bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Fatty Acids on Glucose Metabolism and Type 2 Diabetes
Authors: Sivri Dilek , Akdevelioğlu Yasemin
Published: November 2024

Type 2 diabetes is an inflammatory, non-infectious disease characterized by dysfunctional pancreatic β-cells and insulin resistance. Although lifestyle, genetic, and environmental factors are associated with a high risk of type 2 diabetes, nutrition remains one of the most significant factors. Specific types and increased amounts of dietary fatty acids are associated with type 2 diabetes and its complications. Dietary recommendations for the prevention of type 2 diabetes advocate for a diet that is characterized by reduced saturated fatty acids and trans fatty acids alongside an increased consumption of monounsaturated fatty acids, polyunsaturated fatty acids, and omega-3 fatty acids. Although following the recommendations for dietary fatty acid intake is important for reducing type 2 diabetes and its related complications, the underlying mechanisms remain unclear. This review will provide an update on the mechanisms of action of fatty acids on glucose metabolism and type 2 diabetes, as well as dietary recommendations for the prevention of type 2 diabetes.
Effect of the Mediterranean Diet Supplemented With Olive Oil Versus the Low-Fat Diet on Serum Inflammatory and Endothelial Indexes Among Adults: A Systematic Review and Meta-analysis of Clinical Controlled Trials
Authors: Pourrajab Behnaz , Fotros Danial , Asghari Parastoo , Shidfar Farzad
Published: November 2024

Context

Inflammation and endothelial dysfunction are important risk factors for chronic diseases, including cardiovascular diseases and related mortality.

Objective

This systematic review and meta-analysis aimed to assess the effects of 2 popular dietary patterns—a Mediterranean (MED) diet supplemented with olive oil and a low-fat diet (LFD)—on factors related to inflammation and endothelial function in adults.

Data Sources and Data Extraction

The following online databases were searched for related studies published until August 7, 2024: PubMed/Medline, Scopus, Clarivate Analytics Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar. Two independent researchers selected the studies based on the eligibility criteria.

Data Analysis

The effect sizes were expressed as Hedges' g with 95% CIs. A total of 16 eligible trials with 20 effect sizes were included in the analyses. This meta-analysis revealed that the MED diet supplemented with olive oil significantly improved all of the indicators of the study compared with the LFD, except in the case of E-selectin, in which a low and nonsignificant decrease was reported.

Conclusion

Available evidence suggests that a MED diet supplemented with olive oil compared with the LFD significantly improves inflammation and serum endothelial function in adults.

Systematic Review Registration

PROSPERO registration no. CRD42023485718.
Unravelling the Role of Chitin and Chitosan in Prebiotic Activity and Correlation With Cancer: A Narrative Review
Authors: Ferri Irene , Canala Benedetta , Rossi Luciana
Published: November 2024

This review describes the state of the art regarding the prebiotic role of chitin and the interactions of chitin and chitosan with cancer cells. Chitin is the second most abundant polysaccharide in nature and a constitutive component of crustacean shells and the exoskeleton of insects. Chitosan is the deacetylated form of chitin, which is obtained by chemical processing or the enzymatic activity of deacetylases found in microorganisms and insects. Edible insects have recently been introduced in Western countries, thus raising concerns regarding food safety and due to their chitin content and the release of chitosan during the digestive process. The roles of insect chitin and chitosan in the gastrointestinal tract, microbiome modulation, and cancer have been widely investigated. Several in vitro and in vivo studies have shown the possible microbiota modulation of chitin and its relevant communication with the immune system, thus confirming its prebiotic activity. No evidence has been provided on the cancerogenic activity of chitin; however, studies have suggested that chitin has a cytotoxic effect on cancer cell lines. Chitosan has been confirmed to exhibit apoptotic and cytotoxic activities on cancer cells in several in vitro studies on cancer cell lines and in vivo models. In conclusion, the literature does not show a direct connection between the presence of chitin or chitosan and the onset of cancer. However, cytotoxic and apoptotic activities in relation to cancerous lines have been demonstrated.
Petrology of Tourmaline-Bearing Blueschist from SW Tianshan, China, and Its Implication in B-Rich Fluid Migration in Subduction Zone
Authors: Shen Tingting , Hu Han , Zhang Lifei , Xu Jie Dodo , Tian Zuolin , Bader Thomas , Ma Jinlong , Zhang Jianxin , Peng Weigang , Yang Jingsui
Published: November 2024

Boron geochemistry can track fluid–rock interaction during subduction zone metamorphism. Rare tourmaline-bearing blueschists, which are associated with ultrahigh-pressure (UHP) serpentinites are first recognized in SW Tianshan, China. Detailed petrology, whole-rock and mineral chemistry, B isotope analysis, and modeling characterized two consecutive stages of tourmaline crystallization (Tur-I, Tur-II). Tourmaline included in, or intergrown with, garnet and the cores of tourmaline in rock matrixes and veins are Tur-I, which grew during prograde metamorphism at 430°C to 460°C/470°C, ~1.9–2.1 GPa. The rims of tourmaline in rock matrixes and veins are Tur-II, which formed during initial exhumation at 460°C to 490°C, ~2.1–1.7 GPa. Variable δ11B values of tourmaline (+8‰, Tur-I to −2‰, Tur-II) point to a 11B-rich signature of the fluid infiltrating at Stage I. With progressing metamorphism, δ11B decreased in the fluid. The high-δ11B Tur-I (up to +8‰) could not have crystallized from fluid released from the high-pressure metapelites (−12‰ to −7‰) and metabasites (−15‰ to −5‰) surrounding the tourmaline host rocks given the lower δ11B values. Modeling of B isotope fractionation yields the δ11B values of −9‰ to −5‰, −11‰ to −1‰, and +8‰ to +17‰ for the fluids equilibrium with the restitic metapelites, metabasites, and serpentinites, respectively. The tourmaline and whole-rock B isotope data, along with the tourmaline compositions, point to the associated serpentinites as source of the fluid that infiltrated the metamorphic rocks. This fluid was released by the partial dehydration of serpentinites through the reaction antigorite + brucite = olivine + water at forearc depth. We propose that metabasites in subduction zones can acquire 11B-rich signatures through interaction with serpentinite-derived fluids, leading to the formation of robust tourmaline minerals at shallow levels. As a new reservoir of heavy boron, these metabasites can then transport this signature to greater depths.
Carbon and nitrogen signaling regulate FLOWERING LOCUS C and impact flowering time in Arabidopsis
Authors: Gramma Vladislav , Olas Justyna Jadwiga , Zacharaki Vasiliki , Ponnu Jathish , Musialak-Lange Magdalena , Wahl Vanessa
Published: November 2024

The timing of flowering in plants is modulated by both carbon (C) and nitrogen (N) signaling pathways. In a previous study, we established a pivotal role of the sucrose-signaling trehalose 6-phosphate pathway in regulating flowering under N-limited short-day conditions. In this work, we show that both wild-type Arabidopsis (Arabidopsis thaliana) plants grown under N-limited conditions and knock-down plants of TREHALOSE PHOSPHATE SYNTHASE 1 induce FLOWERING LOCUS C (FLC) expression, a well-known floral repressor associated with vernalization. When exposed to an extended period of cold, a flc mutant fails to respond to N availability and flowers at the same time under N-limited and full-nutrition conditions. Our data suggest that SUCROSE NON-FERMENTING 1 RELATED KINASE 1-dependent trehalose 6-phosphate-mediated C signaling and a mechanism downstream of N signaling (likely involving NIN-LIKE PROTEIN 7) impact the expression of FLC. Collectively, our data underscore the existence of a multi-factor regulatory system in which the C and N signaling pathways jointly govern the regulation of flowering in plants.
Partnership between the Swedish police and civil society organizations. Encouraging and hindering factors for a successful collaboration
Authors: Jonsson Cecilia
Published: November 2024

The notion that the police need to work in interorganizational partnerships has been well-established for decades, although the task has proved difficult. Based on interviews with representatives from strategically selected CSOs, this study examines encouraging and hindering factors for collaboration with the police. It also shows that the statements of the three CSOs echo previous research where the police is involved. The study concludes that firstly, the police must recognize the CSOs as trustworthy and consider their activities to be of police interest. Secondly, the CSOs must manage to penetrate the police organization’s physical and cultural boundaries in order to offer their services. Thirdly, a division of labour must be established where the benefits of collaboration are evident for both parties. Fourthly, collaboration must be organizationally institutionalized. It is worth noting that not all CSOs strive for closer collaboration; some prefer to keep a distance.
Strong Absorptions of Thermal Neutrons Caused by Virtual States
Authors: Yamaguchi Yukito , Okada M , Terao T , Furusho S , Okamoto T , Yagi Y , Fumimoto T , Maeda T , Nakamoto R , Ito M
Published: November 2024

Cross sections of compound nucleus (CN) formation by S-wave neutron scattering, the study of which was begun by Feshbach et al. in a pioneering work, are reanalyzed by the optical model plus the Jost function method (JFM), which is a modern theory for handling bound and unbound continuum states in a unified manner. We have calculated the CN cross section for thermal neutron scattering ($E_n=25.3$ meV) by about 300 stable targets. The enhancements in the CN cross section in specific mass number regions, $A\sim 10, 50$, and 160, which are well known results in the previous optical model analyses, are reproduced by the present calculation. The JFM calculation is applied to investigate the origin of the enhanced CN cross section, and the poles in the scattering matrices (S-matrices) are systematically explored in the complex momentum plane. In JFM, the S-matrix poles representing the virtual states, which are different from the usual resonances described by the Breit–Wigner formula, appear around the origin (zero energy) in the momentum plane in the mass region with the enhanced CN cross section. The present analysis of the S-matrix means that the virtual state strongly enhances the CN cross section. We also discuss the present results in connection with giant resonances and compound nuclear resonances, which were regarded in previous studies as established theories to understand the enhanced absorption of the thermal neutron.
“Superstitious” Investors
Authors: Guo Hongye , Wachter Jessica A
Published: November 2024

We reconsider the excess volatility puzzle through the lens of a model in which agents believe they can predict dividend growth when in fact they cannot. Besides excess volatility in the time series, the model explains the value premium, and the explanatory power of the value factor. In support of the model, we show that analysts’ earnings forecasts align with market valuation and that analysts are far more optimistic about growth stocks than they are about value stocks. Using both survey and price data, we show that the same mechanism can explain the excess returns earned by investing in high-interest rate currencies. (JEL G12, G15, G41)
Disseminated Knowledge: The Advancement of Finnish Occupational Medicine and Work Psychology in a Transnational Context, c. 1945–1952
Authors: Mannevuo Mona
Published: November 2024

This article focuses on the advancement of Finnish occupational medicine in the immediate post-war period, situating its development within a transnational context. Its objective is to offer insight into Finnish post-war industrial medicine and particularly developments in mental health care. The empirical methodology addresses a previously unexplored case study: the connections between the Finnish Institute of Occupational Health (FIOH) and Roffey Park Rehabilitation Centre, established in 1943 to address various cases of industrial neurosis. The case study sheds light on the ways in which FIOH adopted reformist ideas from transnational medical communities by aligning them with the needs of Finland’s war reparations industry. The article argues that FIOH’s experts advanced new theories of mental disorder for Finland’s newly modern industrial society, and that these initiatives should be situated within broader transnational endeavours in the mental hygiene movement.
Intracellular Mg2+ concentrations are differentially regulated in the sperm head and mid‐piece in acrosome reaction inducing conditions
Authors: Sánchez‐Cárdenas C. , De la Vega‐Beltrán J. L. , Weber W. D. , Orta G. , Sánchez‐Guevara Y. , Hernández‐Cruz A. , Darszon A. , Visconti P. E.
Published: November 2024

The sperm ability to fertilize involves the regulation of ATP levels. Because inside cells, ATP is complexed with Mg2+ ions, changes in ATP levels result in changes in intracellular Mg2+ concentration ([Mg2+]i), which can be followed using intracellular Mg2+ sensors such as Mag‐520. In this work, we tested conditions known to decrease sperm ATP such as starvation and capacitation. As expected, in these conditions [Mg2+]i increased in all cell compartments. In contrast, when ATP increases, such as adding nutrients to starved sperm, [Mg2+]i significantly decreases in all compartments. On the other hand, when the acrosome reaction was induced, either with progesterone or with ionomycin, [Mg2+]i was differentially regulated in the head and mid‐piece. While Mag‐520 fluorescence increased in the sperm mid‐piece, it decreased in the head. These changes were observed in capacitated as well as in starved sperm but not in sperm incubated in conditions that do not support capacitation. Changes in [Mg2+]i were still observed when the sperm were incubated in high extracellular Mg2+ suggesting that this decrease is not due to Mg2+ efflux. Interestingly, the progesterone and ionomycin effects on [Mg2+]i were abolished on sperm incubated in Ca2+‐free media. Altogether, these results indicate that [Mg2+]i is regulated in sperm during capacitation and acrosomal reaction, and suggest that these measurements can serve to evaluate ATP levels in real time.
Blastocyst complementation generates exogenous donor‐derived liver in ahepatic pigs
Authors: Simpson Sean G. , Park Ki‐Eun , Yeddula Sai Gautham Reddy , Waters Jerel , Scimeca Erin , Poonooru Ravikanth Reddy , Etches Rob , Telugu Bhanu P.
Published: November 2024

Liver diseases are one of the leading causes of morbidity and mortality worldwide. Globally, liver diseases are responsible for approximately 2 million deaths annually (1 of every 25 deaths). Many of the patients with chronic liver diseases can benefit from organ transplantation. However, stringent criteria for placement on organ transplantation waitlist and chronic shortage of organs preclude access to patients. To bridge the shortfall, generation of chimeric human organs in pigs has long been considered as an alternative. Here, we report feasibility of the approach by generating chimeric livers in pigs using a conditional blastocyst complementation approach that creates a vacant niche in chimeric hosts, enabling the initiation of organogenesis through donor‐derived pluripotent cells. Porcine fetal fibroblasts were sequentially targeted for knockin of CRE into the endogenous FOXA3 locus (FOXA3CRE) followed by floxing of exon 1 of HHEX (FOXA3CREHHEXloxP/loxP) locus. The conditional HHEX knockout and constitutive GFP donor (COL1ACAG:LACZ 2A EGFP) were used as nuclear donors to generate host embryos by somatic cell nuclear transfer, and complemented and transferred into estrus synchronized surrogates. In the resulting fetuses, donor EGFP blastomeres reconstituted hepatocytes as confirmed by immunohistochemistry. These results potentially pave the way for exogenous donor‐derived hepatogenesis in large animal models.
The role of the co‐chaperone DNAJB11 in polycystic kidney disease: Molecular mechanisms and cellular origin of cyst formation
Authors: Busch Tilman , Neubauer Björn , Schmitt Lars , Cascante Isabel , Knoblich Luise , Wegehaupt Oliver , Schöler Felix , Tholen Stefan , Hofherr Alexis , Schell Christoph , Schilling Oliver , Westermann Lukas , Köttgen Michael
Published: November 2024

Autosomal dominant polycystic kidney disease (ADPKD) is caused by mutations in PKD1 and PKD2, encoding polycystin‐1 (PC1) and polycystin‐2 (PC2), which are required for the regulation of the renal tubular diameter. Loss of polycystin function results in cyst formation. Atypical forms of ADPKD are caused by mutations in genes encoding endoplasmic reticulum (ER)‐resident proteins through mechanisms that are not well understood. Here, we investigate the function of DNAJB11, an ER co‐chaperone associated with atypical ADPKD. We generated mouse models with constitutive and conditional Dnajb11 inactivation and Dnajb11‐deficient renal epithelial cells to investigate the mechanism underlying autosomal dominant inheritance, the specific cell types driving cyst formation, and molecular mechanisms underlying DNAJB11‐dependent polycystic kidney disease. We show that biallelic loss of Dnajb11 causes cystic kidney disease and fibrosis, mirroring human disease characteristics. In contrast to classical ADPKD, cysts predominantly originate from proximal tubules. Cyst formation begins in utero and the timing of Dnajb11 inactivation strongly influences disease severity. Furthermore, we identify impaired PC1 cleavage as a potential mechanism underlying DNAJB11‐dependent cyst formation. Proteomic analysis of Dnajb11‐ and Pkd1‐deficient cells reveals common and distinct pathways and dysregulated proteins, providing a foundation to better understand phenotypic differences between different forms of ADPKD.
CD59 double knockout mice express a CD59ba hybrid fusion protein that mediates insulin secretion
Authors: Ekström A. , Villoutreix B. O. , Halperin J. , Renström E. , Blom A. M. , King B. C.
Published: November 2024

CD59 is a cell‐surface inhibitor of the terminal step in the complement cascade. However, in addition to its complement inhibitory function, a non‐canonical role of CD59 in pancreatic beta cells has been identified. Two recently discovered intracellular alternative splice forms of CD59, IRIS‐1 and IRIS‐2, are involved in insulin exocytosis through interactions with SNARE‐complex components. In mice, the CD59 gene has undergone duplication and to further explore the role of CD59 in insulin secretion, blood glucose homeostasis was studied in a CD59 double knockout (CD59abKO) mouse model. However, no phenotypic deviation related to insulin secretion or blood glucose homeostasis was observed for the CD59abKO mice. Instead, a CD59ba hybrid transcript formed as a consequence of the mutation induced to generate the model was identified. This hybrid transcript is expressed in pancreatic islets of the CD59abKO mice and is comprised of the remaining exons of the two CD59 genes spliced together. Similar to canonical CD59, the CD59ba hybrid was found to be glycosylated and present on the cell surface when exogenously expressed in INS‐1 832/13 cells. Furthermore, INS‐1 832/13 cells over‐expressing the mouse CD59ba hybrid retained normal insulin secretion following siRNA‐mediated knockdown of canonical CD59. Hence, although the CD59ba hybrid has lost the complement inhibitory function, the intracellular insulin secretory function remains. These results provide further information concerning the structural requirements of CD59 in its intracellular role relative to its role as a complement inhibitor. It also highlights the importance of carefully assessing plausible consequences of induced mutations in research models.
Paravertebral versus Pectoralis-II (Interpectoral and Pectoserratus) Nerve Blocks for Postoperative Analgesia after Nonmastectomy Breast Surgery: A Randomized, Controlled, Observer-masked Noninferiority Trial
Authors: Gabriel Rodney A. , Curran Brian P. , Swisher Matthew W. , Sztain Jacklynn F. , Tsuda Paige S. , Said Engy T. , Alexander Brenton , Finneran John J. , Abramson Wendy B. , Black Jessica R. , Wallace Anne M. , Blair Sarah , Donohue Michael C. , Abdullah Baharin , Xu Nicole Y. , Cha Brannon J. , Ilfeld Brian M.
Published: November 2024

Background:

Pectoralis-II and paravertebral nerve blocks are both used to treat pain after breast surgery. Most previous studies involving mastectomy identified little difference of significance between the two approaches. Whether this is also accurate for nonmastectomy procedures remains unknown.

Methods:

Participants undergoing uni- or bilateral nonmastectomy breast surgery anticipated to have at least moderate postoperative pain were randomized to a pectoralis-II or paravertebral block (90 mg ropivacaine per side for both). Surgeons and recovery room staff were masked to treatment group assignment, and participants were not informed of their treatment group. Injectate for pectoralis-II blocks was ropivacaine 0.3% (30 ml) per side. Injectate for paravertebral blocks was ropivacaine 0.5% (9 ml in each of two levels) per side. This study hypothesized that pectoralis-II blocks would have noninferior analgesia (numeric rating scale) and noninferior cumulative opioid consumption within the operating and recovery rooms combined (dual primary outcomes). The study was adequately powered with n = 100, but the target enrollment was raised to n = 150 to account for higher-than-anticipated variability.

Results:

The trial was ended prematurely with 119 (79%) of the original target of 150 participants enrolled due to (masked) surgeon preference. Within the recovery room, pain scores were higher in participants with pectoralis-II (n = 60) than paravertebral blocks (n = 59): median [interquartile range], 3.3 [2.3, 4.8] versus 1.3 [0, 3.6] (95% CI, 0.5 to 2.6; P < 0.001). Similarly, intravenous morphine equivalents were higher in the pectoralis-II group: 17.5 [12.5, 21.9] versus 10.0 mg [10, 20] (95% CI, 0.1 to 7.5; P = 0.004). No block-related adverse events were identified in either group.

Conclusions:

After nonmastectomy breast surgery, two-level paravertebral blocks provided superior analgesia and opioid sparing compared with pectoralis-II blocks. This is a contrary finding to the majority of studies in patients having mastectomy, in which little significant difference was identified between the two types of blocks.
Pediatric Orthopaedic Surgeons Manage Pediatric Diaphyseal Clavicle Fractures Differently Than Nonpediatric Orthopaedic Specialists
Authors: Higgins Margaret J. , Gomez Robert W. , Storino Morgan , Jessen David , Lamb Zachary J. , Jain Neil , Greenhill Dustin A.
Published: November 2024

Background:

Pediatric clavicle fractures are often managed by physicians with and without pediatric subspecialty training. The aim of this study is to identify if variability of practice exists between pediatric orthopaedic surgeons versus nonpediatric orthopaedic specialists during management of pediatric diaphyseal clavicle fractures.

Methods:

Patients ≤18 years of age with an acute, closed diaphyseal clavicle fracture treated between January 2018 and July 2023 by a large hospital-employed multispecialty orthopaedic practice (in a regional and academic health network) were retrospectively reviewed. The study involved 26 orthopaedic surgeons (including 3 pediatric, 8 sports medicine, and 6 general) and 11 nonoperative sports medicine physicians, all of which accept patients ranging 0 to 18 years of age. Exclusion criteria included open or impending open fractures and insufficient data. Demographic, radiographic, and outpatient treatment parameters were recorded. Age groups were separated into <10 and ≥10 years old to control for age-associated differences.

Results:

Among 560 pediatric clavicle fractures, 385 met inclusion criteria (43.6% of which were treated by a pediatric orthopaedic surgeon), and 361 were treated nonoperatively. Follow-up averaged 48.8 days until orthopaedic discharge and 16.9 months until the most recent well-child visit (80% had a well-child visit after orthopaedic discharge). No patient <10 years of age had elective surgery, but pediatric orthopaedic surgeons demonstrated lower surgical rates in adolescent patients than nonpediatric specialties (4.3% vs. 14.4%, OR=3.8, P=0.027). Among the 169 nonoperative patients <10 years of age, pediatric orthopaedic surgeons completed fewer outpatient visits (2.1±0.8 vs. 2.4±0.8, P<0.037), shorter follow-up durations (28.5±18.9 vs. 41.8±22.6 d, P<0.001), less radiographic series (2.1±0.8 vs. 2.4±1.0, P<0.047), and less total radiographs (4.3±1.8 vs. 5.0±2.3, P<0.013) than nonpediatric specialists.

Conclusions:

The surgical rate of acute, closed diaphyseal clavicle fractures is lower among pediatric versus nonpediatric orthopaedic surgeons in adolescents. During nonoperative management of pediatric clavicle fractures, pediatric orthopaedic surgeons treat young patients (but not adolescents) with less outpatient visits and radiographs than nonpediatric orthopaedic physicians.

Level of Evidence:

Level III
Balancing the Interactions: Assessing Antiplatelet and Antiretroviral Therapy Drug–Drug Interactions in People Living With HIV
Authors: Matsikas Athena , Marsh Kassandra , Huynh Quy , Pashun Raymond , Papadopoulos John , Ahuja Tania
Published: November 2024

The clinical effect of drug–drug interactions (DDIs) between antiplatelets and antiretroviral therapy (ART) on bleeding, thrombosis, and other major adverse cardiovascular events (MACE) is unknown. The objective of this retrospective study was to assess the incidence of DDI at P2Y12 inhibitor (P2Y12inh) initiation and the effect of DDI on patient outcomes. Adult people living with HIV (PLWH) receiving ART newly initiated on an oral P2Y12inh were included. The primary outcome was the incidence of DDI between ART and P2Y12inh at P2Y12inh initiation. Secondary outcomes included bleeding events, MACE, and switches in P2Y12inh. There were 149 PLWH included, of these, 119 (80%) were initiated on clopidogrel, 23 (15%) on ticagrelor, and 7 (5%) on prasugrel. Ninety-three PLWH (60%) had a DDI at time of P2Y12inh initiation, with highest incidence in the clopidogrel group (n = 84, 71%), followed by ticagrelor (n = 9, 39%) and none with prasugrel. Within 1 year, MACE occurred in 12 PLWH, with DDI present at the time of 4 events. There were 29 bleeding events occurring within 1 year, including 17 events with DDI at time of event. However, 88% of DDI in patients with bleeding events were expected to decrease the efficacy of P2Y12inh. Though we observed high incidence of DDI between P2Y12inh and ART in PLWH, MACE and bleeding events at 1 year did not correlate with DDI. It remains unknown whether DDI presence at P2Y12inh initiation with ART causes clinical outcomes of concern, or whether underlying platelet reactivity in PLWH is associated with these events.
Primary biliary cholangitis: Personalizing second-line therapies
Authors: Levy Cynthia , Bowlus Christopher L.
Published: November 2024

Primary biliary cholangitis (PBC) is an enigmatic, autoimmune disease targeting the small intralobular bile ducts resulting in cholestasis and potentially progression to biliary cirrhosis. Primarily affecting middle-aged women, the diagnosis of PBC is typically straightforward, with most patients presenting with cholestatic liver tests and the highly specific antimitochondrial antibody. For decades, the foundational treatment of PBC has been ursodeoxycholic acid, which delays disease progression in most patients but has no impact on PBC symptoms. Large cohort studies of patients with PBC have established the benefit of maximizing the reduction in serum alkaline phosphatase levels with ursodeoxycholic acid and the need to add second-line agents in patients who do not achieve an adequate response. Advances in the understanding of bile acid physiology have led to the development of new agents that improve cholestasis in patients with PBC and are predicted to reduce the risk of disease progression. Obeticholic acid, the first second-line therapy to be approved for PBC, significantly improves liver biochemistries and has been associated with improved long-term clinical outcomes but is limited by its propensity to induce pruritus. Elafibranor and seladelpar are peroxisome proliferator-activated receptor agonists recently approved for use in patients with PBC, whereas bezafibrate and fenofibrate are available as off-label therapies. They also have shown biochemical improvements among patients with an inadequate response to ursodeoxycholic acid but may improve symptoms of pruritus. Herein, we review the patient features to consider when deciding whether a second-line agent is indicated and which agent to consider for a truly personalized approach to PBC patient care.
Evaluating Early Nerve Injury and Its Relationship With Leprosy Reactions in Patients With Leprosy: A Prospective Cohort Study
Authors: Lin Lan-Mei , Wu Hao , Zhu Wan-Rong , Dong Can-Bin , Zhang Qi , Zheng Cheng-Hui , Liang Xiao-Niu , Long Heng , Xu Jin-Hua , Ding Hong , Du Juan
Published: November 2024

Objective:

Leprosy is an infectious disease that can be accompanied by disability caused by peripheral neuropathy. Early detection of leprosy is essential to reduce its debilitating sequelae. Ultrasound is a noninvasive test that can detect nerve loss, but ultrasound measurement depends on the skill level of operators. Radiomics is an emerging field related to the extraction and quantification of information, which may provide new solutions for early detection of neuropathy caused by leprosy. This study aimed to combine radiomics and ultrasonography to evaluate nerve damage in the early stages of leprosy in China.

Methods:

Patients were enrolled at the Wenshan Prefecture Institute of Dermatology between October 2018 and December 2022. High-resolution ultrasound imaging of the peripheral nerves was performed. Quantitative ultrasound features were extracted from the images from 5 follow-ups. Radiomic features were selected for a comparative analysis of the disease course using a linear mixed-effects model to control for potential confounding effects.

Results:

Nine patients with leprosy were enrolled in this study, consisting of 5 males and 4 females with an average age of 34.44 ± 13.58 years. With the change of treatment time, the ultrasound radiomics features of different parts of the linear mixed-effects model showed a trend of change: the nerve density (mean, skewness) was improved, the fascicular structure (kurtosis) was restored, and the abnormal morphological features in some parts were reduced (P < 0.05). Patients with type 1 leprosy reactions exhibited a lower mean and skewness, higher kurtosis, and increased quantitative morphological characteristics.

Conclusion:

The study provided the feasibility of ultrasound radiomics to digitally visualize the progression of nerve damage in leprosy patients. Ultrasound radiomics can be a low-cost method with high-throughput characteristics for clinical operators of different skill levels in early nerve injury detection of leprosy.
Do transition to practice hour requirements make a difference in adverse action and medical malpractice payment reports: An analysis from the National Practitioner Data Bank
Authors: Dillon Deborah
Published: November 2024

Background:

The transition to practice (TTP) hour requirement presents a barrier to full practice authority (FPA) for nurse practitioners (NPs). Since 2015, the predominant method of granting FPA entails a TTP hour requirement.

Purpose:

Adverse action reports (AARs) and medical malpractice payment reports (MMPRs) of NPs were compared in states with FPA on initial licensure and states with FPA requiring a TTP hour period using data from the National Practitioner Data Bank (NPDB). The relationship of TTP hours to AARs and MMPRs was also evaluated.

Methodology:

A secondary analysis was obtained from a review of retrospective data in the NPDB. States examined were those that grant FPA on initial advanced practice registered nurse licensure and states that require a TTP hour requirement as part of their criteria for granting FPA.

Results:

In a 5-year period, postimplementation of FPA or 5-year postexpiration of the TTP requirement in 23 states, plus the District of Columbia, revealed that states with FPA granted on initial licensure demonstrated a lower incidence of AARs and MMPRs at the 5-year period compared with states that require a TTP hour period. No relationship existed between the amount of TTP hours and the incidence of AARs and MMPRs.

Conclusion:

Transition to practice hours remains a barrier to NPs achieving FPA. It is important for nursing to continue to build the body of evidence that refutes or supports the need for TTP hours.

Implications:

These data can be used when lobbying at the state level in the remaining states seeking FPA.
Rural-Urban Disparities in Mobile Health Application Ownership and Utilization Among Cancer Survivors
Authors: Mahmood Asos , Mahmood Aram , Kedia Satish , Chang Cyril F.
Published: November 2024

Objective:

Mobile health applications (mHealth apps) can provide health care and health-promoting information while contributing to improving cancer survivors’ quality of life and health outcomes. However, little is known about the rural-urban distribution of mHealth app ownership and utilization. In this study, we explore the characteristics of cancer survivors who own and use mHealth apps and examine rural-urban disparities in mHealth app ownership and utilization among cancer survivors.

Methods:

We utilized data from the “Health Information National Trends Survey–Surveillance, Epidemiology, and End Results” pilot study, fielded among cancer survivors from 3 U.S. cancer registries (Iowa, New Mexico, and California) in 2021. Our sample included 942 cancer survivors who reported owning a smart device (a smartphone and/or a tablet computer). The analyses included computing weighted proportions and fitting a multivariable regression model.

Results:

Overall, 60.3% of cancer survivors reported using mHealth apps, and 16.9% resided in rural areas. Approximately 45.0% of rural cancer survivors reported utilizing mHealth apps (vs 63.5% of urban survivors). Regression analysis revealed that rural cancer survivors had 46.0% lower odds of owning and using mHealth apps compared with their urban counterparts (adjusted odds ratio = 0.54; 95% CI: 0.36, 0.80).

Conclusions:

Rural cancer survivors were less likely to own and use mHealth apps compared with urban survivors. Rural cancer survivors usually face structural and health care system-related barriers to health care access and affordability. Leveraging mHealth technology as a tool could potentially contribute to improving health care delivery for rural cancer survivors, and help address existing structural and informational barriers to access.
Gold standard nephroureterectomy, chemoprophylaxis and surveillance in upper tract urothelial carcinoma
Authors: Basile Giuseppe , Bandini Marco , Li Roger , Poch Michael A. , Necchi Andrea , Spiess Philippe E.
Published: November 2024

Purpose of review

The purpose of this review is to summarize the most recent evidence on surgical management, strategies to reduce tumor recurrence, and surveillance regimens in patients diagnosed with upper tract urothelial carcinoma (UTUC) and elected for radical treatment.

Recent findings

Minimally invasive surgery is gaining momentum in the surgical management of UTUC. Chemoprophylaxis is still the gold standard to reduce intravesical recurrence after radical nephroureterectomy (RNU). Novel surveillance strategies have been proposed to adapt follow-up regimens to patients’ characteristics.

Minimally invasive surgery has been associated with comparable oncological outcomes to the open approach while improving postoperative morbidity. In these cases, bladder cuff excision (BCE) is mostly performed by an extravesical approach, that demonstrates a noninferiority compared to the intravesical one in terms of oncological outcomes. Although lymphadenectomy is recommended in patients with high-risk tumors, its benefits are still unclear. Currently, there is a lack of recent prospective trials on chemoprophylaxis to reduce intravesical recurrence post RNU, making single-dose postoperative chemotherapy instillation the standard treatment. Although novel risk stratification models were released by international urological guidelines, their validity is mainly nonevidence-based. Risk-adapted follow-up strategies incorporating cystoscopy and cross-sectional imaging accounting for individual patient factors should be implemented.
The role of MRI in muscle-invasive bladder cancer: an update from the last two years
Authors: Pastorino Giovanni Luigi , Mercinelli Chiara , Necchi Andrea
Published: November 2024

Purpose of review

Muscle invasive bladder cancer (MIBC) is aggressive and requires radical cystectomy and neoadjuvant therapy, yet over 40% of patients face recurrence. The loss of the bladder also significantly reduces quality of life. Accurate staging, crucial for treatment decisions, is typically done through transurethral resection (TURBT), but inconsistencies in pathology affect diagnosis in 25% of cases. MRI is the most precise imaging method for evaluating local tumor invasiveness. This review discusses recent advances in MRI for staging MIBC and predicting responses to neoadjuvant therapy.

Recent findings

Vesical imaging – reporting and data system (VI-RADS) accuracy may improve if combined with ADC maps and tumor contact length, while a bi-parametric MRI approach without contrast could reduce side effects without losing diagnostic precision, though evidence is mixed. VI-RADS shows promise in predicting neoadjuvant therapy responses, and the new nacVI-RADS score is in development. Non-Gaussian diffusion-weighted imaging techniques and machine learning could enhance accuracy but need more integration with mpMRI. VI-RADS may assist in evaluating responses in bladder-sparing regimens. Urodrill, an MRI-guided biopsy, aims to replace diagnostic TURBT but needs more accuracy data.

MRI in MIBC is evolving, offering potential for accurate local staging and reduced side effects by avoiding TURBT. Predicting neoadjuvant treatment response could guide personalized treatment and bladder preservation. Larger trials are needed to validate these findings.
Bart syndrome with musculoskeletal deformity: a rare case report
Authors: Pokhrel Sanish , Niraula Zenish , Ghimire Pradip , Ale Magar Sugam , Acharya Ashish , Awal Kiran
Published: November 2024

Introduction:

Bart syndrome is a rare genetic disorder characterized by epidermolysis bullosa (EB), aplasia cutis congenita, that is congenital local absence of skin and nail abnormalities.

Case Presentation:

The authors herein, present a case of a 14-year-old boy with Bart syndrome. The syndrome was diagnosed clinically. On examination, multiple generalized blisters were present and absence of nails in the toes of both feet and the middle finger of the left hand, which was associated with musculoskeletal deformity.

Discussion:

Bart syndrome, an inherited autosomal dominant disorder, is an exceedingly rare disorder. Musculoskeletal deformity is an uncommon presentation of this syndrome. It is mostly associated with Dystrophic type of EB. It is mostly a clinical diagnosis; however, histopathological study, direct immunofluorescence, and genetic testing helps in diagnosing the type of EB.

Conclusion:

The absence of skin in a localized area at birth is a crucial indicator for diagnosing Bart syndrome at birth, which later heals and can obscure the diagnosis. Early diagnosis and conservative management prevent the disease progression and complications.
False-Positive Radioiodine Uptake Related to Posttraumatic Scab Demonstrated by SPECT/CT in a Patient With Differentiated Thyroid Cancer
Authors: Mostowski Romane , de Pontville Michel , Bardet Stéphane , Ciappuccini Renaud
Published: November 2024

A 20-year-old man with papillary thyroid cancer received a fourth radioiodine regimen to treat 131I-avid lung metastases. Posttherapeutic whole-body scan revealed focal radioiodine uptake on the anterior region of the left lower limb that was not visible on previous whole-body scan and which suggested skin contamination. Visual examination of the left leg evidenced a posttraumatic scab caused by a fall 2 weeks before. Skin metastasis was ruled out. 131I SPECT/CT acquisition ruled out bony uptake and confirmed that the skin uptake was related to the superficial scab.
Red Breast Syndrome—Where Has It Gone?
Authors: Navarro Yelissa , Makarewicz Nathan , Hinson Chandler , Thawanyarat Kometh , Coleman-Belin Janet , Loan Phillip , Modi Suraj , Nazerali Rahim S.
Published: November 2024

Background

Red breast syndrome (RBS) has been noted in past literature as a possible complication of implant-based breast reconstruction (IBBR) with the use of acellular dermal matrices (ADMs). Since its first appearance in 2009, RBS has drawn growing medical attention with reported incidence ranging from 7%–9%. There has been a noted decrease in the emergence of RBS despite its inclusion among the analyzed complications in a number of studies. This systematic review aims to evaluate the trend in reported RBS incidence over time and appropriately determine an accurate incidence of RBS from reported literature since the emergence of the phenomena.

Methods

A systematic literature review was performed in July 2023 that analyzed the incidence of RBS among retrospective cohort studies on complication rates of IBBR with ADM. Patient demographics, RBS incidence rates, and all-cause complications were captured. The review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and Methodological Index for Nonrandomized Studies criteria was used to assess study quality.

Results

From 2009 to 2023, a total of 48 studies (n = 6251) met inclusion criteria of which 35 studies from 2017 to 2023 were not already included in a prior systematic review (n = 5246). The mean incidence of RBS in the unreported studies was 2.88% with a weighted mean of 3.22%. Analysis of the trend in RBS over time shows an increasing reported incidence rate from 2009 with a peak in incidence between 2016 and 2017, followed by a steady decline through 2022. Twenty-six of the studies were published from 2016 to 2019.

Conclusions

The incidence of RBS among prior studies and systematic reviews has fluctuated significantly since its initial emergence in 2009. Reported incidence rates have been on the decline since 2018 with a true weighted incidence of 3.22% from analysis of recent reported studies. Potential causes for the decline in incidence include practice changes in ADM preparation, changes in the ADM brand used for IBBR, and improved categorization of RBS compared to cellulitis/infection. Despite more robust criteria for diagnosis, no consensus for management has yet been established.
Reduction Mammaplasty
Authors: Kalmar Christopher L. , White-Dzuro Colin G. , Mok Jean W. , Perdikis Galen
Published: November 2024

Background

While there is mounting evidence that closed suction drains are not necessary, there is a paucity of literature to demonstrate that drains are harmful after breast reduction. The purpose of this study was to investigate the effect of drains on postoperative seroma, hematoma, and infection, as well as elucidate any risk factors that may be implicated in the development of these complications.

Methods

A retrospective cohort study was conducted of all reduction mammaplasty procedures at our university medical center between 2010–2020. Pedicle type, skin incision, drain utilization, breast excision mass, sternal notch to nipple distance, and inframammary fold to nipple distance were analyzed with postoperative outcomes including hematoma, seroma, infection, dehiscence, nipple necrosis, and fat necrosis.

Results

This study included 944 female patients undergoing reduction mammaplasty. Median age was 39.0 years, median body mass index was 31.9 kg/m2, and median breast mass resected was 742 grams per side. Drain utilization did not significantly reduce postoperative hematoma (P = 0.196), seroma (P = 0.185), nipple necrosis (P = 0.511), or fat necrosis (P = 0.113), but drain utilization significantly increased postoperative surgical site infection (P = 0.011). Patients with breast mass removed over 1500 g had significantly higher risk of hematoma (P = 0.002), fat necrosis (P < 0.001), and nipple necrosis (P < 0.001) compared to patients with less than 1500 g removed. In patients with greater than 1500 g resected, drain utilization did not significantly decrease risk of hematoma (P = 0.086) or seroma (P = 0.497).

Conclusions

Breast reduction greater than 1500 g per side significantly increased risk of hematoma, nipple necrosis, and fat necrosis. Drain utilization did not demonstrate any advantageous effects, rather it increased risk of infection. Future multicenter study will be needed to confirm these findings across different patient referral networks and practice patterns.
A Mobile Craniofacial Surgery Unit: Reconstructing Casualties of War in Ukraine
Authors: Antonyshyn Kira , Teshima Tara Lynn , Al-Shaqsi Sultan , Enepekides Danny , Higgins Kevin , Levis Carolyn , Sigurdson Leif , Phillips John , Antonyshyn Oleh
Published: November 2024

This paper describes the development and implementation of a mobile craniofacial surgical unit designed to address complex posttraumatic craniofacial deformities in both civilian and military casualties resulting from Russia’s invasion of Ukraine. Restricted air space, limited possibilities for transportation of personnel and equipment, frequent interruption of power and water supply, and constant threat of injury to patients and medical personnel from missile and drone strikes, precludes reliable and safe delivery of tertiary care. The Canada Ukraine Surgical Aid Program (CUSAP) addressed these challenges by establishing a mobile craniofacial surgery unit, operating just outside of the war zone. The following report characterizes the civilian and military casualties, highlights the barriers to the provision of adequate tertiary care locally, and provides a detailed description of the measures that were taken to organize the mobile unit. The effectiveness of this program is documented, and specific challenges are illustrated through case examples. We believe this model serves as a template for delivering surgical aid to victims of any global disaster where care cannot be provided locally.