bluuebunny/crossref_metadata_2025 huggingface dataset:
Acupressure in the treatment of patients with mild infection of COVID-19 omicron variant: A prospectively observational study
Authors: Yang Qiqi , Jiang Tianxin , Ma Shouliang , Liu Wen , Wang Baoguo , Wang Jie , Chen Shaofei , Li Meng , Li Fei
Published: August 2023

During the coronavirus disease 2019 epidemic, acupressure has been widely used as a complementary treatment for coronavirus disease 2019 in China, but its safety and effectiveness have not been determined until now. This was a prospectively observational study containing 400 cases of mild infection of Omicron who were admitted to Chongming Flower Expo Makeshift Hospital from April 1, 2022 to May 1, 2022. Patients were assigned to receive basic treatment or a combination with acupressure treatment (5 minutes per acupoint, at least twice daily), from admission to discharge. The conversion time of viral RNA assay, the recovery time of symptoms and the clinical cure rate at day 7 were compared in 2 groups. All cases were included in the final analysis. The time to conversion of viral RNA assay (6 vs 7 days, P < .001) and time to symptom recovery (2 vs 4 days, P < .001) were markedly shortened in the acupressure treatment group compared to controls. The time to recovery from individual symptoms of coughing, a sore throat, a fever, fatigue, poor appetite, and insomnia were shorter in the treatment group compared to the control (all P < .05), but there was no statistical difference in reducing the recovery time from headache, muscle ache, anxiety, loss of taste between 2 groups (all P > .05). In addition, acupressure therapy also revealed a higher clinical cure rate at day 7 than basic treatment alone (91% vs 65%, P < .001) and reported no serious adverse events. This study provided evidence for acupressure therapy in treatment of Omicron infection concerning the viral load disappearance and the clinical symptoms improvements. Findings were expected to help guide efforts to position acupressure therapy as a therapeutic option for patients with Omicron variant.
Circadian rhythm in systemic autoimmune conditions: Potential of chrono-immunology in clinical practice: A narrative review
Authors: Awuah Wireko Andrew , Huang Helen , Kalmanovich Jacob , Mehta Aashna , Mikhailova Tatiana , Ng Jyi Cheng , Abdul-Rahman Toufik , Adebusoye Favour Tope , Tan Joecelyn Kirani , Kamanousa Karl , Ferreira Tomas , Roy Sakshi , Kundu Mrinmoy , Yarlagadda Rohan , Mukerjee Nobendu , Alexiou Athanasios , Papadakis Marios
Published: August 2023

The circadian rhythm (CR) is a fundamental biological process regulated by the Earth’s rotation and solar cycles. It plays a critical role in various bodily functions, and its dysregulation can have systemic effects. These effects impact metabolism, redox homeostasis, cell cycle regulation, gut microbiota, cognition, and immune response. Immune mediators, cycle proteins, and hormones exhibit circadian oscillations, supporting optimal immune function and defence against pathogens. Sleep deprivation and disruptions challenge the regulatory mechanisms, making immune responses vulnerable. Altered CR pathways have been implicated in diseases such as diabetes, neurological conditions, and systemic autoimmune diseases (SADs). SADs involve abnormal immune responses to self-antigens, with genetic and environmental factors disrupting self-tolerance and contributing to conditions like Systemic Lupus Erythematosus, Rheumatoid Arthritis, and Inflammatory Myositis. Dysregulated CR may lead to increased production of pro-inflammatory cytokines, contributing to the systemic responses observed in SADs. Sleep disturbances significantly impact the quality of life of patients with SADs; however, they are often overlooked. The relationship between sleep and autoimmune conditions, whether causal or consequential to CR dysregulation, remains unclear. Chrono-immunology investigates the role of CR in immunity, offering potential for targeted therapies in autoimmune conditions. This paper provides an overview of the connections between sleep and autoimmune conditions, highlighting the importance of recognizing sleep disturbances in SADs and the need for further research into the complex relationship between the CR and autoimmune diseases.
Treatment of malignant perivascular epithelioid cell tumor (PEComa) on the knee with an anterolateral thigh free flap: A case report
Authors: Lim Beom Jin , Roh Si-Gyun , Shin Jin Yong , Lee Nae-Ho , Chung Yoon Kyu , Jang Kyu Yun
Published: August 2023

Rationale:

The World Health Organization defines a perivascular epithelioid cell tumor (PEComa) as a mesenchymal neoplasia composed of perivascular epithelioid cells with characteristic morphological and immunohistochemical features. Although PEComas have the potential to behave in a malignant fashion, malignant PEComas are extremely rare.

Patient concerns:

An 83-year-old man visited our clinic presented with palpable, painless, and movable mass in the right knee area.

Diagnoses:

Malignant PEComa was diagnosed by incisional biopsy. No metastases was confirmed by radiologic imaging including PET/CT, magnetic resonance imaging, high resolution computed tomography.

Interventions:

We performed wide excision of the mass and used an anterolateral thigh free flap to reconstruct the defect on the right knee.

Outcomes:

The permanent histopathology showed malignant PEComa was totally resected. The flap which was performed to cover the defect was survived and the patient discharge without any complications.

Lessons:

PEComa can metastasize to various anatomical regions. Although there is no established standardized treatment, radical resection is still considered the cornerstone of treatment. Rapid and appropriate defect coverage is important to improve the patient’s prognosis.
Microcystic adnexal carcinoma of the eyelid and orbit: A case report and review of literature
Authors: Huang Shiwei , Xia Yang , Zhu Yueyang , Ren Zhiyuan , Dong Yaru
Published: August 2023

Microcystic adnexal carcinoma (MAC), a rare and low-grade malignant skin tumor, is characterized by a high rate of misdiagnosis and a preponderance for local recurrence, but seldom seen nodal or distant metastasis. Although MAC typically occurs almost in the head and neck region, primary eyelid or orbital MAC is very rare. To explore the unique characteristics of the eyelid and orbital MAC, we reviewed the relevant literature. Based on its distinctive anatomical location and the aggressive behavior, eyelid or orbital MAC not only exhibit a high rate of misdiagnosis and local recurrence, but also lead to serious complications such as disfigurement after orbital exenteration, paranasal sinuses or intracranial invasion, even death. Misdiagnosis of MAC commonly result from its rarity and nonspecific clinical and histopathological presentation. To reduce or avoid misdiagnosis, it is important to increase awareness for MAC and obtain a full-thickness biopsy specimen in histopathological analysis. Due to its extensive invasive growth pattern, MAC has a high rate of local recurrence, so complete excision with clear margins and long-term follow-up of patients with MAC are necessary. About those serious complications of the eyelid and orbital MAC, early and accurate diagnosis, complete excision is very important. Moreover, an interprofessional team consisting of ophthalmologist, otolaryngologist, neurologist, dermatologist, pathologist, radiologist is needed to evaluate and treat this disease. In summary, increasing awareness, early and accurate diagnosis, complete excision, long-term follow-up, and a multidisciplinary team is crucial for management of the eyelid and orbital MAC.
Ultrasonographic examination of the safe zone for medial needle approach towards the median-innervated flexor digitorum profundus muscle: Effect of changes in position of the forearm
Authors: Park Hyun Jin , Woo Sang Rok , Park Sun Jung , Yoon Joon Shik
Published: August 2023

The flexor digitorum profundus (FDP) is a forearm flexor muscle. Certain cases require the needle to be inserted accurately and safely into the deep, lateral portion of the FDP, which is innervated by the anterior interosseous nerve. In this study, we compared 2 techniques for approaching the median-innervated FDP (MFDP) medially, each according to the position of the forearm, supinated or pronated. The forearms of healthy volunteers without any musculoskeletal problems of the upper extremities were examined. Using high-resolution ultrasonography, the medial aspects of the forearms were scanned with elbows flexed at 90°. Using the images obtained, several parameters for distance and angle were measured in 2 different positions: forearm-supinated and forearm-pronated. Thirty-seven forearms from the volunteers were subject to examination. The angle α, which is the valid angle of insertion when approaching with the needle towards the deeply located MFDP, slightly increased from 22.89° to 23.41° when the forearm was pronated from the supinated position; however, this increase was not statistically significant. In contrast, the angle β, which is the safe angle of insertion when approaching with the needle towards the MFDP without contacting the ulnar nerve, was significantly increased from 41.40° to 46.80° upon forearm pronation. Because the safe angle of insertion of the needle medially into the MFDP increases with forearm pronation, the forearm-pronated position is recommended, instead of the forearm-supinated position, when inserting a needle into the MFDP in the medial aspect of the forearm.
Sacubitril/valsartan-induced liver injury: A case report and literature review
Authors: Zhang Ting , Cai Jin-lian , Yu Jie
Published: August 2023

Rationale:

Sacubitril/valsartan (Entresto) is the first drug approved for the treatment of symptomatic chronic heart failure with reduced ejection fraction in adult patients. There have been no reports of hepatotoxicity secondary to sacubitril/valsartan administration. Here, we report the first case of severe liver injury caused by sacubitril/valsartan.

Patient concerns:

A 90-year-old female patient taking sacubitril/valsartan was admitted due to chronic heart failure. Subsequently, the patient developed serious liver injury with increased hepatic transaminases.

Diagnosis:

Drug-induced liver injury, sacubitril/valsartan-related. No liver injury caused by other reasons was observed after thorough examination. After the withdrawal of sacubitril/valsartan, the liver function of the patient gradually returned to normal.

Interventions:

We chose general liver protection methods to improve her hepatic function, including magnesium isoglycyrrhizinate at 100 mg daily and polyene phosphatidylcholine capsules at 456 mg 3 times daily. We consulted with a hepatologist to discuss the best plan for her treatment. The last, we stopped sacubitril/valsartan.

Outcomes:

After the withdrawal of sacubitril/valsartan, the liver function of the patient gradually returned to normal.

Lessons:

Sacubitril/valsartan-induced liver injury is very rare. Clinicians should pay particular attention to the possibility of hepatotoxicity during sacubitril/valsartan treatment.
Occupational therapists views on addressing the sexuality of adult clients in rehabilitation settings: A qualitative focus group study
Authors: Hwang Na-Kyoung , Park Ji-Su , Shim Sun-Hwa
Published: August 2023

Sexuality is a common concern among people with disabilities or chronic conditions, and failure to address sexuality can lead to poorer rehabilitation outcomes. To explore the factors affecting addressing the sexuality of adult clients in clinical practice as perceived by Korean Occupational Therapists (OTs) and the perspective on what needs to be established to address sexuality in occupational therapy practice. This descriptive qualitative study using focus group interviews was conducted with 15 OTs providing rehabilitation services for adult clients in the post-onset maintenance phase or for outpatients in Seoul, South Korea. Data collected through focus groups were analyzed using the constant comparative method. The main factors influencing addressing clients sexuality in clinical practice were identified: “absence of institutional system for addressing sexuality in rehabilitation setting” for environmental factors; “lack of professional competency” for therapist-related factors; and “repressed sexuality” for client-related factors. Moreover, recognizing that “sexual health is one of the goals of rehabilitation” and prioritizing it in rehabilitation settings are essential. OTs must be “experts with knowledge and skills” to access the client’s sexuality, and “education and publicity” should be actively conducted to raise awareness of sexual health for clients. To deal with clients sexuality, institutional preparation should be prioritized under the recognition that sexual health is one of the goals of rehabilitation. In addition, it is necessary to prepare a relevant curriculum for OTs and create awareness so that clients can recognize improving sexual activity as a role of OTs.
Involvement of KLRK1 in immune infiltration of head and neck squamous cell carcinoma correlates with favorable prognosis
Authors: Tan Haosheng , Yang Huaiyu , Qian Jiaxin , Liu Shaoyan , Yan Dangui , Wei Liyuan , Liu Wensheng
Published: August 2023

Head and neck squamous cell carcinoma (HNSCC) is a malignancy commonly found in the head and neck region, with a low 5-year survival rate. Although immunotherapy has made significant progress, its efficacy in HNSCC treatment remains unsatisfactory. Killer cell lectin-like receptor K1 (KLRK1), a marker highly expressed in immune cells, can bind to its ligands expressed by cancer cells to exert its antitumor effect. However, the role of KLRK1 in HNSCC has yet to be studied extensively. This study aimed to explore the involvement of KLRK1 in immune infiltration of HNSCC and its correlation with prognosis. We analyzed KLRK1 expression data from the Cancer Genome Atlas database. The relationship between KLRK1 and immune cell infiltration has also been investigated. Finally, we analyzed the association between the expression of KLRK1 and its ligands and the prognosis of patients with HNSCC. We found that KLRK1 was highly expressed in HNSCC and correlated with better prognosis. KLRK1 expression was correlated with age, histological grade, HPV infection, pT, pN, pTNM stage, primary site, and survival status. High expression levels of KLRK1 have been linked to high levels of immune cell infiltration, particularly CD4/8 (+) T lymphocytes. Among the ligands of KLRK1, UL16 binding protein (ULBP) 1-3 showed high expression, which was associated with an increased risk of death. Notably, the expression of KLRK1 was negatively correlated with ULBP1-3. Patients with high levels of ULBP2/3 expression in tonsil carcinoma had poorer prognosis than those with low levels (P < .01), whereas ULBP1 expression levels had no significant effect on tonsil carcinoma prognosis (P = .770). The expression levels of ULBP1/3 were correlated with worse prognosis in patients with laryngeal cancer (P < .05), whereas there was no significant correlation between ULBP2 expression levels and overall survival (P = .269). Our study revealed that KLRK1 is highly expressed in HNSCC and is associated with a better prognosis and immune infiltration. Patients with high expression of KLRK1 ligands exhibited worse prognoses, possibly because of the expression of more soluble ligands.
Can remimazolam be safely used in cardiac tamponade?: A case report
Authors: Heo Hyun Joo , Kim Geonbo , Kim Yu Yil , Park Junyoung
Published: August 2023

Rationale:

Remimazolam, a benzodiazepine drug, has recently been developed and is currently used for the induction and maintenance of anesthesia. Remimazolam provides hemodynamic stability during anesthesia induction. However, in patients with cardiac tamponade, it is unclear how hemodynamic stability is maintained during the induction and maintenance of general anesthesia with remimazolam.

Patient concerns:

An 88-year-old male patient had developed hemopericardium due to penetration of a pigtail catheter into the left ventricle during pericardiocentesis, which was performed to treat massive pericardial effusion.

Diagnoses:

The patient was diagnosed with acute cardiac tamponade and a hemothorax. Hemopericardium and hemothorax were confirmed on chest radiography and computed tomography performed immediately after pericardiocentesis.

Interventions:

Decompressive pericardiostomy was performed through a left anterolateral thoracotomy with 1-lung ventilation under general anesthesia. Remimazolam was administered for total intravenous anesthesia.

Outcomes:

Severe hypotension and bradycardia occurred during the induction of anesthesia with remimazolam (6 mg/kg/hours).

Lessons:

Remimazolam may induce severe hemodynamic instability during induction of general anesthesia in patient with cardiac tamponade.
Sustained Response with Dose-reduced Selpercatinib in a Pediatric Patient with Metastatic NCOA4-RET Fusion Papillary Thyroid Carcinoma
Authors: Suydam Anna C. , Bach Alicia , Markovina Stephanie , Grigsby Perry , Sprague Jennifer , Armstrong Amy E.
Published: August 2023

Understanding the molecular landscape of papillary thyroid carcinoma (PTC), the most common thyroid cancer in children, creates additional therapeutic approaches. RET gene rearrangements are observed in pediatric PTC, and selective inhibition of RET is now possible with specific tyrosine kinase inhibitors designed to target diverse RET-activating alterations. We present a 13-year-old female with metastatic PTC, clinically resistant to radioactive iodine, and found to harbor a NCOA4-RET fusion. She responded to selpercatinib treatment with the elimination of supplemental oxygen need, marked reduction in pulmonary nodules and mediastinal lymphadenopathy, and biomarker decline. The response was maintained despite 2 dose reductions for possibly related weight gain.
Establishing a Statewide Wastewater Surveillance System in Response to the COVID-19 Pandemic: A Reliable Model for Continuous and Emerging Public Health Threats
Authors: Neyra Milagros , Hill Dustin T. , Bennett Lydia J. , Dunham Christopher N. , Larsen David A.
Published: August 2023

Context:

The COVID-19 pandemic sparked efforts across the globe to implement wastewater surveillance for SARS-CoV-2.

Program:

New York State (NYS) established the NYS Wastewater Surveillance Network to estimate the levels of COVID-19 community risk and to provide an early indication of SARS-CoV-2 transmission trends. The network is designed to provide a better understanding of public health burdens and to assist health departments to respond effectively to public health threats.

Implementation:

Wastewater surveillance across NYS increased from sporadic and geographically spare in 2020 to routine and widespread in 2022, reaching all 62 counties in the state and covering 74% of New Yorkers. The network team focused on engaging local health departments and wastewater treatment plants to provide wastewater samples, which are then analyzed through a network-affiliated laboratory. Both participating local health departments and wastewater treatment plants receive weekly memos on current SARS-CoV-2 trends and levels. The data are also made publicly available at the state dashboard.

Evaluation:

Using standard indicators to evaluate infectious disease surveillance systems, the NYS Wastewater Surveillance Network was assessed for accuracy, timeliness, and completeness during the first year of operations. We observed 96.5% sensitivity of wastewater to identify substantial/high COVID-19 transmission and 99% specificity to identify low COVID-19 transmission. In total, 80% of results were reported within 1 day of sample collection and were published on the public dashboard within 2 days of sample collection. Among participating wastewater treatment plants, 32.5% provided weekly samples with zero missing data, 31% missed 1 or 2 weeks, and 36.5% missed 3 or more weeks.

Discussion:

The NYS Wastewater Surveillance Network continues to be a key component of the state and local health departments' pandemic response. The network fosters prompt public health actions through real-time data, enhancing the preparedness capability for both existing and emerging public health threats.
Safety and Efficacy of the Sientra Silicone Gel Round and Shaped Breast Implants: 6-Year Results of the U.S. Postapproval Study
Authors: Calobrace M. Bradley , Schwartz Michael R. , Kaufman David L. , Gordon Ashley E. , Cohen Robert , Harrington Jennifer , Dajles Denise , Zeidler Kamakshi
Published: August 2023

Background:

After approval of Sientra silicone gel breast implants in March of 2012, the U.S. Food and Drug Administration required completion of a 10-year U.S. postapproval study. The authors present results from the first 6 years of this study.

Methods:

An ongoing, open-label, prospective, multicenter study is being conducted to evaluate the long-term clinical performance of Sientra implants in patients undergoing breast augmentation, reconstruction, and revision in the postmarket environment. Enrollment of 5197 patients (10,327 implants) was completed on March 6, 2015 (4046 primary augmentation, 895 revision-augmentation, 149 primary reconstruction, and 107 revision-reconstruction). Analyses were conducted at year 6 (database lock: January 24, 2022).

Results:

Across all cohorts who received an implant, the Kaplan-Meier risk of investigator-reported Baker grade III/IV capsular contracture was 4.1% (3.9% with submuscular placement and 6.75%with subglandular placement), the risk of reoperation was 11.6%, and the risk of implant removal was 7.8% (5.9% with implant replacement and 2.0% without replacement). The primary reason (>50%) for reoperation was aesthetic (eg, style/size change). The Kaplan-Meier risk of rupture, calculated for patients who underwent explantation or MRI for rupture evaluation, was 5.8%. Overall, 82.6% of patients were highly satisfied/happy with their implant. No cases of breast implant–associated anaplastic large cell lymphoma were reported.

Conclusion:

Six-year results of the postapproval study were consistent with the 10-year core study and provide additional evidence in a large data set supporting the comprehensive safety and effectiveness profile of the Sientra implants.
Measuring Outcomes in Aesthetic Surgery by Board Certified Plastic Surgeons
Authors: Colwell Amy S. , Ramly Elie P. , Chung Kevin C.
Published: August 2023

Aesthetic surgery is a visual specialty where plastic surgeons and patients work together to enhance or restore face and body harmony. The field of aesthetic surgery is advanced through descriptive technical procedures and outcomes research. With increasing competition in cosmetic medicine, aesthetic surgery stands to benefit from an evidence-based approach to document the high standards of care from board-certified plastic surgeons. In this article, we highlight challenges, current objective and subjective outcomes, and a path forward.
An Enigmatic Case of Skeletal Fluorosis
Authors: DeMarco Kara M. , Major Joshua W. , Young Colin R. , Hassantoufighi Arash
Published: August 2023

Skeletal fluorosis is more common in the developing world, but is occasionally seen in the United States. We present radiographic, scintigraphic, CT, and clinical images of a 26-year-old woman with rapidly progressive, debilitating, polyostotic periostitis, and diffuse osteosclerosis typical of skeletal fluorosis. Laboratory analyses supported this diagnosis. The source of excess fluoride intake was elusive until a concurrent mental health workup revealed the patient’s proclivity for inhaling air-duster cans containing difluoroethane. Difluoroethane inhalant abuse is an increasingly reported cause of skeletal fluorosis that astute clinicians should recognize. Discontinuation and sobriety from this toxic agent are essential for recovery.
Langerhans Cell Histiocytosis Showed Intense Uptake of 68Ga-FAPI
Authors: Pan Qingqing , Zhang Hongzhe , Cao Xinxin , Li Jian , Luo Yaping
Published: August 2023

A 23-year-old man was recently diagnosed with Langerhans cell histiocytosis (LCH). 68Ga-FAPI PET/CT showed multiple lesions with intense FAPI uptake in the axial and appendicular skeleton with lytic or mixed bone destruction, consistent with osseous lesions of LCH. FAPI-avid foci around the right atrium and inferior vena cava, as well as micronodules and thin-walled cysts in the lungs, were also noted, possibly also involvement of LCH. This case suggested that 68Ga-FAPI PET/CT may have the potential to be applied in evaluation of LCH.
The Elephant in the Room
Authors: Alimi Yewande , Bevilacqua Lisa A. , Snyder Rebecca A. , Walsh Danielle S. , Jackson Patrick G. , Tuttle J.E. , Altieri Maria S.
Published: August 2023

Objective:

To examine the association between race, experience of microaggressions, and implicit bias in surgical training.

Summary Background Data:

There is persistent underrepresentation of specific racial and ethnic groups in the field of surgery. Prior research has demonstrated significant gender differences among those who experience microaggressions during training. However, little research has been conducted on the association between race and experiences of microaggressions and implicit bias among surgical trainees.

Methods:

A 46-item survey was distributed to general surgery residents and residents of surgical subspecialties through the Association of Program Directors in Surgery listserv and social media platforms. The questions included general information/demographic data and information about experiencing, witnessing, and responding to microaggressions during surgical training. The primary outcome was the prevalence of microaggressions during surgical training by self-disclosed race. Secondary outcomes were predictors of and adverse effects of microaggressions.

Results:

A total of 1,624 resident responses were obtained. General surgery residents comprised 825 (50.8%) responses. The female-to-male ratio was nearly equal (815:809). The majority of respondents identified as non-Hispanic white (63.4%), of which 5.3% of residents identified as non-Hispanic Black, and 9.5% identified as Hispanic. Notably, 91.9% of non-Hispanic Black residents (n=79) experienced microaggressions. After adjustment for other demographics, non-Hispanic Black residents were more likely than non-Hispanic White residents to experience microaggressions (OR:8.81, P<0.001). Similar findings were observed among Asian/Pacific Islanders (OR:5.77, P<0.001) and Hispanic residents (OR:3.35, P<0.001).

Conclusion:

Race plays an important role in experiencing microaggressions and implicit bias. As the future of our specialty relies on the well-being of the pipeline, it is crucial that training programs and institutions are proactive in developing formal methods to address the bias experienced by residents.
Identification and characterization of two CRISPR/Cas systems associated with the mosquito microbiome
Authors: Hegde Shivanand , Rauch Hallie E. , Hughes Grant L. , Shariat Nikki
Published: August 2023

The microbiome profoundly influences many traits in medically relevant vectors such as mosquitoes, and a greater functional understanding of host–microbe interactions may be exploited for novel microbial-based approaches to control mosquito-borne disease. Here, we characterized two novel clustered regularly interspaced short palindromic repeats (CRISPR)/Cas systems in

Serratia

sp. Ag1, which was isolated from the gut of an Anopheles gambiae mosquito. Two distinct CRISPR/Cas systems were identified in

Serratia

Ag1, CRISPR1 and CRISPR2. Based on cas gene composition, CRISPR1 is classified as a type I-E CRISPR/Cas system and has a single array, CRISPR1. CRISPR2 is a type I-F system with two arrays, CRISPR2.1 and CRISPR2.2. RT-PCR analyses show that all cas genes from both systems are expressed during logarithmic growth in culture media. The direct repeat sequences of CRISPRs 2.1 and 2.2 are identical and found in the arrays of other

Serratia

spp., including

S. marcescens

and

S. fonticola

, whereas CRISPR1 is not. We searched for potential spacer targets and revealed an interesting difference between the two systems: only 9 % of CRISPR1 (type I-E) targets are in phage sequences and 91 % are in plasmid sequences. Conversely, ~66 % of CRISPR2 (type I-F) targets are found within phage genomes. Our results highlight the presence of CRISPR loci in gut-associated bacteria of mosquitoes and indicate interplay between symbionts and invasive mobile genetic elements over evolutionary time.
Prevalence and epidemiological characteristics of methicillin-resistant Staphylococcus aureus isolated from cattle as a part of the One Health approach
Authors: Venugopal Nimita , Tewari Rituparna , Ganaie Feroze A. , Mitra Susweta , Shome Rajeswari , Shome Bibek R.
Published: August 2023

In India, limited studies are available on the epidemiological aspects of methicillin-resistant Staphylococcus aureus (MRSA) infections in both animal and human settings. Herein, we investigated the prevalence, antimicrobial resistance profile, and molecular characteristics of MRSA isolates recovered from cattle using the One Health approach. Out of 66 mecA-positive staphylococci, species-specific multiplex PCR detected 24% (n=16) of isolates as MRSA. Maximum antibiotic resistance was seen against cloxacillin (94%, n=15) and least for enrofloxacin and cephalothin (each 13%, n=2). Overall, 13% (n=2) of MRSA isolates were multidrug-resistant. Molecular characterization by SCCmec typing identified 88% (n=14) of MRSA isolates as type V. Twelve isolates (75%) belonged to novel spa-type t17242, of which 67% (n=8) belonged to agr type I. MLST analysis revealed ST 1687 (50%, n=8) as the most predominant sequence type.  Circulation of different MRSA clones among the cattle populace offers a risk of transmission to humans through direct contact, food chain, or environmental contamination. Thus, continuous monitoring of MRSA strains is imperative for early diagnosis and for establishing effective treatment strategies to restrain the disease burden caused by MRSA infections.
A dynamic model of neurovascular coupling network accounting for capillaryK+-sensing vasomotion
Authors: Yuan Zhixuan , Yu Yangyang , Wu Ying
Published: August 2023

Neurovascular coupling (NVC) is a fundamental unit that elucidates the regulation of vascular activity by neuronal electrical activity, ensuring adequate blood flow to the brain’s active regions and optimizing neural function. In this article, we propose a comprehensive dynamic model of a neural vascular coupling network that integrates the capillaryK+sensing mechanism and its impact on vascular motion. Our computational framework incorporates the dynamics of neurons, astrocytes, and smooth muscle cells at the cellular level. By integrating recent experimental findings, we have successfully demonstrated the ability of capillary endothelial cells to detect localized fluctuations in extracellular potassium (K+) concentration via the Kir2.1 channel situated on their membranes. Subsequently, these cells transmit this signal to smooth muscle cells, initiating the release of vasoactive substances and thereby facilitating vascular movement. This sequence of events serves as the fundamental basis of our model. Furthermore, the simulation we provide supports the inclusion of a temperature term in our model, enabling accurate replication of experimental observations: variations in neuronal electrical activity resulting from an increase in temperature and subsequent vasoconstriction. In conclusion, our dynamic model presents a valuable tool for investigating the mechanisms underlying neurovascular coupling and the role of capillaryK+sensing in regulating vascular activity. It enhances our understanding of brain function and offers insights for developing therapeutic interventions for neurovascular diseases.

Author summary

It is widely accepted that neuronal activity induces vasodilation, resulting in increased blood flow, while vascular activity provides energy supply to the nervous system. The role of astrocytes in these processes has been extensively studied, revealing their dual involvement in neuronal firing and facilitation of energy delivery to the nervous system through blood vessels. As cellular mediators of bidirectional processes, astrocytes play a crucial role in promoting neurovascular coupling, leading to the formation of neurovascular coupling units. Building upon existing experimental observations and previous theoretical reports, the present study successfully replicates the phenomenon of vasodilation caused by an increase in potassium ion concentration in the perivascular space, as well as vasoconstriction resulting from elevated potassium ion concentration. A new neuron-astrocyte-endothelial-smooth muscle cell coupling network model, incorporating temperature considerations, was constructed to achieve these outcomes. Additionally, by manipulating temperature, the experimental observation of neuronal vasoconstriction during febrile seizures was successfully reproduced. These results highlight the significance of the neurovascular coupling unit as the fundamental entity for investigating the functions and mechanisms of the nervous system and brain.
Differences in pathogenetic mechanism between Tibetan and Han high-altitude polycythemia based on a whole genome-wide association study
Authors: Zhuoma Basang , Shixuan Zhang , Xianwei Ke , Zhuoma Duoji , La Yang , Danzeng Qiangba , Yang De , Zixin Hu , Yanyun Ma , Meng Hao , Zeshan Lin , Yi Li , Jiucun Wang , Juan Wu
Published: August 2023

High-altitude polycythemia (HAPC) is a common and serious chronic disease affecting people of highland and plains ancestry living at high altitudes. This study investigated genetic susceptibility differences for HAPC among ethnic groups, with 2,248 volunteers participating, including 898 HAPC patients (nHan= 450, nTibetan= 448). The study included a GWAS of 198 cases (nHan= 100, nTibetan= 98), which revealed eight Tibetan HAPC-susceptibility single-nucleotide polymorphisms and four Han HAPC-susceptibility VARIANTs. Among them, the common polymorphism locus rs7618658 (SNX4,Pcombine<5e-8) was found and verified in both Tibetans and Han Chinese. Furthermore, the exploration of TibetanEPAS1suggested that the rs1374749 locus ofEPAS1, alongwith other locus-linked status changes, may be a prevalence factor for HAPC, and the GGTAC haplotype in which it is located is a risk haplotype for HAPC (P = 5.14E-9, OR = 1.85).The study showed significant genetic susceptibility to HAPC between Tibetans and Han Chinese, with Tibetans mainly susceptible in oxygen-sensing pathways such asEPAS1, which are associated with several phenotypes (Hemoglobin, Hematocrit, and Platelets, etc), while Han Chinese patients exhibited susceptibilities mainly in cell differentiation and angiogenesis, such as inSNX4andLPAR1, which are similarly significantly associated with hemoglobin, hematocrit, and platelets.
Dysosmia and dysgeusia as differential diagnostics for clinical triaging of COVID-19 cases
Authors: Hoa Phong Pham Huu Thien , Brai Emanuele , Barve Aatmika , Kouchiar Azarnoush , Annoni Jean-Marie , Auber Lavinia Alberi
Published: August 2023

Smell and taste disorders are recognized as frequent, and often the only, signs occurring in the early phase of SARS-Cov-2 infection and in many cases perdure as post-viral symptoms. This evidence raised a general reconsideration of chemosensory deficits, further suggesting that their appearance can be considered as a discriminative and predictive tool to detect COVID-19 cases. In this study, encompassing the first and second pandemic wave, participants estimated their olfactory and gustatory sensitivity, plus they were administered the validated Brief Smell Identification Test (BSIT). We observed that smell and taste impairments were mainly experienced by COVID-19-positive subjects with comparable severity of respiratory symptoms as non-COVID-19 patients. In addition, we noticed that the diagnostic power of subjective olfactory assessments upon SARS-Cov-2 infection is comparable to quantitative evaluation, suggesting that self-reporting could be adopted as the first line of intervention, anticipating more exhaustive procedures aimed at containing COVID-19 diffusion and consequently preserving general health. Overall, results from this work share similarity with other studies, therefore further underlying that olfactory and gustatory disbalance can be distinctive hallmarks in COVID-19 continuum.
Photon Absorption Remote Sensing Imaging of Breast Needle Core Biopsies is Diagnostically Equivalent to Gold Standard H&E Histologic Assessment
Authors: Tweel James E.D. , Ecclestone Benjamin R. , Gaouda Hager , Dinakaran Deepak , Wallace Michael P. , Bigras Gilbert , Mackey John R. , Reza Parsin Haji
Published: August 2023

STRUCTURED Abstract

OBJECTIVE

Photon absorption remote sensing (PARS) is a new laser-based microscope technique that permits cellular level resolution of unstained fresh, frozen, and fixed tissues. Our objective was to determine whether PARS could provide image quality sufficient for diagnostic assessment of breast cancer needle core biopsies (NCB).

DESIGN

We PARS imaged and virtually H&E stained seven independent unstained formalin fixed paraffin-embedded breast NCB sections. These identical tissue sections were then subsequently stained with standard H&E and digitally scanned. Both the 40x PARS and H&E whole slide images were assessed by seven breast cancer pathologists, masked to the origin of the images. A concordance analysis was performed to quantify the diagnostic performances of standard H&E and PARS virtual H&E.

RESULTS

The PARS images were deemed of diagnostic quality and pathologists were unable to distinguish the origin of the images above that expected by chance. The diagnostic concordance on cancer vs. benign was high between PARS and conventional H&E (98% agreement) and there was complete agreement for within PARS images. Similarly, agreement was substantial (kappa > 0.6) for diagnosis of specific cancer subtypes. PARS virtual H&E inter-rater reliability was broadly consistent with the published literature on diagnostic performance of conventional histology NCBs across all tested histologic features.

CONCLUSIONS AND RELEVANCE

PARS was able to provide images on unstained tissues slides that were diagnostically equivalent to conventional H&E. Due to its ability to non-destructively image fixed and fresh tissues, and the suitability of the PARS output for artificial intelligence assistance in diagnosis, this technology has the potential to improve both the speed and accuracy of breast cancer diagnosis.
Chikungunya virus antepartum transmission and abnormal infant outcomes in Nigeria
Authors: Sagay Atiene S. , Hsieh Szu-Chia , Dai Yu-Ching , Chang Charlotte Ajeong , Ogwuche Jerry , Ige Olukemi O. , Kahansim Makshwar L. , Chaplin Beth , Imade Godwin , Elujoba Michael , Paul Michael , Hamel Donald J. , Furuya Hideki , Khoury Ricardo , Boaventura Viviane Sampaio , de Moraes Laíse , Kanki Phyllis J. , Wang Wei-Kung
Published: August 2023

Chikungunya virus (CHIKV) has become a global public health concern since the reemergence of the Indian Ocean lineage and expansion of the Asian genotype. CHIKV infection causes acute febrile illness, rash, and arthralgia and during pregnancy may affect both mothers and infants.

The mother-to-child transmission (MTCT) of CHIKV in Africa remains understudied. We screened 1006 pregnant women at two clinics in Nigeria between 2019 and 2022 and investigated the prevalence and MTCT of CHIKV. Of the 1006, 119 tested positive for CHIKV IgM, of which 36 underwent detailed laboratory tests. While none of the IgM reactive samples were RT-PCR positive, 14 symptomatic pregnant women were confirmed by CHIKV neutralization test. Twelve babies were followed with 8 normal and 4 abnormal outcomes, including stillbirth, cleft lip/palate with microcephaly, preterm delivery, polydactyly with sepsis and jaundice. CHIKV IgM testing identified 3 antepartum transmissions, further studies will determine its impact in antepartum infection.
Prevalence of long covid-19 among pediatric age group in Duhok city, Kurdistan region, Iraq
Authors: Khalid Rojeen Chalabi , Jamal Tamara Bassam , Mahdi Sara Ardalan , Mustafa Abdullah Saeed
Published: August 2023

Background

A range of persistent symptoms that can develop in some people after they have recovered from acute COVID-19, is known as Long COVI-19. It can affect people of all ages and severity of initial illness, including those who had mild or asymptomatic infections.. Dealing with Long COVID-19 can be challenging, and the best course of action will depend on the specific symptoms and individual needs of the patient. This study aims to detect the prevalence of long covid-19 among the children who tested positive for IgG test. If IgG antibodies are detected in a person’s blood sample, it suggests that they have been infected with SARS-CoV-2 at some point in the past and their immune system has responded by producing antibodies against the virus.

Material and Methodology

From (October 22ndtill December 4th2022) the data of this study had been collected through a face-to-face interview with withdrawing blood samples for serum Immunoglobin-G test in laboratory of (General zakho Teaching Hospital in Zakho) and (Hevi Pediatric Teaching Hospital in Duhok). A total number of 330 children aged between 5-12 ages participated in this study. Moreover, If IgG antibodies are detected in a person’s blood sample, it suggests that they have been infected with SARS-CoV-2 at some point in the past and their immune system has responded by producing antibodies against the virus.

Results

(Fatigue 12/ 85.7%), (cough 10/ 71.4%), (post exertional malaise 5/ 35.7%) were the most detected symptoms among the 14 positive patients. Followed by (headache, dizziness, hair loss, loss of appetite, loss/change in smell and taste, difficulty in sleep, mood change, abdominal pain, change in bowel habits, chest pain) to lesser extent.

Conclusion

long-term sequelae of Covid-19 now is becoming a challenge that needs more continued research and collaboration among healthcare providers, researchers, and patients are essential. Long COVID-19 is a public health concern that requires ongoing attention and resources, as well as support for those who are experiencing its debilitating effects. Out of 330 children only 4.6% (14 children) were experiencing long covid-19 symptoms for more than 4 weeks after acute infections in Duhok city.
Signet ring cell histology is an independent predictor of poor prognosis in gastric adenocarcinoma: A population-based analysis
Authors: Huang Zheyu , Chen Chao , Han Jianglong , Wei Yuxuan , Chen Ruyan , Deng Haiyu , Jian Tingting , Liu Wenmin , Fu Zhenming
Published: August 2023

Background

To test the hypothesis that signet ring cell (SRC) histology is an independent predictor of poor prognosis in gastric adenocarcinoma regardless of tumoral clinical presentation.

Methods

We conducted a population-based study to examining the prognostic factors of these two histological subtypes of gastric cancer using data of gastric cancer patients from the Surveillance, Epidemiology, and End Results (SEER) registry between January 2004 and December 2020. Univariate and multivariate Cox regression, and propensity score matching (PSM) models were used to investigate the association between clinical characteristics and prognosis and to calculated hazard ratios (HRs), and corresponding 95% confidence intervals (95% CI).

Results

Among a total of 38,336 patients, there were 7,979 SRC and 30,357 non-SRC gastric cancer patients. At presentation, SRC significantly differs from non-SRC patients in the distribution of age, sex, race, primary site and stage. Overall, SRC patients confers worse overall survival (OS: HR = 1.21, 95% CI: 1.17-1.24) and cancer-specific survival (CSS: HR = 1.27, 95% CI: 1.23-1.31) than non-SRC patients. Compared with non-SRC gastric cancer, although stage I SRC has overall better survival (mOS: 90vs68 months,P< 0.001), however, this better survival of SRC was mainly driven by younger age at diagnosis. After adjusted for age at diagnosis as a continuous variable, early stage SRC patients even has a higher risk of mortality (HR = 1.13, 95% CI: 1.03-1.23 and HR = 1.26, 95% CI: 1.13-1.40 for AJCC stage I and II, respectively). While at advanced stages (stage IV), SRC directly confers worse prognosis and has poorer responses to chemotherapy (P-heterogeneity< 0.001) in either patients with negative (P-heterogeneity= 0.009) or positive peritoneal cytology (P-heterogeneity= 0.055).

Conclusion

After adjustment of age, SRC confers worse prognosis at all stages. Our study indicates, stage for stage, the SRC histology per se conveys additional risk of mortality. The results support the concept that SRC is a distinct subtype of gastric adenocarcinoma and SRC histology is an independent predictor of poor prognosis for gastric cancer.
The Limits of Prompt Engineering in Medical Problem-Solving: A Comparative Analysis with ChatGPT on calculation based USMLE Medical Questions
Authors: Patel Dhavalkumar , Raut Ganesh , Zimlichman Eyal , Cheetirala Satya Narayan , Nadkarni Girish , Glicksberg Benjamin S , Freeman Robert , Timsina Prem , Klang Eyal
Published: August 2023

Background

Prompt engineering significantly improves the performance of Large Language Models (LLMs), including GPT-3.5 and GPT-4. However, its utilization remains largely uncharted in the medical field.

Objective

This research aimed to assess the influence of different prompt engineering strategies on ChatGPT (GPT-3.5) in solving medical problems, specifically focusing on medical calculations and clinical scenarios.

Design

We utilized three different prompting strategies—direct prompting, the chain of thoughts (CoT), and a modified CoT method—across two sets of USMLE-style questions.

Setting

The experiment was conducted using a 1000-question dataset, generated by GPT-4 with a specialized prompt, and a secondary analysis with 95 actual USMLE Step 1 questions.

Measurements

Model performance was assessed based on accuracy in answering medical calculation and clinical scenario questions across varying difficulty levels and medical subjects.

Results

Direct prompting demonstrated non-inferior accuracy compared to the CoT and modified CoT methods in both question categories. This trend remained consistent regardless of difficulty level or subject matter in the GPT-4-generated dataset and USMLE Step 1 sample questions.

Limitations

The study evaluated GPT-3.5 for answering and GPT 4 for question generation, limiting generalizability.

Conclusion

Our findings indicate that while prompt engineering can facilitate question generation, as exemplified by GPT-4, it does not necessarily improve model performance in answering medical calculation or clinical scenario questions. This suggests that the ChatGPT model is already effectively optimized for such tasks. Additionally, this finding simplifies the use of such models in healthcare settings, allowing practitioners to interact effectively with tools like ChatGPT without the need for complex prompt engineering, potentially encouraging wider adoption in clinical practice for problem-solving, patient care, and continuous learning.