bluuebunny/crossref_metadata_2025 huggingface dataset:
A rare case of leiomyosarcoma with a pleomorphic component of the sigmoid colon
Authors: Omameuda Takahiko , Koizumi Masaru , Miyahara Yuzo , Kitabayashi Hiroyuki , Shiozawa Mikio , Kondo Satoru , Kawai Shigeo , Kodama Masaaki
Published: July 2024

A 66-year-old man presented to our institution with a positive fecal occult blood test and lower abdominal pain. Although a tumor was found in the sigmoid colon, biopsy and imaging studies failed to enable the diagnosis of the cancer, and the patient underwent surgery for treatment and diagnosis. The tumor had two distinct areas with differing features shown both histopathologically and on imaging; it was thus diagnosed as a leiomyosarcoma of the sigmoid colon with a pleomorphic component. Here, we describe a rare case of leiomyosarcoma of the sigmoid colon with a pleomorphic component. There are no reports of leiomyosarcoma with pleomorphic components arising in the colon in the literature; thus, the recurrence and metastatic characteristics are unknown. Therefore, accumulating cases in the literature may provide valuable insights into diagnosing and treating these rare tumors.
The fusicoccin story revisited
Authors: de Boer Albertus H
Published: July 2024

Fusicoccin (FC) is one of the most studied fungal metabolites to date. The finding that the plasma membrane H+-ATPase in combination with 14-3-3 proteins acts as a high-affinity receptor for FC was a breakthrough in the field. Ever since, the binding of FC to the ATPase–14-3-3 receptor complex has taken center stage in explaining all FC-induced physiological effects. However, a more critical review shows that this is not evident for a number of FC-induced effects. This review challenges the notion that all FC-affected processes start with the binding to and activation of the plasma membrane ATPase, and raises the question of whether other proteins with a key role in the respective processes are directly targeted by FC. A second unresolved question is whether FC may be another example of a fungal molecule turning out to be a ‘copy’ of an as yet unknown plant molecule. In view of the evidence, albeit not conclusive, that plants indeed produce ‘FC-like ligands’, it is worthwhile making a renewed attempt with modern improved technology to answer this question; the answer might upgrade FC or its structural analogue(s) to the classification of plant hormone.
CyCoNP lncRNA establishes cis and trans RNA–RNA interactions to supervise neuron physiology
Authors: Desideri Fabio , Grazzi Alessandro , Lisi Michela , Setti Adriano , Santini Tiziana , Colantoni Alessio , Proietti Gabriele , Carvelli Andrea , Tartaglia Gian Gaetano , Ballarino Monica , Bozzoni Irene
Published: July 2024

The combination of morphogenetic and transcription factors together with the synergic aid of noncoding RNAs and their cognate RNA binding proteins contribute to shape motor neurons (MN) identity. Here, we extend the noncoding perspective of human MN, by detailing the molecular and biological activity of CyCoNP (as Cytoplasmic Coordinator of Neural Progenitors) a highly expressed and MN-enriched human lncRNA. Through in silico prediction, in vivo RNA purification and loss of function experiments followed by RNA-sequencing, we found that CyCoNP sustains a specific neuron differentiation program, required for the physiology of both neuroblastoma cells and hiPSC-derived MN, which mainly involves miR-4492 and NCAM1 mRNA. We propose a novel lncRNA-mediated ‘dual mode’ of action, in which CyCoNP acts in trans as a classical RNA sponge by sequestering miR-4492 from its pro-neuronal targets, including NCAM1 mRNA, and at the same time it plays an additional role in cis by interacting with NCAM1 mRNA and regulating the availability and localization of the miR-4492 in its proximity. These data highlight novel insights into the noncoding RNA-mediated control of human neuron physiology and point out the importance of lncRNA-mediated interactions for the spatial distribution of regulatory molecules.
BOD1L mediates chromatin binding and non-canonical function of H3K4 methyltransferase SETD1A
Authors: Hoshii Takayuki , Kikuchi Sota , Kujirai Tomoya , Masuda Takeshi , Ito Tomoko , Yasuda Satoshi , Matsumoto Makoto , Rahmutulla Bahityar , Fukuyo Masaki , Murata Takeshi , Kurumizaka Hitoshi , Kaneda Atsushi
Published: July 2024

The H3K4 methyltransferase SETD1A plays an essential role in both development and cancer. However, essential components involved in SETD1A chromatin binding remain unclear. Here, we discovered that BOD1L exhibits the highest correlated SETD1A co-dependency in human cancer cell lines. BOD1L knockout reduces leukemia cells in vitro and in vivo, and mimics the transcriptional profiles observed in SETD1A knockout cells. The loss of BOD1L immediately reduced SETD1A distribution at transcriptional start sites (TSS), induced transcriptional elongation defect, and increased the RNA polymerase II content at TSS; however, it did not reduce H3K4me3. The Shg1 domain of BOD1L has a DNA binding ability, and a tryptophan residue (W104) in the domain recruits SETD1A to chromatin through the association with SETD1A FLOS domain. In addition, the BOD1L-SETD1A complex associates with transcriptional regulators, including E2Fs. These results reveal that BOD1L mediates chromatin and SETD1A, and regulates the non-canonical function of SETD1A in transcription.
Ocr-mediated suppression of BrxX unveils a phage counter-defense mechanism
Authors: Li Shen , Xu Tianhao , Meng Xinru , Yan Yujuan , Zhou Ying , Duan Lei , Tang Yulong , Zhu Li , Sun Litao
Published: July 2024

The burgeoning crisis of antibiotic resistance has directed attention to bacteriophages as natural antibacterial agents capable of circumventing bacterial defenses. Central to this are the bacterial defense mechanisms, such as the BREX system, which utilizes the methyltransferase BrxX to protect against phage infection. This study presents the first in vitro characterization of BrxX from Escherichia coli, revealing its substrate-specific recognition and catalytic activity. We demonstrate that BrxX exhibits nonspecific DNA binding but selectively methylates adenine within specific motifs. Kinetic analysis indicates a potential regulation of BrxX by the concentration of its co-substrate, S-adenosylmethionine, and suggests a role for other BREX components in modulating BrxX activity. Furthermore, we elucidate the molecular mechanism by which the T7 phage protein Ocr (Overcoming classical restriction) inhibits BrxX. Despite low sequence homology between BrxX from different bacterial species, Ocr effectively suppresses BrxX’s enzymatic activity through high-affinity binding. Cryo-electron microscopy and biophysical analyses reveal that Ocr, a DNA mimic, forms a stable complex with BrxX, highlighting a conserved interaction interface across diverse BrxX variants. Our findings provide insights into the strategic counteraction by phages against bacterial defense systems and offer a foundational understanding of the complex interplay between phages and their bacterial hosts, with implications for the development of phage therapy to combat antibiotic resistance.
Veteran's Health Administration HIV Care Continuum: 2019 vs 2022
Authors: Maier Marissa , Beste Lauren A , Lowy Elliott , Hauser Ronald G , Van Epps Puja , Yakovchenko Vera , Rogal Shari , Chartier Maggie , Ross David
Published: July 2024

Background

The diagnosis-based Human Immunodeficiency Virus (HIV) Care Continuum offers a well-established framework for measuring HIV care quality. It is used by the government agencies, community organizations, and health care institutions to “guide the nation's response to HIV” and assesses HIV care from the time of HIV diagnosis through viral suppression. Our objective is to present the Veteran Health Administration's (VHA) HIV Care Continuum, assess postpandemic versus prepandemic performance, and compare VHA performance to Centers for Disease Control and Prevention–published data.

Methods

We conducted a nationwide retrospective cohort analysis examining the care continuum for people with HIV (PWH) in VHA care in 2019 versus 2022. Measurements included linkage to care, receipt of care, retention in care, and viral suppression. We used multivariable logistic regression of virological suppression to identify factors associated with viral suppression.

Results

In VHA in 2019, 83% of individuals newly diagnosed with HIV were linked to care, 84% of PWH received care, 76% were retained in care, and viral suppression was 76% among those with HIV and 93% of those with viral load (VL) results. In 2022, 74% were linked to care, 79% received care, 67% were retained in care, and viral suppression was 70% among those with HIV and 94% of those with a VL result.

Conclusions

VHA has achieved >90% viral suppression among those with a VL result. Among all PWH, viral suppression decreased an absolute 5.2% between 2019 and 2022. VHA's performance on the HIV Care Continuum exceeds the national HIV Care Continuum reported by the Centers for Disease Control and Prevention.
From disease specific to universal health coverage in Lesotho: successes and challenges encountered in Lesotho’s digital health journey
Authors: Maoeng Monaheng , Bruce Kerry , Motebang Maletsatsi , Chen Carolyn Wetzel , Lecher Shirley , Gadisa Tsigereda , Saito Suzue , Ntsaba Mantebaleng
Published: July 2024

In Lesotho, the Ministry of Health and key donors have made significant advancements to develop digital health solutions specific to HIV services including an eRegister which is interoperable with the health management information system, pharmacy services and the laboratory information system. New investments from the Millennium Challenge Corporation will expand digital health services to all reported communicable and non-communicable disease areas at health facilities throughout the country. This paper explores how digital health interventions designed to support comprehensive HIV care can be leveraged to provide universal digital health coverage. Specifically, three priority areas will be addressed: (i) governance, security, and system architecture (ii) power, connectivity, and equipment (iii) human resources and change management.
Cultural Responsiveness in Academic Physical Therapy: An Administrative Case Report
Authors: Kennedy V Kai , Temple Sara , Pak Sang , Scheid Alison , Teherani Arianne , van der Schaaf Marieke , Fitzsimmons Amber
Published: July 2024

Objective

This paper describes how the administrative leadership of 1 physical therapy department curated, implemented, and evaluated a culturally responsive administrative support strategy to foster a positive working environment. Participants’ perceptions of culturally responsive practices were explored using climate survey data.

Methods

This case occurred in the physical therapy and rehabilitation science department at an academic medical center in the United States. The department administers 5 educational programs, 3 faculty practices, a community clinic, and a robust research enterprise and employs over 100 employees. After a historic sociocultural event, administrators implemented a series of actions to understand the needs of department employees and to respond in a culturally responsive manner. Interventions included supportive activities, educational opportunities, and community-building events. The department administered an annual climate survey to assess the employees’ perceptions of the working climate, perceived impacts of the culturally responsive interventions, and suggestions for improving department climate. Survey analysis included frequency statistics and thematic content analysis with sensitizing concepts from a culturally responsive practice framework previously applied in primary and secondary school settings.

Results

A total of 131 employees participated in the annual climate survey from 2020 to 2022. Employees’ confidence to identify and address microaggressions in working environments showed trends of overall improvement, and overall self-reported experiences with racial discrimination decreased. Participants reported positive trends in addressing discrimination among colleagues but also reported addressing offensive behaviors perpetrated by patients.

Conclusion

Findings suggest that culturally responsive interventions are associated with positive trends in employee climate. Interventions tailored to the audience and curated to deepen cultural knowledge, enhance self-awareness, and validate others fostered a shared commitment to cultural equity.

Impact

Administrative leaders have a role in fostering an inclusive climate by capitalizing on culturally significant teachable moments with sound culturally responsive strategy, bidirectional culturally sensitive communication, individual development, and collective action.
Requirement of Pdgfrα+ cells for calvarial bone repair
Authors: Xing Xin , Li Zhao , Xu Jiajia , Chen Austin Z , Archer Mary , Wang Yiyun , Xu Mingxin , Wang Ziyi , Zhu Manyu , Qin Qizhi , Thottappillil Neelima , Zhou Myles , James Aaron W
Published: July 2024

Platelet-derived growth factor receptor α (PDGFRα) is often considered as a general marker of mesenchymal cells and fibroblasts, but also shows expression in a portion of osteoprogenitor cells. Within the skeleton, Pdgfrα+ mesenchymal cells have been identified in bone marrow and periosteum of long bones, where they play a crucial role in participating in fracture repair. A similar examination of Pdgfrα+ cells in calvarial bone healing has not been examined. Here, we utilize Pdgfrα-CreERTM;mT/mG reporter animals to examine the contribution of Pdgfrα+ mesenchymal cells to calvarial bone repair through histology and single-cell RNA sequencing (scRNA-Seq). Results showed that Pdgfrα+ mesenchymal cells are present in several cell clusters by scRNA-Seq, and by histology a dramatic increase in Pdgfrα+ cells populated the defect site at early timepoints to give rise to healed bone tissue overtime. Notably, diphtheria toxin-mediated ablation of Pdgfrα reporter+ cells resulted in significantly impaired calvarial bone healing. Our findings suggest that Pdgfrα-expressing cells within the calvarial niche play a critical role in the process of calvarial bone repair.
Bacteriophage Φ21’s receptor-binding protein evolves new functions through destabilizing mutations that generate non-genetic phenotypic heterogeneity
Authors: Gerbino Krista R , Borin Joshua M , Ardell Sarah M , Lee Justin J , Corbett Kevin D , Meyer Justin R
Published: July 2024

How viruses evolve to expand their host range is a major question with implications for predicting the next pandemic. Gain-of-function experiments have revealed that host-range expansions can occur through relatively few mutations in viral receptor-binding proteins, and the search for molecular mechanisms that explain such expansions is underway. Previous research on expansions of receptor use in bacteriophage λ has shown that mutations that destabilize λ’s receptor-binding protein cause it to fold into new conformations that can utilize novel receptors but have weakened thermostability. These observations led us to hypothesize that other viruses may take similar paths to expand their host range. Here, we find support for our hypothesis by studying another virus, bacteriophage 21 (Φ21), which evolves to use two new host receptors within 2 weeks of laboratory evolution. By measuring the thermodynamic stability of Φ21 and its descendants, we show that as Φ21 evolves to use new receptors and expands its host range, it becomes less stable and produces viral particles that are genetically identical but vary in their thermostabilities. Next, we show that this non-genetic heterogeneity between particles is directly associated with receptor use innovation, as phage particles with more derived receptor-use capabilities are more unstable and decay faster. Lastly, by manipulating the expression of protein chaperones during Φ21 infection, we demonstrate that heterogeneity in receptor use of phage particles arises during protein folding. Altogether, our results provide support for the hypothesis that viruses can evolve new receptor-use tropisms through mutations that destabilize the receptor-binding protein and produce multiple protein conformers.
9. Risk Factors Analysis and Probability of Uncontrolled Hypertension on Chronic Kidney Disease Patients in Karawang
Authors: Fatimah Liliana Surya , Narinastiti Diantika , Gisrianti Reina Syafira , Firdaus Zulfian , Pariyana  , Gunawan Arif , Irwin  , Sofyan Ahmad
Published: July 2024

Background: Uncontrolled Hypertension has been highly prevalent recently. Controlling hypertension in Chronic Kidney Disease (CKD) patients is important to decrease morbidity and mortality. According to the International Society of Hypertension (ISH) Guideline 2020, CKD patients with blood pressure ≥140/90 mmHg should be treated to achieve a target blood pressure of <130/80 mmHg (<140/80 in elderly patients). Several risk factors have been identified as being associated with uncontrolled hypertension.

Objective: To determine the prevalence, probability and analyze risk factors of uncontrolled hypertension in CKD patients.

Method: This research is a cross-sectional study. Subjects were patients aged >18 years who have been diagnosed with CKD or with e GFR <60 mL/minute/1.73 m2 for at least 3 months at Karawang Regional Public Hospital using consecutive sampling. Laboratory data is taken based on medical records and interviewed with a questionnaire for identified risk factors, and adherence to taking medication using a Morisky Score (MMAS-8) questionnaire. Risk factor analysis used logistic regression with a significance level of p<0.05.

Results: The prevalence of uncontrolled hypertension in CKD patients was 66,3%. Factors that significantly associated with uncontrolled hypertension on CKD was the gender factor, men have higher risk than women (OR=5,360;95% CI:1,672-17,190; p=0,003), salty food consumption (OR=10,490;95% CI:3,719-29,583; p=0,000), and medication adherence (OR=12,659;95% CI= 4,469-35,864; p=0,000). Based on the regression model, the probability was 99.96%.

Conclusion: Factors that were significantly associated with the prevalence of uncontrolled hypertension in CKD patients were gender, salty food consumption, and medication adherence with a probability of 99,96%.
12. Correlation between Calcium Phosphate Product and Visit-to-Visit Blood Pressure Variability in Patients with Chronic Hemodialysis
Authors: Lubis Fadhyl Zuhry , Hoesin Mohammad
Published: July 2024

Background: Large blood pressure variability contributed significant cardiovascular risks in chronic hemodialysis patients. The interplay between Calcium Phosphate Product (CPP) and visit-to-visit blood pressure (BP) variability remains understudied despite its potential impact. Associations between parathyroid hormone (PTH), plasma calcium (Ca), and phosphorus (P) with blood pressure highlight the multifaceted nature of hypertension in this population.

Objective: This study aims to elucidate the specific correlation between CPP and parameter of visit-to-visit average blood pressure variability which consist of Systolic Blood Pressure (SBP) with Standard Deviation (SD), Coefficient of Variation (CV), variability independent of the mean (VIM), Average Real Variability (ARV), offering insights for targeted interventions in chronic hemodialysis care.

Method: This prospective, observational, cross-sectional study enrolled patients undergoing hemodialysis for over three months using non-probability consecutive sampling. The study spanned a six-month period from July 2023 to December 2023. Correlation and two-way ANOVA analyses were conducted to examine the impact of the CPP product on each parameter of BP variability.

Result: This study comprised a cohort of 38 participants, with a mean age of 49±10 years. CPP exhibited a strong correlation with the average SD (r=0.89, p=<0.0001), CV (r=0.68, p=<0.0001), and ARV (r=0.85, p=<0.0001). Additionally, there was a moderate correlation observed between CPP and the VIM (r=0.45, p=0.03). In addition, Two-Way ANOVA indicated significant differences in all blood pressure variability parameters between normal and high CPP groups (p<0.05).

Conclusion: In summary, our findings highlight substantial correlations between CPP and BP variability, emphasizing mineral metabolism’s relevance in hemodialysis.
20. Association of Dipping Status on Ambulatory Blood Pressure Monitoring with Cardiocerebrovascular Events in Patients with Essential Hypertension: A Meta-Analysis Study
Authors: Wangsa Syahpri Putra , Yuristo Eddy , Ali Zulkhair , Effendi Ian , Novadian  , Suprapti  , Kartika Herleni , Mulia Deddy Primadona , Arief Akbar Kgs. M. Yusuf , Elfiani  , Ferry Yuniarti Rery Tri , Pratama Novandra Abdillah , Makky Chairil , Rachman Edy Nur , Abadi Zulfikar , Julita Eva
Published: July 2024

Background: Essential hypertension is a major risk factor for the occurrence of cardiocerebrovascular events (CCE). Ambulatory blood pressure monitoring (ABPM) has become an important tool in blood pressure monitoring in patients with hypertension, and the concept of “dipping status” which refers to a decrease in blood pressure during sleep, has gained significant attention as a potential predictor for cardiovascular events.

Objective: to evaluate the association between dipping status on ABPM and cardiovascular events in patients with essential hypertension.

Method: This study was a systematic review and meta-analysis of prospective cohort studies. Study searches were conducted in PubMed, Sciencedirect, and Proquest as well as manual searches using the snowballing method. Inclusion criteria were studies with research subjects of essential hypertension patients who underwent ABPM examination. Dipping status was considered positive if there was a >10% decrease in blood pressure at night during sleep. Included studies must contain data on the outcomes of CCE for a minimum period of six months. Study review was conducted according to the PRISMA flowchart. Study quality and risk of bias were assessed using the Newcastle Ottawa Scale for cohort studies. Study results were displayed as forest plots.

Result: The meta-analysis included data from seven observational studies that included 10990 patients with essential hypertension. That patients with dipping status on ABPM had a lower risk of CCE compared with patients without dipping status (OR 0.74, 95% CI: 0.59-0.92, p

Conclusion: that dipping status on ABPM is a protective factor against CCE in patients with essential hypertension.
26. Unraveling The Safety Profile of Intensive Blood Pressure Strategy in Elderly: A Systematic Review and Meta-Analysis
Authors: Samudera Nurrobi Yusuf Aji , Winston Kevin
Published: July 2024

Introduction: The appropriate blood pressure target for older patients with hypertension is a subject of ongoing debate. Determining the safety profiles associated with intensive versus standard blood pressure strategy in this demographic is crucial for blood pressure management decisions.

Objective: This study aims to compare the safety profiles of intensive versus standard blood pressure strategy in the elderly population with hypertension.

Methods: A systematic search of major databases, including PubMed, Scopus, Science Direct, and Web of Science, identified Randomized Control Trials comparing intensive versus standard blood pressure strategy. Safety indicators, including hypotension, syncope, renal impairment, fracture, dizziness, and serious adverse events, were assessed. Outcome definitions were derived from individual studies, and the Cochrane risk-of-bias tool evaluated the study quality. Random-effects models were used for pooling effect estimates with Review Manager 5.4 software.

Results: Among five identified RCTs, the analysis revealed increased risk of hypotension (RR: 1.36; 95% CI: 1.10-1.69; p: 0.005; I2: 0%). However, no significant differences were observed in syncope (RR: 1.39; 95% CI: 0.95-2.03; p: 0.09; I2: 0%), renal impairment (RR: 1.11; 95% CI: 0.85-1.45; p: 0.43; I2: 11%), fracture (RR: 0.75; 95% CI: 0.41-1.39; p: 0.36; I2: 0%), dizziness (RR: 1.10; 95% CI: 0.71-1.71; p: 0.67; I2: 36%) and serious adverse events (RR: 1.05; 95% CI: 0.91-1.20; p: 0.29; I2: 19%).

Conclusion: Intensive blood pressure strategy is significantly associated with higher risk of hypotension. Careful consideration of these findings is crucial in blood pressure management decisions.
39. Efficacy Between Combination of Ambrisentan and Tadalafil versus Monotherapy in Patients with Pulmonary Arterial Hypertension: Systematic Review
Authors: Zebua Alfred , Sabran Mohammad Z. , Nathania F. , Harjanto Jovanda A. , Rubismo Kenza Y. , Kurniawan Andree
Published: July 2024

Background: Pulmonary arterial hypertension is a progressive disorder that causes endothelial dysfunction and vascular remodeling that can block small pulmonary arteries resulting in increased pulmonary vascular resistance and pulmonary pressure. Presently ambrisentan or tadalafil is frequently used for pulmonary arterial hypertension as a monotherapy. However, the combination of ambrisentan and tadalafil versus monotherapy remains unclear for pulmonary arterial hypertension.

Objective: Hence, this systematic review aims to evaluate the efficacy between ambrisentan plus tadalafil versus monotherapy as a treatment option in patients with pulmonary arterial hypertension.

Method: We extracted data from the PubMed Central (PMC), Science Direct, and PubMed databases using keywords ((ambrisentan) AND (tadalafil)) AND (pulmonary arterial hypertension) on December 10th 2023. Eligible studies were selected based on the inclusion and exclusion criteria. Studies included were associated with pulmonary arterial hypertension within the last 5 years, clinical trial, randomized controlled trial, and cohort. We exclude reviews, studies on animal, pediatric patients, case reports and series, meta-analysis, and unavailability of full papers. Then, the quality of studies included was assessed using the JADAD scale.

Result: Through inclusion criterias mentioned above, five studies were extracted from six eligible one. We include 5 randomized controlled trials in this systematic review. We assessed all of the studies using the JADAD scale in decent quality at all. Studies included the combination of ambrisentan with tadalafil exhibited better profile than monotherapy in terms of overall survival for pulmonary arterial hypertension patients.

Conclusion: It is shown that ambrisentan plus tadalafil is superior compared with monotherapy for pulmonary arterial hypertension.
44. The Relationship between P Wave and Corrected QT Dispersion with The Left Ventricular Ejection Fraction (LVEF) and The Severity of Coronary Artery Stenosis in Coronary Artery Disease: A Cross-sectional study
Authors: Triono Muhammad Rizki , Abduh M Saugi
Published: July 2024

Background: Noninvasive electrocardiographic markers are useful for detecting atrial and ventricular dysrhythmias. In severe coronary artery disease (CAD), ventricular dysfunction and atrial ischemia may occur, leading to the prolongation of atrial depolarization.

Objective: This study aimed to evaluate the relationship between P-wave and corrected QT parameters on electrocardiography (ECG) with the left ventricular ejection fraction (LVEF) and the severity of coronary artery disease (CAD).

Method: This cross-sectional observational study collected secondary data from 117 patients with CAD who underwent coronary angiography and ECG recording between May 2022 and October 2023 at the Cardiac Center, Sultan Agung Islamic Hospital, Semarang. ECG parameters and echocardiographic quantification of LVEF were assessed by cardiologist prior to coronary angiography. The severity of CAD was assessed and classified based on the degree of stenosis.

Result: Among the 117 patients, 86 (73.5%) were male, with a mean age of 59.47 ± 10.4 years. Maximum P wave interval (P max) and P wave dispersion (PWD) were significantly higher in the significant stenosis CAD group (105.12 ± 24.69 ms vs. 92.43 ± 27.64 ms, P = 0.02, 60.37 ± 24.72 ms vs. 42.70 ± 26.77 ms, P = 0.002, respectively). Corrected QT dispersion (QTcd) was borderline significantly higher in the significant stenosis CAD group (71.21 ± 31.85 ms vs. 59.75 ± 34.64, P = 0.09).

Conclusion: Our results demonstrate a significant relationship of P max & PWD with the severity of CAD stenosis. No significant relationship was found between P wave & corrected QT findings and LVEF.
47. Non-atherosclerotic Myocardial Infarction (MI) as The Consequence of Hypertensive Emergencies (HE): what is the underlying possible mechanism?
Authors: Septian M. , Taufiqurrahman A.
Published: July 2024

Background: HE defined as rapid increase of blood pressure (BP) accompanied by organs damage. Cardiac complications are the most prevalent target organ including MI.

Case Illustration: A 64 years old, female patient complained an abrupt worsening dyspnea accompanied by a heartburn sensation felt 1 day before admission. These were the first ever symptoms the patient has been experienced, but patient has long-standing hypertension. The blood pressure recorded was 210/110 mmHg, the rest were stable. The physical examination revealed the rales from both lungs. It was found inversion of T in antero-inferior leads from electrocardiography (ECG), laboratory study showed T troponin elevation as 76 ng/L. The patient diagnosed with HE with target organ damage acute heart failure (AHF) and non ST-elevation myocardial infarction (NSTEMI), the patient was given nitroglycerin infusion and decided to do the coronary-angiography but there were no sclerotic lesions that found in the patient’s coronary arteries.

Discussion: This non-atherosclerotic MI either can be a type 2 MI or MI with non-obstructive coronary arteries (MINOCA). The long standing hypertension could alter the heart structure and microvascular that lead to the oxygen supply-demand mismatch, this probably the cause to type 2 MI. Hypertension interfere the small arteries causing hypertrophy, narrowing its lumen and reduced its density. All the mentioned mechanisms act in coronary microvascular dysfunction (CMD) as on of the MINOCA etiopathogenesis.

Conclusion: HE was associated with organ injuries including the cardiovascular system. The manifestation can be an acute coronary syndrome with the variable mechanisms.
48. Acute Lung Oedema with Hypertensive Emergency and NSTEMI in occurance of Cardiorenal Syndrome in Patient: A Case Report
Authors: Kusumawardhani N M , Zulkarnain H
Published: July 2024

Background: Cardiorenal syndrome is a disorders involving both the heart and kidneys in which acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other organ. This case report show how cardiac disfunction leading to cardiorenal syndrome.

Case Illustration: A 64-year-old woman complained for shortness of breath and chest pain a week before arrived at ED. Patient’s vital sign BP 180/100, HR 101, SpO2:92% room air, has a history of diabetes, and hypertension on regular medication. ECG revealed ST depression in I, aVL, V3-V5. Chest X-ray shows Pulmonary Oedema. Echocardiograph resulted in RWMA (+), ejection fraction 46%. Laboratory result in high creatinine concentration leading to renal dysfunction with eGFR 21 mL/min/1.73m2 (CKD-EPI 2021), and high troponin I level 6.07. The patient was given ISDN and furosemide injection for her hypertensive emergency and pulmonary oedema therapy also heparin injection as ACS treatment with renal dysfunction.

Discussion: cardiorenal syndrome type 2 is described by chronic cardiac abnormalities resulting in impaired renal function.

Result: after 3 days of treatment for acute lung oedema, complaints of shortness of breath had improved, the patient had kidney function re-checked and there was improvement to eGFR 48 mL/min/1.73m2. Patient then underwent a PCI after Coronary angiography resulted stenosis 80-90% proximal-mid RCA, 90% stenosis ostial PDA.

Conclusion: An adequate treatment of cardiac dysfunction in cardiorenal syndrome can also improve renal condition.
67. Successful managing Long term blood pressure control in complicated cerebral hemorrhage with renal failure: a survival case report
Authors: Sholichah Zuhrotus , Gunawan Atma
Published: July 2024

Introduction: Hypertensive emergencies in acute kidney failure can cause severe damage to internal organs, including recurrent ICH and cardiovascular disease (CVD). Effective blood pressure control is crucial for reducing these risks. We present herein a case of A spontaneous ICH patient successfully passed the critical phase.

Case Ilustration: A 49-year-old man experienced sudden unconsciousness while at home due to poorly controlled chronic hypertension. He had a history of CKD, DM, and atrial fibrillation. The patient had 215/121 mmHg blood pressure, right hemiparesis, irregular heart rate, high ureum and creatinine. The Head CT scan Showed Multiple sites cerebral Hemorrhage. Treatment included continuous intravenous Nicardipin and Amiodarone, with hemodyalization 2-3 times a week and Emergency External ventricular drainage was placed to manage the intracranial pressure. Oral anti hypertensions Candesartan 1x16 mg, Adalat oros 1x30 mg and 2.5 mg Bisoprolol were added. The patient’s blood pressure improved, but the GCS remained unimproved. After four weeks discharged, the patient had clear speech and could independently mobilize without assistance.

Discussion: Cerebral autoregulation maintains cerebral blood flow. Aggressive management of acute hypertension in ICH is still controversial. In the long-term, oral antihypertensive drugs should be titrated as soon as possible to achieve a goal BP <130/80 mm Hg

Result: The choice of BP-lowering agents is crucial for optimizing risk reduction, with thiazide-type diuretics, calcium channel blockers, ACE inhibitors, or angiotensin receptor blockers being the main therapy.

Conclusion: Managing BP control from hyperacute to chronic stages will be essential for the better recovery of patients after ICH.
76. The Effect of Sleep Duration on Hypertension Risk in Adult Asian Population: A Systematic Review and Meta-Analysis
Authors: Nurrobi Yusuf Aji Samudera , Winston Kevin , Falakhi Moh Fajil
Published: July 2024

Introduction: Sleep duration has been proposed as a potential and important modifiable risk factor, yet its precise relationship with hypertension among Asian adults remains unclear.

Objective: This meta-analysis aims to elucidate the impact of short sleep duration on hypertension risk within the adult Asian population.

Methods: A systematic search of databases including PubMed, Scopus, and ScienceDirect was conducted to identify relevant studies published up to 4 January 2024. Eligible studies encompassed observational cohort studies and cross-sectional studies that compared between short sleep duration and normal sleep duration with hypertension risk among Asian adults. The definitions for short and normal sleep durations were derived from the definitions used in the studies themselves. Cochrane risk-of-bias tool were employed to assess the quality of included studies. Random-effects models were utilized to pool effect estimates. All statistical analysis were conducted using Review Manager 5.4 software.

Results: Seven studies that assess sleep duration and hypertension risk in Asian populations were identified. Based on meta-analysis of 5 studies, short sleep duration is associated with hypertension risk when compared with normal sleep duration (OR: 1.39; 95% CI: 1.10-1.74; p: 0.006; I2: 78%). However, subgroup analysis showed that association between short sleep duration and hypertension risk is only evident in females only studies (OR: 1.25; 95% CI: 1.01-1.54; p: 0.04; I2: 78%). Meanwhile, short sleep duration is not associated with hypertension risk in males only studies (OR: 1.43; 95% CI: 0.90-2.26; p: 0.13; I2: 74%).

Conclusion: Short sleep duration is associated with increased hypertension risk in Asian population.
Spontaneous Resolution of Congenital Insufficiency of the Extensor Tendon Central Slip
Authors: Soldado Francisco , Nguyen Trong-Quynh , Rojas-Neira Juliana , Rodriguez-Ostuni Daniel , Cherqaoui Abdelmounim , Díaz-Gallardo Paula
Published: July 2024

Background:

The congenital insufficiency of the extensor tendon central slip of the fingers is a relatively rare condition, with only a few reported cases in pediatric patients, as described in 2 clinical series. In this study, we aimed to present the natural history of a significant number of untreated patients with this deformity.

Methods:

This study has received institutional review board approval, and parents provided informed consent following the Declaration of Helsinki guidelines for biomedical research involving humans. A retrospective analysis of children with this deformity, ranging from June 2008 to July 2021, was collected by 1 surgeon. The inclusion criteria included children with a supple PIP flexion deformity, characterized by MP hyperextension and PIP extension lag, which had been present since birth. Complete passive PIP extension and the absence of volar skin webbing differentiated this condition from camptodactyly.

Results:

The mean age of 24 children with 57 involved digits at diagnosis was 7 months (range, 1 to 17) and the mean follow-up was 6 years to 9 months (2 yr to 1 mo to 13 yr). Six patients had an incorrect previous diagnosis of camptodactyly.

Active PIP extension recovered progressively. At the final follow-up, complete PIP extension occurred in all except 4 cases in which a residual 10° extension lag. The mean time for a complete active PIP extension was 2 years to 7 months (20 mo to 3 yr to 9 mo). Nineteen cases (79%) showed a mild FDS contracture of the involved digits at the final follow-up.

The deformity was bilateral in 15 children (62.5%) and involved only 1 finger (unilaterally or bilaterally) in 15 cases (62.5%), and 2 fingers in 6 (25%). Little and ring fingers were most commonly involved. In 7 cases, there was a family history of finger deformity.

Conclusions:

Congenital insufficiency of the extensor tendon central slip typically resolves spontaneously within the first 4 years of life. Literature suggests that splinting can expedite the correction of the deformity and thus, if possible, it can be used. In most cases, a residual, clinically insignificant FDS contracture may be present. This condition is often misdiagnosed as camptodactyly.

Level of Evidence:

IV.
Early Findings of a Preterm Twin Cohort Study Examining the Effect of General Anesthesia on Developmental Outcomes
Authors: Escobar Natalie , Levy-Lambert Dina , Fisher Jason , DiMaggio Charles , Kazmi Sadaf , Tomita Sandra
Published: July 2024

Purpose:

The premature infant brain may be particularly vulnerable to anesthesia effects, but there is conflicting evidence on the association between anesthesia exposure and developmental outcomes. Twin studies can control for confounding factors. A twin cohort of premature twins provides internal control of difficulty to measure confounders and delivers added power to a study examining the effects of anesthesia on neurodevelopmental outcomes.

Methods:

We conducted a retrospective cohort study of sets of premature twins and multiples born at an academic medical center, in which 1 member of the set was exposed to general anesthesia. The primary outcome was the composite scores using Bayley Scale of Infant and Toddler Development III performed at age 6 months to 18 months. Unpaired and paired analyses were performed with linear regression models, Wilcoxon signed rank test, and Mann–Whitney U test.

Results:

We identified 81 children born at less than 32 weeks gestation within 39 sets of twins and 1 set of triplets for a total of 18 paired observations. All of the exposed infants had a single exposure to general anesthesia. There was no significant association between anesthesia exposure and a diagnosis of developmental delay (OR = 0.8; 95% confidence interval, 0.2–3.2; p = 0.99). Regression models demonstrated no association between anesthesia exposure and cognitive (96.67 vs 97.50; p = 0.74), language (98.33 vs 98.61; p = 0.94), or motor (96.25 vs 96.44; p = 0.91) composite Bayley scores. There was no association between duration of anesthesia and the 3 composite Bayley scores (p = 0.33; p = 0.40; p = 0.74).

Conclusion:

Using a premature twin cohort with discordant exposure to anesthesia, our data did not demonstrate any association between anesthesia exposure and developmental delay in this vulnerable population of premature infants.
Artificial Intelligence for Mohs and Dermatologic Surgery: A Systematic Review and Meta-Analysis
Authors: Mirza Fatima N. , Haq Zaim , Abdi Parsa , Diaz Michael J. , Libby Tiffany J.
Published: July 2024

BACKGROUND

Over the past decade, several studies have shown that potential of artificial intelligence (AI) in dermatology. However, there has yet to be a systematic review evaluating the usage of AI specifically within the field of Mohs micrographic surgery (MMS).

OBJECTIVE

In this review, we aimed to comprehensively evaluate the current state, efficacy, and future implications of AI when applied to MMS for the treatment of nonmelanoma skin cancers (NMSC).

MATERIALS AND METHODS

A systematic review and meta-analysis was conducted following PRISMA guidelines across several databases, including PubMed/MEDLINE, Embase, and Cochrane libraries. A predefined protocol was registered in PROSPERO, with literature search involving specific keywords related to AI and Mohs surgery for NMSC.

RESULTS

From 23 studies evaluated, our results find that AI shows promise as a prediction tool for precisely identifying NMSC in tissue sections during MMS. Furthermore, high AUC and concordance values were also found across the various usages of AI in MMS, including margin control, surgical recommendations, similarity metrics, and in the prediction of stage and construction complexity.

CONCLUSION

The findings of this review suggest promising potential for AI to enhance the accuracy and efficiency of Mohs surgery, particularly for NMSC.
Finding Our Lanes: A Roadmap for Collaboration Between Academic Medical Centers and Behavioral Telehealth Companies
Authors: Eden Daniel J. , Hermann Alison , Sombrotto Lisa B. , Wilner Philip J. , Chen Justin A.
Published: July 2024

Outpatient mental health care in the United States is delivered by an uncoordinated patchwork of public and private entities that struggle to effectively differentiate the care they provide. The COVID-19 pandemic catalyzed transformative changes in this space, including rapid adoption of telehealth and escalating private sector investment to provide services for individuals wishing to obtain care through insurance. In this article, we briefly review the current landscape of ambulatory mental health care. Utilizing Kissick’s Iron Triangle model of health care delivery, we compare the relative strengths and weaknesses of academic medical centers and the growing private sector, entities potentially positioned to synergistically foster a mental health ecosystem with improved quality, access, and cost-effectiveness. A roadmap for strategic integration is presented for how academic centers—institutions frequently overwhelmed by patient volume—might leverage partnerships with a private sector eager to utilize novel technology to improve access, demonstrate data-driven outcomes, and advocate for improved reimbursement from payers. We also assess the potential risks and pitfalls of such collaboration. In return, academic institutions can refocus on their strengths, including research, systems knowledge, quality-improvement initiatives, education and training, and specialty clinical care.
Dysphoric Milk Ejection Reflex (D-MER): A Novel Neuroendocrine Condition with Psychiatric Manifestations
Authors: Schildkrout Barbara , MacGillivray Lindsey , Raj Shreya , Lauterbach Margo
Published: July 2024

Learning Objectives: After participating in this CME activity, readers should be better able to:

• Describe how the symptoms of dysphoric milk ejection reflex (D-MER) affect nursing patients.

• Discuss how physicians, psychologists, and clinicians can support their patients experiencing D-MER.

Dysphoric milk ejection reflex (D-MER) is characterized by a sudden onset of profoundly negative emotions that are temporally linked to milk letdown when breastfeeding or pumping breast milk. These affective experiences have no psychological precipitants and only last for minutes. D-MER is relatively underappreciated in the physician-oriented medical literature, although there are important clinical and public health consequences when a nursing parent experiences unwanted, negative emotions paired with breastfeeding. D-MER can undermine the parent’s confidence and may affect bonding with their infant; it may also contribute to weaning earlier than planned. It is especially important for psychiatrists and other health care professionals who may be called upon to evaluate postpartum patients or nursing parents to be knowledgeable about D-MER. This perspective article aims to provide information about D-MER to the psychiatric and broader medical communities, and to underscore the need for additional research on this topic. Drawing on a literature search, the article first traces historical recognition of D-MER as a clinical entity, then summarizes the clinical characteristics of D-MER and recommends an assessment and management approach that emphasizes psychoeducation. The article also discusses factors that have contributed to the underappreciation of this condition, outlines gaps in our understanding, and suggests next steps for epidemiological and clinical research. D-MER is likely a neuroendocrine condition with psychiatric manifestations. Given that it is episodic but with predictable timing, this condition presents a unique opportunity for scientific investigation.
Pain Assessment in the Outpatient Pediatric Burn Patient: An Integrative Review
Authors: Colson Cindy , Ascenzi Judy , Waibel Elizabeth , Busch Deborah
Published: July 2024

Background:

There is no standardized practice in pediatric pain assessment with burn injuries in the outpatient clinic setting.

Objective:

This review aims to identify reliable, validated tools to measure pain in the pediatric burn clinic population.

Methods:

The literature search for this integrative review was conducted using the databases of PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane, and Embase from 2011 to 2023. Quality and relevance were appraised using the Johns Hopkins Nursing Evidence-Based Practice Model. Reporting was done according to a Preferred Reporting Items for Systemic Reviews and Meta-Analysis checklist.

Results:

Fourteen articles and two clinical practice guidelines met inclusion criteria and were included in this review.

Conclusion:

The Pain Observation Scale for Young Children and the COMFORT Behavior Scale tools have shown good reliability and construct validity and can be safely used to measure background and procedural pain in daily burn practice. Further research on reliable, validated pain assessment techniques in the pediatric burn population is needed.