bluuebunny/crossref_metadata_2025 huggingface dataset:
The evolutionary trajectories of specialized metabolites towards antiviral defense system in plants
Authors: Ahmad Naveed , Xu Yi , Zang Faheng , Li Dapeng , Liu Zhenhua
Published: January 2024

Viral infections in plants pose major challenges to agriculture and global food security in the twenty-first century. Plants have evolved a diverse range of specialized metabolites (PSMs) for defenses against pathogens. Although, PSMs-mediated plant-microorganism interactions have been widely discovered, these are mainly confined to plant-bacteria or plant-fungal interactions. PSM-mediated plant-virus interaction, however, is more complicated often due to the additional involvement of virus spreading vectors. Here, we review the major classes of PSMs and their emerging roles involved in antiviral resistances. In addition, evolutionary scenarios for PSM-mediated interactions between plant, virus and virus-transmitting vectors are presented. These advancements in comprehending the biochemical language of PSMs during plant-virus interactions not only lay the foundation for understanding potential co-evolution across life kingdoms, but also open a gateway to the fundamental principles of biological control strategies and beyond.

Graphical Abstract

The putative co-evolutionary triad of plant metabolites (PSM) mediated interactions between plant, viruses and their insect vectors.

This dynamic trio is depicted through the interplay represented by pink and green arrows, signifying the PSM mediated bidirectional interactions occurring between the virus, the host plant, and the vector.
Pulmonary valve replacement for porcelain right ventricular outflow tract following repeated surgical intervention
Authors: Fujita Satoshi , Tatewaki Hideki , Sakamoto Ichiro , Tanoue Yoshihisa , Shiose Akira
Published: January 2024

Background

Repeat surgery is common in adult congenital heart disease, and valve-related procedures are the most frequent indication for re-intervention. In these cases, problems such as advanced adhesion, deterioration and calcification of the prosthesis used, progression of cardiac dysfunction, and worsening of the general condition are often observed.

Case presentation

We herein report a 43-year-old patient with repaired pulmonary atresia and ventricular septal defect who experienced repeated right heart failure and protein-losing enteropathy after multiple bioprosthetic tricuspid and pulmonary valve replacements. The patient was successfully treated with a fourth pulmonary valve replacement and third tricuspid valve replacement using a mechanical valve. During surgery, peeling off and removing the right ventricular outflow conduit was risky due to dense adhesion to the ascending aorta with extremely severe calcification; thus, the mechanical pulmonary valve was implanted to a more proximal position of the right ventricular outflow tract after removing the leaflet only and leaving the stent of the bioprosthetic valve within the conduit. The right heart failure and protein-losing enteropathy were relieved with this surgery, and the patient has remained in remission for over 5 years.

Conclusion

Although severe adhesion and porcelain-like calcification caused by multiple surgical interventions were a major issue in this case, good surgical results were obtained. This method has a major advantage over conventional pulmonary valve replacement with right ventricle outflow tract reconstruction when the right ventricular outflow tract conduit shows severe adhesion and calcification.
Changes in Isoleucine, Sarcosine, and Dimethylglycine During OGTT as Risk Factors for Diabetes
Authors: Liu Yixian , Liu Xiaoxuan , He Qian , Huang Xu , Ren Yanv , Dong Zuoliang
Published: January 2024

Context

Current metabolomics studies in diabetes have focused on the fasting state, while only a few have addressed the satiated state.

Objective

We combined the oral glucose tolerance test (OGTT) and metabolomics to examine metabolite-level changes in populations with different glucose tolerance statuses and to evaluate the potential risk of these changes for diabetes.

Methods

We grouped participants into those with normal glucose tolerance (NGT), impaired glucose regulation (IGR), and newly diagnosed type 2 diabetes (NDM). During the OGTT, serum was collected at 0, 30, 60, 120, and 180 minutes. We evaluated the changes in metabolite levels during the OGTT and compared metabolic profiles among the 3 groups. The relationship between metabolite levels during the OGTT and risk of diabetes and prediabetes was analyzed using a generalized estimating equation (GEE). The regression results were adjusted for sex, body mass index, fasting insulin levels, heart rate, smoking status, and blood pressure.

Results

Glucose intake altered metabolic profile and induced an increase in glycolytic intermediates and a decrease in amino acids, glycerol, ketone bodies, and triglycerides. Isoleucine levels differed between the NGT and NDM groups and between the NGT and IGR groups. Changes in sarcosine levels during the OGTT in the diabetes groups were opposite to those in glycine levels. GEE analysis revealed that during OGTT, isoleucine, sarcosine, and acetic acid levels were associated with NDM risks, and isoleucine and acetate levels with IGR risks.

Conclusion

Metabolic profiles differ after glucose induction in individuals with different glucose tolerance statuses. Changes in metabolite levels during OGTT are potential risk factors for diabetes development.
P-17 Hypophosphatemia related to intravenous iron therapy: A case report
Authors: Uysal Serhat , Mammadhasanova Narmin , Muradov Ilkin , Kocaman Banu Betül , Soltanova Lala , Sahin Serdar , Kadıoğlu Pınar
Published: January 2024

Introduction

Intravenous iron supplementation is a good alternative to oral iron replacement in iron deficiency anaemia. Intravenous iron formulations such as ferric carboxymaltose allow administration of high doses of elemental iron and enable correction of total iron deficit in one or two infusions. An important complication of ferric carboxymaltose is hypophosphatemia caused by increased secretion of the phosphaturic hormone, fibroblast growth factor 23 (FGF23). In this case, we aimed to present our patient with this rare side effect of intravenous iron replacement.

Clinical Case

A 40-year-old female patient who has no chronic systemic disease was admitted to our endocrinology service for fatigue and weakness. In the patient's history, it was learned that she had been treated with 2500 mg intravenous iron replacement (ferric carboxymaltose) for iron deficiency anaemia in the last month. In the laboratory tests; serum phosphorus 1.05 mg/dl (normal 2.5-4.5 mg/dl), corrected calcium 8.45 mg/dl (normal 8.4-10.2 mg/dl), 25-OH vitamin D 31.4 µg/L (normal >30 µg/L), parathormone 83.2 pg/ml (normal 15-65 ng/ml), alkaline phosphatase 63 U/L (normal 35-105 U/L). Fractional excretion of phosphate (FePO4) confirmed renal phosphate wasting (FePO4: 28.6%; normal <5%). Urinary protein and glucose were negative. FGF23 measured 71 pg/ml (normal <59 pg/mL). Intravenous iron-induced hypophosphataemia was suspected. After initiation of oral phosphate and 1,25-dihydroxyvitamin D3 supplementation, serum phosphate rose to reference range (Figure 1). The patient was taken to outpatient follow-up.

Conclusion

Physicians should be aware of hypophosphatemia as a common complication of intravenous iron therapy and monitor serum phosphate concentrations in patients receiving repeated doses.Figure 1.Patient phosphorus data during follow-up
P-26 Recurrent diabetic ketoacidosis-like symptoms and factitious hyperglycemia as a Munchausen syndrome in diabetes mellitus type 1: A case report
Authors: Niafar Mitra , Erensoy Habib , Tekantapeh Sepideh Tahsini
Published: January 2024

Introduction

Factitious disorder (FD) is diagnosed by pretending to be sick with no abnormal examination or paraclinical study in the presence of psychiatric symptoms which also is named Munchausen's syndrome. The prevalence of the disease among hospitalized patients is approximately 9%.

Clinical Case

A 17-year-old girl with type 1 diabetes mellitus was referred to endocrinology clinic with uncontrolled diabetes, dizziness, abdominal pain, nausea and vomiting. She was treated with multiple daily insulin during 4 years but in last 8 months her self-monitoring of blood glucose ranges was out of control and have BG (blood glucose) different ranges of 40-560mg/dl. She was admitted to control her brittle diabetes with insulin infusion but even with high dose insulin infusion up to 20 IU/hr mostly her BS were above 400mg/dl. The notable point was that BG level was measured by laboratory was lower than glucometer. She also complained of severe abdominal pain and nausea during admission that mimics diabetic ketoacidosis in the presence of hyperglycemia despite the lack of ketonuria and metabolic acidosis. She admitted to hospital several times over the last year to control high level of BG. In psychiatric examination, she has good cooperation in response to questions. Mental Status Examination was not normal. Her mood was depressive and behavior was aggressive. Mild depressive symptoms and borderline features were seen in her Rorschach test. Finally because of high suspicion to associated psychiatric problems, to find the cause of high BG despite high insulin dose prescription, patient behaviors were monitored insensible. We found that she impregnated her finger to the date palm a few minutes before blood glucose check with glucometer devices at times when she is alone in the room. The patient had different deceptive behaviors depending on the method of treatment. But the answer to the question of why the patient was not suffering from hypoglycemia despite high doses of insulin injection is, when insulin infusion by pump was started to control high BG, intravenous cannula secretly separated from insulin infusion set and insulin thrown away. Also she secretly eats fruit juice and jam to prevent hypoglycemic attack for high-dose insulin injection. She took the water into the insulin pen instead of insulin and injected so that the nurses did not notice. Frauds were changed by switching the treatment methods. HbA1c was requested last week of hospitalization which shows 8%. Although all BGwas above 300 mg/dl during this prolonged hospitalization, it did not match with chronic hyperglycemia.

Conclusion

The main purpose of this article was in relation to a diabetic patient with brittle diabetes, difficulty in control BG level, discrepancies between patient symptoms and sings, factitious disorder or Munchausen syndrome should always be in our mind.
P-27 Sweet moves - Hemichorea associated with non-ketotic hyperglycemia
Authors: Martins João Dinis , Pina Henrique , Silveira Débora , Duarte Miguel Saianda , Féria Rita Palma , Ribeiro Ana Cláudia , Guerra Sílvia , Valadas Cristina
Published: January 2024

Introduction

Hemichorea is a movement disorder characterized by involuntary, irregular, and often violent movements of one hemibody, typically caused by dysfunction in the basal ganglia. There are several potential causes of hemichorea, namely vascular lesions, autoimmune conditions, structural lesions, drugs, or metabolic disturbances, among others.

Hemichorea associated with non-ketotic hyperglycemia is a rare condition with a reported prevalence of 1 in 100.000. Although its exact mechanisms are not fully understood, it is believed to be linked to metabolic changes and vascular abnormalities associated with diabetes and its management involves optimizing blood sugar levels.

Clinical Case

This is the case of a female patient, 76 years old, caucasian with known medical history of hypertension, type 2 diabetes, and dyslipidemia. The woman, admitted to the Neurology department, presented with involuntary movements of the left hemibody and face, with sudden onset, one day before admission. There was no history of visual changes, headache, dizziness, syncope, or other symptoms and there were no recent changes in her usual medication. The neurological examination didn't show any defects other than the choreic movements of the left hemiface and hemibody. Blood tests revealed an HbA1c level of 9.3% and a glucose level of 254 mg/dL.

A brain CT scan revealed a possible hypodensity of the right insula, besides signs of microangiopathic leukoencephalopathy. A brain MRI was ordered and showed, on the right putamen, hyperintensity on T1, mild hyperintensity on Flair (Fig.1), and mild hypointensity on T2, without areas of diffusion restriction suggesting ischaemic vascular damage - radiologic findings consistent with hemichorea associated with non-ketotic hyperglycemia. Strict glycemic control was achieved in cooperation with the Endocrinology department, with complete resolution of symptoms.

Conclusion

Although rare, hyperglycemia should be considered as a potential cause of hemichorea, as correction of the underlying condition will lead to rapid improvement of the movements and is the most important feature for diagnosis. This case shows the myriad of clinical presentations that a person living with Diabetes can have.Figure 1.Brain MRI scan.Brain MRI scan showing, on the right putamen, mild hyperintensity on Flair.
P-52 Our objective was to present a case with secondary hypophysitis
Authors: Soltanova Lala , Sahin Serdar , Alay Murat , Kadıoğlu Pınar
Published: January 2024

Clinical Case

A 36-year-old male patient was admitted to an external center with weakness, sexual dysfunction, polydipsia and polyuria. The Laboratory analysis showed partial hypopituitarism (Table 1).

The sella MR imaging was performed to determine the etiology. It was showed that the thickness of the pituitary gland was thinner than normal (3 mm, Partially Empty Sella). The pituitary stalk was also significantly enlarged, measuring up to 7.5 mm, and there was an increase in contrast enhancement, as shown in Figure 1. The patient was subsequently started on Prednisolone, L-thyroxine, testosterone propionate, and Desmopressin acetate to treat panhypopituitarism.

The ACE level was within the normal range, and tests including quantiferon, vasculitis markers (c-ANCA, P-ANCA, ANA), AFP, Beta hCG, LDH, and beta2 microglobulin all yielded negative results. Given these findings and considering primary hypophysitis, a pulse steroid therapy of 1 gram was administered over a span of 2 days (Figure 1).

In the control pituitary MRI 3 months after the treatment: Heterogeneous contrast-enhancing thickening of approximately 16×10mm in the pituitary stalk and a lesion of approximately 22×10mm in the diameter of the epiphysis with heterogeneous contrast enhancement were observed (Figure 2). During this period, the patient was considered to have hypophysitis again, and 1 gr of pulse steroid treatment was administered for 2 days. (Figure 2)

Six months after the start of the treatment, the patient was admitted due to sudden onset of double vision and headache. In the pituitary MRI, he was referred to our center upon detection of a 22×13×10 mm contrast-enhancing bilobular lesion that slightly compresses the optic chiasm, and also a 15×10 mm lobulated lesion in the pineal gland (Figure 3).

An emergency operation was planned for the lesion, who was compressing the optic chiasm and whose progressing mass size was, for diagnostic and therapeutic purposes. The patient underwent surgery. Preoperative b hCG was negative, and AFP was 2.6 (<13). The histopathological examination revelaed germinoma.

Conclusion

Hypophysitis is a rare inflammatory disease that affects the pituitary gland and infundibulum as a result of autoimmune, infiltrative, infectious, neoplastic, drug-induced or sometimes unknown pathogenic processes. Some authors recommend a biopsy if the pituitary stalk size is >6.5 mm or if new lesions develop on the stalk. Germinomas, one of the causes of secondary hypophysitis, usually present with a hypothalamic/pineal mass and isolated stalk thickening and has been reported in only a few cases. Serologically, beta human chorionic gonadotropin (β-hCG) and alpha-fetoprotein (85-90%) may be normal in brain germinomas. Therefore, normal negative results of AFP and B-hCG do not exclude germinoma.

Table 1
O-10 Lymph node ACTH washout determined the source of ACTH secretion in a patient with Cushing's Syndrome due to medullary thyroid cancer
Authors: Onur İşler Alperen , Nahit Şendur Süleyman , Gönül İremli Burçin , Ünlütürk Uğur , Cennet Ömer , Bülent Doğrul Ahmet , Gürlek Alper
Published: January 2024

Introduction

Ectopic ACTH syndrome constitutes 18% of Cushing's syndrome cases, and in rare cases, ACTH secretion from medullary thyroid cancer cells is the source of ectopic ACTH production. Here we report a catastrophic Cushing's syndrome case owing to medullary thyroid cancer in which the source of ACTH production was demonstrated by lymph node ACTH washout.

Clinical Case

A 23 year-old male was admitted to other clinics with complaints of inability to lose weight despite diet and exercise, and weight gain of approximately 40 kg, which had been going on for the last two years. At his application, his weight was 160 kg and his body mass index was 42.51 kg/m2. On physical examination, clinical stigmata suggesting Cushing's syndrome such as moon face, buffalo hump, supraclavicular fat deposition, acanthosis nigricans, centripedal obesity, purple striae on the abdomen were noted. The biochemical and hormonal evaluation confirmed ACTH-dependent Cushing's syndrome (Table 1). To establish the source of excess ACTH, first, a pituitary MRI was performed which revealed a 4×2 mm adenoma on the left side of the gland. In PET-CT, a 24×20 mm hypoechoic nodule in the inferior of the right thyroid lobe, and several pathological lymph nodes at the right side of the neck were detected. Serum calcitonin levels were high (6528 ng/L) and fine-needle aspiration biopsy from the thyroid nodule documented medullary thyroid cancer. The patient underwent bilateral total thyroidectomy and right cervical lymph node dissection. The pathology report was compatible with metastatic medullary thyroid cancer.

After surgery, the remission of hypercortisolemia was not achieved and the patient was started on metyrapone treatment before the permanent treatment plan. Postoperative Gallium-68 DOTA PET-CT indicated residual disease and increased uptake in retropharyngeal, bilateral cervical level 2-4, right level 3, bilateral central, and bilateral lower cervical lymph nodes. The persistence of hypercortisolemia after surgery was most likely attributed to residual disease, however, it was considered that pituitary adenoma may also be the cause of ACTH secretion. Therefore, to confirm the source of ACTH secretion, ACTH washout samples were taken from the cervical lymph nodes and were found to be high as 958 ng/L. Reoperation was performed for recurrent mass and lymph node metastases.

Conclusion

Medullary thyroid cancer should definitely be considered in cases of ectopic ACTH syndrome. ACTH washing from the suspected lymph node may be an option for diagnostic purposes. In addition to the patient's primary tumor, hypercortisolism should also be treated.Table 1.Cushing's assessment tests
P-73 A case of malignant struma ovary
Authors: Abbasgholizadeh Anna , Yavuz Dilek
Published: January 2024

Introduction

Germ cell malignancies originate from primordial gonadal and infrequently extragonadal germ cells. Germ cell tumors account for approximately 15–20% of all ovarian neoplasms, of which only 2% to 3% are malignant. Teratomas make up 95% of these malignancies. Struma ovarian teratomas are tumors in which thyroid tissue accounts for more than half of the bulk.

Clinical Case

A 42-year-old female patient with abdominal distress was admitted to the obstetrics and gynecology outpatient clinic. An examination of the pelvis revealed a palpable mass in the region of the right adnexa. On ultrasound examination, a 4.5 cm hypoechoic cyst and a 5 cm septal anechoic cyst were detected in the right adnexal region. The dynamic contrast-enhanced abdominal MRI, observed for additional evaluation, revealed dimensions of 12*5*9 cm within the right adnexal region, specifically the right lateral region, with a cystic dominant lesion measuring 5 cm in diameter and a 5 cm solid component. The laboratory analysis revealed normal hemogram and transaminase levels. Thyroid function assays revealed TSH concentrations of 1.61 mIU/L (reference range: 0.48-4.81),ft4 concentrations of 1.26 ng/dL (reference range: 0.78-1.51), and ft3 concentrations of 3.15 ng/dL (reference range: 2.04-4.42). In addition, LH was 3.69 IU/L, FSH was 9.42 IU/L, and E2 was 20.70 ng/L. All tumor markers fell within normal limits. TAH BSO plus lymph node dissection plus omentectomy plus peritoneal lavage was performed. The histopathological examination revealed a 4 cm diameter tumor consistent with thyroid papillary carcinoma tissue in the right ovary. BRAF V600 was negative. Thyroid USG revealed two 5 mm hypoechoic nodules, and a fine needle aspiration biopsy of the thyroid revealed atypical follicular epithelium (AUS Bethesda 3). She underwent a total thyroidectomy. The histopathological analysis was consistent with multifocal thyroid papillary microcarcinoma.

Conclusion

Due to the presence of a tumor focus greater than 10 mm in the struma ovary, the patient was deemed high risk and adjuvant RAI therapy was planned. Close surgical margin, >10 mm PTC focus in the struma ovary, presence of aggressive histopathology, lymphovascular invasion, and presence of BRAF/RAS mutation are histopathological high-risk indicators.
P-76 Down Syndrome and Thyroid hormone levels - how low can you go?
Authors: Martins João Dinis , Pina Henrique , Silveira Débora , Féria Rita Palma , Guerra Sílvia , Valadas Cristina
Published: January 2024

Introduction

Down syndrome (DS) is the most common chromosomal condition among live-born infants. It is associated with intellectual disability as well as medical issues ranging from congenital heart disease, obstructive sleep apnea, celiac disease, to endocrinopathies, namely thyroid disorders. The spectrum of thyroid dysfunction in patients with DS include congenital hypothyroidism, subclinical hypothyroidism, acquired hypothyroidism, and hyperthyroidism.

Identifying medical comorbidities in these patients can be crucial to optimize their quality of life.

Clinical Case

This is the case of a male patient, 30 years old, caucasian, institutionalized, with DS and known medical history of esophageal dilation, macroglossia, valvular heart disease with mild aortic insufficiency and left ventricular moderated hypertrophy, macrocytic anemia, and pulmonary embolism 10 months earlier.

Due to pallor, somnolence, fatigue, thin and fragile hair, and bradycardia, blood tests were requested and revealed an elevated TSH (385.20 mUI/L, N 0.27-4.20) with undetectable free T4 levels (<0.5 pmol/L, N 12.0-22.0), macrocytic anemia (Hb 11.4 g/dL; MCV 102 fL), renal dysfunction (creatinine 1.73 mg/dL) and hypercholesterolemia (total cholesterol 310 mg/dL; LDL 236 mg/dL). The chest X-ray revealed an heart silhouette enlargement and the echocardiogram showed left ventricular hypertrophy with preserved ejection fraction, diastolic dysfunction, and mild pericardial effusion. The thyroid ultrasound revealed a globally reduced gland, with diffuse hyperechogenicity and heterogeneity, suggesting thyroiditis.

The patient was referred to the emergency department and the additional study revealed the presence of anti-TPO and anti-TG antibodies and a severe CK elevation (9280 UI/L, N 46-171). The patient, although lethargic, presented with normal blood pressure, heart rate, and body temperature during the hospital admission. Searching our national health system database, it was found the patient already had TSH elevation with undetectable free T4 levels at least 12 years before, in another hospital, but had lost follow-up there after the blood tests, and therefore remaining undiagnosed and untreated.

Oral levothyroxine reposition was started, first with 50 micrograms and then 100 micrograms and the patient was discharged after 5 days with follow-up at the Endocrinology department. Two months later, there were already clinical and laboratory changes, with improved level of consciousness and normalized free T4 levels.

Conclusion

Although hypothyroidism is a common and widely recognized condition, this case emphasizes how challenging the diagnosis can be in a person with DS.

Knowing that this syndrome is associated with several organic dysfunctions, namely endocrine disorders with non-specific clinical manifestations, there must be a high level of suspicion in order to screen, diagnose, and treat the comorbidities that may appear.
Dopamine Agonists as a Novel “Cure” for Autoimmune Diabetes
Authors: Sahota Shaan , Cooper Lorcan , Sirkova Anelia , Stojanovic Nemanja
Published: January 2024

We present a patient who, when treated for macroprolactinoma with a dopamine agonist (DA), was able to stop insulin treatment of his autoimmune diabetes for 2 years. The patient was diagnosed with autoimmune diabetes after presenting to emergency services in diabetic ketoacidosis aged 50 years. On presentation, he had high titers of autoantibodies associated with pancreatic islet cell destruction and a high level of glycated hemoglobin. On review in the endocrinology clinic, he displayed signs and symptoms of hypogonadism. Subsequent investigations revealed low testosterone and high prolactin with a pituitary macroadenoma on magnetic resonance imaging. He was diagnosed with a macroprolactinoma and treated with DA. This treatment reversed his insulin requirement and he achieved excellent glycemic control without any hypoglycemic agent. At this point, his diagnosis was revised to latent autoimmune diabetes of adults. Two years after commencing the DA, insulin had to be restarted. We hypothesize that in addition to autoimmune destruction of the pancreatic β cells, there were several other causes of hyperglycemia in this patient, including hyperprolactinemia and hypogonadism. The correct diagnosis led to significant weight loss and appropriate therapy, with a dramatic improvement in quality of life.
Public Health Informatics and the Perioperative Physician: Looking to the Future
Authors: Mudumbai Seshadri C. , Gabriel Rodney A. , Howell Stephen , Tan Jonathan M. , Freundlich Robert E. , O’Reilly-Shah Vikas N. , Kendale Samir , Poterack Karl , Rothman Brian S.
Published: January 2024

The role of informatics in public health has increased over the past few decades, and the coronavirus disease 2019 (COVID-19) pandemic has underscored the critical importance of aggregated, multicenter, high-quality, near-real-time data to inform decision-making by physicians, hospital systems, and governments. Given the impact of the pandemic on perioperative and critical care services (eg, elective procedure delays; information sharing related to interventions in critically ill patients; regional bed-management under crisis conditions), anesthesiologists must recognize and advocate for improved informatic frameworks in their local environments. Most anesthesiologists receive little formal training in public health informatics (PHI) during clinical residency or through continuing medical education. The COVID-19 pandemic demonstrated that this knowledge gap represents a missed opportunity for our specialty to participate in informatics-related, public health-oriented clinical care and policy decision-making. This article briefly outlines the background of PHI, its relevance to perioperative care, and conceives intersections with PHI that could evolve over the next quarter century.
Perioperative Fluid and Vasopressor Therapy in 2050: From Experimental Medicine to Personalization Through Automation
Authors: Coeckelenbergh Sean , Vincent Jean-Louis , Duranteau Jacques , Joosten Alexandre , Rinehart Joseph
Published: January 2024

Intravenous (IV) fluids and vasopressor agents are key components of hemodynamic management. Since their introduction, their use in the perioperative setting has continued to evolve, and we are now on the brink of automated administration. IV fluid therapy was first described in Scotland during the 1832 cholera epidemic, when pioneers in medicine saved critically ill patients dying from hypovolemic shock. However, widespread use of IV fluids only began in the 20th century. Epinephrine was discovered and purified in the United States at the end of the 19th century, but its short half-life limited its implementation into patient care. Advances in venous access, including the introduction of the central venous catheter, and the ability to administer continuous infusions of fluids and vasopressors rather than just boluses, facilitated the use of fluids and adrenergic agents. With the advent of advanced hemodynamic monitoring, most notably the pulmonary artery catheter, the role of fluids and vasopressors in the maintenance of tissue oxygenation through adequate cardiac output and perfusion pressure became more clearly established, and hemodynamic goals could be established to better titrate fluid and vasopressor therapy. Less invasive hemodynamic monitoring techniques, using echography, pulse contour analysis, and heart-lung interactions, have facilitated hemodynamic monitoring at the bedside. Most recently, advances have been made in closed-loop fluid and vasopressor therapy, which apply computer assistance to interpret hemodynamic variables and therapy. Development and increased use of artificial intelligence will likely represent a major step toward fully automated hemodynamic management in the perioperative environment in the near future. In this narrative review, we discuss the key events in experimental medicine that have led to the current status of fluid and vasopressor therapies and describe the potential benefits that future automation has to offer.
Supraglottic Airway Devices: Present State and Outlook for 2050
Authors: van Zundert André A. J. , Gatt Stephen P. , van Zundert Tom C. R. V. , Hagberg Carin A. , Pandit Jaideep J.
Published: January 2024

Correct placement of supraglottic airway devices (SGDs) is crucial for patient safety and of prime concern of anesthesiologists who want to provide effective and efficient airway management to their patients undergoing surgery or procedures requiring anesthesia care. In the majority of cases, blind insertion of SGDs results in less-than-optimal anatomical and functional positioning of the airway devices. Malpositioning can cause clinical malfunction and result in interference with gas exchange, loss-of-airway, gastric inflation, and aspiration of gastric contents. A close match is needed between the shape and profile of SGDs and the laryngeal inlet. An adequate first seal (with the respiratory tract) and a good fit at the second seal of the distal cuff and the gastrointestinal tract are most desirable. Vision-guided insertion techniques are ideal and should be the way forward. This article recommends the use of third-generation vision-incorporated-video SGDs, which allow for direct visualization of the insertion process, corrective maneuvers, and, when necessary, insertion of a nasogastric tube (NGT) and/or endotracheal tube (ETT) intubation. A videoscope embedded within the SGD allows a visual check of the glottis opening and position of the epiglottis. This design affords the benefit of confirming and/or correcting a SGD’s position in the midline and rotation in the sagittal plane. The first clinically available video laryngeal mask airways (VLMAs) and multiple prototypes are being tested and used in anesthesia. Existing VLMAs are still not perfect, and further improvements are recommended. Additional modifications in multicamera technology, to obtain a panoramic view of the SGD sitting correctly in the hypopharynx and to prove that correct sizes have been used, are in the process of production. Ultimately, any device inserted orally—SGD, ETT, NGT, temperature probe, transesophageal scope, neural integrity monitor (NIM) tubes—could benefit from correct vision-guided positioning. VLMAs also allow for automatic recording, which can be documented in clinical records of patients, and could be valuable during teaching and research, with potential value in case of legal defence (with an airway incident). If difficulties occur with the airway, documentation in the patient’s file may help future anesthesiologists to better understand the real-time problems. Both manufacturers and designers of SGDs may learn from optimally positioned SGDs to improve the design of these airway devices.
Remote Monitoring and Artificial Intelligence: Outlook for 2050
Authors: Feinstein Max , Katz Daniel , Demaria Samuel , Hofer Ira S.
Published: January 2024

Remote monitoring and artificial intelligence will become common and intertwined in anesthesiology by 2050. In the intraoperative period, technology will lead to the development of integrated monitoring systems that will integrate multiple data streams and allow anesthesiologists to track patients more effectively. This will free up anesthesiologists to focus on more complex tasks, such as managing risk and making value-based decisions. This will also enable the continued integration of remote monitoring and control towers having profound effects on coverage and practice models. In the PACU and ICU, the technology will lead to the development of early warning systems that can identify patients who are at risk of complications, enabling early interventions and more proactive care. The integration of augmented reality will allow for better integration of diverse types of data and better decision-making. Postoperatively, the proliferation of wearable devices that can monitor patient vital signs and track their progress will allow patients to be discharged from the hospital sooner and receive care at home. This will require increased use of telemedicine, which will allow patients to consult with doctors remotely. All of these advances will require changes to legal and regulatory frameworks that will enable new workflows that are different from those familiar to today’s providers.
Beyond the Echo: The Evolution and Revolution of Ultrasound in Anesthesia
Authors: Harutyunyan Robert , Jeffries Sean D. , Morse Joshua , Hemmerling Thomas M.
Published: January 2024

This article explores the evolving role of ultrasound technology in anesthesia. Ultrasound emerged decades ago, offering clinicians noninvasive, economical, radiation-free, and real-time imaging capabilities. It might seem that such an old technology with apparent limitations might have had its day, but this review discusses both the current applications of ultrasound (in nerve blocks, vascular access, and airway management) and then, more speculatively, shows how integration of advanced ultrasound modalities such as contrast-enhanced imaging with virtual reality (VR), or nanotechnology can alter perioperative patient care. This article will also explore the potential of robotics and artificial intelligence (AI) in augmenting ultrasound-guided anesthetic procedures and their implications for medical practice and education.
Robotic Anesthesia: A Vision for 2050
Authors: Hemmerling Thomas M. , Jeffries Sean D.
Published: January 2024

The last 2 decades have brought important developments in anesthetic technology, including robotic anesthesia. Anesthesiologists titrate the administration of pharmacological agents to the patients’ physiology and the needs of surgery, using a variety of sophisticated equipment (we use the term “pilots of the human biosphere”). In anesthesia, increased safety seems coupled with increased technology and innovation. This article gives an overview of the technological developments over the past decades, both in terms of pharmacological and mechanical robots, which have laid the groundwork for robotic anesthesia: target-controlled drug infusion systems, closed-loop administration of anesthesia and sedation, mechanical robots for intubation, and the latest development in the world of communication with the arrival of artificial intelligence (AI)–derived chatbots are presented.
Multi-monoubiquitylation controls VASP-mediated actin dynamics
Authors: McCormick Laura E. , Suarez Cristian , Herring Laura E. , Cannon Kevin S. , Kovar David R. , Brown Nicholas G. , Gupton Stephanie L.
Published: January 2024

The actin cytoskeleton performs multiple cellular functions, and as such, actin polymerization must be tightly regulated. We previously demonstrated that reversible, non-degradative ubiquitylation regulates the function of the actin polymerase VASP in developing neurons. However, the underlying mechanism of how ubiquitylation impacts VASP activity was unknown. Here, we show that mimicking multi-monoubiquitylation of VASP at K240 and K286 negatively regulates VASP interactions with actin. Using in vitro biochemical assays, we demonstrate the reduced ability of multi-monoubiquitylated VASP to bind, bundle, and elongate actin filaments. However, multi-monoubiquitylated VASP maintained the ability to bind and protect barbed ends from capping protein. Finally, we demonstrate the electroporation of recombinant multi-monoubiquitylated VASP protein altered cell spreading morphology. Collectively, these results suggest a mechanism in which ubiquitylation controls VASP-mediated actin dynamics.
Το ενιαίο ευρωπαϊκό σύστημα ασύλου
Authors: Σίντος Δημήτριος
Published: January 2024

Το αντικείμενο της διατριβής αφορά την πορεία ενοποίησης των πολιτικών της Ευρωπαϊκής Ένωσης και των κρατών μελών για το άσυλο. H διατριβή επικεντρώνεται στο Κοινό Ευρωπαϊκό Σύστημα Ασύλου και στον τρόπο με τον οποίο επιτελείται ο διαμοιρασμός της ευθύνης διαχείρισης αιτούντων διεθνή προστασία, ανάμεσα στα κράτη μέλη. Η βασική υπόθεση εργασίας είναι ότι οι εθνικές κυβερνήσεις αποτελούν συσσωματωμένες μονάδες που η δράση τους διακρίνεται από συλλογική ορθολογικότητα. Τo βασικό ερώτημα που τίθεται είναι το εξής: ποιοι είναι οι βασικοί λόγοι για τους οποίους δεν έχει καταστεί δυνατή, έως σήμερα, η διαμόρφωση μιας ενιαίας ενωσιακής πολιτικής σχετικά με το μεταναστευτικό ζήτημα και τις διαδικασίες διαχείρισης αιτημάτων διεθνούς προστασίας; Προσεγγίζοντας το ζήτημα από τη σκοπιά των θεωριών για την ολοκλήρωση της ΕΕ αποδίδεται έμφαση στην ανάδειξη των αιτίων του ατελούς χαρακτήρα και ιδιαιτέρως στην ανάλυση των βασικών παραγόντων που διαμορφώνουν τις προτιμήσεις και τις επιλογές των κυβερνήσεων των κρατών μελών. Εφαρμόζοντας τη μέθοδο των αναλυτικών αφηγήσεων στο πεδίο των πολιτικών επιστημών, η διατριβή αναδεικνύει τους παράγοντες διαμόρφωσης της στάσης των εθνικών κυβερνήσεων στις διαπραγματεύσεις σχετικά με την πολιτική για το άσυλο σε επίπεδο Ευρωπαϊκής Ένωσης. H ανάλυση εμπλουτίζεται με στοιχεία από τις θεωρίες του φιλελεύθερου διακυβερνητισμού, του ιστορικού θεσμισμού και του μεταλειτουργισμού. Η διατριβή καταλήγει στη διατύπωση ενός ερμηνευτικού μοντέλου που αντιλαμβάνεται τις θεσμικές εξελίξεις από την περίοδο της κρίσης και έπειτα ως αλλαγή και όχι ως στασιμότητα.
Thoroughness of philosophy and return to religion in Tanabe Hajime
Authors: Doi Hiroto
Published: January 2024

Japanese philosopher Tanabe Hajime (1885–1962) not only discussed religion in ways that were rooted in the fundamental claims of his writings, such as Shinran in Philosophy as Metanoetics (1946), but he also made proposals on religion, as in Demonstration of Christianity (1948), where he advocated for the need for a “second religious reformation.” For Tanabe, philosophy and religion (along with science) are fused in a specific way, and it is possible to find a vision of religion to be aimed for that is worth considering as a theory of religion among Japanese philosophers. To examine the theory of religion in Tanabe, this study focuses on the work, Demonstration of Christianity, and other works from the perspective of religious studies. In Demonstration of Christianity, the concept of absolute religion toward the second religious reformation is envisioned based on Tanabe’s dialectics of the absolute mediation, and a discussion on his world religion can be found, although it is limited to Christianity and some Buddhist sects. Reflecting his absolute dialectic, Tanabe says that this world religion was established through the absolute mediation of Christianity with “Nembutsu-Zen” (the unification of Pure Land Buddhism and Zen Buddhism). One cannot deny the impression of Christocentrism in these discussions, but they are in fact the result of Tanabe’s thoroughness in philosophy. What can be drawn from these discussions is that Tanabe's theory of religion is strongly connected to Platonism, which he considered the root of his dialectics. For example, by the third article in Existence, Love, and Practice (1947), “Self-Transcendence in Platonism and Faith in Gospel.” Tanabe’s argument reveals the characteristics of conceiving a new religion that combines Eastern and Western ideas, philosophy, and religion through a creative interpretation of Platonism, the source of Western thought where philosophy and religion are inseparably linked.
Assessment of knowledge, attitude and practices of self-medication among the geriatric population of the Wardha district in central India: A cross-sectional study
Authors: Ghodkhande Khushal , Gaidhane Dr. Abhay
Published: January 2024

Background The incidence of self-medication varies greatly for each country. It is a widely used method across advanced and developing nations worldwide. Self-medication is taking pharmaceuticals without seeking physician advice for a diagnosis or treatment. This study will evaluate geriatrics’ knowledge, attitudes, and practices regarding self-medication. The objectives of the current study are to examine the practice of self-medication and assess the knowledge and attitude toward the same in the senior population, as well as the socio-demographic aspects influencing its usage and the reasons for its use. We also aim to test the correlation between demographic issues and self-medication. Methods A cross-sectional study will be conducted in the rural community area of the Wardha district. A survey will be used to evaluate the entire sample of geriatric age groups to determine the socio-demographic characteristics and associated risk factors for practicing self-medication. A semi-structured, pre-validated questionnaire Self-Medication Scale (SMS) will be used to understand the participants’ practice and attitudes regarding self-medication. The frequency and percentages of descriptive statistics will be determined. The correlation among variables will be discovered using the Chi-Square Test. Tables, graphs, and charts will present the data analysed. Study implications The present study will help formulate guidelines on medicine access and reinforce them with strong policy implementation mechanisms. The study will also help provide medical insurance or free consultations for populations in need.
Memory in the digital age
Authors: Mandolessi Silvana
Published: January 2024

This article explores the configuration of collective memory under the impact of the digital turn. In recent debates, there has been a marked tendency to interpret ‘digital memory’ as a new type of memory, which is radically different from the traditional conceptualization. Even leading authors in the field claim that the digital revolution implies the end of collective memory. However, I argue that despite the transformations that memory undergoes in the digital age, these changes do not imply a new ontology of memory but rather a materialization of the theoretical claims made by Memory Studies since the field's inception. To support this hypothesis, I analyze digital memory in relation to three topics: first, I focus on the problematic definition of collective memory to demonstrate how the digital realm allows us to rethink the social nature of memory through a different concept of the social. By contrasting Halbwachs' notion of the social, which forms the basis of memory studies, with the alternative proposal of Gabriel Tarde, I argue that the latter enables us to refine the concept of the ‘collective’ that we have inherited from the founding figure of memory studies. Second, I delve into the new ontology of the digital archive showing how it materializes one of the defining features of collective memory: its mobile, dynamic, and procedural nature. Lastly, I address the inversion of the dialectic between memory and forgetting to highlight the specificity of these practices in the digital environment. I demonstrate how these changes effectively implement, surpassing older technologies, the concept of collective memory as a distributed and dynamic technological process that shapes our shared representations of the past.
Investigation of the effects surface alteration via coatings on the condensation heat transfer and wettability
Authors: Martelo David F , Schneider Georgia , Bhamji Imran , Wojdyla Anna , Mittal Garima , Malik Nigar Gul , Nair Jayakumari Arunima Bhuvanendran , Kale Namrata , Snorrason David Ingvi , Ingason Arni , Taddei Paolo , Paul Shiladitya
Published: January 2024

Background Heat exchangers are a critical component in organic Rankine cyclic (ORC) geothermal power plants as they represent more than 50% of the capital. In this study, the thermal performance of coatings devised for condensation heat exchangers have been studied. Methods For this purpose, a mock-up heat exchanger rig was designed and fabricated. The coatings used for the trials are of hydrophobic nature, in order to promote a change in the heat transfer mode from film-wise condensation to drop-wise condensation. The coatings for this study were developed by chemical vapour deposition and magnetron sputtering on aluminium substrates. The wettability and adhesion of the coatings was characterized before and after the tests. Statistical analysis was used to analyse the heat transfer related data. Results The results indicate that the silica based coating produced an improvement in the heat transfer performance indicators and the working fluid caused a deterioration of the wetting properties. However, even at the end of the tests, the coated samples performed better than the substrate material in terms of heat transfer performance. Conclusions The results of this research prove that shifting from film-wise condensation to drop-wise condensation is viable method to improve heat transfer efficacy. However, a one to one correlation could not be established with water contact angles measured in water or diiodomethane suggesting that wettability properties in ORC fluid could differ to established in these conventional fluids for contact angle measurements.