bluuebunny/crossref_metadata_2025 huggingface dataset:
ATP13A3 variants promote pulmonary arterial hypertension by disrupting polyamine transport
Authors: Liu Bin , Azfar Mujahid , Legchenko Ekaterina , West James A , Martin Shaun , Van den Haute Chris , Baekelandt Veerle , Wharton John , Howard Luke , Wilkins Martin R , Vangheluwe Peter , Morrell Nicholas W , Upton Paul D
Published: April 2024

Aims

Potential loss-of-function variants of ATP13A3, the gene encoding a P5B-type transport ATPase of undefined function, were recently identified in patients with pulmonary arterial hypertension (PAH). ATP13A3 is implicated in polyamine transport but its function has not been fully elucidated. In this study, we sought to determine the biological function of ATP13A3 in vascular endothelial cells (ECs) and how PAH-associated variants may contribute to disease pathogenesis.

Methods and results

We studied the impact of ATP13A3 deficiency and overexpression in EC models [human pulmonary ECs, blood outgrowth ECs (BOECs), and human microvascular EC 1], including a PAH patient–derived BOEC line harbouring an ATP13A3 variant (LK726X). We also generated mice harbouring an Atp13a3 variant analogous to a human disease–associated variant to establish whether these mice develop PAH. ATP13A3 localized to the recycling endosomes of human ECs. Knockdown of ATP13A3 in ECs generally reduced the basal polyamine content and altered the expression of enzymes involved in polyamine metabolism. Conversely, overexpression of wild-type ATP13A3 increased polyamine uptake. Functionally, loss of ATP13A3 was associated with reduced EC proliferation, increased apoptosis in serum starvation, and increased monolayer permeability to thrombin. The assessment of five PAH-associated missense ATP13A3 variants (L675V, M850I, V855M, R858H, and L956P) confirmed loss-of-function phenotypes represented by impaired polyamine transport and dysregulated EC function. Furthermore, mice carrying a heterozygous germline Atp13a3 frameshift variant representing a human variant spontaneously developed a PAH phenotype, with increased pulmonary pressures, right ventricular remodelling, and muscularization of pulmonary vessels.

Conclusion

We identify ATP13A3 as a polyamine transporter controlling polyamine homeostasis in ECs, a deficiency of which leads to EC dysfunction and predisposes to PAH. This suggests a need for targeted therapies to alleviate the imbalances in polyamine homeostasis and EC dysfunction in PAH.
Anaerobic oxidation of ammonium and short-chain gaseous alkanes coupled to nitrate reduction by a bacterial consortium
Authors: Wu Mengxiong , Liu Xiawei , Engelberts J Pamela , Tyson Gene W , McIlroy Simon J , Guo Jianhua
Published: April 2024

The bacterial species “Candidatus Alkanivorans nitratireducens” was recently demonstrated to mediate nitrate-dependent anaerobic oxidation of short-chain gaseous alkanes (SCGAs). In previous bioreactor enrichment studies, the species appeared to reduce nitrate in two phases, switching from denitrification to dissimilatory nitrate reduction to ammonium (DNRA) in response to nitrite accumulation. The regulation of this switch or the nature of potential syntrophic partnerships with other microorganisms remains unclear. Here, we describe anaerobic multispecies cultures of bacteria that couple the oxidation of propane and butane to nitrate reduction and the oxidation of ammonium (anammox). Batch tests with 15N-isotope labelling and multi-omic analyses collectively supported a syntrophic partnership between “Ca. A. nitratireducens” and anammox bacteria, with the former species mediating nitrate-driven oxidation of SCGAs, supplying the latter with nitrite for the oxidation of ammonium. The elimination of nitrite accumulation by the anammox substantially increased SCGA and nitrate consumption rates, whereas it suppressed DNRA. Removing ammonium supply led to its eventual production, the accumulation of nitrite, and the upregulation of DNRA gene expression for the abundant “Ca. A. nitratireducens”. Increasing the supply of SCGA had a similar effect in promoting DNRA. Our results suggest that “Ca. A. nitratireducens” switches to DNRA to alleviate oxidative stress caused by nitrite accumulation, giving further insight into adaptability and ecology of this microorganism. Our findings also have important implications for the understanding of the fate of nitrogen and SCGAs in anaerobic environments.
Agency Insights: The first steps of the DMA adventure
Authors: Bacchiega Alberto , Tombal Thomas
Published: April 2024

This piece is a short essay on the first steps of the implementation of the Digital Markets Act. Our paper is divided in three sections. In the first section “Why does the DMA exist?”, we come back on the genesis of the DMA and the complementing role it plays with competition law. In the second section “Challenges of Gatekeeper Designations”, we look back at this first important step in the implementation of the DMA, and highlight that a key topic in the context of these designation proceedings has been the determination of the appropriate delineation of the core platform services to be designated. Finally, in the third section “Challenges of DMA compliance”, we set out our high-level vision and approach for the concrete implementation of the DMA by the gatekeepers and their endeavour to comply with the various obligations and prohibitions contained in the DMA. In this regard, we highlight that our aim with the DMA is to create room for opportunities.
Standardized ileal digestibility of amino acids in Chinese fermented soybean meal from different sources fed to mid and late-gestating sows
Authors: Li Guowei , Wang Ya , Zhang Junhao , Xu Shengyu , Lin Yan , Hua Lun , Li Jian , Feng Bin , Fang Zhengfeng , Jiang Xuemei , Zhuo Yong , Che Lianqiang , Wu De
Published: April 2024

We determined apparent ileal digestibility (AID) and standardized ileal digestibility (SID) values of crude protein (CP) and amino acids (AA) in fermented soybean meal from five different sources (FSBM 1 to 5) in China when fed to mid and late-gestating sows. Twenty-four parity four sows (12 at 30 d in gestation and 12 at 80 d in gestation) were fitted with a T-cannula in the distal ileum and used in this experiment. Sows were randomly assigned to a replicated 6 × 3 Youden square design including six diets and three periods. Six diets were provided for sows in mid and late gestation, including a nitrogen-free diet and five test diets containing 26% FSBM from different sources. Results showed that there were differences in AID and SID of CP among the different FSBM samples, but no differences between sow physiological stages were observed. Specifically, when mid-gestating sows were fed FSBM 2, the AID of CP was the lowest, whereas FSBM 3 exhibited a greater AID of CP when compared to the other FSBM samples (P < 0.01). Furthermore, during late gestation, FSBM 3 consistently had greater SID of CP when compared to other FSBM samples (P < 0.01). The ileal digestibility of most AA varied with different FSBM samples. In both mid and late gestation, differences (P < 0.05) were observed for AID of lysine, tryptophan, histidine, and arginine across different FSBM samples. Similarly, the AID of dispensable AA (cysteine, glutamine, and serine) also exhibited differences (P < 0.05) across different FSBM samples in both mid and late-gestating sows. For mid-gestating sows, SID differences relating to lysine, phenylalanine, tryptophan, threonine, and arginine were observed among different diets (P < 0.05). In late-gestating sows, SID values for lysine, tryptophan, leucine, and arginine differed across diets (P < 0.05). Furthermore, the ileal digestibility of some dispensable AA was influenced by physiological stage, as evidenced by greater AID and SID values for glycine, glutamine, cysteine, and serine in late-gestating sows when compared to mid-gestating sows (P < 0.01). In summary, our study determined AA ileal digestibility of different FSBM fed to mid and late-gestating sows. We observed that the AA ileal digestibility differed among five FSBM samples, but the physiological stage of sows did not affect the ileal digestibility of CP and most AA. Additionally, when formulating diets for sows, it is crucial to consider the nutritional value differences of FSBM.
Toxicity of isocycloseram, an isoxazoline insecticide, against laboratory and field-collected German cockroaches (Blattodea: Ectobiidae)
Authors: Lee Shao-Hung , So John , Kund Gregory S , Lum Jun-Yin , Trinh Ethan , Ta Emily L , Chungsawat Rattanan , Choe Dong-Hwan , Cox David L , Rust Michael K , Lee Chow-Yang
Published: April 2024

Isocycloseram is a new insecticide in the isoxazoline class that targets insect GABA-gated chloride channels. In this study, we evaluated a cockroach gel bait formulation containing 1% isocycloseram against a susceptible strain (UCR) and 5 field-collected strains (WM, RG386, Ryan, CDR, and SY) of the German cockroach, Blattella germanica (L.) (Blattodea: Ectobiidae), and compared it with several commercial insecticide baits in the laboratory. Using the Ebeling choice box method, we also tested a residual deposit of an SC formulation of isocycloseram against the UCR, RG386, and Ryan strains. The isocycloseram bait was among the fastest-performing treatments against adult males (mean survival time: 0.9–2.7 days) and mixed stages and sexes (mean survival time: 1.4–5.4 days) across all strains. Secondary transfer effects of the bait were demonstrated in the UCR strain by exposing new adult males to individuals killed by direct bait treatment. Physiological resistance was not detected in the WM, CDR, and RG386 strains with topical treatment of a diagnostic dose (3× LD95) of isocycloseram developed using the UCR strain. However, topical assays revealed resistance ratios (RR50) of 1.6 and 3.0× in the Ryan and SY strains, respectively. The performance of a 0.05% isocycloseram residual application against the Ryan strain was improved with the addition of piperonyl butoxide.
The Impact of NGO-Provided Aid on Government Capacity: Evidence from Uganda
Authors: Deserranno Erika , Nansamba Aisha , Qian Nancy
Published: April 2024

This paper investigates whether NGO-provided basic healthcare crowds out or crowds in similar services provided by the government in rural Uganda. We find that NGO entry reduces the number of government workers, which leads to a reduction in government-provided health services. The results are driven by the NGO often hiring the government worker in places where skilled labor is scarce. In places where skilled labor is relatively abundant, the NGO hires a second person and complements government healthcare.Thus, the effects of NGO entry on government capacity are nuanced.
A ‘ring in ring’ skin infection in a returning traveller
Authors: Visser Benjamin Jelle , Van Den Broucke Steven
Published: April 2024

A 40-year-old woman developed an itchy, expanding cutaneous lesion with two erythematous rings after visiting Senegal. Fungal culture revealed Microsporum audouinii, a fungus causing tinea corporis or capitis commonly in Africa but increasingly reported in outbreaks in Europe.
The clade-specific target recognition mechanisms of plant RISCs
Authors: Iwakawa Hiro-oki
Published: April 2024

Eukaryotic Argonaut proteins (AGOs) assemble RNA-induced silencing complexes (RISCs) with guide RNAs that allow binding to complementary RNA sequences and subsequent silencing of target genes. The model plant Arabidopsis thaliana encodes 10 different AGOs, categorized into three distinct clades based on amino acid sequence similarity. While clade 1 and 2 RISCs are known for their roles in post-transcriptional gene silencing, and clade 3 RISCs are associated with transcriptional gene silencing in the nucleus, the specific mechanisms of how RISCs from each clade recognize their targets remain unclear. In this study, I conducted quantitative binding analyses between RISCs and target nucleic acids with mismatches at various positions, unveiling distinct target binding characteristics unique to each clade. Clade 1 and 2 RISCs require base pairing not only in the seed region but also in the 3′ supplementary region for stable target RNA binding, with clade 1 exhibiting a higher stringency. Conversely, clade 3 RISCs tolerate dinucleotide mismatches beyond the seed region. Strikingly, they bind to DNA targets with an affinity equal to or surpassing that of RNA, like prokaryotic AGO complexes. These insights challenge existing views on plant RNA silencing and open avenues for exploring new functions of eukaryotic AGOs.
Renal Transplantation in HIV-positive and HIV-negative People With Advanced Stages of Kidney Disease: Equity in Transplantation
Authors: Hosseini-Moghaddam Seyed M , Kang Yuguang , Bota Sarah E , Weir Matthew A
Published: April 2024

Background

People with HIV are at a greater risk of end-stage kidney disease than the general population. Considering the risk of death after end-stage kidney disease, access to renal transplantation in people with HIV is critically important.

Methods

We included all adult patients on chronic dialysis in Ontario, Canada, between 1 April 2007 and 31 December 2020. We determined the probability of kidney transplantation with competing risk of death over time since the initiation of dialysis by calculating the adjusted subdistribution hazard ratios (sdHR; 95% confidence interval [CI]). We also compared long-term renal allograft and posttransplant mortality outcomes between HIV-negative and HIV-positive persons.

Results

Of 40 686 people (median age, 68 years; interquartile range, 57–77; 38.4% women), 173 were HIV-positive and 40 513 were HIV-negative. The incidence of kidney transplantation in HIV-negative and HIV-positive patients was 40.5 (95% CI, 39.4-41.6)/1000 person-years and 35.0 (95% CI, 22.8-53.7)/1000 person-years, respectively (P = .51). Considering the competing risk of death, HIV-positive people had a significantly lower chance of receiving kidney transplants than HIV-negative people (sdHR, 0.46 [95% CI, .30–.70]). The long-term allograft failure risk was not significantly different between HIV-negative and HIV-positive people, considering the competing risk of posttransplant death (sdHR, 1.71 [95% CI, .46-6.35]).

Conclusions

Although the incidence and crude probability of kidney transplantation were similar among HIV-negative and HIV-positive persons in this cohort, those with HIV had a significantly lower likelihood of kidney transplantation than those without HIV. Having HIV was not significantly associated with a poor long-term allograft outcome compared with patients without HIV.
Response and Adaptive Mechanism of Flavonoids in Pigmented Potatoes at Different Altitudes
Authors: Wu Xiaojie , Xiao Jiping
Published: April 2024

Altitude is an important ecological factor affecting plant physiology and ecology, material metabolism and gene expression. Tuber color changes were observed in purple and red potatoes growing at four different elevations ranging from 1,800 ± 50 to 3,300 ± 50 m in the Tiger Leaping Gorge area of Yunnan Province. The results showed that the total phenol content, total flavone content, total anthocyanin content and biological yield of anthocyanin increased with increasing altitude until 2,800 ± 50 m, and the highest anthocyanin content were detected in the purple potato Huaxinyangyu and the red potato Jianchuanhong at the flowering stage and budding stage, respectively. Combined transcriptomic and metabolomic analyses revealed that the content and diversity of flavonoids are associated with genes expression via the promotion of propane metabolism to improve potato adaptation to different altitudes. These results provide a foundation for understanding the coloring mechanism and creating new potato germplasms with high resistance and good quality via genetic manipulation.
When is problem-oriented policing most effective? A systematic examination of heterogeneity in effect sizes for reducing crime and disorder
Authors: Hinkle Joshua C , Weisburd David , Telep Cody W , Petersen Kevin
Published: April 2024

This article presents results from a systematic review and meta-analysis of problem-oriented policing (POP). The results show an overall 33.8% relative reduction in crime/disorder in treatment groups relative to controls, which adds to evidence that POP is an effective strategy that police leaders should adopt. There is, however, a great deal of variation in effect sizes, and moderator analyses were conducted to examine when POP may work best. Preliminary findings suggest POP may have larger impacts when responses are broader and involve more partner agencies/groups, when more of the agency is involved in the program, and when targeting property crime and disorder. Importantly, our findings also show that shallower implementations of POP still had significant impacts and suggest that POP should be implemented even if an agency cannot initially carry out in-depth problem-solving. Future research should supplement meta-analyses with narrative reviews to further identify what makes POP most effective.
Diagnostic Guide for Sclerotial Blight and Circular Spot of Sweetpotato
Authors: Mascarenhas J. , Quesada-Ocampo L. M.
Published: April 2024

Agroathelia rolfsii (anamorph: Sclerotium rolfsii) is a soilborne fungal pathogen that can cause disease on over 500 documented host species, including economically important field and vegetable crops. The pathogen commonly infects the stem or crown of most hosts, but it is also capable of damaging fruit and root structures that are near the soil line, resulting in wilting, stunting, and plant death. Two diseases caused by this pathogen are sclerotial blight and circular spot, both of which are detrimental for sweetpotato production. A. rolfsii is a necrotrophic pathogen and can be cultured from susceptible hosts and on artificial media. The purpose of this diagnostic guide is to provide characteristic traits for identifying A. rolfsii in sweetpotato as well as outline methods for pathogen isolation, morphological and molecular characterization, culture maintenance and long-term storage, and pathogenicity testing.
Magnetic Resonance Imaging Indirect Signs for Anterior Instability of the Lateral Meniscus in Pediatric and Adolescent Patients
Authors: Niu Emily L. , Kinnard Matthew J. , Hoyt Benjamin W. , Zember Jonathan , Murphy Timothy P.
Published: April 2024

Background:

Anterior instability (AI) of the LM is potentially debilitating in young patients. The use of magnetic resonance imaging (MRI) to diagnose AI is limited due to the lack of reliable and accurate MRI findings. The ability to identify AI preoperatively would potentially improve the diagnosis and treatment of this pathology. This study presents a novel MRI finding (“phantom sign”) for the detection of AI of the LM and demonstrates its reliability and accuracy.

Methods:

Three independent blinded reviewers performed retrospective review of preoperative MRI for all patients who underwent LM repair between July 1, 2019, and March 31, 2022, at a single center. Positive phantom sign was defined as abnormal signal intensity on MRI of the anterior horn of the LM on the coronal sequence at the anterior tibial insertion of the anterior cruciate ligament (ACL). Preoperative MRI was also evaluated for other signs of LM anterior instability. Intrarater and inter-rater reliability was assessed for rater scoring of presence of pathology on MRI. Predictive ability of each imaging finding with at least good (ICC 0.6 or above) reliability was also evaluated based on documented intraoperative findings.

Results:

Fifty-five preoperative MRIs of arthroscopically treated LM tears were reviewed. Median age was 15 years (range 6 to 20), and 21 patients (38.2%) were female. Twenty-seven patients (49.1%) had a discoid meniscus. LM AI was present on arthroscopy for 25 knees (45.45%), and among these, 21 had discoid morphology. Interrater reliability was substantial for phantom sign (ICC 0.71, 97.5% CI: 0.55-0.82), posterior displacement (ICC 0.71, 97.5% CI: 0.55-0.82), and posterior “megahorn” (ICC 0.76, 97.5% CI: 0.62-0.85). On predictive analysis, phantom signs were 98% sensitive and 76.7% specific for LM AI. Posterior displacement and posterior megahorn were specific for AI (both 93.34%), though with limited sensitivity (32% and 28.6%, respectively).

Conclusions:

Phantom sign is a reliable and sensitive MRI finding for anterior instability, even in the absence of frank displacement on preoperative MRI. A positive finding should prompt a thorough arthroscopic evaluation of the anterior horn of the LM.

Level of Evidence:

Level III—case control study.
Additive manufacturing of degradable magnesium alloys and their application in orthopedic implants
Authors: Wang Hanbo , Qiang Lei , Mi Xuelian , Wang Tianchang , Xu Xiang
Published: April 2024

Recently, with the continuous research on magnesium alloy materials, the production and processing technology of magnesium alloys are continuously improved, bringing in their improved mechanical properties and corrosion resistance. Therefore, magnesium alloys have once again become one of the research hotspots of orthopedic degradable materials. Meanwhile, the biocompatibility and biosafety properties of magnesium alloys were considered. The magnesium ions generated after the magnesium alloy is degraded in the body, will participate in the human body's metabolism, regulate bone metabolism activities, and contribute to the synthesis of new bone. Some research studied that magnesium ions can regulate the metabolic function of the human body through multiple signaling pathways, and in vitro cells, and experiments have proved this point of view. Therefore, magnesium alloys are expected to become a promising material in orthopedic treatment, due to their good biocompatibility, degradability, and mechanical properties. In this review, we provide an overview of the degradable magnesium alloys and some key surface treatments and additive manufacturing of these materials to promote their application in orthopedic implants.
Consequences of Violating Conditions of Counting Statistics Are Not Severe when Measuring Radon Progeny Concentrations with the Thomas and Kusnetz Methods
Authors: Jenkins Phillip H.
Published: April 2024

When analyzing samples of radon progeny using the Thomas or Kusnetz methods, we violate one of the conditions of counting statistics because we use counting times that are not short compared with the half-lives of the radionuclides. The result is that we overestimate the uncertainties of the counts if we use counting statistics without correction. In this work, I describe the method by which I adjusted the values of variance of the counts theoretically to values that are more accurate and calculated the amounts by which I overestimate the values of counting uncertainty by using counting statistics without correction. These values are surprisingly small: 4–5% for the Thomas method and 2–3% for the Kusnetz method. Now, I can correct uncertainty values of radon progeny measurements if it is appropriate to do so. The detailed calculations I present here may be used for determining corrections to the counting uncertainty for a method for measuring radon progeny concentration using different sampling and/or counting times than those described here. Further, they may be used for any sample, not necessarily radon progeny, that requires a long counting time to acquire a significant number of observed counts.
An Unusual Chorioretinal Manifestation of Relapsing Polychondritis Coexisting with Scleritis: A Case Report
Authors: Akada Masahiro , Muraoka Yuki , Ishihara Kenji , Morooka Satoshi , Hata Masayuki , Tsujikawa Akitaka
Published: April 2024

Purpose:

To report an atypical chorioretinal manifestation concomitant with severe scleritis in a patient diagnosed with relapsing polychondritis.

Methods:

A 53-year-old male, with a six-month history of recurrent bilateral auricular cartilage inflammation was admitted to our hospital. Clinical and pathological examinations of the auricular cartilage led to the diagnosis of relapsing polychondritis.

Results:

Ophthalmological examination revealed a localized elevation in the superonasal quadrant of the left fundus, where the scleritis was more severe than in other regions. B-mode ultrasonography revealed choroidal thickening and subretinal lesions in this area, along with a white retinal lesion identified during the fundus examination. Further investigation using optical coherence tomography (OCT) unveiled subretinal and retinal lesions in the same region, with dispersed cells into the vitreous cavity in a fountain-like pattern. After treatment with systemic corticosteroids and cyclophosphamide, there was an improvement in scleritis, conjunctivitis, and retinal vasculitis; however, the white retinal lesion progressed to retinal atrophy. Concurrently, a decrease in the number of vitreous cells emanating from the area of fountain-like leakage was noted.

Conclusions:

Retinal manifestations of relapsing polychondritis are underrepresented in the literature. This report presents a unique case of relapsing polychondritis with a localized retinal manifestation observed on OCT imaging, thereby broadening our understanding of the potential localized retinal presentations associated with this disease.
Prognostic factors and treatment responses among patients with gross residual disease in differentiated thyroid cancer
Authors: Chiew Yvonne Ee Wern , Yang Yi-Ting , Chi Shun-Yu , Chan Yi-Chia , Chang Yen-Hsiang , Lim Lay San , Chen Wen-Chieh , Chen Yung-Nien , Wu Shu-Ting , Chou Chen-Kai
Published: April 2024

Background:

Various postoperative staging systems were developed to assess the outcome of differentiated thyroid cancer from initial risk after surgery to dynamic changing prognosis during follow-up. The objective of our retrospective cohort study was to identify risk factors contributing to macroscopic positive surgical margin (R2 resection) and parameters in discriminating the treatment responses and prognosis among R2 patients.

Methods:

In total, 242 differentiated thyroid cancer patients with extrathyroidal extension who underwent a thyroidectomy at Kaohsiung Chang Gung Memorial Hospital between January 2013 and July 2018, were included. The patients were grouped according to the presence or absence of gross residual disease (R2). The R2 patients were further classified into two categories according to their treatment response into excellent and nonexcellent groups. The parameters and treatment outcomes were compared between these groups.

Results:

The mean follow-up time was 45.3 months. Two hundred seven (85.5%) patients had either surgery-free or microscopic margins (R0/R1), while 35 (14.5%) had R2 resection. In the R2 group (n = 35), 15 (42.9%) patients achieved an excellent response, while 20 (57.1%) achieved a nonexcellent response. Statistically significant differences were observed in the extent of neck dissection, TSH-Tg level, post-RAI Tg level, nodal status, and recurrence between the two groups. The Kaplan–Meier curves for 5-year local and distant recurrence-free survival of R0/R1 versus R2 patients were 90.0% versus 66.3%, and 98.4% versus 90.7%, respectively (p < 0.001). Among the R2 patients, the excellent responders had a higher local recurrence-free survival than nonexcellent responders (93.3% vs. 45.1%, p = 0.008).

Conclusion:

There are significant disparities in recurrence-free survival among R2 patients with different treatment responses. The nodal status of papillary thyroid cancer and thyroglobulin level after thyroidectomy and RAI were factors contributing to difference in their treatment responses.
Clinical and economic comparison of laparoscopic versus open hepatectomy for primary hepatolithiasis: a propensity score-matched cohort study
Authors: Chen Xiao-Peng , Zhang Wen-Jun , Cheng Bin , Yu Yuan-Lin , Peng Jun-Lu , Bao Sheng-Hua , Tong Chao-Gang , Zhao Jun
Published: April 2024

Background:

It is unclear whether laparoscopic hepatectomy (LH) for hepatolithiasis confers better clinical benefit and lower hospital costs than open hepatectomy (OH). This study aim to evaluate the clinical and economic value of LH versus OH.

Methods:

Patients undergoing OH or LH for primary hepatolithiasis at Yijishan Hospital of Wannan Medical College between 2015 and 2022 were divided into OH group and LH group. Propensity score matching (PSM) was used to balance the baseline data. Deviation-based cost modelling and weighted average median cost (WAMC) were used to assess and compare the economic value.

Results:

A total of 853 patients were identified. After exclusions, 403 patients with primary hepatolithiasis underwent anatomical hepatectomy (OH n=143; LH n=260). PSM resulted in 2 groups of 100 patients each. Although LH required a longer median operation duration compared with OH (285.0 versus 240.0 min, respectively, P<0.001), LH patients had fewer wound infections, fewer pre-discharge overall complications (26 versus 43%, respectively, P=0.009), and shorter median postoperative hospital stays (8.0 versus 12.0 days, respectively, P<0.001). No differences were found in blood loss, major complications, stone clearance, and mortality between the two matched groups. However, the median overall hospital cost of LH was significantly higher than that of OH (CNY¥52,196.1 versus 45,349.5, respectively, P=0.007). Although LH patients had shorter median postoperative hospital stays and fewer complications than OH patients, the WAMC was still higher for the LH group than for the OH group with an increase of CNY¥9,755.2 per patient undergoing LH.

Conclusion:

The overall clinical benefit of LH for hepatolithiasis is comparable or even superior to that of OH, but with an economic disadvantage. There is a need to effectively reduce the hospital costs of LH and the gap between costs and diagnosis-related group reimbursement to promote its adoption.
Standardize the surgical technique and clarify the oncologic significance of robotic D3-D4 lymphadenectomy for upper rectum and sigmoid colon cancer with clinically more than N2 lymph node metastasis
Authors: Chen Tzu-Chun , Liao Yu-Tso , Huang John , Hung Ji-Shiang , Liang Jin-Tung
Published: April 2024

Background:

The territory of D3-D4 lymphadenectomy for upper rectal and sigmoid colon cancer varies, and its oncological efficacy is unclear. This prospective study aimed to standardize the surgical technique of robotic D3-D4 lymphadenectomy and clarify its oncologic significance.

Methods:

Patients with upper rectal or sigmoid colon cancer with clinically suspected more than N2 lymph node metastasis were prospectively recruited to undergo standardized robotic D3-D4 lymphadenectomy. Immediately postsurgery, the retrieved lymph nodes were mapped to five N3-N4 nodal stations: the inferior mesenteric artery, para-aorta, inferior vena cava, infra-renal vein, and common iliac vessels. Patients were stratified according to their nodal metastasis status to compare their clinicopathological data and overall survival. Univariate and multivariate analyses were performed to determine the relative prognostic significance of the five specific nodal stations. Surgical outcomes and functional recovery of the patients were assessed using the appropriate variables.

Results:

A total of 104 patients who successfully completed the treatment protocol were assessed. The standardized D3-D4 lymph node dissection harvested sufficient lymph nodes (34.4±7.2) for a precise pathologic staging. Based on histopathological analysis, 28 patients were included in the N3-N4 nodal metastasis-negative group and 33, 34, and nine patients in the single-station, double-station, and triple-station nodal metastasis-positive groups, respectively. Survival analysis indicated no significant difference between the single-station nodal metastasis-positive and N3-N4 nodal metastasis-negative groups in the estimated 5-year survival rate [53.6% (95% CI: 0.3353–0.7000) vs. 71.18% (95% CI: 0.4863–0.8518), P=0.563], whereas patients with double-station or triple-station nodal metastatic disease had poor 5-year survival rates (24.76 and 22.22%), which were comparable to those of AJCC/UICC stage IV disease than those with single-station metastasis-positive disease. Univariate analysis showed that the metastatic status of the five nodal stations was comparable in predicting the overall survival; in contrast, multivariate analysis indicated that common iliac vessels and infra-renal vein were the only two statistically significant predictors (P<0.05) for overall survival.

Conclusions:

Using a robotic approach, D3-D4 lymph node dissection could be safely performed in a standardized manner to remove the relevant N3-N4 lymphatic basin en bloc, thereby providing significant survival benefits and precise pathological staging for patients. This study encourages further international prospective clinical trials to provide more solid evidence that would facilitate the optimization of surgery and revision of the current treatment guidelines for such a clinical conundrum.
Diagnostic value of endoscopic ultrasound in pelvic masses with bowel involvement
Authors: She Yumo , Sun Siyu , Ge Nan
Published: April 2024

Background:

The diagnostic ability of endoscopic ultrasound (EUS) for intestinal infiltration by pelvic masses has aroused considerable interest in many oncological settings. This study aimed to evaluate the effectiveness of EUS in predicting colorectal invasion in patients with pelvic masses and compare its accuracy with that of other imaging methods, namely pelvic MRI and abdominal computed tomography (CT), in predicting intestinal involvement in patients with histologically confirmed colorectal invasion.

Methods:

A hundred and eighty-four female patients with histologically confirmed benign or malignant pelvic masses were enrolled in a retrospective-prospective study. All patients underwent EUS, pelvic MRI, and one or more of abdominal CT, transvaginal sonography, and colonoscopy examinations before surgery. The surgical and pathological results were used as the gold standard to evaluate the diagnostic accuracy of EUS for colorectal invasion of pelvic masses.

Results:

This study included 184 patients who underwent surgery, with the time between EUS and surgery ranging from 1 to 309 (mean, 13.2) days. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of EUS for benign and malignant pelvic masses infiltrating the intestine were 83.3, 97.8, 99.1, and 66.2%, respectively. The overall diagnostic accuracy was 87.0%.

Conclusions:

EUS is a simple, noninvasive, reliable, and accurate technique for the preoperative diagnosis of pelvic masses infiltrating the intestine. The authors recommend the use of this technology by gynecologists, as well as its incorporation into the preoperative diagnostic process to determine the most suitable surgical method. This would help in avoiding unexpected situations and unnecessary resource wastage during surgery.
Impact of immediate postrecanalization cooling on outcome in acute ischemic stroke patients with a large ischemic core: prospective cohort study
Authors: Bai Xuesong , Qu Xin , Nogueira Raul G. , Chen Wenhuo , Zhao Hao , Cao Wenbo , Gao Peng , Yang Bin , Wang Yabing , Chen Jian , Chen Yanfei , Wang Yuxin , Shang Feng , Cheng Weitao , Xu Yueqiao , Qi Meng , Jiang Lidan , Chen Wenjin , Lu Jie , Ma Qingfeng , Wang Ning , Jiao Liqun
Published: April 2024

Background:

Patients with large acute ischemic strokes (AIS) often have a poor prognosis despite successful recanalization due to multiple factors including reperfusion injury. The authors aim to describe our preliminary experience of endovascular cooling in patients with a large AIS after recanalization.

Methods:

From January 2021 to July 2022, AIS patients presenting with large infarcts (defined as ASPECTS ≤5 on noncontrast CT or ischemic core ≥50 ml on CT perfusion) who achieved successful recanalization after endovascular treatment were analyzed in a prospective registry. Patients were divided into targeted temperature management (TTM) and non-TTM group. Patients in the TTM group received systemic cooling with a targeted core temperature of 33° for at least 48 h. The primary outcome is 90-day favorable outcome [modified Rankin Scale (mRS) 0–2]. The secondary outcomes are 90-day good outcome (mRS 0–3), mortality, intracranial hemorrhage and malignant cerebral edema within 7 days or at discharge.

Results:

Forty-four AIS patients were recruited (15 cases in the TTM group and 29 cases in the non-TTM group). The median Alberta Stroke Program Early CT Score (ASPECTS) was 3 (2–5). The median time for hypothermia duration was 84 (71.5–147.6) h. The TTM group had a numerically higher proportion of 90-day favorable outcomes than the non-TTM group (46.7 vs. 27.6%, P=0.210), and no significant difference were found regarding secondary outcomes (all P>0.05). The TTM group had a numerically higher rates of pneumonia (66.7 vs. 58.6%, P=0.604) and deep vein thrombosis (33.3 vs. 13.8%, P=0.138). Shivering occurred in 4/15 (26.7%) of the TTM patients and in none of the non-TTM patients (P=0.009).

Conclusions:

Postrecanalization cooling is feasible in patients with a large ischemic core. Future randomized clinical trials are warranted to validate its efficacy.
Colosplenic fistula diagnosis and management: a case series and review of literature
Authors: Hernandez Dominguez Oscar , Lincango Eddy P. , Spivak Rebecca , Almonacid-Cardenas Federico , Prien Christopher , Uchino Tairin , Spivak Anna , Hull Tracy L. , Steele Scott R. , Holubar Stefan D.
Published: April 2024

Background:

A colosplenic fistula (CsF) is an extremely rare complication. Its diagnosis and management remain poorly understood, owing to its infrequent incidence. Our objective was to systematically review the etiology, clinical features, diagnosis, management, and prognosis to help clinicians gain a better understanding of this unusual complication and provide aid if it is to be encountered.

Methods:

A systematic review of studies reporting CsF diagnosis in Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and Wiley Cochrane Library from 1946 to June 2022. Additionally, a retrospective review of four cases at our institution were included. Cases were evaluated for patient characteristics (age, sex, and comorbidities), CsF characteristics including causes, symptoms at presentation, diagnosis approach, management approach, pathology findings, intraoperative complications, postoperative complications, 30-day mortality, and prognosis were collected.

Results:

Thirty patients with colosplenic fistulas were analyzed, including four cases at our institution and 26 single-case reports. Most of the patients were male (70%), with a median age of 56 years. The most common etiologies were colonic lymphoma (30%) and colorectal carcinoma (17%). Computed tomography (CT) was commonly used for diagnosis (90%). Approximately 87% of patients underwent a surgical intervention, most commonly segmental resection (81%) of the affected colon and splenectomy (77%). Nineteen patients were initially managed surgically, and twelve patients were initially managed non-operatively. However, eleven of the non-operative patients ultimately required surgery due to unresolved symptoms. The rate of postoperative complications was (17%). Symptoms resolved with surgical intervention in 25 (83%) patients. Only one patient (3%) had had postoperative mortality.

Conclusions:

Our review of 30 cases worldwide is the largest in literature. Colosplenic fistulas are predominantly complications of neoplastic processes. Colosplenic fistula may be successfully and safely treated with splenectomy and resection of the affected colon, with a low rate of postoperative complications.
Clinical study reveals the efficacy of sirolimus in treating primary immune thrombocytopenia: findings from a single-center study
Authors: Feng Yaqing , Meng Haitao , Mu Caiqin , Zhang Yanfang , Liu Xi , Shi Yaqun , Wang Hongjin
Published: April 2024

Immune thrombocytopenia (ITP) is an autoimmune disease that arises because of self-destruction of circulating platelets. The mechanism remains complicated and lacks a standard clinical treatment. Current first-line and second-line medications for ITP have shown limited effectiveness, necessitating the exploration of new therapeutic options. Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor that has been demonstrated to inhibit lymphocyte activity, indicating potential for SRL in the treatment of ITP. This study aimed to evaluate the clinical efficacy of sirolimus as a second-line drug in patients with ITP. The starting dose of sirolimus for adults ranged from 2 to 4 mg/day, with a maintenance dose of 1 to 2 mg/day. For children, the starting dose was 1–2 mg/day, with a maintenance dose of 0.5–1 mg/day. The dosage could be adjusted if needed to maintain a specific blood concentration of sirolimus, typically between 5 and 15 ng/ml, throughout the treatment period. After 3 months, the overall response rate was 60% (12/20), with 30% of patients (6/20) achieving a complete response (CR) and 30% (6/20) achieving a partial response (PR). The CR rate at 6 months remained consistent with the 3-month assessment. No major adverse events were reported, indicating that sirolimus was well tolerated and safe. Analysis of peripheral blood Treg cell percentages in both the control and ITP showed no significant difference before treatment. The percentage of Treg cells increased after treatment with sirolimus, suggesting that sirolimus increases Treg cells. These findings suggest that sirolimus serves as an effective second-line treatment option for ITP, demonstrating favorable clinical efficacy.
Human Caring Perspectives of Care Meanings and Expressions in a Nigerian Cancer Care Setting
Authors: Nwozichi Chinomso , Hamash Kawther , Ramos Mary Dioise , Ogunmuyiwa Ayodeji O. , Martins-Akinlose Oluwaseun D. , Bakare Mosidat Olabisi , Ojewale Margaret Olutosin
Published: April 2024

Background

Caring in Africa is often viewed from sociopolitical and humanity perspectives.

Objective

The aim of this study was to investigate the meanings and expressions of caring from the narratives of persons living with cancer and their nurses.

Methods

This study adopted a qualitative ethnonursing methodology. A purposive sampling technique was used to select the key participants, who were grouped into 7 nurses and 6 patients. General participants included 4 physicians, 3 ward assistants, and 6 patients’ relatives. Interviews of participants were digitally audio-taped and then transcribed verbatim. Data analysis in this study followed the phases of ethnonursing data analysis enabler and was conducted using NVivo 14 software. Data categories were reviewed and sorted to discover recurrent patterns within the data.

Results

Caring was seen as a social practice that is both transactional and transformational. Six thematic patterns emerged: restoring hope, reaching out to the inner lifeworlds of the patients, mutual empathy, going the extra mile, compassionate presence, and being human/having a sense of human connection. The study revealed that there are discernible patterns in care needs and expectations, even though each cancer patient is unique in his or her specific care needs and expectations.

Conclusion

Caring in this study constituted a variety of meanings, and human caring was demonstrated and practiced interpersonally. Hence, there is evidence of living caring in everyday life, in observable ways.

Implications for Practice

Nurses should enhance both their own and the patient’s sense of personal meaning in the caring partnership to enable them to be present in concrete unique nursing situations with the suffering human being.
Comparison of the Predictive Validity of Norton and Braden Scales in Determining the Risk of Pressure Injury in Elderly Patients
Authors: Kiyat Ibrahim , Ozbas Ayfer
Published: April 2024

Aim

To compare the reliability and predictive validity of Norton and Braden scales in determining the risk of pressure injury in elderly patients.

Design

This research used a comparative design. One hundred thirty elderly patients participated in the study.

Methods

The daily pressure injury risk of participants was evaluated by a researcher using both the Norton and Braden scales in a consecutive manner.

Results

The mean age of patients was 75.1 ± 8.5 years, and that for those without and with pressure injury development was 75.0 ± 8.3 years and 76.1 ± 9.7 years (P < .001), respectively. The reliability coefficients of the Norton and Braden scales were .82 and .89, respectively. The sensitivity, specificity, and positive and negative predictive values of the Norton Scale were 100%, 40.7%, 20.2%, and 100%, and those of the Braden Scale were 100%, 32.7%, 18.3%, and 100%, respectively.

Conclusions

The reliability of both scales for elderly patients was found to be high, and their ability to differentiate patients at risk was comparable. However, both scales had low specificity. Further research is needed to develop scales that have higher predictive validity for the elderly population, taking into account other risk factors that influence total scale scores.
Adult Cancer Patients’ Perceptions of Factors That Influence Hospital Admissions
Authors: Geddie Patricia I. , Loerzel Victoria W.
Published: April 2024

Purpose/Aims

To explore cancer patients’ perceptions of factors that influence hospital readmissions.

Design

A cross-sectional, prospective design was employed utilizing a 1-time survey and brief interviews to measure patients’ perceptions and unplanned hospital admissions.

Methods and Variables

The principal investigator collected data from medical record review, the Hospital Admission Survey, and interviews to measure patient characteristics and perceptions of influencing factors that contributed to an unplanned hospital admission upon admission. Data were analyzed using descriptive statistics to categorize patient perceptions of influencing factors of unplanned hospital admissions.

Results

The top reasons for admission were symptoms of uncontrolled gastrointestinal, pain, fever, and respiratory problems. The majority perceived the admission was unavoidable and wanted to avoid an admission. Perceived influencing factors were related to survey categories of 1) communication (ie, cannot reach physician anytime, cannot get a next-day appointment, medical problems are out of control, advised to go to the emergency department) and 2) home environment (ie, unable to adequately manage symptoms at home and hospital admission is the best place for care). Other survey categories of patient education and palliative care were not perceived as influencing or contributing factors.

Conclusions

These findings highlight opportunities for clinical nurse specialists to target these vulnerable patients and provide expert consultation to address potential barriers and gaps in utilization of appropriate supportive services that may reduce unplanned hospital admissions.