bluuebunny/crossref_metadata_2025 huggingface dataset:
Constitutional Identity and Nation Building
Authors: Hahm Chaihark
Published: December 2023

While “constitutional identity” and “nation building” are both fluid terms susceptible to varying interpretations, this chapter shows that any analysis of one will inevitably lead to consideration of the other. Asia’s nation-building projects, which focused on economic development and political stability, often led to authoritarian constitutional politics. Constitutions were sometimes used to forge a nation by enshrining an official religion or language. Some constitutional entrenchments went further to preclude any change to the nation’s government form or underlying ideology. Asia also includes many instances in which drafting a constitution was a process for delineating the membership boundary of the nation. In addition to exploring the relationship between “constitutional identity” and “nation building,” this chapter discusses how Asian states’ so-called communitarian cultural traditions affect their constitutional identity. The chapter ends by suggesting the need for acknowledging the possibility of multiple constitutional identities within one state.
The Politics of Judicial Review
Authors: Dressel Björn
Published: December 2023

Constitutional review has expanded in Asia over the last two decades, yet observers find the uneven performance of courts there in high-profile constitutional cases puzzling, to the point that the theoretical reach of current models of judicial behavior to Asian settings is being questioned. Starting with a critical review of previous scholarship on constitutional review in the region before turning attention to scholarly contributions that highlight how both law and politics work to determine judicial roles, this chapter argues that a concern with formal institutional roles alone is not sufficient to explain how courts deal with constitutional matters in countries where the law is not as institutionalized as in Western democracies. Instead redirecting attention to how judges regularly mediate, or straddle, the demands imposed by law, politics, and day-to-day relationships, this chapter suggests a contextually grounded informal-relational perspective to advance our understanding of constitutional review and judicial politics in Asia.
Genome Editing of Plant Mitochondrial and Chloroplast Genomes
Authors: Arimura Shin-ichi , Nakazato Issei
Published: December 2023

Plastids (including chloroplasts) and mitochondria are remnants of endosymbiotic bacteria, yet they maintain their own genomes, which encode vital components for photosynthesis and respiration, respectively. Organellar genomes have distinctive features, such as being present as multicopies, being mostly inherited maternally, having characteristic genomic structures and undergoing frequent homologous recombination. To date, it has proven to be challenging to modify these genomes. For example, while CRISPR/Cas9 is a widely used system for editing nuclear genes, it has not yet been successfully applied to organellar genomes. Recently, however, precise gene-editing technologies have been successfully applied to organellar genomes. Protein-based enzymes, especially transcription activator–like effector nucleases (TALENs) and artificial enzymes utilizing DNA-binding domains of TALENs (TALEs), have been successfully used to modify these genomes by harnessing organellar-targeting signals. This short review introduces and discusses the use of targeted nucleases and base editors in organellar genomes, their effects and their potential applications in plant science and breeding.
Environmental problem shifting from climate change mitigation: A mapping review
Authors: Wood Hansen Oskar , van den Bergh Jeroen
Published: December 2023

Climate change mitigation will trigger major changes in human activity, energy systems, and material use, potentially shifting pressure from climate change to other environmental problems. We provide a comprehensive overview of such “environmental problem shifting” (EPS). While there is considerable research on this issue, studies are scattered across research fields and use a wide range of terms with blurred conceptual boundaries, such as trade-off, side effect, and spillover. We identify 506 relevant studies on EPS of which 311 are empirical, 47 are conceptual–theoretical, and 148 are synthetic studies or reviews of a particular mitigation option. A systematic mapping of the empirical studies reveals 128 distinct shifts from 22 categories of mitigation options to 10 environmental impacts. A comparison with the recent IPCC report indicates that EPS literature does not cover all mitigation options. Moreover, some studies systematically overestimate EPS by not accounting for the environmental benefits of reduced climate change. We propose to conceptually clarify the different ways of estimating EPS by distinguishing between gross, net, and relative shifting. Finally, the ubiquity of EPS calls for policy design which ensures climate change mitigation that minimizes unsustainability across multiple environmental dimensions. To achieve this, policymakers can regulate mitigation options—for example, in their choice of technology or location—and implement complementary environmental policies.
Standard Essential Patents: Returning to the Basics on Unwired v Huawei
Authors: Prakash Patra Soumya
Published: December 2023

Standard essential patents have become an extremely crucial element in developing modern technologies and standardization processes. This article examines the importance of standardization and standard essential patents in developing technologies and their effect on the legal jurisprudential environment. The introduction emphasizes the role of standardization in promoting the adoption of various essential technologies. Additionally, it focuses on the significance of standard essential patents that safeguard the technologies underlying such standards. The discussion delves into a particular legal case involving Unwired Planet’s licensing campaign for standard essential patents in the communication industry, emphasizing the judgments handed down by the UK Supreme Court. The analysis further investigates critical issues involved in the decision, such as jurisdiction over global licensing, non-discrimination under fair, reasonable, and non-discriminatory terms, and the flexibility of fair, reasonable, and non-discriminatory negotiations. The UK Supreme Court’s ruling clarifies maintaining a proper equilibrium between the interests of SEP holders and encouraging fair and reasonable licensing practices.
The microRNA7833-AUX6 module plays a critical role in wood development by modulating cellular auxin influx in Populus tomentosa
Authors: Xie Haiyan , Ye Xiao , Liu Chang , Li Dan , Wang Xianqiang , Xu Changzheng , Li Caofeng , Luo Keming , Fan Di , Wu Nengbiao
Published: December 2023

The critical role of auxin on secondary vascular development in woody plants has been demonstrated. The concentration gradient of endogenous indole-3-acetic acid and the cellular and molecular pathways contributing to the auxin-directed vascular organization and wood growth have been uncovered in recent decades. However, our understanding of the roles and regulations of auxin influx in wood formation in trees remains limited. Here, we reported that a microRNA, miR7833, participates in the negative regulation of stem cambial cell division and secondary xylem development in Populus tomentosa. The miR7833 is mainly expressed in the vascular cambium during stem radical growth and specifically targets and represses two AUX/LAX family auxin influx carriers, AUX5 and AUX6, in poplar. We further revealed that poplar AUX6, the most abundant miR7833 target in the stem, is preferentially enriched in the developing xylem and is a positive regulator for cell division and differentiation events during wood formation. Moreover, inhibition of auxin influx carriers by 1-naphthoxyacetic acids abolished the regulatory effects of miR7833 and AUX6 on secondary xylem formation in poplar. Our results revealed the essential roles of the miR7833-AUX6 module in regulating cellular events in secondary xylem development and demonstrated an auxin influx-dependent mechanism for wood formation in poplar.
A Detailed Analysis of Cardiac Rehabilitation on 180-Day All-Cause Hospital Readmission and Mortality
Authors: Duscha Brian D. , Ross Leanna M. , Hoselton Andrew L. , Piner Lucy W. , Pieper Carl F. , Kraus William E.
Published: December 2023

Purpose:

Cardiac rehabilitation (CR) is endorsed for coronary artery disease (CAD), but studies report inconsistent findings regarding efficacy. The objective of this study was to determine whether confounding factors, potentially contributing to these heterogeneous findings, impact the effect of CR on all-cause readmission and mortality.

Methods:

Patients (n = 2641) with CAD, CR eligible, and physically able were identified. Electronic medical records were inspected individually for each patient to extract demographic, clinical characteristic, readmission, and mortality information. Patients (n = 214) attended ≥1 CR session (CR group). Survival was considered free from: all-cause readmission; or composite outcome of all-cause readmission or death. Cox proportional hazards models, adjusting for demographics, comorbidities, and discharge criteria, were used to determine HR with 95% CI and to compare 180-d survival rates between the CR and no-CR groups.

Results:

During 180 d of follow-up, 12.1% and 18.7% of the CR and non-CR patients were readmitted to the hospital. There was one death (0.5%) in the CR group, while 98 deaths (4.0%) occurred in the non-CR group. After adjustment for age, sex, race, depression, anxiety, dyslipidemia, hypertension, obesity, smoking, type 2 diabetes, and discharge criteria, the final model revealed a significant 42.7% reduction in readmission or mortality risk for patients who attended CR (HR = 0.57: 95% CI, 0.33-0.98; P = .043).

Conclusions:

Regardless of demographic characteristics, comorbidities, and cardiovascular discharge criteria, the risk of 180-d all-cause readmission or death was markedly decreased in patients who attended CR compared with those who did not.
Combined use of the CLivD score and FIB-4 for prediction of liver-related outcomes in the population
Authors: Åberg Fredrik , Asteljoki Juho , Männistö Ville , Luukkonen Panu K.
Published: December 2023

Background and Aims:

A need exists for effective and practical tools to identify individuals at increased risk of liver-related outcomes (LROs) within the general population.

Approach and Results:

We externally validated the chronic liver disease (CLivD) score for LROs in the UK Biobank cohort. We also investigated the sequential combined use of CLivD and fibrosis-4 (FIB-4) scores. Our analysis included 369,832 adults without baseline liver disease and with available data for CLivD and FIB-4 computation. LROs reflecting compensated or decompensated liver cirrhosis or HCC were ascertained through linkages with electronic health care registries. Discriminatory performance and cumulative incidence were evaluated with competing-risk methodologies. Over a 10-year follow-up, time-dependent AUC values for LRO prediction were 0.80 for CLivDlab (including gamma-glutamyltransferase), 0.72 for CLivDnon-lab (excluding laboratory values), and 0.75 for FIB-4. CLivDlab demonstrated AUC values exceeding 0.85 for liver-related death and severe alcohol-associated liver outcomes. The predictive performance of FIB-4 increased with rising CLivD scores; 10-year FIB-4 AUC values ranged from 0.60 within the minimal-risk CLivD subgroup to 0.81 within the high-risk CLivD subgroup. Moreover, in the minimal-risk CLivD subgroup, the cumulative incidence of LRO varied from 0.05% to 0.3% across low-to-high FIB-4 strata. In contrast, within the high-risk CLivD subgroup, the corresponding incidence ranged from 1.7% to 21.1% (up to 33% in individuals with FIB-4 >3.25).

Conclusions:

The CLivD score is a valid tool for LRO risk assessment and improves the predictive performance of FIB-4. The combined use of CLivD and FIB-4 identified a subgroup where 1 in 3 individuals developed LROs within 10 years.
Lower individual alpha frequency in individuals with chronic low back pain and fear of movement
Authors: Ho Rachel L.M. , Park Jinhan , Wang Wei-en , Thomas James S. , Cruz-Almeida Yenisel , Coombes Stephen A.
Published: December 2023

Significant progress has been made in linking measures of individual alpha frequency (IAF) and pain. A lower IAF has been associated with chronic neuropathic pain and with an increased sensitivity to pain in healthy young adults. However, the translation of these findings to chronic low back pain (cLBP) are sparse and inconsistent. To address this limitation, we assessed IAFs in a cohort of 70 individuals with cLBP, implemented 3 different IAF calculations, and separated cLBP subjects based on psychological variables. We hypothesized that a higher fear movement in cLBP is associated with a lower IAF at rest. A total of 10 minutes of resting data were collected from 128 electroencephalography channels. Our results offer 3 novel contributions to the literature. First, the high fear group had a significantly lower peak alpha frequency. The high fear group also reported higher pain and higher disability. Second, we calculated individual alpha frequency using 3 different but established methods; the effect of fear on individual alpha frequency was robust across all methods. Third, fear of movement, pain intensity, and disability highly correlated with each other and together significantly predicted IAF. Our findings are the first to show that individuals with cLBP and high fear have a lower peak alpha frequency.
Secondary somatosensory cortex glutamatergic innervation of the thalamus facilitates pain
Authors: Guo Fang , Lin Shi-Da , Du Yu , Hu Ting-Ting , Wang Yi , Chen Zhong , Zhang Shi-Hong
Published: December 2023

Although the secondary somatosensory cortex (SII) is known to be involved in pain perception, its role in pain modulation and neuropathic pain is yet unknown. In this study, we found that glutamatergic neurons in deep layers of the SII (SIIGlu) responded to bilateral sensory inputs by changing their firing with most being inhibited by contralateral noxious stimulation. Optical inhibition and activation of unilateral SIIGlu reduced and enhanced bilateral nociceptive sensitivity, respectively, without affecting mood status. Tracing experiments revealed that SIIGlu sent dense monosynaptic projections to the posterolateral nucleus (VPL) and the posterior nucleus (Po) of the thalamus. Optical inhibition and activation of projection terminals of SIIGlu in the unilateral VPL and Po inhibited and facilitated pain on the contralateral side, respectively. After partial sciatic nerve ligation, SIIGlu became hyperactive as evidenced by higher frequency of spontaneous firing, but the response patterns to peripheral stimulation remained. Optical inhibition of SIIGlu alleviated not only bilateral mechanical allodynia and thermal hyperalgesia but also the negative affect associated with spontaneous pain. Inhibition of SIIGlu terminals in the VPL and Po also relieved neuropathic pain. This study revealed that SIIGlu and the circuits to the VPL and Po constitute a part of the endogenous pain modulatory network. These corticothalamic circuits became hyperactive after peripheral nerve injury, hence contributes to neuropathic pain. These results justify proper inhibition of SIIGlu and associated neural circuits as a potential clinical strategy for neuropathic pain treatment.
The association between parent mental health and pediatric chronic pain: a systematic review and meta-analysis
Authors: Beveridge Jaimie K. , Noel Melanie , Soltani Sabine , Neville Alexandra , Orr Serena L. , Madigan Sheri , Birnie Kathryn A.
Published: December 2023

Mental health problems are common among parents of children with chronic pain and associated with worse outcomes for the child with chronic pain. However, the effect sizes of these associations between parent mental health and pediatric chronic pain vary widely across studies. The aim of this systematic review and meta-analysis was to generate pooled estimates of the (1) prevalence of mental health problems among parents of children with chronic pain and (2) associations between parent mental health and the (2a) presence of child chronic pain and (2b) functioning of children with chronic pain. Embase, MEDLINE, PsycINFO, Web of Science, and CINAHL were searched up to November 2022. Observational studies that examined symptoms or diagnoses of parent anxiety, depression, or general distress and the presence of child chronic pain and/or related functioning were included. From 32,848 records, 2 coders identified 49 studies to include in random-effects meta-analyses. The results revealed that mental health problems among parents of children with chronic pain were common (anxiety: 28.8% [95% CI 20.3-39.1]; depression: 20.0% [15.7-25.2]; general distress: 32.4% [22.7-44.0]). Poorer parent mental health was significantly associated with the presence of chronic pain (anxiety: OR = 1.91 [1.51-2.41]; depression: OR = 1.90 [1.51-2.38]; general distress: OR = 1.74 [1.47-2.05]) and worse related functioning (ie, pain intensity, physical functioning, anxiety and depression symptoms; rs = 0.10-0.25, all Ps < 0.05) in children. Moderator analyses were generally nonsignificant or could not be conducted because of insufficient data. Findings support the importance of addressing parent mental health in the prevention and treatment of pediatric chronic pain.
A Preliminary Controlled Trial of Endoscopic Ultrasound-guided Fiducial Markers to Guide Pancreas Surgery
Authors: Chang Patrick W. , Sadik Jonathan , Sahakian Ara B. , Kankotia Ravi , Ko Christopher , Serna Jessica , Rodriguez Alex , Lee Helen , Kulkarni Sujit , Genyk Yuri , Sheikh Mohd , Buxbaum James L.
Published: December 2023

Objective:

Endoscopic ultrasound (EUS) is routinely used for fiducial marker placement (FMP) to guide stereotactic radiation of pancreatic tumors, but EUS-FMP explicitly to guide surgery has not been studied in a prospective, controlled manner. Multipurpose EUS systems have been developed that facilitate simultaneous EUS-FMP at the time of biopsy. We aimed to evaluate the feasibility of EUS-FMP to guide pancreatic resection.

Methods:

In this prospective trial, we enrolled patients with resectable pancreas masses undergoing tissue sampling and placed preloaded fiducials immediately after biopsy. Intraprocedure confirmation of carcinoma, neuroendocrine, and nonlymphomatous neoplasia by rapid on-site evaluation and lesion size <4 cm was required. The main outcomes were the feasibility and ease of preoperative placement and intraoperative detection of the markers using predefined Likert scales.

Results:

In 20 patients, EUS-FMP was successful before planned surgery and placement was technically straightforward (Likert Scale: 9.1 ± 1.3; range: 1, most challenging to 10, most facile). Intraoperative detection was feasible and improved when compared with a pre-established comparator of 5 representing an equivalent lesion without a marker (Likert Scale: 7.8 ± 2.2; range: 1, most difficult to 10, most facile; P = 0.011). The mean tumor size on EUS was 1.7 ± 0.9 (range: 0.5 to 3.6) cm.

Conclusion:

EUS-FMP is feasible and safe for resectable pancreatic tumors before surgery and may assist in perioperative detection. Preloaded fiducials may be considered for placement at the time of initial referral for EUS–fine needle biopsy.
Perinatal Bereavement in Racially, Culturally, and Gender Diverse Families
Authors: Nurse-Clarke Natasha , Freedle Agata , Bindeman Julie , Jarvis Jennifer , Sember Jessica
Published: December 2023

Perinatal loss, the tragic event of losing a baby before, during, or shortly after birth, is a profoundly distressing experience for any family. We focus on the unique challenges faced by diverse families, encompassing those from underrepresented racial, ethnic, religious, and LGBTQ+ backgrounds. Diverse families often encounter inadequate support, misunderstandings, and even mistreatment during their perinatal loss journeys due to cultural insensitivity and biases. This review underscores the necessity of a trauma-informed, person-centered approach to perinatal bereavement care that respects the diversity of those affected. We emphasize the importance of understanding various cultural perspectives on grief and mortality to provide appropriate and empathetic care.

Our core purpose is to elucidate the challenges confronting diverse families dealing with perinatal loss and to offer actionable strategies for health care providers. By addressing these unique challenges, nurses and other health care professionals can offer culturally sensitive, person-centered support during this distressing time. This review can serve as a resource for nurses and other health care providers, enabling them to provide personalized, culturally sensitive care to diverse families experiencing perinatal loss through a trauma-informed lens. Recognizing and addressing these distinctive needs fosters healing and ensures that nurses and other health care providers are better equipped to guide families through the challenging journey of perinatal bereavement.
Salivary Cortisol and Melatonin, Sleep, and Behavioral Patterns in Older Adults Living With Dementia
Authors: Cho Eunhee , Lee Hyangkyu , Shin Jinhee , Kim Sujin , Heo Seok-Jae , Park Hyunki , Seok Jo Woon
Published: December 2023

Background

Over half of the older adults living with dementia have behavioral and psychological symptoms of dementia (BPSD), including sleep disturbance; however, little is known about physiological markers. Salivary cortisol and melatonin have been identified as potential biomarkers of BPSD, with evidence suggesting a relationship between these biomarkers and various behavioral factors, as well as sleep and activity patterns.

Objectives

The aim of this study was to investigate the time-dependent changes in salivary cortisol and melatonin levels in older adults with dementia, their relationship with the sleep–wake cycle, and their correlation with BPSD symptoms and behavioral factors.

Methods

This observational study conducted in Seoul and Gyeonggi-do, South Korea, used data from 172 older adults with dementia, measuring sleep and activity patterns for 2 weeks using a wearable device, in addition to administering questionnaires for neuropsychiatric and psychological symptoms—the Neuropsychiatric Inventory, Cohen–Mansfield Agitation Inventory, and Cornell Scale for Depression in Dementia. Salivary cortisol and melatonin levels were measured at four time points and divided into four groups based on a dual-trajectory model. Differences among the groups were analyzed using one-way analysis of variance.

Results

The participants showed normal but heterogeneous patterns of salivary cortisol and melatonin levels. Dual-trajectory pattern analysis showed that higher levels of melatonin during the daytime were correlated with poor nighttime sleep efficiency and decreased disinhibited behaviors, and higher levels of cortisol at all four time points were associated with decreased physical activity.

Discussion

Measuring and analyzing periodic changes in cortisol and melatonin levels can predict various behavioral symptoms (e.g., sleep disturbances, activity counts, and disinhibition) in older adults with dementia. A study with an experimental design is needed to discover the direct physiological interactions between cortisol, melatonin, and these symptoms.
Elevated High-Sensitivity Troponin and NT-proBNP Values in Febrile Children
Authors: Borensztajn Dorine M. , Tan Chantal D. , de Rijke Yolanda , Hagedoorn Nienke N. , Verbruggen Sascha C. , Moll Henriette A. , Vermont Clementien L.
Published: December 2023

Objectives

The COVID-19 pandemic and subsequent rise of multisystem inflammatory syndrome in children have raised interest in high-sensitivity troponin (hs-TnT) and N-terminal probrain natriuretic peptide (NT-proBNP) because these have been found to be elevated in many cases of multisystem inflammatory syndrome in children. Our aim was to study hs-TnT and NT-proBNP concentrations in febrile children not affected by COVID-19.

Methods

We retrospectively measured cardiac markers, hs-TnT, and NT-proBNP in leftover blood samples of febrile children (0–18 years) diagnosed and treated in a single-center emergency department (ED) (N = 67) and pediatric intensive care unit (PICU) (N = 19) that participated in a multicenter, prospective study of infection biomarkers (PERFORM).

Results

Concentrations of hs-TnT, median 1.8 ng/L (interquartile range [IQR], 0.0–15.1), and NT-proBNP, 194 pg/mL (IQR, 54.9–706), were higher in febrile children than in controls (N = 25, hs-TnT 0.0 [IQR, 0–0]; NT-proBNP 56.3 [IQR, 29.7–109], both P < 0.001), whereas PICU patients had higher concentrations (hs-TnT 15.1 [IQR, 10.3–102] and NT-proBNP 828 [IQR, 657–4712], both P < 0.001) than ED patients (hs-TnT 0 [IQR, 0–7.4] and NT-proBNP 104 [IQR, 39.5–363]). No differences were found between viral and bacterial infections. Highest concentrations were found in children with either comorbidity predisposing to elevated concentrations (eg, chronic cardiac or renal disease) or children with critical illness or multiorgan failure such as those with septic shock.

Conclusions

Concentrations of hs-TnT and NT-proBNP are often elevated in febrile children with different causes of fever. Concentrations were higher in children admitted to the PICU than in children attending the ED, and seem to reflect disease severity rather than the underlying cause of fever.
High-Frequency Repetitive Transcranial Magnetic Stimulation on Overall Cognition in Patients With Poststroke Cognitive Impairment
Authors: Chen Xin , Xiu Huoqin , Hou Yufei , Chen Xinming , Liu Fang , Tu Shuzhen
Published: December 2023

Objective

The aim of the study is to comprehensively assess the recovery effects of high-frequency repetitive transcranial magnetic stimulation in patients with poststroke cognitive impairment.

Methods

Six English and four Chinese databases were searched for relevant studies published up to January 2022. Randomized controlled trials of patients with poststroke cognitive impairment treated with high-frequency repetitive transcranial magnetic stimulation were included. Included studies were assessed for the risk of bias through the Cochrane Intervention Systematic Review Manual 5.1.0. The meta-analysis was performed using RevMan 5.4 software. The PRISMA 2020 guidelines were followed.

Results

Sixty-one randomized controlled trials (4012 patients) were included. Montreal Cognitive Assessment Score, Mini-Mental State Examination score, event-related potential P300 (P300) amplitude, Loewenstein Occupational Therapy Cognitive Assessment score, and total effective rate of cognitive function were higher in the high-frequency repetitive transcranial magnetic stimulation group than in the control group at the end of the treatment period, and scores of Alzheimer Disease Assessment Scale–Cognitive Subscale and P300 latency were lower in the high-frequency repetitive transcranial magnetic stimulation group than in the control group. Fifty studies had selected the dorsolateral prefrontal cortex as the stimulation site for high-frequency repetitive transcranial magnetic stimulation.

Conclusions

Compared with nonrepetitive transcranial magnetic stimulation or sham repetitive transcranial magnetic stimulation, high-frequency repetitive transcranial magnetic stimulation not only improves the overall cognitive function of poststroke cognitive impairment patients but also has better rehabilitation results.
Establishing a Clinical Care Pathway to Expedite Rehabilitation Transitions for Stroke Patients With Dysphagia and Enteral Feeding Needs
Authors: Braun Robynne , Han Kenneth , Arata Jodi , Gourab Krishnaj , Hearn Johanna , Gonzalez-Fernandez Marlis
Published: December 2023

Objective

The aim of the study is to evaluate the safety and efficacy of a physiatrist-led clinical pathway to expedite rehabilitation transitions for stroke patients with dysphagia requiring nasogastric tube or percutaneous endoscopic gastrostomy.

Design

This is a retrospective single-center observational study in 426 adults with stroke and dysphagia admitted to the acute hospital. Physican Medicine and Rehabilitation (PM&R) was consulted to determine dysphagia prognosis and candidacy for rehabilitation admission with nasogastric tube or percutaneous endoscopic gastrostomy. The proportion of patients accepted with nasogastric tube versus percutaneous endoscopic gastrostomy, progression to total oral diet during rehabilitation, and lengths of stay were tracked.

Results

The rate of recovery to total oral diet for patients accepted with nasogastric tube was 38/44 = 86.3% versus 29/75 = 38.6% with percutaneous endoscopic gastrostomy. There was a significant difference in mean time to total oral diet with nasogastric tube (20.37 days) versus percutaneous endoscopic gastrostomy (34.46 days): t(43) = 4.49, P < 0.001. The acute hospital length of stay was significantly shorter with nasogastric tube (12.9 days) versus percutaneous endoscopic gastrostomy (20.4 days): t(117) = 4.16, P < 0.001. Rehabilitation length of stay did not differ significantly between groups (26.9 vs. 32.0 days).

Conclusion

Physiatrist-led initiatives to evaluate stroke patients with dysphagia can expedite rehabilitation transitions, prevent unnecessary invasive procedures, and reduce acute hospital length of stay.

To Claim CME Credits

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives

Upon completion of this article, the reader should be able to: 1) Describe the benefits of a clinical pathway for accepting patients with nasogastric tube (NGT) to rehabilitation; 2) List criteria evaluated during consultation to identify patients who may be able to recover their swallowing function during rehabilitation; and 3) Explain theways in which a physiatrist-led programfor allowing stroke patients with dysphagia to discharge with NGT in place brings practice patterns into better alignment with existing guidelines.

Level

Advanced

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
STI pathogens in the oropharynx: update on screening and treatment
Authors: Chow Eric P.F. , Fairley Christopher K. , Kong Fabian Y.S.
Published: December 2023

Purpose of review

The rise in antimicrobial resistance in several STI pathogens such as Neisseria gonorrhoeae has become a public health threat as only one first-line treatment remains. Reducing screening interval for gonorrhoea and chlamydia in high-prevalence populations has been proposed to address antimicrobial stewardship, but this remains controversial. This review aimed to revisit the epidemiology of infections at the oropharynx and review the current screening recommendations and treatment guidelines in different populations.

Recent findings

Emerging evidence suggests that the oropharynx is the primary anatomical site for gonorrhoea transmission but maybe not for chlamydia transmission. Most international guidelines recommend 3-monthly oropharyngeal gonorrhoea and chlamydia screening for high-prevalence populations (e.g. men who have sex with men) but not low-prevalence populations (e.g. heterosexuals) given the clinical and public health benefits of screening in low-prevalence populations are still unclear. Doxycycline remains the first-line treatment for oropharyngeal chlamydia in most guidelines. However, some countries have moved from dual therapy (ceftriaxone and azithromycin) to monotherapy (ceftriaxone) for oropharyngeal gonorrhoea treatment to address antimicrobial stewardship.

The transmission of gonorrhoea and chlamydia is still not fully understood. Further work will be required to evaluate the benefits and harms of reducing screening in high-prevalence populations.
Feasibility of Breath-Hold Zero TE Magnetic Resonance Imaging Sequence for Evaluation of Pulmonary Arteriovenous Malformations After Embolotherapy
Authors: Hayashida Yoshiko , Murakami Yu , Fukumitsu Satoshi , Yoshimatsu Yuta , Anai Kenta , Todoroki Yo , Fujisaki Akitaka , Ide Satoru , Aoki Takatoshi
Published: December 2023

We obtained breath-hold zero TE (ZTE) magnetic resonance imaging for the evaluation of pulmonary arteriovenous malformations before and after embolotherapy. To the best of our knowledge, there have been no reports of ZTE for the entire lung imaging in single breath–hold scan time such as 20 seconds. Breath-hold ZTE magnetic resonance imaging can be a useful technique for magnetic resonance–based follow-up of vascular lung diseases without using contrast media, reducing the undesired artifacts from metallic devices.
The Predictive Value of FDG PET/CT for Determining Progression-Free Survival in Advanced Stage III–IV BRAF-Mutated Melanoma Patients Treated With Targeted Therapy—What Can Be Learned From Progression?
Authors: van der Hiel Bernies , Aalbersberg Else A. , van den Eertwegh Alfons J.M. , de Wit-van der Veen Linda J. , Stokkel Marcel P.M. , Lopez-Yurda Marta , Boellaard Ronald , Kapiteijn Ellen W. , Hospers Geke A.P. , Aarts Maureen J.B. , de Vos Filip Y.F.L. , Boers-Sonderen Marye J. , van der Veldt Astrid A.M. , de Groot Jan Willem B. , Haanen John B.A.G
Published: December 2023

Purpose

The aims of this study were to investigate whether (early) PERCIST response monitoring with 18F-FDG PET/CT is predictive for progression-free survival (PFS) in unresectable stage III or IV melanoma patients treated with BRAF/MEK inhibitor (MEKi) and to define dissemination patterns at progression with a lesion-based evaluation in direct comparison to baseline to improve our understanding of 18F-FDG PET/CT during BRAF/MEKi.

Patients and Methods

This prospective multicenter single-arm study included 70 patients with unresectable stage III/IV BRAF-mutated melanoma who underwent contrast-enhanced CT and 18F-FDG PET/CT at baseline and 2 and 7 weeks during treatment with vemurafenib plus cobimetinib and at progression if possible. Tumor response assessment was done with RECIST1.1 and PERCIST. Follow-up PET/CT scans were visually compared with baseline to assess dissemination patterns.

Results

Using RECIST1.1, PFS was not significantly different between the response groups (P = 0.26). At 2 weeks, PERCIST median PFS was 15.7 months for patients with complete metabolic response (CMR) versus 8.3 months for non-CMR (P = 0.035). The hazards ratio (HR) for progression/death in non-CMR versus CMR was 1.99 (95% confidence interval [CI], 1.03–3.84; P = 0.040) and 1.77 (95% CI, 0.91–3.43; P = 0.0935) when adjusting for lactate dehydrogenase (LDH). At 7 weeks, median PFS for PERCIST CMR was 16.7 months versus 8.5 months for non-CMR (P = 0.0003). The HR for progression/death in the non-CMR group was significantly increased (HR, 2.94; 95% CI, 1.60–5.40; P = 0.0005), even when adjusting for LDH (HR, 2.65; 95% CI, 1.43–4.91; P = 0.0020). At week 7, 18F-FDG PET/CT was false-positive in all 4 (6%) patients with new FDG-avid lesions but CMR of known metastases. When 18F-FDG PET/CT was performed at progressive disease, 18/22 (82%) patients had progression of known metastases with or without new 18F-FDG–avid lesions.

Conclusions

This study shows that PERCIST response assessment at week 7 is predictive for PFS, regardless of LDH. At 2 weeks, patients with CMR have longer PFS than patients with non-CMR, but different PET parameters should be investigated to further evaluate the added value of early 18F-FDG PET/CT. Disease progression on PET/CT is predominated by progression of known metastases, and new 18F-FDG–avid lesions during BRAF/MEKi are not automatically a sign of recurrent disease.
Central mechanisms of acupuncture in relieving visceral hypersensitivity in functional gastrointestinal disorders: A narrative review
Authors: Feng Bowen , Wang Yu , Rong Peijing
Published: December 2023

Visceral hypersensitivity (VH), one of the major symptoms of functional gastrointestinal disorders (FGIDs), impacts the social life and quality of life of the patients. Because of the complex pathological mechanism, the drug therapy for VH has unsatisfactory clinical efficacy and induces side effects. Alternative strategies acting on the central nervous system with few side effects are urgently needed. We summarize the central mechanisms of acupuncture in relieving VH to provide theoretical support for the clinical application of acupuncture in the treatment of VH in FGIDs. In this study, we retrieved the related articles from PubMed and Web of Science with the key words of “acupuncture,”“electroacupuncture,” and “visceral hypersensitivity.” According to the sensory conduction, perception, and emotion-related pathways involved in VH, we summarize the central mechanism of acupuncture in relieving VH from the perspectives of molecular biology and neuroimaging. The pathogenesis of VH in FGIDs involves the peripheral and central nervous systems, which are responsible for the transmission and perception of visceral sensations as well as the regulation of emotion. The widespread nature of VH indicates the involvement of the central nervous system. Acupuncture mediates the signaling pathways between the gastrointestinal tract and the brain to regulate gastrointestinal function and relieve VH. Acupuncture relieves VH by integrating multiple pathways and targets. The available studies in this field mainly focus on the regulation of a specific target or chemical transmitter by acupuncture, while the exact connection among these targets remains to be clarified by multilevel and multitarget studies.
Correlation Between Visual Acuity and Foveal Threshold by Automated Perimetry With Size V Stimulus
Authors: Bohm Parker E. , Stunkel Leanne , Van Stavern Gregory P.
Published: December 2023

Background:

Visual acuity has been shown to correlate with foveal threshold as determined by automated perimetry. Although automated perimetry with size V stimulus is commonly used in neuro-ophthalmology practice, the relationship between the visual acuity and the foveal threshold with this larger stimulus is not well known.

Methods:

Retrospective study of patients who had undergone neuro-ophthalmology evaluation and visual field testing with automated perimetry using size V stimulus. Healthy controls were also recruited. Using visual acuity and foveal threshold, Pearson correlation coefficients were calculated, and basic foveal threshold statistics were stratified by visual acuity. Prediction intervals for visual acuities by various foveal threshold were also calculated.

Results:

A total of 106 unique eyes were included. The final Pearson correlation coefficient between visual acuities was −0.795 for the right eye and −0.578 for the left eye, with a pooled correlation coefficient of −0.751 (P < 0.001). A foveal threshold of at least 34 dB was present in 94.4% of eyes with 20/20 visual acuity, and a foveal threshold of greater than 35 dB was not observed in eyes with visual acuity of 20/40 or worse.

Conclusions:

Foveal threshold as determined by automated perimetry using size V stimulus has moderate-to-strong correlation with visual acuity in patients undergoing neuro-ophthalmology evaluation.
Nanopore sequencing elucidates in-vivo development of meropenem resistance by insertion of a mobile genetic element in the porin gene ompC in E. coli.
Authors: Matamoros Sébastien , van Hattem Jarne
Published: December 2023

An ESBL-producing E. coli-isolate recovered from a patient undergoing long-term treatment developed resistance to meropenem without acquiring carbapenem-hydrolysing enzymes. We performed Nanopore and Illumina sequencing and subsequent full hybrid genome assembly of this isolate and the meropenem-susceptible isolate recovered almost 8 weeks prior. Whole genome MLST patterns did not differ between isolates. However, we found the insertion of an IS5-like element in the sequence of the ompC gene and an increase in the number of copies of the CTX-M-15 gene in the resistant isolate. These results show that E. coli can develop resistance under antibiotic pressure by mutations in ompC genes and increasing the copy number of ESBL genes, and the value of next generation sequencing to reveal resistance mechanisms not detected by conventional PCR.
Predicting biomarker for the acute pulmonary embolism by using gene ontology and machine learning
Authors: Zhou Kun , Duan Hui , Chen Zhao , Hao Hu
Published: December 2023

Key Points

Early and Accurate Diagnosis Essential:Acute pulmonary embolism (PE) is a critical condition that demands prompt and precise diagnosis for effective treatment.

Limitations of Current Diagnostics:Existing diagnostic methods like Computed Tomography Pulmonary Angiography (CTPA) have certain limitations, leading to the exploration of alternative approaches.

Potential of Blood-Based Biomarkers:A recent study focused on identifying blood-based biomarkers for PE. This involved using gene ontology analysis and machine learning methods to analyze gene expression data from both PE patients and healthy controls.

Gene Selection and Analysis:The study selected 20 genes for detailed analysis. These included various coagulation factors, fibrinolytic genes, and inflammation markers. Gene Ontology enrichment analysis was performed to understand the biological processes and molecular functions of these genes.

Machine Learning for Diagnosis:Supervised machine learning algorithms were utilized to create classification models using the expression levels of these 20 genes. The models demonstrated promising results in distinguishing PE patients from healthy individuals.

Acute pulmonary embolism (PE) is a life-threatening condition requiring early and accurate diagnosis. Current diagnostic methods like CTPA have limitations, and a study aimed to identify potential blood-based biomarkers for PE using gene ontology analysis and machine learning methods. Gene expression data of PE patients and healthy controls were obtained from the Gene Expression Omnibus database. A total of 20 genes were selected for further analysis, including coagulation factors F7, F10, F12, fibrinolytic genes PLAT, SERPINE1 and SERPINE2, and inflammation markers SELE, VCAM1 and ICAM. Gene Ontology enrichment analysis was performed to identify biological processes and molecular functions overrepresented among the candidate genes. Supervised machine learning algorithms were applied to build classification models using the expression levels of the 20 genes as features. Nested cross-validation was employed to assess model performance. The RF model achieved the highest area under the receiver operating characteristic curve of 0.89, indicating excellent discrimination between PE patients and controls based on the gene expression signature. Validation in larger cohorts is warranted to clinically translate these findings into a non-invasive diagnostic test for PE.
Crystal structure of 2-[(5-amino-1-tosyl-1H-pyrazol-3-yl)oxy]-1-(4-methoxyphenyl)ethan-1-one 1,4-dioxane monosolvate
Authors: Metwally Nadia H. , Elgemeie Galal H. , Jones Peter G.
Published: December 2023

In the structure of the title compound, C19H19N3O5S·C4H8O2, the two independent dioxane molecules each display inversion symmetry. The pyrazole ring is approximately parallel to the aromatic ring of the oxy-ethanone group and approximately perpendicular to the tolyl ring of the sulfonyl substituent. An extensive system of classical and `weak' hydrogen bonds connects the residues to form a layer structure parallel to (201), within which dimeric subunits are conspicuous; neighbouring layers are connected by classical hydrogen bonds to dioxanes and by `weak' hydrogen bonds from Htolyl donors.
Crystal structure and Hirshfeld surface analysis of dimethyl 4-hydroxy-5,4′-dimethyl-2′-(toluene-4-sulfonylamino)biphenyl-2,3-dicarboxylate
Authors: Guliyeva Narmina A. , Burkin Gleb M. , Annadurdyyeva Selbi , Khrustalev Victor N. , Atioğlu Zeliha , Akkurt Mehmet , Bhattarai Ajaya
Published: December 2023

In the title compound, C25H25NO7S, the molecular conformation is stabilized by intramolecular O—H...O and N—H...O hydrogen bonds, which form S(6) and S(8) ring motifs, respectively. The molecules are bent at the S atom with a C—SO2—NH—C torsion angle of −70.86 (11)°. In the crystal, molecules are linked by C—H...O and N—H...O hydrogen bonds, forming molecular layers parallel to the (100) plane. C—H...π interactions are observed between these layers.
Relationship between trust, the investment model and logistics performance in supply chain management
Authors: Lee Changjoon , Ha Byoung-Chun
Published: December 2023

Purpose

This study examines the relationship between trust, the investment model and logistics performance and the importance of commitment between companies in the supply chain. Furthermore, it analyzes satisfaction, quality of alternatives, investment size and commitment level, which are the constituent factors of the investment model, and reviews trust and logistics performance to ascertain their causal relationship.

Design/methodology/approach

The authors examined employees working in supply chain-related departments in Korean companies and further conducted an online survey for a month in January 2022 through the survey agency Entrust Survey, through which the authors distributed a total of 4,082 questionnaires and collected and used a total of 300 questionnaires for statistical analysis. The authors then validated the hypotheses using SPSS 18.0 and AMOS 18.0 using the structural equation modeling method.

Findings

The results showed that trust significantly and positively affects satisfaction levels in the relationship between companies in the supply chain. Trust can lower uncertainty in the transaction process between companies.

Originality/value

In this study, the investment model, which has been predominantly observed in the field of family psychology, was applied to business studies. In addition, the investment model was extended to enable its application to supply chain management research, thereby offering a distinctive research model from preceding studies.
Entrepreneurial intention among women entrepreneurs and the mediating effect of dynamic capabilities: empirical evidence from Lebanon
Authors: Nigam Nirjhar , Shatila Khodor
Published: December 2023

Purpose

Entrepreneurship institutions exhibit substantial gender discrimination despite worldwide efforts to decrease the phenomenon. The MENA area has a low percentage of women entrepreneurs since little is known about women’s desire to start their businesses. The authors use the theory of planned behavior (TPB) to explain what influences women's propensity toward entrepreneurship and what factors discourage them.

Design/methodology/approach

TPB is a psychological theory explaining how individuals act in certain situations. The authors created their database by using a systematic questionnaire. Overall, 350 women entrepreneurs contributed to their dataset. Finally, the authors used structural equation modeling to verify their hypotheses.

Findings

This study helps them to shed light to better understand the dynamics of Entrepreneurial Intention, in women from Lebanon. The authors do not find any relationship between lack of knowledge, funding, networking and entrepreneurial startup intention for Lebanese women. The role of dynamic capabilities in the entrepreneurial landscape of Lebanon, particularly for women, is substantially highlighted by the full mediation observed in the relationship between lack of knowledge and entrepreneurial start-up intentions. The findings discovered that these capabilities could fully mediate the negative impact of lack of networking on the intention to commence entrepreneurial ventures.

Originality/value

This research illustrates and explains how dynamic capabilities mediate the relationship between women entrepreneurs' challenges and their intention to start a business in the Lebanese context.