bluuebunny/crossref_metadata_2025 huggingface dataset:
Core shift in parabolic accelerating jets
Authors: Nokhrina E E , Pushkarev A B
Published: January 2024

The core-shift method is a powerful method to estimate the physical parameters in relativistic jets from active galactic nuclei. The classical approach assumes a conical geometry of jets and a constant plasma speed. However, recent observations have shown that neither may hold close to the central engine, where the plasma in the jet is effectively accelerating and the jet geometry is quasi-parabolic. We modify the classical core-shift method to account for these jet properties. We show that the core-shift index may assume values in the range 0.8−1.2 or 0.53−0.8 depending on the jet geometry and viewing angle, and indices close to both values are indeed observed. We obtain expressions to estimate the jet magnetic field and the total magnetic flux in a jet. We show that the obtained magnetic field value can be easily recalculated down to the gravitational radius scale. For M87 and NGC 315, these values are in good agreement with those obtained by different methods.
Best practices for the execution, analysis, and data storage of plant single-cell/nucleus transcriptomics
Authors: Grones Carolin , Eekhout Thomas , Shi Dongbo , Neumann Manuel , Berg Lea S , Ke Yuji , Shahan Rachel , Cox Kevin L , Gomez-Cano Fabio , Nelissen Hilde , Lohmann Jan U , Giacomello Stefania , Martin Olivier C , Cole Benjamin , Wang Jia-Wei , Kaufmann Kerstin , Raissig Michael T , Palfalvi Gergo , Greb Thomas , Libault Marc , De Rybel Bert
Published: January 2024

Single-cell and single-nucleus RNA-sequencing technologies capture the expression of plant genes at an unprecedented resolution. Therefore, these technologies are gaining traction in plant molecular and developmental biology for elucidating the transcriptional changes across cell types in a specific tissue or organ, upon treatments, in response to biotic and abiotic stresses, or between genotypes. Despite the rapidly accelerating use of these technologies, collective and standardized experimental and analytical procedures to support the acquisition of high-quality data sets are still missing. In this commentary, we discuss common challenges associated with the use of single-cell transcriptomics in plants and propose general guidelines to improve reproducibility, quality, comparability, and interpretation and to make the data readily available to the community in this fast-developing field of research.
Lateral gating mechanism and plasticity of the β-barrel assembly machinery complex in micelles and Escherichia coli
Authors: Gopinath Aathira , Rath Tobias , Morgner Nina , Joseph Benesh
Published: January 2024

The β-barrel assembly machinery (BAM) mediates the folding and insertion of the majority of outer membrane proteins (OMPs) in gram-negative bacteria. BAM is a penta-heterooligomeric complex consisting of the central β-barrel BamA and four interacting lipoproteins BamB, C, D, and E. The conformational switching of BamA between inward-open (IO) and lateral-open (LO) conformations is required for substrate recognition and folding. However, the mechanism for the lateral gating or how the structural details observed in vitro correspond with the cellular environment remains elusive. In this study, we addressed these questions by characterizing the conformational heterogeneity of BamAB, BamACDE, and BamABCDE complexes in detergent micelles and/or Escherichia coli using pulsed dipolar electron spin resonance spectroscopy (PDS). We show that the binding of BamB does not induce any visible changes in BamA, and the BamAB complex exists in the IO conformation. The BamCDE complex induces an IO to LO transition through a coordinated movement along the BamA barrel. However, the extracellular loop 6 (L6) is unaffected by the presence of lipoproteins and exhibits large segmental dynamics extending to the exit pore. PDS experiments with the BamABCDE complex in intact E. coli confirmed the dynamic behavior of both the lateral gate and the L6 in the native environment. Our results demonstrate that the BamCDE complex plays a key role in the function by regulating lateral gating in BamA.
Using Social Media to Identify the Effects of Congressional Viewpoints on Asset Prices
Authors: Bianchi Francesco , Gómez-Cram Roberto , Kung Howard
Published: January 2024

We use a high-frequency identification approach to document that individual politicians affect asset prices. We exploit the regular flow of viewpoints contained in Congress members’ tweets. Supportive (critical) tweets increase (decrease) the stock prices of the targeted firm and the corresponding industry in minutes around the tweet. The bulk of the stock price effects is concentrated in the tweets revealing news about future legislative action. The effects are amplified around committee meeting days, especially when the tweet originates from committee members and influential politicians. Overall, we show that Congress members’ social media accounts are an important source of political news.
Shorter total sleep time is associated with lower CD4+/CD8+ T cell ratios in virally suppressed men with HIV
Authors: Borker Priya V , Macatangay Bernard J , Margolick Joseph B , Punjabi Naresh M , Rinaldo Charles R , Stosor Valentina , Hyong-Jin Cho Joshua , McKay Heather , Patel Sanjay R
Published: January 2024

Study Objectives

Although poor sleep quality is associated with lower CD4+ T cell counts among people living with HIV (PLWH), the association between objective sleep metrics and T lymphocyte subset counts is unknown. We evaluated the association between polysomnography (PSG) derived sleep metrics and T lymphocyte subpopulations in a cohort of men living with HIV.

Methods

Virally suppressed men living with HIV participating in the Multicenter AIDS Cohort Study underwent home overnight PSG. We assessed the association of PSG parameters with CD4+ and CD8+ T cell counts and the CD4+/CD8+ T cell ratio.

Results

Overall, 289 men with mean (±SD) age 55.3 ± 11.3 years and mean CD4+ T cell count 730 ± 308 cells/mm3 were evaluated. Total sleep time (TST) was significantly associated with CD8+ but not CD4+ T cell counts. After adjusting for age, race, depressive symptoms, antidepressant use, and non-nucleoside reverse transcriptase inhibitors use, every hour of shorter TST was associated with an additional 33 circulating CD8+ T cells/mm3 (p = 0.05) and a 5.6% (p = 0.0007) decline in CD4+/CD8+ T cell ratio. In adjusted models, every hour of shorter rapid eye movement (REM) sleep was associated with an additional 113 CD8+ T cells/mm3 (p = 0.02) and a 15.1% lower CD4+/CD8+ T cell ratio (p = 0.006). In contrast, measures of sleep efficiency and sleep-disordered breathing were not associated with differences in T lymphocyte subpopulations.

Conclusions

Our findings suggest that shorter TST and REM sleep durations are associated with differences in T lymphocyte subpopulations among men living with HIV. Addressing sleep may reflect a novel opportunity to improve immune function in PLWH.
Evaluating the National Action Plan (NAP) on antimicrobial resistance, and recommendations for the next 5-year NAP: a roundtable discussion
Authors: Neale Daisy , Cullen Lucky
Published: January 2024

The UK’s current 5-year National Action Plan (NAP) on tackling antimicrobial resistance (AMR), which runs from 2019 to 2024, is coming to an end. As such, the next 5-year NAP is currently under development, and progress made towards the UK’s commitments on AMR is being analysed. This analysis has involved the publication of an addendum to the current NAP, which includes some new and revised commitments. Applied Microbiology International (AMI) held a roundtable discussion in November 2022, inviting UK experts from across the human and animal sectors to discuss their thoughts on progress to date, as well as any recommendations and key considerations they thought should be taken forward. Overall, it was agreed that there is a major disparity between the increasing ambitions of the NAP, and the reducing financial support for achieving said ambitions. The gap between evidence generation and implementing recommendations into real-world settings also presents a key challenge to overcome, if the NAPs commitments are to be achieved. A lack of communication and funding appear to underpin many of the barriers that prevent the successful delivery of current NAP commitments and are therefore highlighted as key areas of concern for policymakers to consider when looking to tackle AMR. The focus should be on successfully implementing and delivering the current NAP commitments ahead of identifying future ambitions.
When two worlds collide: digital assets and your estate plan
Authors: Meyer Christo
Published: January 2024

With the digital world being forced to interact with the physical world when it comes to death and the transfer/succession of asset ownership, we currently have two very different worlds colliding. Even in our technology-focused world, people’s estate plans still only account for “traditional” assets, like a car, bank account, house, etc., whereas more and more individuals own digital assets. Planning for digital assets is much more involved than one may think; different laws and classifications of digital assets make planning for these types of assets very specialized, as you are working with a real risk that a digital asset may be lost forever.
Anticancer activity of zinc oxide nanoparticles on prostate and colon cancer cell line
Authors: Motafeghi Farzaneh , Mortazavi Parham , Shokrzadeh Mohammad
Published: January 2024

Introduction

Considering the numerous drug resistance in cancer and the advancement of science in nanomedicines, it was decided to compare the effectiveness of zinc oxide nanoparticles in colon and prostate cell lines. Considering the importance of factors and Oxidative stress pathways in cancer prevention, the aim of the study is based on oxidative stress mechanisms.

Methodes

In order to evaluate the effects of zinc oxide nanoparticles on colon and prostate cell lines, oxidative stress factors ROS, MDA, and GSH and mitochondrial function were evaluated. The data was analyzed with Prism v8 software, and the significance level was considered to be P < 0.05.

Results

The results showed that nanoparticles induce ROS and reduce intracellular glutathione by destroying and disrupting mitochondrial function, and by increasing ROS production, damage to the lipid membrane and an increase in MDA were also evident. This effect was dose-dependent and the greatest at a concentration of 25 μg/mL. Also, ZnO nanoparticles performed better in the HT29 cell line than in the PC3 cell line.

Conclusion

This study showed that exposure of HT29 and PC3 cancer cells to zinc oxide nanoparticles at different concentrations inhibited growth by cytotoxic effects.
Mitochondrial impairment related to the immunotoxicity of the herbicides clomazone, glyphosate and sulfentrazone in THP-1 cells
Authors: Cestonaro Larissa Vivan , da Silva Artur Christian Garcia , Garcia Solange Cristina , Valadares Marize Campos , Arbo Marcelo Dutra
Published: January 2024

Background

Pesticides are indispensable for the cultivation of crops, especially those of economic importance, such as soybeans. Data on the annual use of herbicides in crops show that they correspond to 50%, making it the most used in agriculture.

Aim

Therefore, the aim of this study was to evaluate the toxicity of the three commercial herbicides (clomazone, glyphosate, and sulfentrazone) in THP-1 cells.

Methods

Cells were incubated with 0–5,000 mg/L of the herbicides for 24 h at 37 °C for cytotoxicity evaluation. Additionally, a few toxicological pathways such as reactive species generation, mitochondrial impairment, and interleukin profile, which have been previously involved in the toxicity of pesticides, were also evaluated.

Results

A potential immunotoxic effect of the herbicides on THP-1 cells was observed, especially glyphosate, as it is a powerful agent of cellular immunotoxicity. It was also possible to verify an increase in oxidative stress and IL-8 levels and mitochondrial dysfunction.

Conclusion

All herbicides showed cytotoxic effects in THP-1 monocytes, which were related to mitochondrial impairment.
NextGenerationEU: Hamiltonian moment or European New Deal?
Authors: Van Malleghem Pieter-Augustijn
Published: January 2024

During the coronavirus disease (COVID-19) pandemic, the European Union (EU) took the unprecedented step of borrowing 750 billion euros on capital markets, part of which was to be spent in the form of grants. As prior interpretations of the Union’s constitution tended to suggest that it had no power for deficit spending, NextGenerationEU (NGEU) arguably constitutes a major constitutional transformation for the Union. As so often in the literature on the EU, the comparison was made with the federal system of the USA: Commentators likened the Union’s constitutional transformation to the transformation engineered by Hamilton, the financial founding father of the USA, as well as Roosevelt’s New Deal. When the USA was teetering on the brink of bankruptcy, Hamilton transformed the landscape of public debt in the USA by proposing to restructure and assume the debt of the states on the balance sheet of the federal government. For the first time, the public debt of the federal government of the USA played a critical role in its economy. The Great Depression prompted another transformation for the finances of the USA. Roosevelt promised his voters to bring back economic growth. During Roosevelt’s tenure in office, the public borrowing of the USA went up significantly. This contribution examines the constitutional controversies provoked by Hamilton’s and Roosevelt’s transformative policies. It argues that, in spite of some similarities, the question of the constitutionality of deficit spending was controversial neither in Hamilton’s nor in Roosevelt’s day. More fundamentally, it argues that both Roosevelt and Hamilton had a transformative vision for the economy not shared by NGEU.
Whole-Genome Sequence of Colletotrichum brevisporum Causing Anthracnose on Papaya (Carica papaya)
Authors: Yang Min , Zhou Chenping , Kuang Ruibin , Wu Xiaming , Wei Yuerong
Published: January 2024

Colletotrichum spp. are the causal agents of papaya anthracnose, which seriously affects the quality and economic value of papaya fruits. Among them, Colletotrichum brevisporum is a new and important causal pathogen of anthracnose in papaya. The infection mechanisms of C. brevisporum are still unclear, and the genome sequence of C. brevisporum has not been released. In order to systemically explore the interaction between papaya and C. brevisporum, we sequenced the whole genome of the C. brevisporum strain C1, which was isolated from an infected papaya fruit in Guangdong Province, China. The assembly consists of 18 scaffolds with a genome size of 62.66 Mb. Furthermore, we identified genes that may be associated with pathogenicity, such as carbohydrate-active enzymes, secreted proteins, and secondary metabolite gene clusters. This genome resource will provide a valuable resource for future studies on the pathogenesis of C. brevisporum and comparative genomic analyses of the Colletotrichum genus.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Targeting ENPP1 depletion may be a promising therapeutic strategy for treating oral squamous cell carcinoma via cytotoxic autophagy‐related apoptosis
Authors: Ma Chao , Zhao Jizhi , Zhou Lian , Jia Congwei , Shi Yanping , Li Xing , Jihu Kedi , Zhang Tao
Published: January 2024

ENPP1 depletion closely related with modulation immunotherapy of several types of cancer. However, the role of ENPP1 correlation with autophagy in oral squamous cell carcinoma (OSCC) pathogenesis remain unknown. In this study, effects of ENPP1 on OSCC cells in vitro were examined by cell proliferation assay, transwell chamber assay, flow cytometry analysis and shRNA technique. Cellular key proteins related to cell autophagy and apoptosis were evaluated by Western blot and immunofluorescent staining. Moreover, functions of ENPP1 on OSCC process were observed in nude mouse model. We reported that overexpression of ENPP1 promote the growth of OSCC cell xenografts in nude mouse model. In contrast, ENPP1 downregulation significantly inhibits OSCC cancer growth and induces apoptosis both in vitro and in vivo, which are preceded by cytotoxic autophagy. ENPP1downregulation induces a robust accumulation of autophagosomes, increases LC3B‐II and decreases SQSTM1/p62 in ENPP1‐shRNA‐treated cells and xenografts. Mechanistic studies show that ENPP1 downregulation increases PRKAA1 phosphorylation leading to ULK1 activation. AMPK‐inhibition abrogates ENPP1 downregulation‐induced ULK1‐activation, LC3B‐turnover and SQSTM1/p62‐degradation while AMPK‐activation potentiates it's effects. Collectively, these data uncover that ENPP1 downregulation induces autophagic cell death in OSCC cancer, which may provide a potential therapeutic target for the treatment of OSCC.
An update on managing patients with multiple sclerosis in primary care
Authors: Hardeman Paula
Published: January 2024

Multiple sclerosis (MS) is an immune-mediated inflammatory condition of the central nervous system causing periods of recurring inflammation and ultimately progression of symptoms over time. MS is a common cause of disability in younger patients. Evidence-based treatment for patients with MS early in their disease course prevents relapses and delays progression. Early treatments for MS were classified as immune-modulating; newer developments that suppress the immune system are more effective in preventing future relapses and progression but carry risks. The increased use of immunosuppressant therapies for patients with MS makes it imperative for clinicians to understand potential risks, benefits, and serious adverse reactions related to these therapies.
A Genome-Wide Association Study of Serum Metabolite Profiles in Septic Shock Patients
Authors: Daubney Emily R. , D’Urso Shannon , Cuellar-Partida Gabriel , Rajbhandari Dorrilyn , Peach Elizabeth , de Guzman Erika , McArthur Colin , Rhodes Andrew , Meyer Jason , Finfer Simon , Myburgh John , Cohen Jeremy , Schirra Horst Joachim , Venkatesh Balasubramanian , Evans David M.
Published: January 2024

OBJECTIVES:

We sought to assess whether genetic associations with metabolite concentrations in septic shock patients could be used to identify pathways of potential importance for understanding sepsis pathophysiology.

DESIGN:

Retrospective multicenter cohort studies of septic shock patients.

SETTING:

All participants who were admitted to 27 participating hospital sites in three countries (Australia, New Zealand, and the United Kingdom) were eligible for inclusion.

PATIENTS:

Adult, critically ill, mechanically ventilated patients with septic shock (n = 230) who were a subset of the Adjunctive Corticosteroid Treatment in Critically Ill Patients with Septic Shock trial (ClinicalTrials.gov number: NCT01448109).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A genome-wide association study was conducted for a range of serum metabolite levels for participants. Genome-wide significant associations (p ≤ 5 × 10–8) were found for the two major ketone bodies (3-hydroxybutyrate [rs2456680] and acetoacetate [rs2213037] and creatinine (rs6851961). One of these single-nucleotide polymorphisms (SNPs) (rs2213037) was located in the alcohol dehydrogenase cluster of genes, which code for enzymes related to the metabolism of acetoacetate and, therefore, presents a plausible association for this metabolite. None of the three SNPs showed strong associations with risk of sepsis, 28- or 90-day mortality, or Acute Physiology and Chronic Health Evaluation score (a measure of sepsis severity).

CONCLUSIONS:

We suggest that the genetic associations with metabolites may reflect a starvation response rather than processes involved in sepsis pathophysiology. However, our results require further investigation and replication in both healthy and diseased cohorts including those of different ancestry.
Core Descriptor Sets for Rectal Prolapse Outcomes Research Using a Modified Delphi Consensus
Authors: Gurland Brooke H. , Olson Craig H. , McCarthy Madison S ,   Pelvic Floor Disorders Consortium Work Group, Bordeianou Liliana G.
Published: January 2024

BACKGROUND:

There is wide variation for prolapse care.

OBJECTIVE:

To determine core descriptor sets for rectal prolapse to enhance outcomes research.

DESIGN:

Descriptors for patients undergoing rectal prolapse surgery were generated through a systematic review and expert opinion. Stakeholders were recruited internationally via list-serve and social media. Experts were encouraged to consider the minimum descriptors that could be considered during clinical care, and descriptors were grouped into core descriptor sets. Consensus was defined as > 70% agreement.

SETTING:

A three-round Delphi process using a 9-point Likert scale based on expert results was distributed via survey. The final interactive meeting used a polling platform.

PARTICIPANTS:

The Pelvic Floor Disorders Consortium interdisciplinary group convened to advance the clinical care of pelvic floor disorders.

MAIN OUTCOME MEASURES:

To achieve expert consensus for core descriptor sets for rectal prolapse using a modified Delphi method.

RESULTS:

A total of 206 providers participated with survey response rates of 82% and 88% respectively. Responders were from North America 56%, Europe 29%, and Latin America, Asia, Australia, New Zealand, and Africa 15%. Ninety-one percent identified as colorectal surgeons and 80% reported more than 5 years of experience (35% > 15 years). Fifty-seven attendees participated in the final meeting and voted on core descriptor sets. Ninety-three percent agreed that descriptors such as age, body mass index, frailty, nutrition, and American Society of Anesthesiology Score correlated to physiologic status. One hundred percent agreed to include baseline bowel function. 100% reported willingness to complete a synoptic operative report. Follow-up intervals 1,3,5 year after surgery (76%) with a collection of recurrence, and functional outcomes at those time periods reached an agreement.

LIMITATIONS:

Individual bias, self-identification of experts, and paucity of the knowledge related to rectal prolapse.

CONCLUSIONS:

This represents the first steps toward international consensus to unify language and data collection processes for rectal prolapse. See Video Abstract.
A Comparison of Preoperative Telephone Call Versus Mailed Educational Materials on Patient-Reported Outcomes in Mohs Micrographic Surgery
Authors: Taylor Savannah L. , Quan Eugenie Y. , Lockhart Ellen Rachel S. , Prickett Kyle A. , Phillips Mariana A.
Published: January 2024

BACKGROUND

Preoperative education has uncertain benefits on the preparedness and satisfaction of patients undergoing Mohs micrographic surgery (MMS).

OBJECTIVE

We sought to determine the effect of a preoperative telephone call on preparedness and satisfaction in patients undergoing same-day office consultation and MMS.

MATERIALS AND METHODS

All new patients (N = 208) scheduled for same-day office consultation and MMS were mailed a standardized preoperative packet. Approximately half of those patients were randomly selected to also receive a preoperative phone call. On the day of the surgery, patients completed an anonymous preoperative and postoperative survey assessing their preparedness and satisfaction with the preoperative education received.

RESULTS

There was no significant difference in patient preparedness between the letter only (LO) and phone call and letter study groups. There was a significant difference in preoperative satisfaction—a higher percentage of LO patients were “somewhat satisfied” or “not satisfied” with the preoperative education received (p = .013).

CONCLUSION

Preoperative phone consultation, in addition to mailed educational materials, did not have a statistically significant effect on patient preparedness in patients undergoing MMS; however, there was a trend toward increased satisfaction with the preoperative education provided in patients who received a preoperative phone call.
Bridging research-policy gaps: An integrated approach
Authors: Khomsi Kenza , Bouzghiba Houria , Mendyl Abderrahmane , Al-Delaimy Ahmed K. , Dahri Amal , Saad-Hussein Amal , Balaw Ghada , El Marouani Ihssane , Sekmoudi Imane , Adarbaz Mouaad , Khanjani Narges , Abbas Nivine
Published: January 2024

It is often difficult for policymakers to make informed decisions without evidence-based support, resulting in potentially ineffective policies. The purpose of this article is to advocate for collaboration and communication between researchers and policymakers to enhance evidence-based policymaking. The workshop hosted by the International Society of Environmental Epidemiology—Eastern Mediterranean Chapter further explores the challenges of connecting researchers and policymakers. The article highlights the gap between researchers and policymakers, attributed to different visions and objectives, time constraints, and communication issues. To strengthen the research-policy interface, strategies such as enhanced communication skills and early involvement of policymakers in research are suggested. The article proposes an integrated model combining the Collaborative Knowledge Model and the policy entrepreneurship mindset, emphasizing the co-creation of knowledge and evidence-based policy solutions. The use of this model can lead to the development of evidence-based policies that effectively address societal needs.
The Fragility of Landmark Randomized Controlled Trials in the Plastic Surgery Literature
Authors: Ormseth Benjamin H. , ElHawary Hassan , Janis Jeffrey E.
Published: January 2024

Background:

Randomized controlled trials (RCTs) are integral to the progress of evidenced-based medicine and help guide changes in the standards of care. Although results are traditionally evaluated according to their corresponding P value, the universal utility of this statistical metric has been called into question. The fragility index (FI) has been developed as an adjunct method to provide additional statistical perspective. In this study, we aimed to determine the fragility of 25 highly cited RCTs in the plastic surgery literature.

Methods:

A PubMed search was used to identify the 25 highest cited RCTs with statistically significant dichotomous outcomes across 24 plastic surgery journals. Article characteristics were extracted, and the FI of each article was calculated. Additionally, Altmetric scores were determined for each study to determine article attention across internet platforms.

Results:

The median FI score across included studies was 4 (2–7.5, interquartile range). The two highest FI scores were 208 and 58, respectively. Four studies (16%) had scores of 0 or 1. Three studies (12%) had scores of 2. All other studies (72%) had FI scores of 3 or higher. The median Altmetric score was 0 (0–3).

Conclusion:

The FI can provide additional perspective on the robustness of study results, but like the P value, it should be interpreted in the greater context of other study elements.
Improving the Lives of Women With Ovarian Cancer
Authors: KARLAN BETH Y.
Published: January 2024

Being a gynecologic oncologist is a privilege. Women with cancer address their challenges with grit and resilience. Their most basic questions motivated my career-long search for scientific answers hidden in genetics, novel therapeutics, and cancer prevention. But medicine is a team sport. Working alongside gifted colleagues and mentoring trainees to assume starring roles on the team has sustained and enriched my career. Advocating for patients and the specialty of gynecologic oncology provided another means to advance research and cancer awareness to improve patient outcomes. The author believe the most exciting times are yet to come.
Seasonal variation in ambulatory blood pressure control in patients on clinic blood pressure-guided antihypertensive treatment
Authors: Ye Xiao-Fei , Wang Wen-Yuan-Yue , Wang Xin-Yu , Huang Qi-Fang , Sheng Chang-Sheng , Li Yan , Wang Ji-Guang
Published: January 2024

Background:

We investigated seasonal variation in ambulatory blood pressure control in hypertensive patients on clinic blood pressure-guided antihypertensive treatment.

Methods:

The study participants were hypertensive patients enrolled in an 8-week therapeutic study. Antihypertensive treatment was initiated with long-acting dihydropyridine calcium channel blockers amlodipine 5 mg/day or the gastrointestinal therapeutic system (GITS) formulation of nifedipine 30 mg/day, with the possible up-titration to amlodipine 10 mg/day or nifedipine-GITS 60 mg/day at 4 weeks of follow-up.

Results:

The proportion of up-titration to higher dosages of antihypertensive drugs at 4 weeks of follow-up was higher in patients who commenced treatment in autumn/winter (n = 302) than those who commenced treatment in spring/summer (n = 199, 24.5 vs. 12.0%, P < 0.001). The control rate of clinic blood pressure, however, was lower in autumn/winter than in spring/summer at 4 (56.7 vs. 70.7%, P = 0.003) and 8 weeks of follow-up (52.5 vs. 74.9%, P < 0.001). At 8 weeks, patients who commenced treatment in autumn/winter, compared with those who commenced treatment in spring/summer, had a significantly (P≤0.03) smaller daytime (mean between-season difference -3.2/-2.8 mmHg) but greater nighttime SBP/DBP reduction (3.6/1.6 mmHg). Accordingly, at 8 weeks, the prevalence of nondippers was significantly (P < 0.001) higher in spring/summer than in autumn/winter for both SBP (54.8 vs. 30.0%) and DBP (53.4 vs. 28.8%).

Conclusion:

Clinic blood pressure-guided antihypertensive treatment requires a higher dosage of medication in cold than warm seasons, which may have led to over- and under-treatment of nighttime blood pressure, respectively.
Blood pressure and variability responses to the down-titration of antihypertensive drugs
Authors: Kim Byung Sik , Lee Yonggu , Shin Jeong-Hun , Heo Ran , Kim Hyun-Jin , Shin Jinho
Published: January 2024

Objectives:

Several recent guidelines have proposed the gradual reduction of antihypertensive drugs for patients with well controlled blood pressure (BP). However, no studies have examined alterations in BP variability (BPV) during the down-titration of antihypertensives. This study aims to investigate changes in home BPV during the down-titration of antihypertensives.

Methods:

We analyzed 83 hypertensive patients who underwent down-titration of antihypertensives and had available home BP data during the down-titration. Down-titration was performed when home SBP was less than 120 mmHg, regardless of the clinic SBP. Primary exposure variable was the standard deviation (SD) of home BP.

Results:

Among 83 patients (mean age 66.3 ± 11.9 years; 45.8% men), down-titration led to increase home SBP (from 110.5 to 118.7 mmHg; P < 0.001), and home DBP (from 68.8 to 72.8 mmHg; P = 0.001) significantly. There were no significant differences in SDs of SBP [from 6.02 ± 3.79 to 5.76 ± 3.09 in morning, P = 0.570; from 6.13 ± 3.32 to 6.63 ± 3.70 in evening, P = 0.077; and from 6.54 (4.80, 8.31) to 6.37 (4.65, 8.76) in home SBP, P = 0.464] and SDs of DBP during the down-titration of antihypertensive drugs.

Conclusion:

Down-titration of antihypertensive drugs did not have notable impact on clinic BP and home BPV, while significantly increasing home BP. These findings provide important insights indicating that the potential concern related to an increase in BPV in the planned strategy of reducing antihypertensive drugs is not substantial.
P-ANCA Vasculitis Presenting with Orbital Infiltration
Authors: Yoo Kristy G. , Abella-Ayala Frank , Lerner Alexander , Kwok Alyssa , Chang Jessica R.
Published: January 2024

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) may affect the eye or orbit, and ophthalmic manifestations of AAV are associated with higher mortality than other inflammatory eye diseases. Perinuclear ANCA (p-ANCA) vasculitis is an uncommon cause of orbital inflammation. A 70-year-old woman with chronic kidney disease presented with a 1-year history of orbital mass and edema around her OD. Fundoscopy revealed 360° optic disc elevation OD. MRI orbits showed an infiltrative, intra- and extraconal lesion extending through the right orbital apex to the cavernous sinus. Labwork and orbital biopsy were consistent with p-ANCA vasculitis, and the patient’s ocular symptoms improved after methylprednisolone. Diagnosis of AAV is complicated by a wide diversity of symptoms, and this case highlights an unusual presentation of p-ANCA vasculitis in the orbit. Ophthalmologists have an important role in diagnosing systemic conditions such as AAV by initiating the proper inflammatory workup.
Isolated Ophthalmoplegia After Periorbital Hyaluronic Acid Filler Injection
Authors: Bruce Carleigh N. , Esmaili Neda
Published: January 2024

Facial filler injections are the second most commonly performed in-office cosmetic procedure. Vision loss is the most feared complication of hyaluronic acid (HA) filler injection, but isolated ophthalmoplegia can also occur. We report the case of a 45-year-old woman who developed nausea and diplopia following HA filler injection to the bilateral periorbital region. She presented with a left hypertropia and left-sided motility deficit without vision involvement. MRI of the orbits demonstrated mild enhancement and enlargement of the left inferior rectus and inferior oblique muscles. Treatment consisted of hyaluronidase injection and oral steroids. HA filler can cause isolated ocular misalignment and diplopia without associated vision loss. Patients should be counseled on these risks before undergoing soft tissue augmentation of the face with HA filler.
Soft Tissue Robotic Assisted Orbital Surgery Using da Vinci SP: A Cadaveric Experience
Authors: Faulkner Jack , Malik Mohsan , Daniel Claire , Uddin Jimmy , Arora Asit , Stein Hubert , Jeannon Jean-Pierre
Published: January 2024

Purpose:

Robotic surgical techniques have transformed many surgical specialties however robotic techniques and applications have been much more limited in ophthalmology. This study aims to evaluate the feasibility of robotic assisted orbital surgery using a single-port novel robotic platform, the da Vinci SP.

Methods:

A series of orbital procedures were performed in cadaveric specimens utilizing the da Vinci SP robotic system. The procedures performed included lacrimal gland dissection and biopsy, medial and lateral orbital wall dissections, enucleation, and lid-sparing orbital exenteration. Successful completion of each procedure was defined by the operating surgeon and was considered the primary outcome and marker of feasibility.

Results:

Seven cadaveric procedures were performed in 3 cadaveric specimens. All 7 procedures were completed successfully without complication. Setup optimization occurred throughout the study and setup and operative times were acceptable. Three instrument arms and 1 endoscope were utilized throughout the study allowing 3 arm operating and dynamic retraction. Instrument size was found to limit surgical access and precision particular at the orbital apex.

Conclusions:

This preclinical study demonstrates that the da Vinci SP can be utilized within the orbit and is feasible for several applications. Robotic surgical systems offer significant advantages over conventional techniques and should be embraced. However, current commercially available robotic platforms are not optimized for the orbit and have their limitations although they may be suitable for some clinical applications.
Pneumococcal Aortitis
Authors: Shah Ali , Myers Joseph P.
Published: January 2024

Infectious aortitis, often leading to mycotic aortic aneurysm, is an uncommon disease. It is usually caused by either Staphylococcus aureus or Salmonella species. Streptococcus pneumoniae is rarely reported as a cause of aortitis. We report a patient with infectious aortitis in which S. pneumoniae was isolated in blood and tissue cultures from emergent open surgical intervention. A review of the literature suggests that pneumococcal aortitis is an emerging infectious disease with many more cases reported during the last 2 decades than in the previous 50 years. Of the cases reported since 2008, only 9 of 28 patients had an associated source for pneumococcal disease (pneumonia, meningitis, or endocarditis). Physicians should include infectious aortitis in the differential diagnosis of patients with primary pneumococcal bacteremia (no initial defined source).
Pharmacoepidemiology and Clinical Correlates of Lithium Treatment for Bipolar Disorder in Asia
Authors: Shuy Yao Kang , Santharan Sanjana , Chew Qian Hui , Lin Shih-Ku , Ouyang Wen-Chen , Chen Chih-Ken , Park Seon-Cheol , Jang Ok-Jin , Park Jun Hyuk , Chee Kok-Yoon , Ding Kwong Sen , Chong Jamaline , Zhang Ling , Li Keqing , Zhu Xiaomin , Jatchavala Chonnakarn , Pariwatcharakul Pornjira , Kallivayalil Roy A. , Grover Sandeep , Avasthi Ajit , Ansari Moin , Maramis Margarita M. , Aung Paing Phyo , Tan Chay Hoon , Xiang Yu-Tao , Chong Mian-Yoon , Park Yong Chon , Kato Takahiro A. , Shinfuku Naotaka , Baldessarini Ross J. , Sim Kang
Published: January 2024

Background

As clinical practices with lithium salts for patients diagnosed with bipolar disorder (BD) are poorly documented in Asia, we studied the prevalence and clinical correlates of lithium use there to support international comparisons.

Methods

We conducted a cross-sectional study of use and dosing of lithium salts for BD patients across 13 Asian sites and evaluated bivariate relationships of lithium treatment with clinical correlates followed by multivariate logistic regression modeling.

Results

In a total of 2139 BD participants (52.3% women) of mean age 42.4 years, lithium salts were prescribed in 27.3% of cases overall, varying among regions from 3.20% to 59.5%. Associated with lithium treatment were male sex, presence of euthymia or mild depression, and a history of seasonal mood change. Other mood stabilizers usually were given with lithium, often at relatively high doses. Lithium use was associated with newly emerging and dose-dependent risk of tremors as well as risk of hypothyroidism. We found no significant differences in rates of clinical remission or of suicidal behavior if treatment included lithium or not.

Conclusions

Study findings clarify current prevalence, dosing, and clinical correlates of lithium treatment for BD in Asia. This information should support clinical decision-making regarding treatment of BD patients and international comparisons of therapeutic practices.
Dyskeratosis congenita: beyond the triad and beyond the cause
Authors: Konda Deepthi , Mathurthi Gopi Krishna , Madhavarapu Praneeth Sai Santosh , Sakthivadivel Varatharajan , Kolavali Raghavendra Rao , Morya Arvind
Published: January 2024

Introduction:

Dyskeratosis congenita (DC) is a rare genodermatosis caused by mutations in various genes encoding the proteins responsible for maintaining the telomere length. It is defined by the presence of three clinical features: nail dystrophy, abnormal skin pigmentation, and oral leukoplakia.

We herein report a typical case of DC with all three classical features along with pancytopenia, osteopenia, and epiphora but with no identifiable pathogenic mutations of DC-associated genes.

Case presentation:

Cutaneous examination revealed areas of hypopigmented and hyperpigmented macules forming a reticular pattern all over the body but mainly over the neck and upper chest, with relative sparing of the face. Skin atrophy with hypopigmentation was observed on the knuckles. The nails showed dystrophy in the form of pterygium, anonychia, and brittleness. The palms showed mild wrinkling with hypopigmented macules. Examination of the oral cavity revealed a white non-removable coating over the tongue and bilateral buccal mucosae (oral leukoplakia); the teeth were normal. Syringing of both eyes was performed by an ophthalmologist, and the patient was diagnosed with punctual stenosis (occlusion of the opening of the lacrimal canaliculus).

Discussion:

DC is a genodermatosis caused by germline mutations in genes encoding telomerase-associated components, shelterin proteins, and other regulators of telomere length and replication. Depending upon the gene involved, the mode of inheritance can be X-linked autosomal dominant or autosomal recessive. DC is characterized by the clinical triad of abnormal skin pigmentation, dystrophic nails, and oral leukoplakia. Patients with DC are also known to develop other rare clinical features at later stages, including epiphora, early graying of the hair, premature tooth loss, enteropathy with malabsorption, immune deficiency, esophageal stricture, cardiomyopathy, liver cirrhosis, osteoporosis and avascular necrosis of the bone. Patients with DC are predisposed to the development of malignancies, especially hematological malignancies and head/neck cancer. Management of DC involves a multidisciplinary approach and includes genetic counseling of family members at risk, regular surveillance of the patient for bone marrow failure and malignancies, and treatment of the associated features and any complications.

Conclusion:

Dyskeratosis congenita (DC) is a rare genodermatosis caused by mutations in various genes encoding telomerase complex. We present a typical case of DC with all three classical features but with no pathogenic mutations of existing DC-associated genes thus raising the possibility of new unidentified genes in the pathogenesis of DC.
Extra-axial cerebellopontine angle nodular medulloblastoma mimicking meningioma: a case report with literature review
Authors: Mehta Aanand , Yadav Manish , Shilpakar Sushil K. , Bohara Sandip , Yadav Digraj
Published: January 2024

Introduction:

Medulloblastoma, a highly malignant embryonal tumor predominantly found in the pediatric population, typically arises within the cerebellum. This case report holds particular importance due to the rarity of medulloblastoma within the cerebellopontine angle (CPA). The distinct anatomical challenge posed by the CPA complex neurovascular structures, along with the absence of pathognomonic clinical or radiographic features, highlights the unique diagnostic and management challenge of this case.

Case presentation:

A 5-year-old boy presented with mild, progressively worsening headaches on CT/MRI imaging, which revealed a solid mass in the left CPA. Radiologically, the lesion closely resembled a CPA meningioma. The patient underwent a left retrosigmoid suboccipital craniectomy, utilizing a modified park bench position and careful burrhole creation. Intraoperatively, the tumor exhibited well-defined margins, firm adherence to cranial nerves, and complex tissue characteristics. Postoperatively, histopathological analysis identified nodular medulloblastoma, WHO grade IV, with immunohistochemical markers confirming its subtype.

Discussion:

This case highlights the critical role of surgical intervention in addressing rare tumors, emphasizing the need for multidisciplinary collaboration in both diagnosis and management to achieve a favorable outcome. Uncommon tumor locations, such as the CPA, require tailored approaches, and the utilization of advanced diagnostic techniques, including immunohistochemistry, aids in accurate subtype classification.

Conclusion:

This case highlights the critical role of surgical intervention in addressing rare tumors, emphasizing the need for multidisciplinary collaboration in both diagnosis and management to achieve a favorable outcome.
A survival case of high-dose amlodipine intoxication with non-cardiogenic pulmonary edema: a case report
Authors: Pant Pankaj , Shah Sangam , Bhattarai Ganesh , Dahal Krishna , Bista Navindra Raj , Bade Sahil , Chapagain Kshitij , Bade Sohail , Pant Sagar
Published: January 2024

Introduction:

Dihydropyridines calcium channel blockers at high dose can have conduction abnormalities, reduced inotropism, and non-cardiogenic pulmonary oedema (NCPE) which otherwise, at standard dosage have only vascular selectivity. They remain one of the commonly used anti-hypertensive exhibiting very lethal outcomes (50% mortality rates) in its overdose.

Case presentation:

The authors present a case of a 21-year-old male with amlodipine intoxication with 43 tabs of 10 mg (total of 430 mg) ingestion manifested by loss of consciousness, hypotension, tachycardia, and respiratory distress.

Discussion:

An amlodipine overdose causes refractory hypotension due to vasodilation and impaired cardiac metabolism and contractility. Further amlodipine toxicity can result in NCPE that manifests clinically as respiratory distress and low oxygen levels due to lung injury caused by inflammation and increased vascular permeability.

Conclusion:

This case report emphasizes the significance of early recognition and prompt treatment of amlodipine intoxication, which can result in serious complications like fluid overload and respiratory distress.
Emergency laparoscopy in underserved settings: optimizing diagnosis and management of appendicitis with ruptured hemorrhagic ovarian cyst
Authors: Abdallah Sary , Tarchichi Jana , Alabidin Ammasri Hussein Z. , Tarchichi Alaa , Moufawad Graziella
Published: January 2024

Introduction and importance:

Laparoscopy is an established widely available technique for diagnosis and management. However, due to its high maintenance and expensive use, it is not readily available in emergency settings especially in underserved area hospitals. The coincidence of gynecologic and nongynecologic surgical emergencies incurs a diagnostic dilemma especially in women of reproductive age presenting with acute abdominal pain.

Case presentation:

This article is a case report about a woman presenting with acute abdominal pain in an underserved area and diagnosed as appendicitis.

Clinical discussion:

Emergency laparoscopy is so rare in underserved areas due to its high maintenance costs as well as the lack of availability of well-trained surgeons and personnel. The exceptional availability of emergency laparoscopy in her case has allowed the codiagnosis of a ruptured hemorrhagic ovarian cyst with the optimal surgical management preventing the complications that could have occurred from misdiagnosing the coincident ruptured hemorrhagic cyst.

Conclusion:

Emergency laparoscopy is not always available in such clinical settings and has, in our case, optimized the management and prevented an undiagnosed ruptured hemorrhagic cyst together with its complications.
A rare case of schwannomatosis with meningioma: a case report
Authors: Neupane Saurav , Kashyap Ashutosh , Paudel Shreeram , Bhattarai Ganesh , Kharel Santosh K. , Adhikari Asim , Ghimire Ashim , Pokharel Simankan , Yadav Pratibha , Yadav Krishna K.
Published: January 2024

Introduction:

Schwannomatosis is characterized by multiple schwannomas without vestibular schwannomas or any other stigmata of neurofibromatosis type 2 (NF2). Schwannomatosis is a rare disorder, with a reported incidence ranging from 1 in 40 000 to 1 in 1.7 million. Meningioma is also associated with schwannomatosis in around 5% of cases.

Case presentation:

We describe a case of a 20-year-old female presenting with progressive weakness of the right lower limb for 7 months with a tingling sensation and numbness of the same limb for 6 months and was found to have schwannomatosis with multiple spinal and right cerebellopontine angle (CPA) (9th/10th cranial nerve) schwannomas and left anterior cranial fossa meningioma.

Discussion:

Schwannomas in schwannomatosis are seen along the cranial, spinal, and peripheral nerves but not along the vestibular nerve, as is characteristically seen in NF2. The occurrence of meningiomas is about 5% in individuals with schwannomatosis, and the patient in our case also had an associated meningioma. The tumor was confirmed to be a schwannoma based on features on an MRI examination and histological examination.

Conclusion:

It is of great significance to identify the entire spectrum of the disease in a patient with schwannomatosis, and to differentiate it from related conditions in order to track and surgically manage the patient appropriately based on symptomatology and imaging findings.