

Conclusion:

This study demonstrates the significance of a standardized imaging protocol to guide the sonographic acquisition of Doppler images and provides important insights into potential issues with data quality. The recommendations have the potential to help future studies assess intraneural blood flow in healthy populations in a more rigorous and reliable way. Incorporating the study’s recommendations into a standardized protocol, there is potential to enhance the diagnostic accuracy of carpal tunnel syndrome and improve diagnosis and treatment.
The iron chaperone poly(rC)-binding protein 1 regulates iron efflux through intestinal ferroportin in mice
Authors: Wang Yubo , Protchenko Olga , Huber Kari D. , Shakoury-Elizeh Minoo , Ghosh Manik C. , Philpott Caroline C.
Published: August 2023

Iron is an essential nutrient required by all cells but used primarily for red blood cell production. Because humans have no effective mechanism for ridding the body of excess iron, the absorption of dietary iron must be precisely regulated. The critical site of regulation is the transfer of iron from the absorptive enterocyte to the portal circulation via the sole iron efflux transporter, ferroportin. Here, we report that poly(rC)-binding protein 1 (PCBP1), the major cytosolic iron chaperone, is necessary for the regulation of iron flux through ferroportin in the intestine of mice. Mice lacking PCBP1 in the intestinal epithelium exhibit low levels of enterocyte iron, poor retention of dietary iron in enterocyte ferritin, and excess efflux of iron through ferroportin. Excess iron efflux occurred despite lower levels of ferroportin protein in enterocytes and upregulation of the iron regulatory hormone hepcidin. PCBP1 deletion and the resulting unregulated dietary iron absorption led to poor growth, severe anemia on a low-iron diet, and liver oxidative stress with iron loading on a high-iron diet. Ex vivo culture of PCBP1-depleted enteroids demonstrated no defects in hepcidin-mediated ferroportin turnover. However, measurement of kinetically labile iron pools in enteroids competent or blocked for iron efflux indicated that PCBP1 functioned to bind and retain cytosolic iron and limit its availability for ferroportin-mediated efflux. Thus, PCBP1 coordinates enterocyte iron and reduces the concentration of unchaperoned “free” iron to a low level that is necessary for hepcidin-mediated regulation of ferroportin activity.
Comparison of metabolomic reconfiguration between Columbia and Landsberg ecotypes subjected to the combination of high salinity and increased irradiance
Authors: Segarra-Medina Clara , Pascual Lidia S. , Alseekh Saleh , Fernie Alisdair R. , Rambla José L. , Gómez-Cadenas Aurelio , Zandalinas Sara I.
Published: August 2023

Background

Plants growing in the field are subjected to combinations of abiotic stresses. These conditions pose a devastating threat to crops, decreasing their yield and causing a negative economic impact on agricultural production. Metabolic responses play a key role in plant acclimation to stress and natural variation for these metabolic changes could be key for plant adaptation to fluctuating environmental conditions.

Results

Here we studied the metabolomic response of two Arabidopsis ecotypes (Columbia-0 [Col] and Landsberg erecta-0 [Ler]), widely used as genetic background for Arabidopsis mutant collections, subjected to the combination of high salinity and increased irradiance. Our findings demonstrate that this stress combination results in a specific metabolic response, different than that of the individual stresses. Although both ecotypes displayed reduced growth and quantum yield of photosystem II, as well as increased foliar damage and malondialdehyde accumulation, different mechanisms to tolerate the stress combination were observed. These included a relocation of amino acids and sugars to act as potential osmoprotectants, and the accumulation of different stress-protective compounds such as polyamines or secondary metabolites.

Conclusions

Our findings reflect an initial identification of metabolic pathways that differentially change under stress combination that could be considered in studies of stress combination of Arabidopsis mutants that include Col or Ler as genetic backgrounds.
Promoter characterization of a citrus linalool synthase gene mediating interspecific variation in resistance to a bacterial pathogen
Authors: Wang Qiying , Wang Xiaochun , Huang Linhua , Cheng Yujiao , Ren Li , Yang Huayu , Zhou Changyong , Wang Xuefeng , He Jun
Published: August 2023

Background

Terpenoids play essential roles in plant defense against biotic stresses. In Citrus species, the monoterpene linalool mediates resistance against citrus canker disease caused by the gram-negative bacteria Xanthomonas citri subsp. citri (Xcc). Previous work had associated linalool contents with resistance; here we characterize transcriptional responses of linalool synthase genes.

Results

Leaf linalool contents are highly variable among different Citrus species. “Dongfang” tangerine (Citrus reticulata), a species with high linalool levels was more resistant to Xcc than “Shatian” pummelo (C. grandis) which accumulates only small amounts of linalool. The coding sequences of the major leaf-expressed linalool synthase gene (STS4) are highly conserved, while transcript levels differ between the two Citrus species. To understand this apparent differential transcription, we isolated the promoters of STS4 from the two species, fused them to a GUS reporter and expressed them in Arabidopsis. This reporter system revealed that the two promoters have different constitutive activities, mainly in trichomes. Interestingly, both linalool contents and STS4 transcript levels are insensitive to Xcc infestation in citrus plants, but in these transgenic Arabidopsis plants, the promoters are activated by challenge of a bacterial pathogen Pseudomonas syringae, as well as wounding and external jasmonic acid treatment.

Conclusions

Our study reveals variation in linalool and resistance to Xcc in citrus plants, which may be mediated by different promoter activities of a terpene synthase gene in different Citrus species.
Inequities in referrals to a breast cancer risk assessment and prevention clinic: a mixed methods study
Authors: King Claire B. , Bychkovsky Brittany L. , Warner Erica T. , King Tari A. , Freedman Rachel A. , Mittendorf Elizabeth A. , Katlin Fisher , Revette Anna , Crookes Danielle M. , Maniar Neil , Pace Lydia E.
Published: August 2023

Background

Inequitable access to personalized breast cancer screening and prevention may compound racial and ethnic disparities in outcomes. The Breast Cancer Personalized Risk Assessment, Education and Prevention (B-PREP) program, located within the Brigham and Women’s Hospital (BWH) Comprehensive Breast Health Center (BHC), provides care to patients at high risk for developing breast cancer. We sought to characterize the differences between BWH primary care patients referred specifically to B-PREP for risk evaluation and those referred to the BHC for benign breast conditions. Through interviews with primary care clinicians, we sought to explore contributors to potentially inequitable B-PREP referral patterns.

Methods

We used electronic health record data and the B-PREP clinical database to identify patients referred by primary care clinicians to the BHC or B-PREP between 2017 and 2020. We examined associations with likelihood of referral to B-PREP for risk assessment. Semi-structured interviews were conducted with nine primary care clinicians from six clinics to explore referral patterns.

Results

Of 1789 patients, 78.0% were referred for benign breast conditions, and 21.5% for risk assessment. In multivariable analyses, Black individuals were less likely to be referred for risk than for benign conditions (OR 0.38, 95% CI:0.23–0.63) as were those with Medicaid/Medicare (OR 0.72, 95% CI:0.53–0.98; OR 0.52, 95% CI:0.27–0.99) and those whose preferred language was not English (OR 0.26, 95% CI:0.12–0.57). Interviewed clinicians described inconsistent approaches to risk assessment and variable B-PREP awareness.

Conclusions

In this single-site evaluation, among individuals referred by primary care clinicians for specialized breast care, Black, publicly-insured patients, and those whose preferred language was not English were less likely to be referred for risk assessment. Larger studies are needed to confirm these findings. Interventions to standardize breast cancer risk assessment in primary care may improve equity.
Glomerular proteomic profiling reveals early differences between preexisting and de novo type 2 diabetes in human renal allografts
Authors: Kipp Anne , Marti Hans-Peter , Babickova Janka , Nakken Sigrid , Leh Sabine , Halden Thea A. S. , Jenssen Trond , Vikse Bjørn Egil , Åsberg Anders , Spagnoli Giulio , Furriol Jessica
Published: August 2023

Background

Diabetes mellitus (DM), either preexisting or developing after transplantation, remains a crucial clinical problem in kidney transplantation. To obtain insights into the molecular mechanisms underlying PTDM development and early glomerular damage before the development of histologically visible diabetic kidney disease, we comparatively analysed the proteome of histologically normal glomeruli from patients with PTDM and normoglycaemic (NG) transplant recipients. Moreover, to assess specificities inherent in PTDM, we also comparatively evaluated glomerular proteomes from transplant recipients with preexisting type 2 DM (T2DM).

Methods

Protocol biopsies were obtained from adult NG, PTDM and T2DM patients one year after kidney transplantation. Biopsies were formalin-fixed and embedded in paraffin, and glomerular cross-sections were microdissected. A total of 4 NG, 7 PTDM and 6 T2DM kidney biopsies were used for the analysis. The proteome was determined by liquid chromatography-tandem mass spectrometry. Relative differences in protein abundance and significantly dysregulated pathways were analysed.

Results

Proteins involved in cell adhesion, immune response, leukocyte transendothelial filtration, and cell localization and organization were less abundant in glomeruli from PTDM patients than in those from NG patients, and proteins associated with supramolecular fibre organization and protein-containing complex binding were more abundant in PTDM patients. Overall, proteins related to adherens and tight junctions and those related to the immune system, including leukocyte transendothelial migration, were more abundant in NG patients than in transplanted patients with DM, irrespective of the timing of its development. However, proteins included in cell‒cell junctions and adhesion, insulin resistance, and vesicle-mediated transport were all less abundant in PTDM patients than in T2DM patients.

Conclusions

The glomerular proteome profile differentiates PTDM from NG and T2DM, suggesting specific pathogenetic mechanisms. Further studies are warranted to validate these results, potentially leading to an improved understanding of PTDM kidney transplant pathophysiology and to the identification of novel biomarkers.
Could cooling dialysate improve inflammatory and nutritional status of hemodialysis patients?
Authors: Elemshaty Asmaa , Sayed-Ahmed Nagy , Mesbah Abeer , Nassar Mohammed Kamal
Published: August 2023

Background

It has been shown that dialysate cooling (lowering the dialysate temperature to 0.5 °C below central body temperature) reduces the incidence of intradialytic hypotension. Other influences on hemodialysis patients, however, have not been adequately investigated. The purpose of this study was to determine the impact of individualized dialysate cooling on nutritional and inflammatory parameters in chronic hemodialysis (HD) patients.

Methods

Seventy HD patients were separated into two groups: group A: (control group) standard dialysate temperature was 37 °C, and group B: (intervention group) dialysate temperature was 0.5 °C below core body temperature. In addition to routine laboratory tests, blood pressure, anthropometric measurements, inflammatory markers, and the malnutrition inflammation score (MIS) were calculated.

Results

After six months of dialysate cooling, intradialytic hypotension episodes were much less prevalent in the intervention group (p = 0.001). Serum ferritin, transferrin saturation (TSAT), high sensitive C-reactive protein (HS-CRP), and Interleukin-6 (IL-6) reduced following dialysate cooling, whereas serum albumin rose. In the control group, IL-6 dropped but serum ferritin, TSAT, albumin, and HS-CRP rose. In both groups, hemoglobin levels dropped, and erythrocyte sedimentation rate (ESR) rose, both groups’ midarm muscle circumference and MIS worsened.

Conclusion

Cold dialysate decreased intradialytic hypotension with no significant improvement of the nutritional and inflammatory surrogates. However, more studies including larger number of patients with longer duration of follow up are required to adequately assess its effect on inflammation and nutrition in chronic hemodialysis patients.
Kappa statistic considerations in evaluating inter-rater reliability between two raters: which, when and context matters
Authors: Li Ming , Gao Qian , Yu Tianfei
Published: August 2023

Background

In research designs that rely on observational ratings provided by two raters, assessing inter-rater reliability (IRR) is a frequently required task. However, some studies fall short in properly utilizing statistical procedures, omitting essential information necessary for interpreting their findings, or inadequately addressing the impact of IRR on subsequent analyses’ statistical power for hypothesis testing.

Methods

This article delves into the recent publication by Liu et al. in BMC Cancer, analyzing the controversy surrounding the Kappa statistic and methodological issues concerning the assessment of IRR. The primary focus is on the appropriate selection of Kappa statistics, as well as the computation, interpretation, and reporting of two frequently used IRR statistics when there are two raters involved.

Results

The Cohen’s Kappa statistic is typically utilized to assess the level of agreement between two raters when there are two categories or for unordered categorical variables with three or more categories. On the other hand, when it comes to evaluating the degree of agreement between two raters for ordered categorical variables comprising three or more categories, the weighted Kappa is a widely used measure.

Conclusion

Despite not substantially affecting the findings of Liu et al.?s study, the statistical dispute underscores the significance of employing suitable statistical methods. Rigorous and accurate statistical results are crucial for producing trustworthy research.
Association between subjective well-being and all-cause mortality among older adults in China
Authors: Zhu Chunsu , Lian Zhiwei , Huang Yongying , Zhong Qiaofeng , Wang Jianmin
Published: August 2023

Background

Although several studies in high-income countries have suggested a positive association between subjective well-being (SWB) and mortality, studies conducted in low- and middle-income countries, such as China, are scarce. The purpose of this study is to examine the association between SWB and all-cause mortality among the older Chinese population.

Methods

Data were from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a population-based longitudinal cohort study in 22 of 31 provinces in mainland China. A total of 13,282 individuals aged 65 ≥ years who were recruited in 2002 and followed-up until 2018 were included. SWB was assessed with an eight-item tool covering life satisfaction, positive affect (including optimism, happiness, personal control and conscientiousness) and negative affect (including anxiety, loneliness and uselessness). Cox proportional hazards regression methods were carried out to estimate the association between SWB and total mortality, adjusting for a wide range of potential confounders. Subgroup analyses and interaction analyses were further conducted.

Results

During the 16.5 years of follow-up, 8459 deaths were identified. Greater SWB was independently associated with a reduced risk of all-cause mortality (adjusted hazard ratio [HR] = 0.85, 95% confidence interval [CI] = 0.81–0.89) after adjustment for age, sex, marital status, education level, place of residence, smoking status, drinking, exercise, diet, BMI, hypertension, diabetes, heart disease, cerebrovascular diseases and cancer. Of the eight individual SWB symptoms, only 2 items, feelings of uselessness (adjusted HR = 0.94, 95% CI = 0.89–0.99) and happiness (adjusted HR = 0.91, 95% CI = 0.86–0.95), were significantly associated with total mortality. Associations remained significant across all subgroups regardless of different characteristics.

Conclusions

Higher SWB overall and 2 certain symptoms (feelings of uselessness and happiness) were independently associated with all-cause mortality risk among older Chinese adults. The association was consistent across different groups, suggesting that promoting a healthier SWB may be beneficial to all older individuals irrespective of their characteristics.
Short-term effects of air pollution on hospitalization for acute lower respiratory infections in children: a time-series analysis study from Lanzhou, China
Authors: Zhang Wancheng , Ling Jianglong , Zhang Runping , Dong Jiyuan , Zhang Li , Chen Rentong , Ruan Ye
Published: August 2023

Background

Short-term exposure to air pollution is associated with acute lower respiratory infections (ALRI) in children. We investigated the relationship between hospitalization for ALRI in children and air pollutant concentrations from January 1, 2014 to December 31, 2020 in Lanzhou City.

Methods

We collected data on air pollutant concentrations and children’s hospitalization data during the study period. A time series regression analysis was used to assess the short-term effects of air pollutants on ALRI in children, and subgroup analyses and sensitivity analyses were performed.

Results

A total of 51,206 children with ALRI were studied, including 40,126 cases of pneumonia and 11,080 cases of bronchiolitis. The results of the study revealed that PM2.5, PM10, SO2 and NO2 were significantly associated with hospitalization for ALRI in children aged 0–14 years. For each 10 µg/m3 increase in air pollutant concentration in lag0-7, the relative risk of ALRI hospitalization in children due to PM2.5, PM10, SO2 and NO2 increased by 1.089 (95%CI:1.075, 1.103), 1.018 (95%CI:1.014, 1.021), 1.186 (95%CI:1.154. 1.219) and 1.149 (95%CI:1.130, 1.168), respectively.

Conclusions

PM2.5, PM10, SO2 and NO2 short-term exposures were positively associated with ALRI, pneumonia and bronchiolitis hospitalizations in Lanzhou, China. Local governments should make efforts to improve urban ambient air quality conditions to reduce hospitalization rates for childhood respiratory diseases.