bluuebunny/crossref_metadata_2025 huggingface dataset:
Ammonites from the lower and middle Toarcian (Jurassic) in the Cantabrian Range (Asturias and Basco-Cantabrian Basin, Northern Spain). Chronostratigraphy, biotic events and correlations with other Iberian basins
Authors: Goy Antonio , Comas-Rengifo Maria Jose , García-Ramos José Carlos , Piñuela Laura
Published: April 2024

The present paper studies the ammonite associations from the terminal Pliensbachian (Spinatum Zone, Hawskerense Subzone) and from the lower-middle Toarcian (Tenuicostatum to Variabilis Zones) in two areas of the Cantabrian Range, situated in the Asturian Basin (AB) and in the Basco-Cantabrian Basin (BCB). The outcrops examined in the AB were situated on the coast, between Villaviciosa and Ribadesella and those of the BCB were located inland, in the provinces of Cantabria and Palencia. The lower boundary of the Toarcian was accurately established with the first record of the genus Dactylioceras in both basins. In the Cantabrian Range, we characterised all the standard zones and subzones of the Toarcian Stage. In order to establish the chronostratigraphic horizons, we considered the evolution of the Dactylioceratidae (Dactylioceratinae) in the Tenuicostatum Zone, of the Hildoceratidae (Harpoceratinae) in the Serpentinum Zone, of the Hildoceratidae (Hildoceratinae) from the last horizon of the Falciferum Subzone to the end of the Bifrons Zone, and of the Phymatoceratidae (Phymatoceratinae) in the Variabilis Zone. We identified the following main regional or global biotic events: 1) the mass extinction of the Amaltheidae Family in the upper part of the Hawskerense Subzone; 2) the expansion of the Dactylioceratinae Subfamily as from the base of the Tenuicostatum Zone; 3) the extinction of practically all the late Arieticeratinae (Emaciaticeras, Canavaria, Tauromeniceras), of the Lioceratoides and of the Dactylioceras (Eodactylites) in the boundary between the Paltum/Mirabile and Semicelatum subzones; 4) the final extinction of the aforementioned groups, and of the Neolioceratoides, Protogrammoceras (Paltarpites) and almost all the Dactylioceras (Orthodactylites) in the boundary between the Tenuicostatum and Serpentinum zones, coinciding with the final stage of the Jenkyns Event. When the factors that caused this event came to an end, at regional or global scale there occurred a recovery of the Dactylioceratinae, Harpoceratinae and Hildoceratinae within a short time interval, with significant radiations of these subfamilies. The Phymatoceratinae subsequently radiated from the Bifrons Zone.
Unilateral temporomandibular joint disorders diagnosed as both disc displacement without reduction and osteoarthritis show vertical craniofacial asymmetry in women
Authors: Han Jung , Choi Sung-Hwan , Ahn Hyung Joon , Kwon Jeong-Seung , Park Younjung , Choi Yoon Jeong
Published: April 2024

Objevtives This study investigated the effects of unilateral temporomandibular disorders (TMDs), specifically disc displacement without reduction and osteoarthritis on one side of the temporomandibular joint (TMJ), on facial asymmetry in women, while the contralateral TMJ exhibits normal findings.
Materials and methods Participants were retrospectively enrolled and divided into an affected group (n=42 with unilateral TMD) and a control group (n=49 with bilateral healthy TMJs). The affected group was dagnosed with osteoarthritis on cone-bema computed tomograph and anterior disk displacement without reduction on magnetic resonance imaging. The control group showed normal findings bilaterally on both tests. Facial asymmetry was quantified using an asymmetry index derived from posteroanterior cephalograms, comparing both groups. The relationship between TMD subfindings and facial asymmetry was also investigated.
Results Significant increases in the asymmetry indexes of the vertical distances from the antegonial notch and gonion to a horizontal reference plane were observed in the affected group (P < 0.05). Additionally, there was a noticeable upward canting of the maxillary, occlusal, and mandibular planes towards the affected side (P < 0.05). Horizontal asymmetry did not differ significantly between groups (P > 0.05). Parafunctional habits in the affected group were correlated with higher asymmetry indexes of the antegonial notch distance (P < 0.05).
Conclusion Women with unilateral TMD exhibit significantly greater vertical facial asymmetry compared to those without TMD.
Clinical relevance These findings may assist clinicians in diagnosing vertical asymmetry in patients with unilateral TMD using cephalograms and in predicting facial asymmetry progression.
Separation of microplastics from deep-sea sediment using an affordable, simple to use, and easily accessible density separation device
Authors: Shaw Katherine R. , Sandquist Rachel , Fairclough Cameron , Black Jesse , Fitzgerald Alexandra , Shaw Jaxson T. , Gallager Scott , Lynch Jennifer
Published: April 2024

Microplastics accumulate in the environment but methods to extract particles from sediment for quantification and identification often lack accuracy and reproducibility. Existing methods vary greatly and many do not achieve adequate microplastic separation. During method development for extraction procedures, spike-recovery experiments (positive controls) are essential to ensure accurate and reproducible results from each sample matrix. Furthermore, the large variability in grain size and organic matter can affect the extraction of microplastics from the matrix; thus, no one method will likely work for all sample types. Scientists have used density separation to separate microplastics from matrices for decades, but apparatuses are often made of plastic, need to be custom made, and require multiple sample transfers from one apparatus to another. This study presents an affordable, easily accessible, and simple to use Density Separation Device (DSD) to remove plastics from deep-sea sediments. Eight polymers were spiked into replicates of environmental sediment, including six fragments: high density polyethylene (HDPE), polypropylene (PP), polyvinyl chloride (PVC), polystyrene (PS), PA6 (PA6), and crumb rubber (CR) and two fibers: cellulose acetate (CA) and polyester (PEST). Two size classes of polymers were used: 100 μm to 300 μm and >300 μm. Using a sodium polytungstate solution as the dense liquid and reflectance FTIR microscopy for particle identification, recoveries of all fragments exceeded 78 % ( CR: 92.7 % ± 30.8 %, PP: 78.4 % ± 34.0 %, HDPE: 93.8 % ± 13.5 %, PS: 86.9 % ± 25.7 %, PA6: 98.4 % ± 63.2 %, PVC: 100.0 % ± 12.4 %,. Fiber recovery was much lower (PEST: 28.1 % ± 28.1 % and CA: 25.9 % ± 17.3 %) because they aggregated, passed through sieves vertically, or were obscured under other particles. The non-spiked sediment replicates were found to contain PE, PP, PEST, and polycarbonate (PC). The fragment recovery success, accessibility (available online, all parts under $200) and ease of use of this DSD should facilitate widespread use, thus helping to standardize sample preparation methods for microplastic metrology.
Lung microbiota of ARDS patients due to COVID-19 receiving ECMO
Authors: Mitsuyama Yumi , Shimizu Kentaro , Motooka Daisuke , Ogura Hiroshi , Fujimi Satoshi , Oda Jun
Published: April 2024

Background
Diversity of the microbiota, which is essential for lower airway homeostasis, is greatly altered in acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is the ultimate protective treatment for the lungs of patients with severe ARDS, but little is known about its effect on the lung microbiota of these patients. The aim of this study was to evaluate the effect of ECMO on the lung microbiota of ARDS patients.
Methods
This was a prospective, observational clinical study of ARDS patients with COVID-19. We performed 16S rRNA and fungal ITS1 profiling and shotgun sequencing on bronchoalveolar lavage fluid (BALF) samples collected from patients with ARDS due to COVID-19.
Results
BALF was collected from 13 patients, five of whom underwent ECMO. The median age of the patients with ECMO was significantly younger than that of those without ECMO (44 [IQR: 36–48] years vs. 64 [IQR: 53–74] years, p < 0.007). The median APACHE II score was significantly higher in the patients with ECMO versus those without ECMO (20 [IQR: 17–22] vs. 15 [IQR: 12–18], p = 0.018). In all ARDS patients, Pseudomonas was the most abundant of the bacteria. The patients with ECMO had more Pseudomonas and more Klebsiella than those without ECMO. The most abundant fungi were unspecified fungi in the patients with ECMO and Emmia lacerata in the patients without ECMO. Alpha diversity of bacteria and fungi did not differ significantly between the two groups. Human betaherpesvirus 5 and human alphaherpesvirus 1 were predominant in all patients, with human betaherpesvirus 5 decreasing over time in the ECMO patients.
Conclusion
The patients with ARDS due to COVID-19 who received ECMO had a different lung microbiota than those who did not receive ECMO.
Conditioned medium from painful schwannomatosis tumors increases pain behaviors in mice
Authors: Rubright Randy , Caterina Michael J. , Belzberg Allan , Ostrow Kimberly Laskie
Published: April 2024

The majority of schwannomatosis (SWN) patients experience debilitating pain. Yet, it is not known why only some schwannomas cause pain or whether mutations in SWN-related genes, (SMARCB1 or LZTR1) differentially influence pain signaling pathways. Here, we established cell lines from SWN tumors resected from patients with varying degrees of pain and bearing mutations in different SWN-related mutations. Compared with conditioned medium (CM) collected from “nonpainful” SWN tumors, CM from “painful” SWN tumors contained elevated levels of specific inflammatory cytokines (IL-6, IL-8, VEGF), and was able to enhance sensory neuron responsiveness to noxious TRPV1 and TRPA1 agonists in vitro. In in vivo studies, injection of CM from painful SWN into the hind paws of healthy mice evoked both more acute pain behavior and greater enhancement of mechanical stimulus-evoked behavioral responses than did CM from nonpainful SWN. Furthermore, the behavioral effects of painful CM differed as a function of the SWN-related gene mutations identified in the tumors of origin. Painful SMARCB1 mutant CM, for example, sensitized mice to mechanical stimulation at low forces, compared to non-painful tumor CM and control media, but this effect waned over time. In contrast, CM from a painful tumor with no detectable mutation in either SMARCB1 or LZTR1 caused the greatest increase in responsiveness to low mechanical forces and this effect lasted for 2 days post-injection. These experiments establish a paradigm for examining the mechanisms by which painful SWN tumors bearing different mutations produce their sensory effects and will thus facilitate better understanding and, potentially, treatment of the pain endured by SWN patients.
Epidemiological characteristics of first-time SARS-CoV-2 Omicron infection among hospital staff in Chengdu, China
Authors: Tang Li , Wang Ye-Yuan , Li Xue , Yang Liu , Luo Ying-Juan , Li Chun-Rong , He Yu-Lei
Published: April 2024

Background After China ended its ‘dynamic zero-COVID policy’ on 7 December 2022, a large-scale outbreak of SARS-CoV-2 Omicron infections emerged across the country. We conducted a hospital-wide prospective study to document the epidemiological characteristics of the outbreak among healthcare workers in a hospital of Chengdu, where no previous staff SARS-CoV-2 infections were detected. Methods All hospital staff members were invited to complete an online questionnaire on COVID-19 in January 2023, and SARS-CoV-2 infection cases were followed up by telephone in June 2023 to collect data on long COVID. Univariable and multivariable logistic regression analyses were performed to evaluate the risk factors of SARS-CoV-2 infection. Results A total of 2,899 hospital staff (93.5%) completed the online questionnaire, and 86.4% were infected with SARS-CoV-2 Omicron. The clinical manifestations of these patients were characterized by a high incidence of systemic symptoms. Cough (83.3%), fatigue (79.8%) and fever (74.3%) were the most frequently reported symptoms. Multivariable logistic analysis revealed that females [adjusted odds ratio (aOR): 1.48, 95% confidence interval (CI): 1.13–1.96] and clinical practitioners (aOR: 9.66, 95% CI: 6.24–14.96) were associated with an increased risk of SARS-CoV-2 infection, whereas advanced age ≥ 60 years (aOR: 0.33, 95% CI: 0.21–0.53) and full COVID-19 vaccination with the latest dose administered 1–3 months before 7 December 2022 (aOR: 0.41, 95% CI: 0.22–0.77) were associated with reduced risk. Only 4.27% cases suffered from long COVID of fatigue, brain fog or both, and for the majority of them, the symptoms were minor. Conclusion Our findings provide a snapshot of the epidemiological situation of SARS-CoV-2 infection among healthcare workers in Chengdu after China's deregulation of COVID-19 control. Data in the study can aid in the development and implementation of effective measures to protect healthcare workers and maintain the integrity of healthcare systems during challenging times such as a rapid and widespread Omicron outbreak.
Association of insulin resistance with chronic kidney disease in individuals without diabetes in a community population in South China
Authors: Li Jiamin , Zhou Qin , Liu Zhen , Zou Hequn
Published: April 2024

Background: To explore the relationship of insulin resistance (IR) with chronic kidney disease (CKD) in individuals without diabetes.
Methods: We performed a cross-sectional survey among 2142 community-based participants without diabetes from southern China from June to October 2012 and excluded the incomplete data. We divided all the participants into four groups according to the quartiles of homeostasis model assessment of IR (HOMA-IR). Logistic regression models were used to explore the associations of IR with CKD in these subjects.
Results: In the unadjusted model, compared with the quartile one group, IR was significantly associated with CKD (odds ratio [OR] = 2.24, P < 0.001; OR = 4.46, P < 0.001) in the quartile three and four groups, and the association was still significant (OR = 2.08, P = 0.005; OR = 3.89, P < 0.001 ) after adjusting for potential confounders (including age, current smoker, current alcohol use, physical inactivity, education level, systolic blood pressure, diastolic blood pressure, serum triglyceride, and body mass index). The area under the receiver operating characteristic curve (95% confidence interval) of HOMA-IR for diagnosing CKD was 0.67 (0.64, 0.71). The cut-off value was 2.5, the sensitivity was 75.2%, and the specificity was 56.4%.
Conclusions: HOMA-IR is associated with CKD in participants without diabetes. Early intervention for IR is important for reducing the incidence of CKD.
Parallel Structure of Hybrid Quantum-Classical Neural Networks for Image Classification
Authors: Xu Zuyu , Hu Yuanming , Yang Tao , Cai Pengnian , Shen Kang , Lv Bin , Chen Shixian , Wang Jun , Zhu Yunlai , Wu Zuheng , Dai Yuehua
Published: April 2024

Hybrid quantum-classical neural networks (QCNNs) integrate principles from quantum computing principle and classical neural networks, offering a novel computational approach for image classification tasks. However, current QCNNs with sequential structures encounter limitations in accuracy and robustness, especially when dealing with tasks involving numerous classes. In this study, we propose a novel solution - the hybrid Parallel Quantum Classical Neural Network (PQCNN) - for image classification tasks. This architecture seamlessly integrates the parallel processing capabilities of quantum computing with the hierarchical feature extraction abilities of classical neural networks, aiming to overcome the constraints of conventional sequential structures in multi-class classification tasks. Extensive experimentation demonstrates the superiority of PQCNN over traditional concatenative structures in binary classification datasets, displaying heightened accuracy and robustness against noise. Particularly noteworthy is PQCNN's significantly improved accuracy on datasets with 5 and 10 classes. These findings underscore the transformative potential of the PQCNN architecture as an advanced solution for enhancing the performance of quantum-classical-based classifiers, particularly in the domain of image classification.
High Output Power 340GHz Frequency Doubler Design Based on Linear Optimization Method
Authors: Liu Zhicheng , Zhou Jingtao , Meng Jin , Wei Haomiao , Yang Chengyue , Su Yongbo , Jin Zhi , Jia Rui
Published: April 2024

In this paper, a linear optimization method(LOM) for the design of terahertz circuits is presented, aimed at enhancing simulation efficacy and reducing the time of the circuit design workflow. This method enables the rapid determination of optimal embedding impedance for diodes across a specific bandwidth to achieve maximum efficiency through harmonic balance simulations. By optimizing the linear matching circuit with the optimal embedding impedance, the method effectively segregates the simulation of the linear segments from the nonlinear segments in the frequency multiplier circuit, substantially increasing the speed of simulations. The design of on-chip linear matching circuits adopts a modular circuit design strategy, incorporating fixed load resistors to simplify the matching challenge. Utilizing this approach, a 340GHz frequency doubler was developed and measured. The results demonstrate that, across a bandwidth of 330GHz to 342GHz, the efficiency of the doubler remains above 10%, with an input power ranging from 98mW to 141mW and an output power exceeding 13mW. Notably, at an input power of 141mW, a peak output power of 21.8mW was achieved at 334GHz, corresponding to an efficiency of 15.8%.
Collision-induced subduction jump recorded by initiation of a >6000-km-long Cambrian subduction zone within the Paleo-Asian Ocean
Authors: Zhu Mingshuai , Pastor–Galán Daniel , Smit Matthijs , Miao Laicheng , Zhang Fuqin , Li Shun , Sanchir Dorjgochoo , Ganbat Ariuntsetseg , Liu Chenghao , Luo Ye
Published: April 2024

Subduction is the main driver of plate tectonics. The initiation of subduction zones is a foundational step in this context, but remains elusive because no present example of subduction initiation exists. Ophiolites formed over nascent subduction zones in the past provide the key to constraining the processes of subduction initiation. In this study, we document three Cambrian ophiolites with supra-subduction zone affinity within the southern part of the Central Asian Orogenic Belt. These ophiolites likely reflect the inception of a plate-boundary scale subduction zone within the Paleo-Asian Ocean. Our findings, together with a comprehensive compilation of Cambrian ophiolites in the Central Asian Orogenic Belt, indicate diachronous subduction initiation(s) along a >6,000 km zone within the Paleo-Asian Ocean between 536-528 Ma. The timing of subduction initiation of the Paleo-Asian Ocean coincides with the closure of the Mirovoi Ocean following the collision of a series of microcontinents with the Siberia Craton. Accordingly, the widespread Cambrian subduction initiation of the Paleo-Asian Ocean most likely represents a typical record of collision-induced subduction jump. Our study provides a new scenario that subduction initiations would locate at oceanic weak zones rather than the passive margins of the accreted microcontinents during the collision-induced subduction jump process.
Exploring the barriers to the development of organizational health literacy in health institutions from the perspective of older patients: a mixed study
Authors: Zhu Jie , Fu Haiyan , Zhang Yining , Lin Jingwen , Li Yijing , Kang Yanru , Sun Runjie , Xu Xinqi , Hou Ping , Duan Pei , Tu Jiayuan , Xue JIn , Mao Xine , Qin Jingwen , Leung Angela , Liu Yongbing
Published: April 2024

Background
The 2020 national health literacy monitoring revealed that only 8.49% of individuals aged 65–69 years, a segment of the older population, possess adequate health literacy levels, indicating a low level in China. Studies have demonstrated that improving the organizational health literacy of healthcare institutions is a crucial approach to addressing low health literacy among older patients.
Objective
To assess the present status of organizational health literacy development within healthcare institutions as perceived by older patients, and to investigate the obstacles hindering such development.
Design:
A mixed-methods approach was employed to investigate both the current status and barriers to the establishment of organizational health literacy within two healthcare institutions.
Participants:
Participants included older individuals aged over 60, clinical staff, and managerial personnel from these two health institutions.
Methods
A survey comprising a questionnaire (n = 178) was administered to older patients to evaluate the establishment of organizational health literacy within healthcare institutions from their viewpoint. Furthermore, interviews (n = 22) were conducted with administrative staff, clinical personnel, and older patients to identify barriers hindering the development of organizational health literacy within healthcare institutions.
Results
Quantitative research indicates that health institutions have been less accommodating to the requirements of older patients, with health information dissemination and communication emerging as the weakest areas. Qualitative investigations revealed three key influencing factors: patient-related factors, including physiological and cognitive decline, as well as low educational attainment among older patients; organizational factors, including inadequate clinical staff numbers, deficient long-term systematic training, and a digital divide resulting from health institutions’ digital advancements; and policy-related factors indicating a lack of regulations governing the establishment of organizational health literacy within healthcare institutions.
Conclusions
This research utilized the social-ecological model as its theoretical underpinning and employed a combination of methodologies to examine the current state and hurdles in establishing organizational health literacy within healthcare institutions. Future studies may consider devising comprehensive interventions based on the barriers identified herein, aiming to enhance organizational health literacy within healthcare institutions, meet the needs of older patients, and promote active aging.
Spatial patterns and effects of invasive plants on soil microbial activity and diversity along river corridors
Authors: Gömöryová Erika , Hrivnák Richard , Galvánek Dobromil , Kochjarová Judita , Skokanová Katarína , Slezák Michal , Svitková Ivana , Šingliarová Barbora , Španiel Stanislav , Gömöry Dušan
Published: April 2024

Background and Aims
Invasive species are a threat to the conservation of biological systems. In Central Europe, riparian ecosystems are especially susceptible to plant invasions, as waterflow mediates the spread of plant propagules, while invasive species may then affect soil including soil microbial communities. As waterflow also enhances connectivity among different segments of a river, spatial continuity of abiotic as well as biotic components of riparian ecosystems is expected.
Methods
We studied activity and functional diversity of microbial communities in three headwater streams in Central Europe. Plant diversity, soil properties and soil microbiota were assessed on 20 sample plots per river regularly distributed along the streams. Soil microbial activity and community-level physiological profiling were used to study the soil microbial community.
Results
Although the α-diversity of plants and soil microbiota was comparable, plant communities were substantially more differentiated than microbial communities. Richness in alien and invasive plants significantly differed among rivers, which was reflected in different spatial patterns and trends of microbial activity and diversity. A high level of spatial continuity and clearest longitudinal trends were observed in the Kysuca river with straightened riverbed and a high occurrence of artificial surfaces in the adjacent areas. The number of both alien and invasive plants significantly affects the composition of microbial functional groups of riverbed soils.
Conclusion
Continuity of processes in riparian ecosystems was confirmed also for headwater streams. However, the extent to which it applies to a particular stream strongly depends on particular environmental setting and stream characteristics.
Upregulation of MMP9 and ORM2 leading to increased neutrophil infiltration as a potential common mechanism in the development of IBD and MDD
Authors: Sun Jiangnan , Gao Ruicheng , Hu jie , Zhuang Zisen , Lin Zhangya
Published: April 2024

Major depressive disorder (MDD) is an emotional distinguished by core clinical symptoms such as low mood, diminished interest, lack of pleasure, reduced activity, and mental inhibition. Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract with with an unknown etiology. Previous studies have indicated a positive association between MDD and IBD, although the specific underlying mechanism remains unclear. The objective of this research was to investigate shared differentially expressed genes (DEGs) common to MDD and IBD through bioinformatics analysis to elucidate the connection.The series matrix files of GSE3365 and GSE98793 were obtained from the NCBI GEO public database. The limma R package was utilized to identify DEGs common to MDD and IBD. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional annotation, protein–protein interaction analysis of the hub genes, weighted gene co-expression network analysis (WGCNA), correlation analysis of the hub genes with immune responses, and analysis of immune infiltrations were conducted. Gene set enrichment analysis was performed to elucidate the underlying pathogenesis. The intersection analysis identified 27 commonly upregulated genes and 13 downregulated genes. Subsequent GO and KEGG analyses revealed enrichment of infection-related signaling pathways among the DEGs. The integration of genes from the WGCNA module and differential genes resulted in the identification of eight commonly upregulated genes: PROS1, ORM2, SLP1, MMP9, CLEC5A, ARG1, OLR1, and EGF. Furthermore, immune infiltration analysis demonstrated an increase in neutrophil infiltration in both the MDD and IBD datasets. ORM2 and MMP9 were found to be correlated with neutrophil infiltration. These pivotal genes, associated with neutrophils and monocytes, play crucial roles in the pathophysiology of both conditions. Targeting ORM2 and MMP9 may hold promise as potential diagnostic and therapeutic strategies for managing the comorbidity of IBD and MDD.
D-PRISM, a global study of diagnostic approaches in severe pneumonia.
Authors: Reyes Luis Felipe , Mayorga Cristian Serrano , Zhang Zhongheng , Tsuji Isabela , De Pascale Gennaro , Prieto Valeria Enciso , Mer Mervyn , Sheehan Elyce , Nasa Prashant , Zangana Goran , Avanti Kostoula , Tabah Alexis , Shrestha Gentle Sunder , Bracht Hendrik , Fatoni Arie Zainul , Abidi Khalid , Sulaiman Helmi bin , Eshwara Vandana Kalwaje , De Bus Liesbet , Hayashi Yoshiro , Korkmaz Pervin , Hssain Ali Ait , Buetti Niccolo , Goh Qing Yuan , Kwiziera Arthur , Koulenti Despoina , Nielsen Nathan D , Povoa Pedro , Ranzani Otavio , Rello Jordi , Morris Andrew Conway
Published: April 2024

Purpose
Pneumonia remains a significant global health concern, particularly among those requiring admission to the intensive care unit (ICU). Despite the availability of international guidelines there remains heterogeneity in clinical management. The D-PRISM study aimed to develop a global overview of how pneumonias (i.e., community-acquired (CAP), hospital-acquired (HAP), and Ventilator-associated pneumonia (VAP)) are diagnosed and treated in the ICU and compare differences in clinical practice worldwide.
Methods
The D-PRISM study was a multinational, survey-based investigation to assess the diagnosis and treatment of pneumonia in the ICU. A self-administered online questionnaire was distributed to intensive care clinicians from 72 countries between September to November 2022. The questionnaire included sections on professional profiles, current clinical practice in diagnosing and managing CAP, HAP, and VAP, and the availability of microbiology diagnostic tests.
Results
A total of 1296 valid responses were collected from ICU clinicians, spread between low-and-middle income (LMIC) and high-income countries (HIC), with LMIC respondents comprising 51% of respondents. There is heterogeneity across the processes of diagnosis, including in clinical assessment where 30% (389) did not require radiological evidence to diagnose pneumonia, variable collection of microbiological samples and use and practice in bronchoscopy. Modal antibiotic treatment duration was 5–7 days for all types of pneumonia.
Conclusions
This study highlighted variations in clinical practice and diagnostic capabilities for pneumonia, particularly issues with access to diagnostic tools in LMICs were identified. There is a clear need for improved adherence to existing guidelines and standardised approaches to diagnosing and treating pneumonia in the ICU.
Systemic Lupus Erythematosus masquerading as an Erythema Multiforme ——acutely and diffusely oral mucosal hyperemia，erosions and ulcerations
Authors: Hu Xiaojing , Liu Fen , Zong Juanjuan
Published: April 2024

Objectives
Systemic Lupus Erythematosus (SLE) can cause oral mucosal lesions, it is a severe autoimmune disease, manifesting as variable kinds of oral lesions. Occasionally, these clinical manifestations maybe be misdiagnosed as other diseases. The aim of the present article is to report a rare case of SLE oral mucosa lesions masquerading as an Erythema multiforme (EM) oral lesions in a young man.
Case Presentation:
A 34-year-old man with acutely oral lesions for about 10 days, presenting as diffusely oral mucosal hyperemia, erosions and ulcerations. The history, the clinical manifestations of the oral mucosal lesions, palms erythematous plaques and painless target lesions, lower limbs painless erythema and laboratory tests results were comprehensively considered. Finally the case was diagnosed as systemic lupus erythematosus.
Conclusions
The report of EM-like oral mucosal lesion of SLE is an extremely rare finding. In the diagnosis of SLE or EM, it is important to consider the history, clinical information and hematological examination. Sometimes histopathology and immunofluorescence are necessary.
Characterization of precipitation and frequency of rainy days in the municipality of Botucatu – São Paulo – Brazil
Authors: Franco Jose Rafael , de Oliveira Victor Crespo , Pai Alexandre Dal , Sarnighausen Valéria Cristina Rodrigues , Rodrigues Sérgio Augusto , Campos Firmo Souza , Pai Enzo Dal
Published: April 2024

Knowledge of the rainfall regime is vital information for agricultural and environmental activities. Rainfall is a component of the hydrological cycle, in which liquid water uses energy from the environment to change its phase to the gaseous phase. The cooling of this water vapor causes condensation and subsequent precipitation. Mean precipitation values, distribution during the year, variation between years, and maximum and minimum values are useful parameters for rural and urban planning. This study aimed to characterize the rainfall regime in the municipality of Botucatu through the assessment of precipitation and frequency of rainy days, considering the history of 52 years. The mean local precipitation during the period of analysis was 1,525.53 ± 284.71 mm. The rainiest month is January, with 284.92 ± 123.87 mm, which is also one of the months with the highest variability. August is the month with the lowest rainfall volume, reaching 40.40 ± 43.72 mm. The highest rainfall volume was observed in 1983, with 2,278 mm accumulated and 147 days of rain. In 1984, the lowest rainfall volume was observed, reaching 964 mm, and only 82 days of rain. The mean number of annual rainy days is 107 ± 14 days. In terms of the frequency of rainy days, 50% of the years in the analyzed history had 12 days or more of rainfall in January, February, March, November, and December. The remaining 50% of the years had up to two days of rain in July and up to 4 days in June.
Expression and significance of Ang-2/Ang-1 in the vitreous of patients with proliferative diabetic retinopathy
Authors: Ma Xiang , Nie Li-li , Jia Bo , Yu Yi-chun , Zhao Yu-xun , Cheng Yan
Published: April 2024

Purpose
To explore the significance of the Ang-2/Ang-1 ratio and VEGF expression in the vitreous of PDR patients.
Methods
A total of 50 PDR patients were enrolled in this study, including 25 who received intravitreal conbercept injection and 25 who did not. The control group consisted of 10 patients with macular holes. Vitreous samples were collected after vitrectomy for determination of Ang-1, Ang-2 and VEGF expression levels by enzyme-linked immunosorbent assay.
Results
The vitreous expression of Ang-1, Ang-2, and VEGF and the Ang-2/Ang-1 expression ratio were significantly greater in the PDR group than in the control group (P < 0.05). The expression of Ang-2 and the Ang-2/Ang-1 expression ratio in the vitreous of the active PDR group were significantly greater than those of the inactive PDR group administered injection and the PDR group without injection. There was a significant positive correlation between the Ang-2/Ang-1 expression ratio and the vitreous expression of VEGF in the PDR group without injection (correlation coefficient: 0.843, P < 0.001).
Conclusions
The increased Ang-2/Ang-1 expression in the vitreous of PDR patients suggest that Ang-2/Ang-1 and VEGF expression are associated with angiogenic activity in PDR.
Integrated analyses of the mechanism of flower color formation in alfalfa (Medicago sativa)
Authors: Wen Zhaozhu , Liu Huancheng , Zhang Qian , Lu Xuran , Jiang Kai , Bao Qinyan , Zhang Zhifei , Yang Guofeng , Wang Zeng-Yu
Published: April 2024

Alfalfa (Medicago sativa) is one of the most valuable forages in the world. As an outcrossing species, it needs bright flowers to attract pollinators to deal with self-incompatibility. Although various flower colors have been observed and described in alfalfa a long time ago, the biochemical and molecular mechanism of its color formation is still unclear. By analyzing alfalfa lines with five contrasting flower colors including white (cream-colored), yellow, lavender (purple), dark purple and dark blue, various kinds and levels of anthocyanins, carotenoids and other flavonoids were detected in different colored petals, and their roles in color formation were revealed. Notably, the content of delphinidin-3,5-O-diglucoside in lines 3, 4 and 5 was 58.88, 100.80 and 94.07 times that of line 1, respectively. Delphinidin-3,5-O-diglucoside was the key factor for purple and blue color formation. Lutein and β-carotene were the main factors for the yellow color formation. By analyzing differentially expressed genes responsible for specific biochemical pathways and compounds, 27 genes were found to be associated with purple and blue color formation, and 14 genes were found to play an important role in yellow color formation. These findings provide a basis for understanding the biochemical and molecular mechanism of alfalfa flower color formation.
Preparation, crystal structure, optical properties, Hirshfeld surface analysis and antimicrobial activity of 4-nitrobenzyl-4-aminopyridinium tetrachlorocuprate(II)
Authors: Li Yu-Ting , Huang Lin , Li Xin-Ran , Hu Bao-Yi , Huang Ke-Xin , Jiang Yan , Yu Jia-Yu , Ni Chun-Lin
Published: April 2024

In this study, we have synthesized a novel organic-inorganic hybrid crystal 4-nitrobenzyl-4-aminopyridinium tetrachlorocuprate(II) [4NO2Bz-4NH2Py]2[CuCl4](1). The single-crystal X-ray diffraction analysis revealed that the crystal belongs to the triclinic space group P–1, and consists of four [4NO2Bz-4NH2Py]+ cations and two [CuCl4]2– anions. O···π, C–H∙∙∙π, π∙∙∙π, N–H∙∙∙Cl, C–H∙∙∙Cl, C–H∙∙∙O, and C–H∙∙∙N weak interactions in the crystals play an important role in facilitating the stacking and stabilization of the crystals. The different types of contribution have been quantified by the calculation of Hirschfeld surface percentage and depicted by fingerprint plots. The bulk phase purity, homogeneity, and morphology of the desired compound were checked using powder XRD, and SEM-EDX analysis. Vibrational, optical, and thermal properties were investigated by FT-IR, UV-Vis spectrum, and TG-DTA measurements of [4NO2Bz-4NH2Py]2[CuCl4](1), respectively. The low energy gap (2.41 eV) suggested that the crystal was a suitable semiconductor material for optical applications. In addition, the compound presented good bactericidal activity against E. coli and S. aureus.
Clinical Phenotype of Pulmonary Vascular Disease Requiring Treatment in Extremely Preterm Infants
Authors: Hong Ki Teak , Shin Seung Han , Kim Ee-Kyung , Kim Han-Suk
Published: April 2024

Background
Pulmonary vascular disease (PVD) and pulmonary hypertension (PH) is a significant disorder affecting prognosis of extremely preterm infants. However, there is still a lack of a consensus on the definition and optimal treatments of PH, and there is also a lack of research comparing these conditions with persistent pulmonary hypertension of newborn (PPHN), early PH, and late PH. To investigate pulmonary hypertension (PH) in extremely preterm infants, this study compared the basal characteristics, short-term outcomes, and treatment duration, categorized by the timing of requiring PH treatment.
Methods
This study retrospectively analyzed extremely preterm infants admitted to a single tertiary center. Between 2018 and 2022, infants with clinical symptoms or echocardiographic evidence of PH who required treatment were divided into three groups based on the timing of treatment initiation: from birth to day 2 (extremely early-period), from day 3 to day 27 (early-period), and after day 28 (late-period). The study compared the outcomes, including mortality rates, bronchopulmonary dysplasia (BPD) severity, PH treatment duration, and oxygen therapy duration, among the three groups.
Results
Among the 157 infants, 67 (42.7%) were treated for PH during their stay. Of these, 39 (57.3%) were treatment in extremely early, 21 (31.3%) in early, and seven (11.4%) in late periods. No significant differences were observed in maternal factors, neonatal factors, or morbidity between the three groups. However, infants who received extremely early-period treatment had a higher mortality rate, but shorter duration of noninvasive respiratory support, oxygen therapy, and PH medication use. On the other hand, the late-period treatment group received longer durations of respiratory support and treatment.
Conclusions
This study revealed differences in mortality rates, respiratory outcomes, and treatment duration between the three groups, suggesting varying pathophysiologies over time in extremely preterm infants.
Liquid Biopsy in Lung Cancer: Nano-Flow Cytometry Detection of Non-Small Cell Lung Cancer in Blood
Authors: Zhang Andong , Gao Qiqi , Tian Chen , Chen Wentao , Pan Catherine , Wang Ling , Huang Jie , Zhang Jing
Published: April 2024

Non-small cell lung cancer (NSCLC) remains a leading cause of global mortality, with current screening and diagnostic methods often lacking in sensitivity and specificity. In our endeavor to develop precise, objective, and easily accessible diagnostic biomarkers for NSCLC, this study aimed to leverage rapidly evolving liquid biopsy techniques to differentiate NSCLC patients from healthy controls by isolating peripheral blood samples and enriching extracellular vesicles (EVs) containing lung-derived proteins (TTF-1 and SFTPB), along with the cancer-associated protein CD151+EVs. Additionally, we established a nano-flow cytometry assay for plasma EVs detection. NSCLC patients demonstrated significantly reduced counts of TTF-1+ EVs and CD151+ EVs in plasma compared to healthy controls (P < 0.0001), while SFTPB + EVs showed no significant difference (P > 0.05). However, integrated analysis of TTF-1+, CD151+, and SFTPB+ EVs yielded area under the curve (AUC) values of 0.917 and 0.845 in the discovery and validation cohorts, respectively. Thus, while further validation is essential, the advanced technologies mentioned above are of great significance for the detection of NSCLC biomarkers.
Characteristics and triage in elderly calling a semi-acute medical helpline in Denmark: A prospective cohort study
Authors: Johansen Sandra Mandrup , Folke Fredrik , Hindhede Anette Lykke , Hasselbalch Rasmus Bo , Iversen Kasper , Møller Tom
Published: April 2024

Objectives
To investigate baseline characteristics associated with elderly calling the medical helpline Medical Helpline 1813 (MH1813) in Denmark and how these baseline characteristics were associated with triage outcomes in a subset population of patients with high degree of worry (DOW).
Setting:
In the Capital Region of Denmark people with acute, non-life-threatening illnesses or injuries are triaged through a single-tier MH1813 for acute healthcare services.
Participants:
Participants were gathered from a prospective cohort established between 24 January and 9 February 2017 who called the MH1813. Out of 11,413 citizens, 1525 (13.3%) were elderly (≥ 65 years). Callers' identification, age, sex, and contact with general practitioner (GP) prior to MH1813-call were collected from the medical helpline's electronic records. Data were enriched using the callers' self-rated health, self-evaluated degree of worry, and registry data on comorbidities.
Results
Forty-two percent of call issues were terminated without any further action. Among 882 triaged to a hospital face-to-face consultation, n = 315 (36%) were admitted and 2/3 discharged directly from the emergency department. More than one third of the most worried elderly callers have had a contact with their GP prior to the MH1813 call. A high versus low level of Charlson Comorbidity Index tended to increase admission rate. Seven-hundred-forty-nine (49%) were self-callers and high DOW (crude and adjusted) was significantly associated to a higher triage outcome of admission in both the total population and the patient self-caller population. Adjusted self-rated health was not significantly associated with admission within the subset group of elderly self-callers with DOW 4–5 (n = 364). Men did more often than woman attend a face-to-face consultation (46% vs. 37%) and subsequent admission (23% vs. 18%).
Conclusion
This study suggests that the aggravation of acute-chronic illnesses among older citizens may lead to acute hospitalization, and inadvertently perpetuating the risk of re-transitions of elderly in the healthcare system.
Opposite Changes Caused by Human Activities in the Occurrence of High Health-Risk Compound Hot-Dry and Hot-Wet Events in China
Authors: Zhao Liang , Yao Haoxin , He Yiling , Dong Wei , shen xinyong , Wang Jingsong , Hu Yamin , Ling Jian , Xiao Zi-niu , Huang Cunrui
Published: April 2024

Compared to a single high-temperature anomaly, compound heat anomalies associated with humidity, such as Compound Hot-Dry Events (CHDEs) and Hot-Wet Events (CHWEs), pose a greater threat to human health. However, it is still unclear how human activities and natural forcings affect the likelihood of these health-related compound heat events. Here we utilize ambulance dispatch data along with meteorological data to study the human activities impact on high health-risk CHDEs and CHWEs in China. We show that relying solely on temperature standards without considering humidity may underestimate the health risks of compound heat events on populations. We find that during the past 40 years, anthropogenic activities in China have increased and decreased the occurrence of high health-risk CHDEs and CHWEs to 2.34 and 0.63 times from 1979 to 2014, respectively, particularly in the middle and lower reaches of the Yangtze River region, compared to natural forcing. And in the future, the opposing contribution of anthropogenic activities will be likely to persist under different shared socioeconomic pathways. We also speculate that, in the future up to 2060, under the carbon-neutral scenario, the frequencies of high health-risk CHDEs and CHWEs caused by human activities can be reduced by one-half and over one-fifth, respectively, compared to the high-emissions scenario (SSP-5.85). Our results provide initial guidance to recognize and asses the health risk of compound events under anthropogenic global warming.
The Prognosis for Delayed Immune Recovery in HIV-Infected Children might be Associated with Pre-cART CD4 + T cell Count Irrespective of Co-Infection with Tuberculosis
Authors: Ogunshola Funsho , Khan Ruhul , Ghebremichael Musie
Published: April 2024

Background: Immune reconstitution following the initiation of combination antiretroviral therapy (cART) significantly impacts the prognosis of individuals infected with human immunodeficiency virus (HIV). Our previous studies have indicated that the baseline CD4+ T cells count and percentage before cART initiation are predictors of immune recovery in TB-negative children infected with HIV, with TB co-infection potentially causing a delay in immune recovery. However, it remains unclear whether these predictors consistently impact immune reconstitution during long-term intensive cART treatment in TB-negative/positive children infected with HIV.
Results: We confirmed that the baseline CD4+ T cell count is a significant predictor of immune recovery following long-term intensive cART treatment among children aged 5 to 18 years. Children with lower CD4+ T cell count prior cART initiation did not show substantial immunological recovery during the follow-up period. Interestingly, children who were co-infected with TB and had higher baseline CD4+ T cell count eventually achieved good immunological recovery comparable to the TB-negative HIV-infected children. Hence, the baseline CD4+ T cell count at the onset of treatment serves as a reliable predictor of immunological reconstitution in HIV-infected children with or without TB co-infection. Taken together, this follow-up study validates our previous findings and further establishes that initiating cART early alongside early HIV testing can help prevent the diminished CD4+ T cell count associated with inadequate immunological reconstitution.