bluuebunny/crossref_metadata_2025 huggingface dataset:
Point of Use Treatment for Medical Devices: From Bedside to Battlefield
Authors: Eberhardt Gina L , Atwood Bethany I , Smith Joshua D
Published: January 2024

Introduction

Point of use (POU) treatment is a critical first step of medical device reprocessing. Reusable instruments and flexible endoscopes require a minimum of terminal sterilization or high-level disinfection, neither of which can be guaranteed if POU is performed incorrectly. Compliance considerations for POU include hospital accreditation readiness, unique austere surgical mission requirements, and the transition of future conflict towards Large Scale Combat Operations. This integrative review aims to describe POU for reusable instruments and endoscopes, and extrapolate implications for Military Health System policies and future considerations.

Materials and methods

The authors performed an integrative review and comprehensive literature search in PubMed and CINAHL with the keywords “point of use,” “point of use cleaning,” “POU,” “instrument,” “high-level disinfection,” “endoscope,” and “clean.” Articles were limited to “English” and “human” from 2017 to 2023. The authors also performed a thorough review of the Defense Health Agency and service-specific doctrine, as well as national guidelines regarding POU adherence.

Results

The literature review yielded 18 articles that discussed the transport and reprocessing of reusable medical devices. Regulatory standards and national guidelines were used to supplement the literature. Seventeen evidence-based criteria were extrapolated from the literature to generate two step-by-step guides for the POU treatment of endoscopes and reusable instruments (Tables I and II). Despite increased morbidity and mortality rates linked to inadequate device reprocessing, compliance with POU procedures remains low. Barriers to practice included complex POU processes, intricately designed surgical instruments and endoscopes, lack of healthcare worker (HCW) knowledge and competency, and inadequate or ambiguously written policies. Training, competency assessments, and clearly written policies and procedures can be cost-effective, evidence-based, and feasible solutions.

Conclusion

Completing POU treatment is critical to a successful surgical mission in both the hospital and austere environment. Implications to practice include implementing evidence-based POU programs that improve patient outcomes and readiness while decreasing costs.
The dragon-II simulations – I. Evolution of single and binary compact objects in star clusters with up to 1 million stars
Authors: Arca Sedda Manuel , Kamlah Albrecht W H , Spurzem Rainer , Giersz Mirek , Berczik Peter , Rastello Sara , Iorio Giuliano , Mapelli Michela , Gatto Massimiliano , Grebel Eva K
Published: January 2024

We present the first results of the Dragon-II simulations, a suite of 19 N-body simulations of star clusters with up to 106 stars, with up to 33 per cent of them initially paired in binaries. In this work, we describe the main evolution of the clusters and their compact objects (COs). All Dragon-II clusters form in their centre a black hole (BH) subsystem with a density 10−100 times larger than the stellar density, with the cluster core containing $50{-}80~{{\rm per\ cent}}$ of the whole BH population. In all models, the BH average mass steeply decreases as a consequence of BH burning, reaching values 〈mBH〉 < 15 M⊙ within 10−30 relaxation times. Generally, our clusters retain only BHs lighter than 30 M⊙ over 30 relaxation times. Looser clusters retain a higher binary fraction, because in such environments binaries are less likely disrupted by dynamical encounters. We find that BH–main-sequence star binaries have properties similar to recently observed systems. Double CO binaries (DCOBs) ejected from the cluster exhibit larger mass ratios and heavier primary masses than ejected binaries hosting single CO binaries (SCOBs). Ejected SCOBs have BH masses mBH = 3−20 M⊙, definitely lower than those in DCOBs (mBH = 10−100 M⊙).
The three hundred project: mapping the matter distribution in galaxy clusters via deep learning from multiview simulated observations
Authors: de Andres Daniel , Cui Weiguang , Yepes Gustavo , De Petris Marco , Ferragamo Antonio , De Luca Federico , Aversano Gianmarco , Rennehan Douglas
Published: January 2024

A galaxy cluster as the most massive gravitationally bound object in the Universe, is dominated by dark matter, which unfortunately can only be investigated through its interaction with the luminous baryons with some simplified assumptions that introduce an un-preferred bias. In this work, we, for the first time, propose a deep learning method based on the U-Net architecture, to directly infer the projected total mass density map from idealized observations of simulated galaxy clusters at multiwavelengths. The model is trained with a large data set of simulated images from clusters of the three hundred project. Although machine learning (ML) models do not depend on the assumptions of the dynamics of the intracluster medium, our whole method relies on the choice of the physics implemented in the hydrodynamic simulations, which is a limitation of the method. Through different metrics to assess the fidelity of the inferred density map, we show that the predicted total mass distribution is in very good agreement with the true simulated cluster. Therefore, it is not surprising to see the integrated halo mass is almost unbiased, around 1 per cent for the best result from multiview, and the scatter is also very small, basically within 3 per cent. This result suggests that this ML method provides an alternative and more accessible approach to reconstructing the overall matter distribution in galaxy clusters, which can complement the lensing method.
Extracting the Global 21-cm signal from Cosmic Dawn and Epoch of Reionization in the presence of Foreground and Ionosphere
Authors: Tripathi Anshuman , Datta Abhirup , Choudhury Madhurima , Majumdar Suman
Published: January 2024

Detection of redshifted H i 21-cm emission is a potential probe for investigating the Universe’s first billion years. However, given the significantly brighter foreground, detecting 21-cm is observationally difficult. The Earth’s ionosphere considerably distorts the signal at low frequencies by introducing directional-dependent effects. Here, for the first time, we report the use of Artificial Neural Networks (ANNs) to extract the global 21-cm signal characteristics from the composite all-sky averaged signal, including foreground and ionospheric effects such as refraction, absorption, and thermal emission from the ionosphere’s F and D-layers. We assume a ‘perfect’ instrument and neglect instrumental calibration and beam effects. To model the ionospheric effect, we considered the static and time-varying ionospheric conditions for the mid-latitude region, where LOFAR is situated. In this work, we trained the ANN model for various situations using a synthetic set of the global 21-cm signals created by altering its parameter space based on the ‘$\rm \tanh$’ parametrized model and the Accelerated Reionization Era Simulations (ARES) algorithm. The obtained result shows that the ANN model can extract the global signal parameters with an accuracy of ${\ge}96\ \hbox{per cent}$ in the final study when we include foreground and ionospheric effects. On the other hand, a similar ANN model can extract the signal parameters from the final prediction data set with an accuracy ranging from 97 to 98 per cent when considering more realistic sets of the global 21-cm signals based on physical models.
The impact and response of mini-haloes and the interhalo medium on cosmic reionization
Authors: Chan Tsang Keung , Benítez-Llambay Alejandro , Theuns Tom , Frenk Carlos , Bower Richard
Published: January 2024

An ionization front (I-front) that propagates through an inhomogeneous medium is slowed down by self-shielding and recombinations. We perform cosmological radiation hydrodynamics simulations of the I-front propagation during the epoch of cosmic reionization. The simulations resolve gas in mini-haloes (halo mass 104 ≲ Mh[M⊙] ≲ 108) that could dominate recombinations, in a computational volume that is large enough to sample the abundance of such haloes. The numerical resolution is sufficient (gas-particle mass ∼20 M⊙ and spatial resolution <0.1 ckpc) to allow accurate modelling of the hydrodynamic response of gas to photoheating. We quantify the photoevaporation time of mini-haloes as a function of Mh and its dependence on the photoionization rate, Γ−12, and the redshift of reionization, zi. The recombination rate can be enhanced over that of a uniform medium by a factor ∼10−20 early on. The peak value increases with Γ−12 and decreases with zi, due to the enhanced contribution from mini-haloes. The clumping factor, cr, decreases to a factor of a few at ∼100 Myr after the passage of the I-front when the mini-haloes have been photoevaporated; this asymptotic value depends only weakly on Γ−12. Recombinations increase the required number of photons per baryon to reionize the Universe by 20 per cent–100 per cent, with the higher value occurring when Γ−12 is high and zi is low. We complement the numerical simulations with simple analytical models for the evaporation rate and the inverse Strömgren layer. The study also demonstrates the proficiency and potential of sph-m1rt to address astrophysical problems in high-resolution cosmological simulations.
The X-ray high-energy cutoff in compact symmetric object Mrk 348
Authors: Liao Mai , Wang Junxian , Kang Jialai , Li Xiaofeng , Zhou Minhua
Published: January 2024

Compact radio active galactic nuclei (AGNs) are thought to be young radio AGN at the early stage of AGN evolution, thus are ideal laboratory to study the high-energy emission throughout the evolution of radio AGN. In this work, we report for the first time the detection of the high-energy cutoff (Ecut), a direct indicator of thermal coronal radiation, of X-ray emission in Mrk 348 (z = 0.015), a young radio galaxy classified as compact symmetric object. With a 100 ks Nuclear Spectroscopic Telescope Array exposure, we find that the high-energy cutoff (Ecut) is firmly detected ($218^{+124}_{-62}$ keV). Fitting with various Comptonization models indicates the presence of a hot corona with temperature kTe = 35–40 keV. These strongly support the corona origin for its hard X-ray emission. The comparison in the Ecut – spectra index Γ plot of Mrk 348 with normal large-scale radio galaxies (mostly Fanaroff–Riley type II) yields no difference between them. This suggests the corona properties in radio sources may not evolve over time (i.e. from the infant stage to mature stage), which is to-be-confirmed with future sample studies of young radio AGNs.
Structural basis for transcription activation by the nitrate-responsive regulator NarL
Authors: Kompaniiets Dmytro , He Lina , Wang Dong , Zhou Wei , Yang Yang , Hu Yangbo , Liu Bin
Published: January 2024

Transcription activation is a crucial step of regulation during transcription initiation and a classic check point in response to different stimuli and stress factors. The Escherichia coli NarL is a nitrate-responsive global transcription factor that controls the expression of nearly 100 genes. However, the molecular mechanism of NarL-mediated transcription activation is not well defined. Here we present a cryo-EM structure of NarL-dependent transcription activation complex (TAC) assembled on the yeaR promoter at 3.2 Å resolution. Our structure shows that the NarL dimer binds at the −43.5 site of the promoter DNA with its C-terminal domain (CTD) not only binding to the DNA but also making interactions with RNA polymerase subunit alpha CTD (αCTD). The key role of these NarL-mediated interactions in transcription activation was further confirmed by in vivo and in vitro transcription assays. Additionally, the NarL dimer binds DNA in a different plane from that observed in the structure of class II TACs. Unlike the canonical class II activation mechanism, NarL does not interact with σ4, while RNAP αCTD is bound to DNA on the opposite side of NarL. Our findings provide a structural basis for detailed mechanistic understanding of NarL-dependent transcription activation on yeaR promoter and reveal a potentially novel mechanism of transcription activation.
Transcription factor PbNAC71 regulates xylem and vessel development to control plant height
Authors: Cong Liu , Shi Yi-ke , Gao Xin-yi , Zhao Xiao-fei , Zhang Hai-qi , Zhou Feng-li , Zhang Hong-juan , Ma Bai-quan , Zhai Rui , Yang Cheng-quan , Wang Zhi-gang , Ma Feng-wang , Xu Ling-fei
Published: January 2024

Dwarfism is an important agronomic trait in fruit breeding programs. However, the germplasm resources required to generate dwarf pear (Pyrus spp.) varieties are limited. Moreover, the mechanisms underlying dwarfism remain unclear. In this study, “Yunnan” quince (Cydonia oblonga Mill.) had a dwarfing effect on “Zaosu” pear. Additionally, the dwarfism-related NAC transcription factor gene PbNAC71 was isolated from pear trees comprising “Zaosu” (scion) grafted onto “Yunnan” quince (rootstock). Transgenic Nicotiana benthamiana and pear OHF-333 (Pyrus communis) plants overexpressing PbNAC71 exhibited dwarfism, with a substantially smaller xylem and vessel area relative to the wild-type controls. Yeast one-hybrid, dual-luciferase, chromatin immunoprecipitation-qPCR, and electrophoretic mobility shift assays indicated that PbNAC71 downregulates PbWalls are thin 1 expression by binding to NAC-binding elements in its promoter. Yeast two-hybrid assays showed that PbNAC71 interacts with the E3 ubiquitin ligase PbRING finger protein 217 (PbRNF217). Furthermore, PbRNF217 promotes the ubiquitin-mediated degradation of PbNAC71 by the 26S proteasome, thereby regulating plant height as well as xylem and vessel development. Our findings reveal a mechanism underlying pear dwarfism and expand our understanding of the molecular basis of dwarfism in woody plants.
Sensory input to cortex encoded on low-dimensional periphery-correlated subspaces
Authors: Barreiro Andrea K , Fontenele Antonio J , Ly Cheng , Raju Prashant C , Gautam Shree Hari , Shew Woodrow L
Published: January 2024

As information about the world is conveyed from the sensory periphery to central neural circuits, it mixes with complex ongoing cortical activity. How do neural populations keep track of sensory signals, separating them from noisy ongoing activity? Here, we show that sensory signals are encoded more reliably in certain low-dimensional subspaces. These coding subspaces are defined by correlations between neural activity in the primary sensory cortex and upstream sensory brain regions; the most correlated dimensions were best for decoding. We analytically show that these correlation-based coding subspaces improve, reaching optimal limits (without an ideal observer), as noise correlations between cortex and upstream regions are reduced. We show that this principle generalizes across diverse sensory stimuli in the olfactory system and the visual system of awake mice. Our results demonstrate an algorithm the cortex may use to multiplex different functions, processing sensory input in low-dimensional subspaces separate from other ongoing functions.
Harnessing cytokine-induced killer cells to accelerate diabetic wound healing: an approach to regulating post-traumatic inflammation
Authors: Yang Yixi , Zhang Cheng , Jiang Yuan , He Yijun , Cai Jiawei , Liang Lin , Chen Zhaohuan , Pan Sicheng , Hua Chu , Wu Keke , Wang Le , Zhang Zhiyong
Published: January 2024

Impaired immunohomeostasis in diabetic wounds prolongs inflammation and cytokine dysfunction, thus, delaying or preventing wound-surface healing. Extensive clinical studies have been conducted on cytokine-induced killer (CIK) cells recently, as they can be easily proliferated using a straightforward, inexpensive protocol. Therefore, the function of CIK cells in regulating inflammatory environments has been drawing attention for clinical management. Throughout the current investigation, we discovered the regenerative capacity of these cells in the challenging environment of wounds that heal poorly due to diabetes. We demonstrated that the intravenous injection of CIK cells can re-establish a proregenerative inflammatory microenvironment, promote vascularization and, ultimately, accelerate skin healing in diabetic mice. The results indicated that CIK cell treatment affects macrophage polarization and restores the function of regenerative cells under hyperglycemic conditions. This novel cellular therapy offers a promising intervention for clinical applications through specific inflammatory regulation functions.
Implementation of EU Regulations in Czechia
Authors: Whelanová Markéta
Published: January 2024

Implementation of EU regulations requires many changes in the Czech legal order. It is often necessary to repeal incompatible national provisions, provide for new penalties and provisions on competence of national institutions, or set up a new system only sketched by the EU regulations. Further, the implementation in Czechia has to match with the other parts of the Czech legal order to be effective. And it must comply with the Czech constitutional imperatives and legal drafting rules which follow from the principle of legal certainty and a rule of law. The main problem appears with European Parliament and Council regulations which establish only very general rules. Also, too many delegated and implementing regulations of the Commission are causing problems, specially when they have short implementation deadlines and change quickly. The article therefore contains examples of loopholes, presents methods to deal with them and sketches paths to be taken in the future.
The effect of shrub cover on conifer water-use patterns, growth and response to precipitation variability in the southern Sierra Nevada
Authors: Goodwin Marissa J , Hurteau Matthew D
Published: January 2024

As wildfires increase in size and severity, large areas of forest are undergoing substantial increases in shrub cover. In forests where water is the limiting resource, the partitioning of soil water between shrubs and young trees may determine how shrubs affect tree growth and water-stress. Here we evaluated juvenile trees (average age = 32 years) of two dominant conifer species in the southern Sierra Nevada of California (Abies concolor (white fir) and Pinus jeffreyi (Jeffrey pine)) growing in the presence or absence of shrubs. The two shrub species included Arctostaphylos patula and Ceanothus cordulatus, a nitrogen-fixing species. We analyzed the δ2H and δ18O values of xylem water for both tree and shrub species to assess how shrub cover affects the water-uptake patterns of conifers and whether there is niche partitioning between trees and shrubs. We found that growing near shrubs did not have a significant effect on the water source dynamics of either tree species, with similar source water contributions calculated for conifers growing in both the presence and absence of shrubs. Using a tree-ring analysis of growth and δ13C from 2016 to 2021, a period of high precipitation variability, we found that shrub cover had a positive effect on tree growth while decreasing carbon discrimination, which may be due to increased nitrogen availability from Ceanothus cordulatus. Overall, our results suggest that growing in the presence of shrubs does not alter the water uptake patterns of white fir and Jeffrey pine and instead may have a positive effect on the growth rates of these species during both wet and dry years.
Intraspecific plasticity and co-variation of leaf traits facilitate Ficus tinctoria to acclimate hemiepiphytic and terrestrial habitats
Authors: Li Yuan , Mo Yu-Xuan , Cui Hong-Li , Zhang Yong-Jiang , Dossa Gbadamassi G O , Tan Zheng-Hong , Song Liang
Published: January 2024

Despite intensive studies on plant functional traits, the intraspecific variation and their co-variation at the multi-scale remains poorly studied, which holds the potential to unveil plant responses to changing environmental conditions. In this study, intraspecific variations of 16 leaf functional traits of a common fig species, Ficus tinctoria G. Frost., were investigated in relation to different scales: habitat types (hemiepiphytic and terrestrial), growth stages (small, medium and large) and tree crown positions (upper, middle and lower) in Xishuangbanna, Southwest China. Remarkable intraspecific variation was observed in leaf functional traits, which was mainly influenced by tree crown position, growth stage and their interaction. Stable nitrogen isotope (δ15N) and leaf area (LA) showed large variations, while stable carbon isotope (δ13C), stomata width and leaf water content showed relatively small variations, suggesting that light- and nitrogen-use strategies of F. tinctoria were plastic, while the water-use strategies have relatively low plasticity. The crown layers are formed with the growth of figs, and leaves in the lower crown increase their chlorophyll concentration and LA to improve the light energy conversion efficiency and the ability to capture weak light. Meanwhile, leaves in the upper crown increase the water-use efficiency to maintain their carbon assimilation. Moreover, hemiepiphytic medium (transitional stage) and large (free-standing stage) figs exhibited more significant trait differentiation (chlorophyll concentration, δ13C, stomata density, etc.) within the crown positions, and stronger trait co-variation compared with their terrestrial counterparts. This pattern demonstrates their acclimation to the changing microhabitats formed by their hemiepiphytic life history. Our study emphasizes the importance of multi-scaled intraspecific variation and co-variation in trait-based strategies of hemiepiphyte and terrestrial F. tinctoria, which facilitate them to cope with different environmental conditions.
The history, systematics, and nomenclature of Thalattosuchia (Archosauria: Crocodylomorpha)
Authors: Young Mark T , Wilberg Eric W , Johnson Michela M , Herrera Yanina , de Andrade Marco Brandalise , Brignon Arnaud , Sachs Sven , Abel Pascal , Foffa Davide , Fernández Marta S , Vignaud Patrick , Cowgill Thomas , Brusatte Stephen L
Published: January 2024

The use of more than one nomenclatural code is becoming increasingly common in some biological sub-disciplines. To minimize nomenclatural instability, we have decided to establish a higher level systematization for Thalattosuchia under both the International Code of Phylogenetic Nomenclature (‘PhyloCode’) and the International Code of Zoological Nomenclature (‘Zoological Code’). We undertook a series of phylogenetic analyses with an expanded dataset to examine the origins of Thalattosuchia within Crocodylomorpha, and determined the clade’s diagnostic characters. Based on these analyses, we provide updated diagnoses for Thalattosuchia and its subclades under both the PhyloCode and Zoological Code. We also introduce two new nomina that are regulated under the PhyloCode (Neothalattosuchia and Euthalattosuchia), and the nomen Dakosaurina, which is registered under both nomenclatural codes. Moreover, we introduce PhyloCode-compliant phylogenetic definitions for Thalattosuchia and its subclades. As we cannot reliably discriminate between the positional hypotheses for Thalattosuchia within Crocodylomorpha, the clades’ origins are as much of a mystery today as they were over a century ago. However, we hope that using the same diagnostic characters to define the same clades, with the same nomina, under both nomenclatural codes will be an example to others to follow.
Role of the CCL20/CCR6 axis in tubular epithelial cell injury: Kidney‐specific translational insights from acute kidney injury to chronic kidney disease
Authors: Yoo Kyung Don , Yu Mi‐yeon , Kim Kyu Hong , Lee Seongmin , Park EunHee , Kang Seongmin , Lim Doo‐Ho , Lee Yeonhee , Song Jeongin , Kown Soie , Kim Yong Chul , Kim Dong Ki , Lee Jong Soo , Kim Yon Su , Yang Seung Hee
Published: January 2024

This study investigated the role of the axis involving chemokine receptor 6 (CCR6) and its ligand chemokine (C–C motif) ligand 20 (CCL20) in acute kidney disease (AKD) using an ischemia–reperfusion injury (IRI) model. The model was established by clamping the unilateral renal artery pedicle of C57BL/6 mice for 30 min, followed by evaluation of CCL20/CCR6 expression at 4 weeks post‐IRI. In vitro studies were conducted to examine the effects of hypoxia and H2O2‐induced oxidative stress on CCL20/CCR6 expression in kidney tissues of patients with AKD and chronic kidney disease (CKD). Tubular epithelial cell apoptosis was more severe in C57BL/6 mice than in CCL20 antibody‐treated mice, and CCR6, NGAL mRNA, and IL‐8 levels were higher under hypoxic conditions. CCL20 blockade ameliorated apoptotic damage in a dose‐dependent manner under hypoxia and reactive oxygen species injury. CCR6 expression in IRI mice indicated that the disease severity was similar to that in patients with the AKD phenotype. Morphometry of CCL20/CCR6 expression revealed a higher likelihood of CCR6+ cell presence in CKD stage 3 patients than in stage 1–2 patients. Kidney tissues of patients with CKD frequently contained CCL20+ cells, which were positively correlated with interstitial inflammation. CCL20/CCR6 levels were increased in fibrotic kidneys at 4 and 8 weeks after 5/6 nephrectomy. These findings suggest that modulating the CCL20/CCR6 pathway is a potential therapeutic strategy for managing the progression of AKD to CKD.
Adolescent Tobacco/Nicotine Use and the Potential Role of Contingency Management-based Interventions
Authors: Shirazi Anaheed , Radgoudarzi Niloofar , Brody Arthur L.
Published: January 2024

The high prevalence of tobacco/nicotine use among youth, including e-cigarettes, is a public health problem in the United States. Early exposure leads to an increased risk of dependence and health consequences in adulthood. We reviewed the literature on current treatment approaches for nicotine/tobacco use in adolescents/young adults and highlighted underexplored areas of treatment research. There are no current Food and Drug Administration–approved medications for treatment of nicotine/tobacco use disorders in adolescents. However, in research settings and on a case-to-case basis, clinical practice medications (including nicotine replacement therapy, bupropion, and varenicline) have been prescribed to this population with consideration of risk-benefit analysis when behavioral treatments are not sufficient to address dependence. Among the nonpharmacological interventions, there is evidence to support the potential for expanded use of contingency management in youth. Neural differences predisposing adolescents to substance use, along with higher attentiveness to value of options in decision making (flexible reward system) may enhance the effectiveness of reward-based approaches for treatment of substance use disorders in this population. The overall high rates of nonresponders across psychosocial and pharmacological treatments highlight the importance of considering novel strategies to improve existing interventions. We suggest that future research be done that considers unique characteristics of today's adolescents, such as high social activism and engagement with digital rewards to tailor contingency management for this age group and assess its effectiveness. Adolescents could potentially benefit from rewards administered through digital media (eg, video games, computer-based apps, and social media influencers).
Development and External Validation of Models to Predict Persistent Hypoxemic Respiratory Failure for Clinical Trial Enrichment*
Authors: Sathe Neha A. , Zelnick Leila R. , Morrell Eric D. , Bhatraju Pavan K. , Kerchberger V. Eric , Hough Catherine L. , Ware Lorraine B. , Fohner Alison E. , Wurfel Mark M.
Published: January 2024

OBJECTIVES:

Improving the efficiency of clinical trials in acute hypoxemic respiratory failure (HRF) depends on enrichment strategies that minimize enrollment of patients who quickly resolve with existing care and focus on patients at high risk for persistent HRF. We aimed to develop parsimonious models predicting risk of persistent HRF using routine data from ICU admission and select research immune biomarkers.

DESIGN:

Prospective cohorts for derivation (n = 630) and external validation (n = 511).

SETTING:

Medical and surgical ICUs at two U.S. medical centers.

PATIENTS:

Adults with acute HRF defined as new invasive mechanical ventilation (IMV) and hypoxemia on the first calendar day after ICU admission.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We evaluated discrimination, calibration, and practical utility of models predicting persistent HRF risk (defined as ongoing IMV and hypoxemia on the third calendar day after admission): 1) a clinical model with least absolute shrinkage and selection operator (LASSO) selecting Pao
2/Fio
2, vasopressors, mean arterial pressure, bicarbonate, and acute respiratory distress syndrome as predictors; 2) a model adding interleukin-6 (IL-6) to clinical predictors; and 3) a comparator model with Pao
2/Fio
2 alone, representing an existing strategy for enrichment. Forty-nine percent and 69% of patients had persistent HRF in derivation and validation sets, respectively. In validation, both LASSO (area under the receiver operating characteristic curve, 0.68; 95% CI, 0.64–0.73) and LASSO + IL-6 (0.71; 95% CI, 0.66–0.76) models had better discrimination than Pao
2/Fio
2 (0.64; 95% CI, 0.59–0.69). Both models underestimated risk in lower risk deciles, but exhibited better calibration at relevant risk thresholds. Evaluating practical utility, both LASSO and LASSO + IL-6 models exhibited greater net benefit in decision curve analysis, and greater sample size savings in enrichment analysis, compared with Pao
2/Fio
2. The added utility of LASSO + IL-6 model over LASSO was modest.

CONCLUSIONS:

Parsimonious, interpretable models that predict persistent HRF may improve enrichment of trials testing HRF-targeted therapies and warrant future validation.
Ultrasonic- and Ultrasound-assisted Improvement of Silhouette of the Torso: Bone Structure High-definition Remodeling (Part I)
Authors: Oñate Valdivieso Carlos , Oñate Valdivieso Daniel , Hoyos Alfredo E. , Perez Pachon Mauricio E. , Aguilar Villa Hugo , Michels Paulo Jr Alberton , Viera Andres , Benavides Jorge E. , Villabona Silvia J. , Ramirez Brian
Published: January 2024

Background:

High-definition liposculpture allowed plastic surgeons to achieve better aesthetic results by carving the underlying muscles and contours in a new way. Several authors have improved the original technique by adding other procedures and new technologies. We designed a new improvement by incorporating bone transformation surgery to overcome the lack of silhouette at the waist and, as a result, optimize the breast-waist-hip ratios.

Methods:

We carried out a prospective multicenter study, with five different surgeons performing the same rib remodeling technique for waist definition. We used an ultrasonic piece for costal corticotomy and real-time ultrasound imaging to perform green-stick fractures over the last two or three floating ribs. Ours is a new technique based on the prior one described by Kudzaev.

Results:

We reported 131 consecutive patients who were enrolled in this study. Waistline diameter decreased an average of 8 cm after surgery (P < 0.05). Most patients were women (n = 125, 95.4%). No major complications were reported. Most common complication was prolonged pain, with only three cases of contour asymmetry, all of which were attributable to noncompliance of constantly wearing the corset + compressive garments. Patients reported a high satisfaction rate and fast recovery (Body-QoL survey).

Conclusions:

Ultrasonic- and ultrasound- assisted indentation surgery of the thorax is a safe and reliable technique for waistline definition, with a high satisfaction rate, almost-invisible scars, and minimal risk for complications. Incorporation of high-definition liposculpture to rib remodeling opens up a new horizon for bone structure modification surgery (S-high-definition remodeling) that can be safely performed for patients who seek better aesthetic outcomes in body contouring.
5-aminolevulinic enhanced brain lesions mimic glioblastoma: A case report and literature review
Authors: Chang Chao-Yuan , Chen Chun-Chung
Published: January 2024

Rationale:

Glioblastoma multiforme (GBM) is a highly malignant primary brain tumor for which maximal tumor resection plays an important role in the treatment strategy. 5-aminolevulinic (5-ALA) is a powerful tool in fluorescence-guided surgery for GBM. However, 5-ALA- enhancing lesion can also be observed with different etiologies.

Patients concerns:

Three cases of 5-ALA-enhancing lesions with etiologies different from glioma

Diagnoses:

The final diagnosis was abscess in 1 patient and diffuse large B-cell in the other 2 patients.

Interventions:

Three patients received 5-aminolevulinic acid-guided tumor resection under microscope with intraoperative neuromonitoring.

Outcomes:

All of our patients showed improvement or stable neurological function outcomes. The final pathology revealed etiologies different from GBM.

Lessons:

The 5-aminolevulinic acid fluorescence-guided surgery has demonstrated its maximal extent of resection and safety profile in patients with high-grade glioma. Non-glioma etiologies may also mimic GBM in 5-ALA-guided surgeries. Therefore, patient history taking and consideration of brain images are necessary for the interpretation of 5-ALA-enhanced lesions.
Prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in a middle-aged population with overweight and normal liver enzymes, and diagnostic accuracy of noninvasive proxies
Authors: van Son K.C. , te Nijenhuis-Noort L.C. , Boone S.C. , Mook-Kanamori D.O. , Holleboom A.G. , Roos P.R. , Lamb H.J. , Alblas G. , Coenraad M.J. , Rosendaal F.R. , de Mutsert R. , Tushuizen M.E.
Published: January 2024

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing at an alarming rate. Elevated liver enzymes are a primary reason to refer patients for further testing. However, liver enzymes within the normal range do not exclude the presence of MASLD. We examined the prevalence of MASLD in a middle-aged population with overweight and normal liver enzymes. In addition, we examined the accuracy of 4 sets of noninvasive proxies for MASLD.

We included 1017 participants from the Netherlands epidemiology of obesity cohort study with body mass index ≥25 kg/m2 and liver enzymes (asparate aminotransferase, alanine aminotransferase, gamma-glutamyltranspeptidase) within normal range. The diagnostic accuracy of biomarker scores (fatty liver index, liver fat score [LFS], STEATO-ELSA, and hepatic steatosis index) was determined against elevated hepatic triglyceride content measured by 1proton magnetic resonance spectroscopy.

Participants (mean age 56 years, 49% women), had a median body mass index of 29.6 kg/m2 and a median hepatic triglyceride content of 4.4%. MASLD was present in 42% of participants and was more common in men than women, with respectively 47% and 36% being affected. The LFS showed the highest accuracy with an area under the curve of 0.72. We identified metabolic syndrome as the prime predictor for MASLD with an odds ratio of 2.95 (95% confidence interval 2.20–3.98).

The prevalence of MASLD in middle-aged men and women with overweight and liver enzymes within the normal range is over 40%. LFS showed the highest accuracy to detect MASLD, but, overall, biomarker scores performed relatively poor. The presence of metabolic syndrome was the prime predictor of MASLD.
The green bad omen in blood smear and the potential of blood purification therapy: A case report
Authors: Chen Yanhui , Ni Wenpeng , Gu Guanghong
Published: January 2024

Rationale:

Green inclusions (GI) are distinct morphological features found in phagocytic cells like neutrophils and monocytes. These intracellular structures exhibit bright green color with unclear boundaries, and their origin and clinical significance are still not fully understood. GI carriers, often middle-aged to elderly with liver dysfunction, face higher mortality rates, earning them the nickname “inclusions of death.” This report presents a rare GI-related pediatric case, demonstrating a favorable response to blood purification therapy.

Patient concerns:

A 10-year-old girl was admitted with recurrent fever, abdominal pain, and neurological symptoms, culminating in a transient cardiac arrest. Blood tests revealed multi-organ injury and a high risk of disseminated intravascular coagulation, while peripheral blood smear detected GI within neutrophil cytoplasm.

Diagnosis:

The patient was diagnosed with acute necrotizing encephalopathy, severe sepsis, and multiple organ failure.

Interventions and outcomes:

After receiving multiple sessions of blood purification therapy, peripheral blood GI levels markedly decreased, accompanied by improvements in various laboratory parameters and signs of neurological recovery. Unfortunately, due to financial constraints, the family opted to transfer the patient back to their local hospital, where she succumbed shortly after discharge.

Lessons:

This case underscores the complexities in managing GI-related pediatric cases. Moreover, it emphasizes the potential benefits of blood purification therapy in such scenarios. Notably, this study highlights a potential correlation between the level of GI in peripheral blood and disease severity, particularly in pediatric cases. While these findings hold clinical significance for the treatment and management of GI-related patients, further research focusing on middle-aged and elderly individuals is imperative to elucidate the fundamental relationship between peripheral blood GI quantity and clinical presentation and to evaluate the efficacy of blood purification in GI-related cases.
Interstitial pneumonia disease induced by osimertinib combined with savolitinib targeted therapy in a lung cancer patient: A case report
Authors: Shen Yikuan , Lou Songgao , Zhang Jiansong
Published: January 2024

Rationale:

MET-TKI is a late-stage treatment for drug-resistant NSCLC that has been marketed in recent years, and interstitial lung disease may be a rare adverse reaction. This case reports the development of interstitial lung disease in a patient with advanced lung cancer who developed during treatment with savolitinib after resistance to osimertinib.

Patient concerns:

A 74-year-old female diagnosed with lung adenocarcinoma was referred to our hospital with chest tightness and shortness of breath following treatment with osimertinib plus savolitinib.

Diagnose:

Chest CT of the patient shows interstitial changes in both lungs, and drug-related interstitial lung disease is considered in the context of the patient previous condition.

Interventions:

The patient is treated with methods such as glucocorticoids, anti-infection, and mechanical ventilation.

Outcomes:

At the 1-year follow-up visit, the patient condition of interstitial lung disease was relatively stable. The patient has passed away due to tumor progression.

Lessons:

This case reported interstitial lung disease following osimertinib plus savolitinib. This suggests that healthcare providers should be aware of early symptoms of interstitial lung disease during treatment and treat them appropriately to prevent symptoms from worsening.
Atrial flutter complicating acute respiratory distress syndrome (ARDS): A rare case report
Authors: Elendu Chukwuka , Amaechi Dependable C.
Published: January 2024

Rationale:

This case report addresses a unique instance of atrial flutter complicating acute respiratory distress syndrome (ARDS), contributing a novel addition to the medical literature. The co-occurrence of these conditions sheds light on a rare clinical scenario that requires careful consideration.

Patient Concerns:

The patient exhibited symptoms of pronounced dyspnea, tachypnea, and hypoxemia. Clinical assessment revealed irregular heart rhythms, notably atrial flutter, alongside characteristic signs of ARDS, including bilateral pulmonary infiltrates and reduced lung compliance.

Diagnoses and Interventions:

After a comprehensive evaluation, the patient was diagnosed with atrial flutter complicating ARDS. Therapeutic measures encompassed antiarrhythmic agents, mechanical ventilation, and targeted ARDS management protocols. The intricate interplay between cardiac and respiratory factors necessitated a multidisciplinary approach.

Outcomes:

Throughout treatment, the patient’s respiratory distress gradually improved. Control of the atrial flutter was achieved, and oxygenation levels were restored within acceptable limits. This successful outcome underscores the significance of a well-coordinated treatment strategy in addressing complex cases like this.

Lessons:

This case highlights the importance of recognizing and managing the intricate relationship between cardiac arrhythmias such as atrial flutter and respiratory complications like ARDS. The successful management of this patient underscores the value of multidisciplinary collaboration and tailored therapeutic interventions. Practitioners should remain vigilant for such rare complications and consider this case a reminder of the potential complexities that can arise in critical care scenarios.
Role of whole body MRI in paraneoplastic/autoimmune syndromes: An MRPET study to standardize protocols, pattern interpretation, and establish yield of MRI
Authors: Mangalore Sandhya , Vankayalapati Sriharish , Gupta Arun Kumar
Published: January 2024

Imaging a case of autoimmune encephalitis (AIE) can be challenging as the underlying tumor may be occult. The aim of this retrospective case-based study is to evaluate role of whole-body MRI/Positron emission tomography (PET) in workup of AIE. Standardizing the whole-body MRI/PET protocol, Cross modality yield with serology and magnetic resonance/PET (MR/PET) and finally highlight the advantage of hybrid MR/PET. We present the retrospective review data from January 2016 to December 2019 referred for whole body MR/PET with suspected AIE/Paraneoplastic syndrome, per consensus criteria, treated at a single tertiary center. Analysis is done group wise based on referral being for oncological, immunological or neuropsychiatric condition. Detailed results with sensitivity and specificity are presented in tabular format with case-based review in our series for protocols and advantages of MR/PET. Among total of 600 MR/PET cases, 227 were suspected of AIE/paraneoplastic syndrome and were referred for whole body imaging. Distribution of Group 1 Known oncology group (n = 10), Group 2 Non oncological systemic illness group (n = 174) and group 3 the primary neuropsychiatric illness (n = 43) with Group 2 being largest. The gender distribution was similar and mean age was 42 years. Seronegative cases (n = 130) were greater than seropositive cases (n = 97). Seropositivity was in the following order Autoimmune > Paraneoplastic > Myositis panel. Whole body MRPET yielded occult malignancy in 9% and imaging abnormality in 88% of cases. Whole body MR/PET has an important role in workup of AIE. Selection of the appropriate protocol is important, especially when history and physical examination are nonspecific.
Student engagement in voluntary service in response to COVID-19 in Guangzhou, China: Implications for disease control and public health education from a cross-sectional study
Authors: Feng Shuaixin , Huang Zhaoqian , Tan Haomin , Deng Junwen , Jiang Hongbo
Published: January 2024

Public health students have been seen as a potential force to meet the demand for health workers during the coronavirus disease 2019 (COVID-19) pandemic. However, few studies have provided empirical data. This study was conducted to summarize the experiences of public health students who engaged in voluntary service in response to the COVID-19 outbreak in Guangzhou, China. A cross-sectional study was conducted among postgraduate and undergraduate students at the School of Public Health, Guangdong Pharmaceutical University, in August 2021. A self-designed online questionnaire was used to collect data on the experience of voluntary service during the early stage of the outbreak (in February 2020) and during the normalization stage of the prevention and control of COVID-19 (in June 2021) in China. Among the 96 students, 40 (41.7%) participated in voluntary service in February 2020, and 56 (58.3%) participated in voluntary service in June 2021. Most of the students participated in the voluntary service due to the motivations to help others (55.2%), to apply theoretical knowledge to practice (74.0%), to improve their fieldwork skills (72.9%), and to gain the experience for future careers (80.2%). Most volunteers were driven by professional responsibility (81.3%). More than half (53.1%) of the students felt anxious during their voluntary service. A lower proportion of students felt anxious in June 2021 than in February 2020 (44.6% vs 65.0%, P = .049), while a higher proportion of students found voluntary service harder than expected in June 2021 than in February 2020 (33.9% vs 7.5%, P = .002). Most students improved their knowledge and skills about COVID-19 after the training, but some knowledge and skills still needed improvement after their voluntary service. Public health students could help support the health system during the COVID-19 pandemic by providing adequate training and protection. More efforts should be made to provide psychological support for student volunteers and to optimize the curriculum to bridge the gap in public health education between theoretical knowledge and practical skills in responding to public health emergencies.
Fatal intracerebral hemorrhage following endovascular Onyx embolization of an arteriovenous malformation: A case report
Authors: Park Geo-Seong , Park Jung-Soo
Published: January 2024

Introduction:

Patients with cerebral arteriovenous malformation (AVM) have a lifetime risk of hemorrhagic stroke. Although identified asymptomatic cases can be monitored with imaging follow-up, treatment is considered in cases of AVM rupture or hemodynamic instability.

Patient concerns:

A 43-year-old man who had been taking antihypertensive drugs for the past 5 years visited our hospital 3 days after the abrupt onset of headache. The patient also complained of progressive ptosis in the left eye.

Diagnoses:

Brain computed tomography (CT) showed a small intraventricular hemorrhage with obstructive hydrocephalus. Subsequent brain CT angiography and magnetic resonance imaging confirmed the presence of an AVM in the cerebellar vermis.

Interventions:

Endovascular embolization was performed directly through the right femoral artery. Near-total obliteration of the AVM nidus was achieved by using multiple Onyx castings.

Outcomes:

The patient developed an altered mental status and right hemiparesis after the procedure. CT performed after the procedure revealed intraventricular hemorrhage in all ventricles, with a left thalamic intracerebral hemorrhage. Despite emergency external ventricular drainage and aggressive treatment for intracranial pressure control, the patient expired on the 14th day after the embolization procedure.

Lessons:

When treating AVMs, especially those with a large nidus of high flow, it is necessary to consider possible hemorrhagic complications and preventive measures.