bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilization of semi-intensive irrigated paddy fields and increasing farmers income on cropping patterns in support of ip400 technology in Central Sulawesi
Authors: Negara Abdi , Ardjanhar Asni , Supriadi Khojin , Udiarto Bagus K
Published: September 2023

Based on the agro-ecosystem and suitability of paddy fields, rice fields have high potential and opportunities to be developed in Central Sulawesi Province, but sometimes the yield is still below the average production. This research has been conducted from May 2021 to June 2022. The research location is Kaleke Village, West Dolo District, Sigi Regency, Central Sulawesi. This study aims to increase the Crop Index and harvested area to increase the production and income of farmers as well as the performance of farmer groups. Research on cropping patterns and alternation of varieties with Rice – Corn – Corn – Rice Cropping Patterns. The treatment area of 1 ha with the planting system used is: for each commodity using components, PTT Paddy rice PTT corn. While the feasibility of farming with an income analysis approach with an R/C ratio. The results showed that: (a) The design of agricultural technology innovations to increase the cropping index of rice crops with MT I results showed the production component of the Inpari 33 variety of rice tiles. R/C Ratio 2.11, on MT. II Jakarin variety corn with a yield of 5.0 tons/ha. R/C Ratio: 2.04, maize variety Sukmaraga MT.III average yield 6.3 tons with R/C Ratio: 2.01 and MT. IV rice variety Inpari 36 with a yield of 5 tons/ha GKP R/C Ratio: 1.59(c) Increasing the Crop Index and harvested area can increase farmers’ income and the performance of farmer groups on technology supporting IP400.
In-plane crushing response and energy absorption of two different arranged circular honeycombs
Authors: Zhang Jun , Shi Boqiang , Shen Yanhua
Published: September 2023

Circular honeycombs have been widely used in many fields due to their excellent mechanical properties recently, however, circular honeycombs with different arrangements have been rarely studied. In this paper, two circular honeycombs with different arrangements were designed and fabricated using a 3D printer. Both honeycombs were investigated by experiment and finite element (FE) analysis to compare their performance. It is worth noting that both honeycombs possess the same relative density. The accuracy of the FE models was validated by comparing them with experimental results and relevant reports. Subsequently, a series of numerical studies were conducted to analyse the in-plane dynamic crushing behaviour and energy absorption characteristics at different impact velocities. Based on different experiment deformation modes were identified from the observation of results respectively. Additionally, continuous circle honeycomb (CCH) exhibits a higher reaction force but is prone to fracture. On the other hand, spacing circle honeycomb (SCH) possesses a lower reaction force but offers greater stability due to its ability to flex and release force. As a result, SCH can effectively absorb energy and demonstrates superior crushing capacity compared to CCH. To investigate and compare the plateau stress and energy absorption of these honeycombs, the FE method was used, which also involved a detailed analysis of the impact velocity and relative density of the honeycomb. It was observed that the crushing stress and energy absorption of SCH were higher than those of CCH with the same impact velocity and relative density. According to the one dimensional shock wave theory, empirical formulas for two circular honeycombs to predict the plateau stress are given respectively with the maximum error lower than 12%. This paper aims to offer valuable insights for the design of different configurations, with the goal of improving the crashworthiness and energy absorption capacity of a specific honeycomb structure.
Diabatic quantum annealing for the frustrated ring model
Authors: Côté Jeremy , Sauvage Frédéric , Larocca Martín , Jonsson Matías , Cincio Lukasz , Albash Tameem
Published: September 2023

Quantum annealing (QA) is a continuous-time heuristic quantum algorithm for solving or approximately solving classical optimization problems. The algorithm uses a schedule to interpolate between a driver Hamiltonian with an easy-to-prepare ground state and a problem Hamiltonian whose ground state encodes solutions to an optimization problem. The standard implementation relies on the evolution being adiabatic: keeping the system in the instantaneous ground state with high probability and requiring a time scale inversely related to the minimum energy gap between the instantaneous ground and excited states. However, adiabatic evolution can lead to evolution times that scale exponentially with the system size, even for computationally simple problems. Here, we study whether non-adiabatic evolutions with optimized annealing schedules can bypass this exponential slowdown for one such class of problems called the frustrated ring model. For sufficiently optimized annealing schedules and system sizes of up to 39 qubits, we provide numerical evidence that we can avoid the exponential slowdown. Our work highlights the potential of highly-controllable QA to circumvent bottlenecks associated with the standard implementation of QA.
Characterization, preparation, and reuse of metallic powders for laser powder bed fusion: a review
Authors: Sun Xiaoyu , Chen Minan , Liu Tingting , Zhang Kai , Wei Huiliang , Zhu Zhiguang , Liao Wenhe
Published: September 2023

Laser powder bed fusion (L-PBF) has attracted significant attention in both the industry and academic fields since its inception, providing unprecedented advantages to fabricate complex-shaped metallic components. The printing quality and performance of L-PBF alloys are influenced by numerous variables consisting of feedstock powders, manufacturing process, and post-treatment. As the starting materials, metallic powders play a critical role in influencing the fabrication cost, printing consistency, and properties. Given their deterministic roles, the present review aims to retrospect the recent progress on metallic powders for L-PBF including characterization, preparation, and reuse. The powder characterization mainly serves for printing consistency while powder preparation and reuse are introduced to reduce the fabrication costs. Various powder characterization and preparation methods are presented in the beginning by analyzing the measurement principles, advantages, and limitations. Subsequently, the effect of powder reuse on the powder characteristics and mechanical performance of L-PBF parts is analyzed, focusing on steels, nickel-based superalloys, titanium and titanium alloys, and aluminum alloys. The evolution trends of powders and L-PBF parts vary depending on specific alloy systems, which makes the proposal of a unified reuse protocol infeasible. Finally, perspectives are presented to cater to the increased applications of L-PBF technologies for future investigations. The present state-of-the-art work can pave the way for the broad industrial applications of L-PBF by enhancing printing consistency and reducing the total costs from the perspective of powders.
Multi-objective parameter optimization for four-stroke single-cylinder diesel engine with soyabean oil blends using NSGA-II
Authors: Kumar Pardeep , Kumar Dhingra Ashwani , Chhabra Deepak , Chhikara Ashish
Published: September 2023

Due to the continuous scarcity of petroleum and related products, there is a greater need for alternative product to petroleum derivatives. The current work investigates the factors influencing the output characteristics of a single-cylinder four-stroke compression ignition engine by utilizing different combinations of blends of soybean biodiesel and fossil diesel, by weight/weight. The experiments have been conducted using the Response Surface Method based on full factorial CCRD and NSGA-II. Mathematical models for BSFC (brake-specific fuel consumption), BTE (brake thermal efficiency), and emission (CO, NOx, and unburned HC) have been proposed using regression equations for optimizing the combustion characteristics (brake-specific fuel consumption), performance characteristics (brake thermal efficiency), and emission parameters (CO, NOx, HC) in NSGA II. A multi-objective optimization problem is created since this investigation aims to minimize BSFC, CO, NOx, and HC and maximize BTE. This research evaluated five optimum combinations of BSFC, BTE, NOx, CO, and HC at variable input factors’ blending ratio and load, and their conformity was checked. It is observed that at a blending ratio of 25.03, the engine performance and emission give better results. At a blending ratio of 25.03% w/w and load 2.08 kW, the brake thermal efficiency is 24.96%, and emission parameters are NOx 52.56 ppm, CO 0.08%, and hydrocarbon 18.11 ppm.
Decreased frontal lobe complexity in left-behind children during joint attention: a fNIRS study with multivariable and multiscale sample entropy analysis
Authors: Ding Keya , Wang Hongan , Li Chuanjiang , Li Hui
Published: September 2023

Human brain development is shaped by experiences, especially during preschool, the critical period for cognitive and socioemotional development. This study employed the functional Near-Infrared Spectroscopy technique to explore the neural differences between left-behind children (LBC) and non-left-behind children (NLBC) on joint attention. Through collecting brain image data of 50 children (26 boys, aged 65.08 ± 6.28 months) and conducting multivariable and multiscale sample entropy (MMSE) analysis, the present study found that: (i) LBC showed lower brain complexity than NLBC in right prefrontal cortex; (ii) all participants demonstrated higher brain complexity in responding to joint attention conditions, compared to initiating joint attention ones; (iii) their brain complexity during joint attention was negatively associated with their emotional abilities. The findings advance our understanding of early brain development in LBC by providing evidence for the neural process characteristics of joint attention. Implications for early intervention to promote their brain development are also addressed.
A deep learning system for retinal vessel calibre improves cardiovascular risk prediction in Asians with chronic kidney disease
Authors: Lim Cynthia Ciwei , Chong Crystal , Tan Gavin , Tan Chieh Suai , Cheung Carol Y , Wong Tien Y , Cheng Ching Yu , Sabanayagam Charumathi
Published: September 2023

Backgraund

Cardiovascular disease (CVD) and mortality is elevated in chronic kidney disease (CKD). Retinal vessel calibre in retinal photographs is associated with cardiovascular risk and automated measurements may aid CVD risk prediction.

Methods

Retrospective cohort study of 860 Chinese, Malay and Indian participants aged 40–80 years with CKD [estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2] who attended the baseline visit (2004–2011) of the Singapore Epidemiology of Eye Diseases Study. Retinal vessel calibre measurements were obtained by a deep learning system (DLS). Incident CVD [non-fatal acute myocardial infarction (MI) and stroke, and death due to MI, stroke and other CVD] in those who were free of CVD at baseline was ascertained until 31 December 2019. Risk factors (established, kidney, and retinal features) were examined using Cox proportional hazards regression models. Model performance was assessed for discrimination, fit, and net reclassification improvement (NRI).

Results

Incident CVD occurred in 289 (33.6%) over mean follow-up of 9.3 (4.3) years. After adjusting for established cardiovascular risk factors, eGFR [adjusted HR 0.98 (95% CI: 0.97–0.99)] and retinal arteriolar narrowing [adjusted HR 1.40 (95% CI: 1.17–1.68)], but not venular dilation, were independent predictors for CVD in CKD. The addition of eGFR and retinal features to established cardiovascular risk factors improved model discrimination with significantly better fit and better risk prediction according to the low (<15%), intermediate (15–29.9%), and high (30% or more) risk categories (NRI 5.8%), and with higher risk thresholds (NRI 12.7%).

Conclusions

Retinal vessel calibre measurements by DLS were significantly associated with incident CVD independent of established CVD risk factors. Addition of kidney function and retinal vessel calibre parameters may improve CVD risk prediction among Asians with CKD.
Infection and Immunity
Authors: Playfair John H.L. , Bancroft Gregory J.
Published: September 2023

Infection & Immunity
gives an overview looking at immunity with respect to infection. It describes the key infectious agents our bodies encounter and how our immune system responds to them. It also explains how diseases are spread and what measures we can take to control this spread, from vaccination to increasing public awareness. Chapters cover topics such as HIV, TB, and malaria. The text then goes on to look at infantile diarrhoea and respiratory disease. Chapters also considers innate recognition, cell signalling, cancer, and pregnancy.
CsTT8 regulates anthocyanin accumulation in blood orange through alternative splicing transcription
Authors: Wang Jianhui , Xu Rui , Qiu Shuangping , Wang Weichun , Zheng Fan
Published: September 2023

A homologous gene of basic-helix–loop–helix AtTT8 in Arabidopsis thaliana was identified in juice sac cells of pulp tissues from blood orange (Citrus sinensis cv ‘Tarocco’), which was designated as CsTT8 in this study. Additionally, the mRNA levels of TT8 with the full-length open reading frame were significantly higher in ‘Tarocco’ than in mutant fruit lacking pigment in pulp or peel tissues. However, an alternative splicing transcript, Δ15-TT8, with the fourth exon skipped, was also identified from transcripts different in length from that in ‘Tarocco’. The mRNA levels of Δ15-TT8 were higher in mutant fruit lacking pigment in pulp or peel tissues than in the wild type. Therefore, the TT8/Δ15-TT8 mRNA level ratio was found to be crucial for sufficient pigment in either pulp or peel tissues. TT8 from blood orange fruit demonstrated the capacity for nucleus localization and binding to other proteins. In contrast, Δ15-TT8, lacking the fourth exon, lost its ability to interact with RUBY1 and to localize at the nucleus. Using a dual luciferase reporter assay and transient overexpression in tobacco, we proved that two regulatory complexes formed by a functional TT8 with different MYB(v-myb avian myeloblastosis viral oncogene homolog)-type partners significantly promoted expression of an anthocyanin biosynthetic gene and a proton pumping gene, leading to anthocyanin and citrate production. Our findings suggest that TT8, rather than dysfunctional Δ15-TT8, is possibly involved in modulating anthocyanin biosynthesis and its transport into vacuoles by proton gradients. However, increased mRNA levels of the dysfunctional alternative splicing transcript may act as a negative feedback to downregulate TT8 expression and limit anthocyanin accumulation in blood oranges.
Macrophage-expressed SRA ameliorates alcohol-induced liver injury by suppressing S-glutathionylation of Notch1 via recruiting thioredoxin
Authors: Li Lei , Luo Jialiang , Zhu Zhengyumeng , Wang Ping , Xu Qishan , Chang Bo , Wang Di , Yu Lu , Lu Xiao , Zhou Jia , Chen Qingyun , Zuo Daming
Published: September 2023

Scavenger receptor A (SRA) is preferentially expressed in macrophages and implicated as a multifunctional pattern recognition receptor for innate immunity. Hepatic macrophages play a primary role in the pathogenesis of alcoholic liver disease. Herein, we observed that SRA expression was significantly increased in the liver tissues of mice with alcohol-related liver injury. SRA-deficient (SRA−/−) mice developed more severe alcohol-induced liver disease than wild-type mice. Enhanced liver inflammation existed in alcohol-challenged SRA−/− mice and was associated with increased Notch activation in hepatic macrophages compared with wild-type control animals. Mechanistically, SRA directly bound with Notch1 and suppressed its S-glutathionylation, thereby inhibiting Notch pathway activation. Further, we determined that the SRA interacted with thioredoxin-1 (Trx-1), a redox-active protein. SRA inhibited Trx-1 dimerization and facilitated the interaction of Trx-1 with Notch1. Application of a Trx-1-specific inhibitory agent during macrophage stimulation abolished SRA-mediated regulation of the Notch pathway and its downstream targets. In summary, our study revealed that SRA plays a critical role in macrophage inflammatory response by targeting Notch1 for its glutathionylation. SRA-mediated negative regulation of Notch activation might serve as a novel therapeutic strategy for alcohol-induced liver injury.
Safety of Single High-Dose Liposomal Amphotericin B for Induction Treatment of Cryptococcal Meningitis and Histoplasmosis in People With HIV: A Systematic Review and Meta-analysis
Authors: Kang HeeEun , Uy John P , Ho Caroline C , Blunt Heather B , Riblet Natalie B , Pasqualotto Alessandro C , Murphy Richard A
Published: September 2023

Background

Evidence for efficacy of single, high-dose liposomal amphotericin B (LAmB) in HIV-associated cryptococcal meningitis and histoplasmosis is growing. No systematic review has examined the safety of this regimen across multiple studies.

Methods

We systematically searched Medline, Scopus, and the Cochrane Library from inception to April 2023 for studies reporting grade 3 and 4 adverse events (AEs) with single high-dose LAmB vs traditional amphotericin regimens for HIV-associated fungal infections.

Results

Three trials (n = 946) were included. Compared with traditional regimens, single high-dose LAmB was associated with equivalent risk of grade 3 and 4 AEs (risk ratio [RR], 0.75; 95% CI, 0.53–1.06) and lower overall risk of grade 4 AEs (RR, 0.68; 95% CI, 0.55–0.86), grade 4 renal (RR, 0.43; 95% CI, 0.20–0.94) and grade 4 hematological AEs (RR, 0.46; 95% CI, 0.32–0.65).

Conclusions

Single, high-dose LAmB is associated with a lower risk of life-threatening AEs compared with other World Health Organization–endorsed amphotericin B–based regimens in invasive HIV–related fungal infection.
“Meeting Patients Where They're at”: Clinician Perspectives on Integration of Family Planning Services into Office-Based Addiction Treatment
Authors: Lee Eung-Mi , O'Connor Sarah K. , Pancholi Rushina , White Katharine O. , Woodhams Elisabeth , Patton Elizabeth W.
Published: September 2023

Objectives

To study clinician perspectives on the feasibility of incorporating family planning services within office-based addiction treatment (OBAT) clinics. We sought to understand the unique facilitators of and barriers to the integration of contraceptive services within the OBAT model with a goal to support the design and implementation of a program tailored to meet the reproductive health needs of patients with substance use disorder.

Methods

After obtaining institutional review board approval, we conducted qualitative semistructured interviews with OBAT clinicians (registered nurses, advanced practice registered nurses, and physicians) at a tertiary-care safety-net hospital. Interview transcripts were analyzed using deductive codes utilizing key components of the Promoting Action on Research Implementation in Health Services and Ottawa Decision Support Frameworks.

Results

We analyzed 20 interviews. Our data noted 3 major themes: (1) evidence to support integration of family planning and OBAT, (2) inherent strengths and facilitative factors of the OBAT model, and (3) barriers and challenges of the OBAT model influencing successful integration. Strengths included the destigmatizing and trust-building OBAT approach to care, common use of patient-centered counseling, and providers' nuanced understanding of substance use disorder–specific impacts on reproductive health. Barriers included time constraints, balancing urgent patient recovery needs, the desire for additional contraception provision training, and concern for potential contraceptive coercion.

Conclusions

Office-based addiction treatment clinics have inherent strengths that may make it a beneficial location for integrated family planning services. Future research should elicit patient perspectives to ensure the implementation of a family planning program in OBAT that supports patients' reproductive goals while avoiding stigma or reproductive coercion.
Medical Device Testing: Methods, Significance, and Clinical Applications
Authors: Solmos Susan , Gefen Amit , Black Joyce , Orlov Aleksei , Belo Orel , Cuddigan Janet
Published: September 2023

GENERAL PURPOSE

To present a study conducting objective biomechanical testing of medical devices known to cause medical device-related pressure injuries (MDRPIs) in critically ill adults and comparing those results with clinical outcomes associated with each device.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Explain the results of the study of the relationships between objective biomechanical tests of medical devices and clinical outcomes that help inform clinicians using these devices.

2. Synthesize the background information that informed the study.

OBJECTIVE

To conduct bioengineering testing of devices that cause medical device-related pressure injuries (MDRPIs) in critically ill adults and compare testing results to the MDRPI clinical outcomes associated with each device.

METHODS

Following the identification of MDRPI from oxygen-delivery devices and nasogastric tubes in critically ill adults who were hospitalized between January 2016 and October 2022, the specific manufacturer and model number of the devices were identified. Twelve devices and two prophylactic dressings in original packaging were sent to a bioengineering laboratory for testing. Using an integrated experimental-computational approach, the compressive elastic moduli (E [MPa]) was measured for each device and prophylactic dressing and compared with the properties of normal adult skin. The authors hypothesized that devices with greater mechanical stiffness (ie, higher E [MPa]) would be associated with a greater number and severity of MDRPIs.

RESULTS

Researchers identified 68 patients with 88 MDRPIs. All PI stages except stage 4 were represented. Nasogastric tubes had the highest mechanical stiffness and were the most common MDRPI identified. In contrast, no soft nasal cannula MDRPIs were reported. Devices associated with the highest number of MDRPIs also had the highest E [MPa] values; researchers noted a moderate association between E [MPa] values and pressure injury severity. Prophylactic dressings had E [MPa] values within the range of normal adult skin.

CONCLUSION

The relative mechanical stiffness of a device is an important factor in MDRPI etiology. However, factors such as duration of device use, tightness when securing devices, correct fit, and heat and humidity under devices should be considered in predicting MDRPI severity.
Healthcare-Associated Infections and the Hospital Bed
Authors: Call Evan , Call Kasey J. , Oberg Craig , Capunay Cassidee , Clark Daniel N.
Published: September 2023

OBJECTIVE

Bedframes are a potential source of bacterial contamination, fomites, and healthcare-associated infections for patients with active skin wounds and other underlying conditions. Bedframes also differ in their design, materials, texture, and ease of disassembly for cleaning. In this study, the authors evaluated five hospital bedframes in terms of retained soil and ease of cleaning as rated by volunteers.

METHODS

Hospital mattresses were placed on five different bedframes and soiled with mock bodily fluids containing Geobacillus stearothermophilus endospores as an indicator organism for contamination. In a second set of experiments, volunteers evaluated the bedframes for ease of cleaning; fewer than 30% of the volunteers had experience cleaning in hospitals or had previously received infection-control training. Questionnaires evaluated subjective measures such as ease of cleaning and texture.

RESULTS

Researchers observed a strong correlation between the initial amount of soil retained, the most probable number calculations of endospore counts, and the number of washes to reach extinction (no detectable endospores). Although volunteers’ rankings for ease of cleaning were independent of the amount of soil retained, their rankings correlated with the actual washes to reach undetectable limits and bedframe materials that were perceived as harder to clean.

CONCLUSIONS

This study demonstrates the importance of both bedframe design and user cleaning experience in reducing bedframes as a source of healthcare-associated infections.
Short- and Long-term Outcomes of an Acellular Dermal Substitute versus Standard of Care in Burns and Reconstructions: A Phase I/II Intrapatient Randomized Controlled Trial
Authors: Gardien Kim L. M. , Pijpe Anouk , Brouwer Katrien M. , Stoop Matthea , Singh Simarjeet K. , Timmermans Floyd W. , Vlig Marcel , van Zuijlen Paul P. M. , Middelkoop Esther
Published: September 2023

OBJECTIVE

Dermal substitutes promote dermal regeneration and improve scar quality, but knowledge gaps remain regarding their efficacy and indications for use. The authors investigated the safety and short- and long-term efficacy of an acellular dermal substitute in patients with full-thickness wounds.

METHODS

This intrapatient randomized controlled, open-label, phase I (safety) and phase II (efficacy) study compared treatment with Novomaix (Matricel GmbH), a dermal collagen/elastin-based scaffold, with split-thickness skin graft (STSG) only. The primary safety outcome was graft take at 5 to 7 days postsurgery. Postsurgical scar quality was assessed by measuring elasticity, color, and scores on the Patient and Observer Scar Assessment Scale at 3 months, 12 months, and 6 years.

RESULTS

Twenty-five patients were included, of which 24 received treatment allocation. Graft take and wound healing were statistically significantly lower/delayed in the dermal matrix group compared with STSG alone (P < .004). Serious adverse events were delayed epithelialization in four dermal matrix and three STSG study areas. At 12 months postsurgery, skin extension (P = .034) and elasticity (P = .036) were better for the dermal matrix group compared with the group receiving STSG alone. Other scar quality parameters at 12 months and 6 years did not differ between treatment arms.

CONCLUSIONS

The dermal substitute was a safe treatment modality for full-thickness wounds. Compared with STSG alone, time to wound healing was slightly increased. Nevertheless, scar quality at 12 months seemed somewhat improved in the wounds treated with the dermal substitute, indicative of enhanced scar maturation. In the long term, final scar quality was similar for both treatment modalities.
Enrichment strategies for clinical trials targeting skin fibrosis and interstitial lung disease in systemic sclerosis
Authors: Herrick Ariane L. , Denton Christopher P.
Published: September 2023

Purpose of review

This review gives an update on enrichment strategies for clinical trials in patients with systemic sclerosis (SSc) in two contexts – skin fibrosis in early diffuse cutaneous disease, and SSc-related interstitial lung disease (ILD) – focusing on reports from the last 18 months. Lessons have been learnt from recent studies, making this review timely.

Recent findings

Recent trials have highlighted how patients included into trials must be carefully selected to include ‘progressors’, that is, those most likely to benefit from treatment, and how drug mechanism action of action will influence trial design. For skin fibrosis, current enrichment strategies are mainly on clinical grounds (including disease duration, extent of skin thickening, tendon friction rubs and anti-RNA polymerase III positivity). Gene expression signatures may play a role in the future. For ILD, current enrichment strategies (degree of lung involvement as assessed by pulmonary function and high-resolution computed tomography) may help to recruit the most informative patients, but should avoid being too stringent to be feasible or for findings to be generalizable.

Both skin fibrosis and ILD trials are challenging in SSc. Ongoing work on enrichment strategies should help to differentiate effective new treatments from placebo with smaller sample sizes than have been included in recent studies.
Large language models and the future of rheumatology: assessing impact and emerging opportunities
Authors: Mannstadt Insa , Mehta Bella
Published: September 2023

Purpose of review

Large language models (LLMs) have grown rapidly in size and capabilities as more training data and compute power has become available. Since the release of ChatGPT in late 2022, there has been growing interest and exploration around potential applications of LLM technology. Numerous examples and pilot studies demonstrating the capabilities of these tools have emerged across several domains. For rheumatology professionals and patients, LLMs have the potential to transform current practices in medicine.

Recent findings

Recent studies have begun exploring capabilities of LLMs that can assist rheumatologists in clinical practice, research, and medical education, though applications are still emerging. In clinical settings, LLMs have shown promise in assist healthcare professionals enabling more personalized medicine or generating routine documentation like notes and letters. Challenges remain around integrating LLMs into clinical workflows, accuracy of the LLMs and ensuring patient data confidentiality. In research, early experiments demonstrate LLMs can offer analysis of datasets, with quality control as a critical piece. Lastly, LLMs could supplement medical education by providing personalized learning experiences and integration into established curriculums.

As these powerful tools continue evolving at a rapid pace, rheumatology professionals should stay informed on how they may impact the field.
Gallbladder angiodysplasia: a literature review
Authors: Rehman Shafi , Salehi Mahsa , Lorraine Co Edzel , Rehman Bushra , Saeidi Saeid G.
Published: September 2023

Introduction:

Angiodysplasia is a vascular lesion responsible for 6% of lower gastrointestinal bleeding cases. It is generally located in the cecum and ascending colon in elderly patients. Angiodysplasia of the gallbladder is a rare condition. The main objective of this literature review was to summarize the demographics, clinical signs and symptoms, gross findings, histopathology, immunohistochemistry, treatment, and follow-up of patients with gallbladder angiodysplasia.

Methods and materials:

The authors searched PubMed, ScienceDirect, and Google Scholar using relevant keywords. The search was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using appropriate keywords. The case reports included were those dealing exclusively with human subjects, were published in the English language, and had free, full-text, public access. Data was extracted and case reports were evaluated.

Results:

Of the 1097 studies initially identified, 3 (0.27%) were analyzed. There were two females (66.6%) and one male (33.3%). The mean age of presentation was 47.6 years. The most common presenting complaint was colicky right upper abdominal pain in two cases (66.6%). Elective cholecystectomy was performed in only two cases (66.6%). In one case (33.3%), petechiae were diffusely present in the gastric mucosa and patchy in the gallbladder, duodenum, jejunum, ileum, cecum, and ascending colon on autopsy. Histopathological findings were consistent with gallbladder angiodysplasia in all three cases (100%). On immunohistochemistry CD-34, CD-31, and D2-40 were positive in only one case.

Conclusions:

Despite conflicting data, histological and immunohistochemical analyses play major roles in the diagnosis of gallbladder angiodysplasia. Nonetheless, further clinical studies are required to provide universal guidelines for the treatment and diagnosis of angiodysplasia of the gallbladder.
Assessing the benefits and drawbacks of cryolipolysis as a noninvasive body sculpting technique: risks, side effects, and future research – an editorial
Authors: Ali Tooba , Habib Ashna , Riaz Rumaisa , Shaukat Ayesha , Akilimali Aymar
Published: September 2023

This article discusses cryolipolysis, a noninvasive body sculpting method that freezes and removes fat cells. It explores the historical context of fat reduction treatments and the development of noninvasive techniques as alternatives to invasive liposuction. Cryolipolysis gained popularity after U.S. Food and Drug Administration (FDA) approval and has become one of the most frequently utilized noninvasive cosmetic procedures globally. The abstract delves into case reports and complications associated with cryolipolysis, such as persistent lumps, frostbite lesions, and skin necrosis, highlighting potential risks and limitations. It also addresses common side effects like erythema, numbness, and bruising, as well as more severe adverse events such as dysesthesia and paradoxical adipose hyperplasia. Safety considerations and relative contraindications are discussed, emphasizing the importance of consulting qualified medical professionals who adhere to pretreatment and posttreatment instructions and use FDA-approved technology. Patience and a healthy lifestyle are stressed for optimal outcomes. In conclusion, cryolipolysis offers a safe and convenient fat removal option with long-lasting benefits. However, it may not be suitable for significant fat loss or certain medical conditions. Consulting medical experts and considering personal preferences are essential in making an informed decision about cryolipolysis as a body sculpting option.
Thiotepa-busulfan-fludarabine Compared to Treosulfan-based Conditioning for Haploidentical Transplant With Posttransplant Cyclophosphamide in Patients With Acute Myeloid Leukemia in Remission: A Study From the Acute Leukemia Working Party of the EBMT
Authors: Saraceni Francesco , Labopin Myriam , Raiola Anna M. , Blaise Didier , Reményi Péter , Sorà Federica , Pavlu Jiri , Bramanti Stefania , Busca Alessandro , Berceanu Ana , Battipaglia Giorgia , Visani Giuseppe , Sociè Gerard , Bug Gesine , Micò Caterina , La Nasa Giorgio , Musso Maurizio , Olivieri Attilio , Spyridonidis Alexandros , Savani Bipin , Ciceri Fabio , Nagler Arnon , Mohty Mohamad ,   on behalf of the Acute Leukemia Working Party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT)
Published: September 2023

We conducted a registry analysis including adult acute myeloid leukemia (AML) patients in remission who had received thiotepa, busulfan, and fludarabine (TBF) or treosulfan-based (Treo) conditioning for haplo-hematopoietic stem cell transplant (HSCT) with posttransplant cyclophosphamide (PTCy) between 2010 and 2020. A total of 1123 patients met the inclusion criteria (968 received TBF and 155 received Treo). A 1:1 matched-pair analysis was performed on 142 TBF and 142 Treo patients. In the Treo group, 68% of patients received treosulfan at a dose ≥36 g/m2 and 54% of patients received a second alkylator (thiotepa or melphalan). We observed a trend toward increased incidence of grade II–IV acute (a) graft-versus-host disease (GVHD) at 180 days in the TBF group compared with Treo (29% versus 20%; P = 0.08), while incidence of grade III–IV aGVHD was not statistically different. Similarly, the incidence of chronic (c) GVHD was not statistically different in the 2 groups. Incidence of nonrelapse mortality at 2 years was 19% in TBF and 14% in Treo (P = 0.4). Relapse incidence at 2 years was not statistically different in the 2 groups (16% and 18% in TBF and Treo, respectively; P = 0.9). Leukemia-free survival, overall survival, and GVHD-free, relapse-free survival was 65% versus 68% (P = 0.6), 73% versus 76% (P = 0.5), and 54% versus 53% (P = 0.8) in TBF versus Treo, respectively. In conclusion, we did not find a significant difference between the 2 conditioning in the present study; Treo and TBF represent 2 valid alternative regimens for haplo-HSCT with PTCy for AML in remission.
Update on Dry Eye Disease Treatment: Evidence From Randomized Controlled Trials
Authors: Ucakhan Omur O. , Celik-Buyuktepe Tuna , Yang Lin , Wogu Brian , Asbell Penny A.
Published: September 2023

Although the ultimate goal of dry eye disease (DED) management is to restore the ocular surface and tear film homeostasis and address any accompanying symptoms, addressing this is not an easy task. Despite the wide range of current treatment modalities targeting multiple aspects of DED, the available DED management literature is quite heterogeneous, rendering evaluation or comparison of treatment outcomes hard or almost impossible. There is still a shortage of well-designed, large-scale, nonsponsored, randomized, controlled trials (RCTs) evaluating long-term safety and efficacy of many targeted therapies individually or used in combination, in the treatment of identified subgroups of patients with DED. This review focuses on the treatment modalities in DED management and aims to reveal the current evidence available as deduced from the outcomes of RCTs.
Effect of 3% Diquafosol Sodium on Dry Eye After Femtosecond Laser-Assisted In Situ Keratomileusis and Small Incision Lenticule Extraction Surgery in High-Myopic Eyes
Authors: Gao Dengxin , Lv Xiaotong , Zhang Fengju , Song Yanzheng , Xu Yushan
Published: September 2023

Purpose:

To evaluate the effect of 3% diquafosol sodium eye drop on dry eye after femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small incision lenticule extraction (SMILE) in high-myopic eyes.

Methods:

Eighty-one cases with high myopia (162 eyes) who received FS-LASIK or SMILE were divided into four groups by surgical design and tear film stability: D-FS-LASIK (5s <breakup time [BUT] <10s) and D-SMILE (5s <BUT <10s) were treated with 3% diquafosol sodium and 0.3% sodium hyaluronate eye drops, C-FS-LASIK and C-SMILE (BUT ≥10s) treated with 0.3% sodium hyaluronate. Follow-up points were performed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Schirmer I test, BUT, fluorescein staining, and objective optical quality were measured, and questionnaires were acquired.

Results:

The D-SMILE group showed increase in BUT postoperatively (1m: P=0.006, 3m: P=0.004), whereas C-FS-LASIK (1m: P=0.012) and C-SMILE (1m: P=0.036) groups showed decrease in BUT. Higher ΔBUT were observed in D-FS-LASIK (1m: P=0.027) and D-SMILE (1m: P=0.001, 3m: P=0.012) postoperatively. The D-FS-LASIK group showed less decrease than C-FS-LASIK group in Schirmer I. The D-SMILE group showed increase in Schirmer I, whereas C-SMILE showed decrease in 3 months. ΔOSDI was lower in D-SMILE group than in C-SMILE group (1m: P=0.026, 3m: P=0.035). Fatigue was severer in D-SMILE group than in C-SMILE group preoperatively (P=0.019), although there was no significant difference postoperatively. Objective scattering index (1m: P=0.002, 3m: P=0.021) and tear film objective scattering index (1m: P=0.005, 3m: P=0.010) were lower in D-FS-LASIK group than in C-FS-LASIK group postoperatively. The D-FS-LASIK group showed better VA20% (P=0.036) and VA9% (P=0.027) than the C-FS-LASIK group 1 month postoperatively.

Conclusions:

3% Diquafosol sodium eye drop was effective for SMILE and FS-LASIK–related dry eye in high-myopic eyes. It is necessary to focus on perioperative anti–dry eye management and especially pay attention to the eyes with risk factors, including unstable tear film, high myopia, and FS-LASIK surgery.
Chlamydia psittaci–Induced Reactive Infectious Mucocutaneous Eruption With Ocular Involvement
Authors: Gholap Radhika S. , Engelmann Alexander R. , Munir Wuqaas M.
Published: September 2023

Introduction:

This report highlights a postinfectious mucocutaneous inflammatory response involving the ocular surface and adnexa after Chlamydophila psittaci exposure.

Case Description:

A 35-year-old man presented after a prodrome of upper respiratory symptoms with rash and mucocutaneous blistering involving the ocular and oral mucosa, causing pseudomembranous conjunctivitis and corneal epithelial defects. Extensive inflammatory and infectious workup suggested recent C. psittaci infection. The patient was treated with doxycycline and supportive therapy, whereas the ocular surface was treated with lubrication and prophylactic antibiotics. In follow-up, he has retained excellent visual acuity but required scleral contact lenses to control ocular surface symptoms because of fibrotic changes of the marginal conjunctiva.

Discussion:

Such blistering inflammation has most commonly been described after pediatric respiratory infections because of Mycoplasma pneumoniae with additional instances related to Chlamydia pneumoniae, Epstein–Barr virus, influenza B, and other stimuli. To the best of our knowledge, this is the first reported case of C. psittaci–induced reactive infectious mucocutaneous eruption (RIME). RIME is a rare parainfectious inflammatory condition with sequelae frequently involving the periocular mucosa. Although systemic and nonocular adverse outcomes in this condition tend to be self-limited, the impact on the ocular surface may be severe, and the consequences to vision may be ongoing, especially if not treated aggressively at the outset.
Transplant Candidate Outcomes After Declining a DCD Liver in the United States
Authors: Ishaque Tanveen , Eagleson Mackenzie A. , Bowring Mary G. , Motter Jennifer D. , Yu Sile , Luo Xun , Kernodle Amber B. , Gentry Sommer , Garonzik-Wang Jacqueline M. , King Elizabeth A. , Segev Dorry L. , Massie Allan B.
Published: September 2023

Background.

In the context of the organ shortage, donation after cardiac death (DCD) provides an opportunity to expand the donor pool. Although deceased-donor liver transplantation from DCD donors has expanded, DCD livers continue to be discarded at elevated rates; the use of DCD livers from older donors, or donors with comorbidities, is controversial.

Methods.

Using US registry data from 2009 to 2020, we identified 1564 candidates on whose behalf a DCD liver offer was accepted (“acceptors”) and 16 981 candidates on whose behalf the same DCD offers were declined (“decliners”). We characterized outcomes of decliners using a competing risk framework and estimated the survival benefit (adjusted hazard ratio [95% confidence interval]) of accepting DCD livers using Cox regression.

Results.

Within 10 y of DCD offer decline, 50.9% of candidates died or were removed from the waitlist before transplantation with any type of allograft. DCD acceptors had lower mortality compared with decliners at 10 y postoffer (35.4% versus 48.9%, P < 0.001). After adjustment for candidate covariates, DCD offer acceptance was associated with a 46% reduction in mortality (0.54 [0.49–0.61]). Acceptors of older (age ≥50), obese (body mass index ≥30), hypertensive, nonlocal, diabetic, and increased risk DCD livers had 44% (0.56 [0.42–0.73]), 40% (0.60 [0.49–0.74]), 48% (0.52 [0.41–0.66]), 46% (0.54 [0.45–0.65]), 32% (0.68 [0.43–1.05]), and 45% (0.55 [0.42–0.72]) lower mortality risk compared with DCD decliners, respectively.

Conclusions.

DCD offer acceptance is associated with considerable long-term survival benefits for liver transplant candidates, even with older DCD donors or donors with comorbidities. Increased recovery and utilization of DCD livers should be encouraged.
Using Regression Equations to Enhance Interpretation of Histology Lesions of Kidney Transplant Rejection
Authors: Sikosana Majid L.N. , Reeve Jeff , Madill-Thomsen Katelynn S. , Halloran Philip F. ,   the INTERCOMEX Investigators
Published: September 2023

Background.

The Banff system for histologic diagnosis of rejection in kidney transplant biopsies uses guidelines to assess designated features—lesions, donor-specific antibody (DSA), and C4d staining. We explored whether using regression equations to interpret the features as well as current guidelines could establish the relative importance of each feature and improve histologic interpretation.

Methods.

We developed logistic regression equations using the designated features to predict antibody-mediated rejection (AMR/mixed) and T-cell–mediated rejection (TCMR/mixed) in 1679 indication biopsies from the INTERCOMEX study (ClinicalTrials.gov NCT01299168). Equations were trained on molecular diagnoses independent of the designated features.

Results.

In regression and random forests, the important features predicting molecular rejection were as follows: for AMR, ptc and g, followed by cg; for TCMR, t > i. V-lesions were relatively unimportant. C4d and DSA were also relatively unimportant for predicting AMR: by AUC, the model excluding them (0.853) was nearly as good as the model including them (0.860). Including time posttransplant slightly but significantly improved all models. By AUC, regression predicted molecular AMR and TCMR better than Banff histologic diagnoses. More importantly, in biopsies called “no rejection” by Banff guidelines, regression equations based on histology features identified histologic and molecular rejection-related changes in some biopsies and improved survival predictions. Thus, regression can screen for missed rejection.

Conclusions.

Using lesion-based regression equations in addition to Banff histology guidelines defines the relative important of histology features for identifying rejection, allows screening for potential missed diagnoses, and permits early estimates of AMR when C4d and DSA are not available.
UNOS Decisions Impact Data Integrity of the OPTN Data Registry
Authors: Tsapepas Demetra S. , King Kristen , Husain Syed Ali , Yu Miko E. , Hippen Benjamin E. , Schold Jesse D. , Mohan Sumit
Published: September 2023

Background.

The Organ Procurement Transplant Network (OPTN)/United Network for Organ Sharing (UNOS) registry is an important national registry in the field of solid organ transplantation. Data collected are mission critical, given its role in organ allocation prioritization, program performance monitoring by both the OPTN and the Centers for Medicare & Medicaid Services, and countless observational analyses that helped to move the field forward. Despite the multifaceted importance of the OPTN/UNOS database, there are clear indications that investments in the database to ensure the quality and reliability of the data have been lacking.

Methods.

This analysis outlines 2 examples: (1) primary diagnosis for patients who are receiving a second transplant and (2) reporting peripheral vascular disease in kidney transplantation to illustrate the extensive challenges facing the veracity and integrity of the OPTN/UNOS database today.

Results.

Despite guidance that repeat kidney transplant patients should be coded as “retransplant/graft failure” rather than their native kidney disease, only 59% of new incident patients are coded in this manner. Peripheral vascular disease prevalence more than doubled in a 20-y span when the variable became associated with risk adjustment.

Conclusions.

This article summarizes critical gaps in the OPTN/UNOS database, and we bring forward ideas and proposals for consideration as a path toward improvement.
Characterization of an unanticipated indium-sulfur metallocycle complex
Authors: Morris Joshua J. , Nevin Adam , Cornelio Joel , Easun Timothy L.
Published: September 2023

We have produced a novel indium-based metallocycle complex (
In-MeSH
), which we initially observed as an unanticipated side-product in metal–organic framework (MOF) syntheses. The serendipitously synthesized metallocycle forms via the acid-catalysed decomposition of dimethyl sulfoxide (DMSO) during solvothermal reactions in the presence of indium nitrate, dimethylformamide and nitric acid. A search through the Cambridge Structural Database revealed isostructural zinc, ruthenium and palladium metallocycle complexes formed by other routes. The ruthenium analogue is catalytically active and the
In-MeSH
structure similarly displays accessible open metal sites around the outside of the ring. Furthermore, this study also gives access to the relatively uncommon oxidation state of In(II), the targeted synthesis of which can be challenging. In(II) complexes have been reported as having potentially important applications in areas such as catalytic water splitting.