bluuebunny/crossref_metadata_2025 huggingface dataset:
Diaspora at war: mobilization of the Ukrainian diaspora in the first 2 years of the Russian full-scale invasion
Authors: Fihel Agnieszka , Homel Kseniya , Jaroszewicz Marta , Lesińska Magdalena , Bentz Anne-Sophie
Published: February 2025

Drawing on theoretical frameworks from social movement studies, this article investigates the mobilization of the Ukrainian diaspora in the first 2 years of the full-scale aggression of Russia against Ukraine. Based on desk research and in-depth interviews with activists from Ukrainian organizations in France and Poland, the analysis demonstrates that, despite different political opportunities, the Ukrainian communities reinforced their political position in relation to the institutions of residence countries and gained new spheres of influence in the respective national arenas. Pre-existing mobilizing structures and practices, mostly based on the Euromaidan legacy, facilitated the achievement of far-reaching objectives, the coordination of actions, and the integration of grass-root forms of activism within the community. This was framed by a sense of uniqueness, responsibility to the homeland, and strengthening of national sentiments, a series of factors that sometimes amplified the pressure on newly arrived war migrants. In both countries of residence, the full-scale war led to high levels of diaspora mobilization and consolidation.
Chronic pericarditis secondary to pericardial lymphangioma. An unusual presentation of an unusual tumor: case report
Authors: Oviedo Adrián M , Dávalos Gerardo A , Molina Gabriel A , Parrales Diana E , Heredia Mauricio R , Muñoz-Palomeque Santiago
Published: February 2025

Pericardial lymphangiomas are exceptionally rare and affect both children and adults. Although they are usually asymptomatic, they can cause symptoms secondary to the mass effect, from syncope or palpitations to arrhythmia or congestive heart failure. The most reliable diagnostic methods are echocardiography, computed tomography, and magnetic resonance imaging, with subsequent confirmation by histopathology. Its treatment consists of complete surgical resection. We present the case of a 2-year-old female patient with a definitive diagnosis of pericardial lymphangioma who debuted with cardiac tamponade and hemodynamic repercussions. She underwent a pleuropericardial window by lateral thoracotomy with resection of nodular masses at the posterior level of the pericardium without complications. The patient's evolution and prognosis were favorable.
Closed-loop bowel obstruction caused by a right inguinal hernia containing the transverse colon: an unusual case report
Authors: Alnumay Abdulaziz , Batais Salman , Albalawi Alwateen , Alzaharani Najd , Aldeligan Saleh Husam
Published: February 2025

Inguinal hernias are common, with a lifetime risk of 25% in men. Approximately 10% become incarcerated, risking complications like strangulation and bowel obstruction. Herniation of the transverse colon (TC) is rare, especially when causing a closed-loop obstruction. A 67-year-old male with poorly controlled type II diabetes and hypertension presented with a symptomatic right inguinoscrotal hernia, showing nausea, vomiting, and partial bowel obstruction. A computed tomography (CT) scan revealed a herniated TC causing a closed-loop obstruction. Emergency open hernia repair with a modified Shouldice technique and mesh was performed. Viable TC and omentum were reduced. The patient recovered without complications and was discharged on the fourth postoperative day. This case involved a rare TC herniation causing a closed-loop obstruction, confirmed by CT imaging. The open approach was selected due to the risk of ischemia and anticipated adhesions. A modified Shouldice repair with mesh reinforced the inguinal canal, reducing recurrence risk. The patient’s postoperative course was uneventful. This case highlights the rarity of TC herniation causing closed-loop obstruction. CT scans were crucial for diagnosis, enabling prompt surgical intervention, which is key to preventing serious complications.
Unusual presentation of polyethylene tibial fracture in a polio patient: a case report
Authors: Alsheikh Khalid A , Almahayni Abdullah O , Alqaseer Sumaia M , Alotaibi Wafa S , Aljaafri Ziad A
Published: February 2025

The concept of posterior cruciate ligament (PCL)-substituting total knee prostheses has been widely used for total knee arthroplasty (TKA). This design provides better femoral rollback with knee flexion, as it permits more stability under flexion by preventing tibial posterior subluxation. Here, we report a case of an unusual presentation of polyethylene tibial post fracture in a polio patient. Our patient had a history of staged bilateral TKA five years prior to the new presentation. Once the diagnosis was confirmed, the patient was admitted electively for TKA revision and polyethylene exchange. The procedure went well and without complications, and the patient was satisfied upon follow-ups in the clinic.
Unicentric retroperitoneal Castleman’s disease in young Nepalese women
Authors: Khadga Ajit , Adhikari Mahesh Bahadur , Maharjan Bipin , Gautam Ravi Kiran , Mishra Prashant , Basnet Birodh , Yadav Deepak Kumar , Acharya Shoshan
Published: February 2025

Castleman disease (CD) is a rare lymphoproliferative disorder of uncertain etiology, most commonly affecting the chest and neck, with retroperitoneal involvement being exceptionally rare. It can present as either unicentric or multicentric disease, with the unicentric form typically affecting younger individuals. Due to its rarity and overlapping features with conditions like non-Hodgkin lymphoma and paraganglioma. CD is often misdiagnosed, making immunohistochemical analysis crucial for accurate diagnosis. We report a rare case of retroperitoneal CD in a 23-year-old female referred to our hospital after a CT scan revealed a retroperitoneal tumor anterior to the lower pole of her left kidney at the L3-L4 vertebral level. An initial core biopsy suggested paraganglioma; however, following laparoscopic tumorectomy, histopathological analysis confirmed Castleman disease of the hyaline vascular and plasma cell type.
Case report of a seminal vesicle schwannoma involving prostate and bladder: diagnostic pathway and management
Authors: Suraci Paolo Pietro , Al Salhi Yazan , Candita Giuseppe , Fuschi Andrea , Scalzo Silvio , Rera Onofrio Antonio , Valenzi Fabio Maria , Antonioni Alice , Sequi Manfredi Bruno , Graziani Damiano , Martino Giorgio , Di Gregorio Giovanni , Gianfrancesco Filippo , Erra Luca , Lako Kostika , Zucchi Alessandro , Bozzini Giorgio , Capodiferro Paola , Petrozza Vincenzo , Carbone Antonio , Pastore Antonio Luigi
Published: February 2025

Seminal vesicle neoplasms are extremely rare. Schwannoma is a benign tumor of the peripheral nerve sheath composed of Schwann cells. Most of these tumors are silent and become symptomatic with compression of adjacent organs and nerves. We present a case of a 65-year-old man with a history of predominant storage lower urinary tract symptoms. Prostate-specific antigen was within normal ranges, and imaging documented a nodular lesion in the prostate, one in the left seminal vesicle and another one adjacent to the right bladder wall. We successfully performed a prostate biopsy and a trans-urethral resection of the bladder to excise and typify the lesion. Histopathology investigation revealed the final diagnosis of schwannoma.
Recycling of purine nucleotides in legumes: functional specialization of enzyme isoforms in adenine salvage, cytokinin homeostasis, and nodulation control
Authors: Becana Manuel
Published: February 2025

This article comments on:

López CM, Alseekh S, Martínez Rivas FJ, Fernie AR, Prieto P, Alamillo JM. 2025. CRISPR/Cas9 editing of two adenine phosphoribosyl transferase coding genes reveals the functional specialization of adenine salvage proteins in common bean. Journal of Experimental Botany 76, 346–362 https://doi.org/10.1093/jxb/erae424.
RNA exosome-driven RNA processing instructs the duration of the unfolded protein response
Authors: Matabishi-Bibi Laura , Goncalves Coralie , Babour Anna
Published: February 2025

Upon stresses, cellular compartments initiate adaptive programs meant to restore homeostasis. Dedicated to the resolution of transient perturbations, these pathways are typically maintained at a basal level, activated upon stress, and critically downregulated upon reestablishment of cellular homeostasis. As such, prolonged activation of the unfolded protein response (UPR), a conserved adaptive transcriptional response to defective endoplasmic reticulum (ER) proteostasis, leads to cell death. Here, we elucidate an unanticipated role for the nuclear RNA exosome, an evolutionarily conserved ribonuclease complex that processes multiple classes of RNAs, in the control of UPR duration. Remarkably, the inactivation of Rrp6, an exclusively nuclear catalytic subunit of the RNA exosome, curtails UPR signaling, which is sufficient to promote the cell’s resistance to ER stress. Mechanistically, accumulation of unprocessed RNA species diverts the processing machinery that maturates the messenger RNA encoding the master UPR regulator Hac1, thus restricting the UPR. Significantly, Rrp6 expression is naturally dampened upon ER stress, thereby participating in homeostatic UPR deactivation.
Multiplexed epigenetic memory editing using CRISPRoff sensitizes glioblastoma to chemotherapy
Authors: Lin Katie , Zou Christopher , Hubbard Akane , Sengelmann Sasha , Goudy Laine , Wang I-Ching , Sharma Rohit , Pak Joanna , Foster Kyla , Ozawa Tomoko , de Groot John F , Phillips Joanna , Vasudevan Harish N , Raleigh David R , Marson Alexander , Murthy Niren , Gilbert Luke A , Berger Mitchel S , Liu S John
Published: February 2025

Background

Glioblastoma (GBM) carries a poor prognosis, and new therapeutic strategies are necessary to improve outcomes for patients with this disease. Alkylating chemotherapies including temozolomide (TMZ) and lomustine (CCNU) are critical for treating GBM, but resistance mechanisms, including hypomethylation of O6-methylguanine-DNA methyltransferase (MGMT) promoter, undermine treatment. CRISPRoff is a programmable epigenetic memory editor that can induce stable and heritable gene silencing after transient delivery, and we hypothesize that CRISPRoff could potentiate the activity of TMZ and CCNU through long term suppression of target genes.

Methods

We transiently delivered CRISPRoff mRNA along with sgRNAs against target genes using both electroporation and lipid nanoparticles (LNPs) into established GBM cell lines, patient-derived primary GBM cultures, and orthotopic GBM xenografts. Gene repression, specificity, and stability was measured by RT-qPCR, Western blot, bisulfite sequencing, and RNA-sequencing. Sensitivity to chemotherapies was measured by cell viability dose response, microscopy, and bioluminescence imaging. Genome-wide mapping of CCNU sensitizers was performed using CRISPRi screens.

Results

CRISPRoff induced complete suppression of MGMT and sensitization to TMZ that were stable for over 8 months of continuous cell propagation. GBM orthotopic tumors treated with CRISPRoff against MGMT demonstrated sensitivity to TMZ in vivo, and CRISPRoff delivery resulted in chemosensitivity in patient-derived primary GBM. Genome-wide CRISPRi screens identified combinatorial genetic vulnerabilities (BRIP1, FANCE) that were targetable by multiplexed CRISPRoff to achieve sensitization to CCNU.

Conclusion

Transient delivery of a site-specific epigenetic memory can induce stable, complete, and multiplexed suppression of target genes for therapeutic application in GBM.
Radiographic reporting in adolescent idiopathic scoliosis: Is there a discrepancy comparing radiologists’ reports and surgeons’ assessments?
Authors: Sidhu Kara , Filezio Marina Rosa , Singh Vishwajeet , Birk Manjot , Parsons David
Published: February 2025

Objectives

Cobb angle is a standard method for quantification of scoliosis in adolescent idiopathic scoliosis to guide treatment decisions. Precise and timely curve detection can ensure early referrals, amenable for bracing. Radiology reports serve as a guiding tool for family physicians to expedite specialist referrals. Therefore, accurate and reliable measurement of Cobb angle at the community level is crucial. This retrospective study investigated the agreement in Cobb angle measurement between radiologists and spine surgeons.

Methods

Eighty radiographic reports (Cobb angle, Risser stage, and end vertebrae selection) completed by radiologists and spine surgeons were compared. To assess interrater reliability, interclass correlation coefficients (ICC) with 95% confidence intervals (CIs) were computed. ICC < 0.70, 0.70 to 0.79, 0.80 to 89, and 0.9 to 0.99 were considered poor, fair, good, and excellent reliability, respectively. All radiographs were assessed for quality.

Results

The agreement between spine surgeons and radiologists was poor (ICC = 0.65, 95% CI: 0.13 to 0.97). The agreement between spine surgeons and community radiologists was poor (ICC = 0.45, 95% CI: 0.17 to 0.66). Risser stage was not reported in 56 of the 80 reports. ICC between spine surgeons and radiologists for the Risser stage was poor (ICC = 0.625, 95% CI: 0.325 to 0.794). For end vertebrae identification, there was absolute agreement of end vertebrae identification in 23 of the 80 scans.

Conclusions

This study demonstrated a significant disagreement in scoliosis measurement between radiologists and spine surgeons, which significantly impacts appropriateness of referrals. Methods to improve triaging using allied health professional (i.e., nurse practitioners) may help ensure that patients presenting with scoliosis are referred in a timely manner.
Surfing vortex rings for energy-efficient propulsion
Authors: Gunnarson Peter , Dabiri John O
Published: February 2025

Leveraging background fluid flows for propulsion has the potential to enhance the range and speed of autonomous aerial and underwater vehicles. In this work, we demonstrate experimentally a fully autonomous strategy for exploiting vortex rings for energy-efficient propulsion. First, an underwater robot used an onboard inertial measurement unit (IMU) to sense the motion induced by the passage of a vortex ring generated by a thruster in a 13,000-L water tank. In response to the sensed acceleration, an impulsive maneuver entrained the robot into the material boundary of the vortex ring. After entrainment, the robot was propelled across the tank without expending additional energy or control effort. By advecting with the vortex ring, the robot achieved a nearly fivefold reduction in the energy required to traverse the tank compared to swimming in quiescent flow. Using the controlled finite-time Lyapunov exponent field and corresponding Lagrangian coherent structures, we analyze and explain the initial entrainment process and the sensitivity to the starting time and position of the surfing maneuver. Additionally, linear acceleration as sensed by the onboard IMU was found to correspond with the pressure gradient of the background flow, and rotational acceleration is suggested as a method for measuring the vorticity of the vortex ring. This study serves as a proof-of-concept demonstration of the potential for onboard inertial measurements to enable efficient interaction with background fluid flows.
Breathing unequal air: environmental disadvantage and residential sorting of immigrant minorities in England and Germany
Authors: Rüttenauer Tobias , Bader Felix , Ehler Ingmar , Best Henning
Published: February 2025

Despite ongoing debates on environmental justice, the link between selective residential migration and the unequal exposure to environmental hazards remains underexplored. Previous research has often relied on spatially aggregated data and focused on single-country analyses, limiting our understanding of broader patterns. We address this gap using longitudinal household-level data from the UK Household Longitudinal Study and the German Socio-Economic Panel linked to air pollution estimates (NO2, PM2.5, and SO2). We find that immigrant minorities are exposed to higher levels of air pollution at their place of residence. The overall disadvantage faced by immigrant minorities in England is three times as large as in Germany. Given that immigrant households start under initially higher levels of air pollution, one would expect convergence with non-immigrant populations over time due to residential moves. However, immigrants face a substantial penalty when moving. If native households started in similar neighborhoods as immigrants—the relevant counterfactual—they would experience higher gains from relocation. Socio-economic factors cannot explain these differences. The pattern holds in both England and Germany, although inequalities in residential mobility are more pronounced in England. In particular, racial and ethnic minorities, such as Bangladeshi, Caribbean, and African migrants in England and Turkish migrants in Germany, experience the largest environmental disadvantages.
Institutional anomie, religious ecologies, and violence in American communities
Authors: Stroope Samuel , Bacon Rachel J , Barton Michael S , Brault Elizabeth E , Kroeger Rhiannon A , Baker Joseph O
Published: February 2025

Institutional anomie theory (IAT) posits that religion is a social institution that influences crime, yet religion has been relatively neglected in empirical research on IAT. We elaborate the role of religion within IAT, methodologically differentiate religious traditions, and empirically test hypotheses regarding local religious ecologies and community homicide over time in the United States. In analyses of county-level panel data, we find that increases in the evangelical Protestant adherent rate are directly associated with increases in homicide rates, while increases in the Catholic adherent rate are directly associated with decreases in homicide rates. Using spatial analysis to examine spillover effects from adjacent locations, increases in the Catholic adherent rate and the evangelical Protestant adherent rate are indirectly associated with increases in homicide, while increases in the mainline Protestant adherent rate are indirectly associated with decreases in homicide. The total effect (both direct and indirect) for changes in the evangelical Protestant adherent rate is the largest in the model. In sum, elaborating and extending IAT, this study theorizes and then demonstrates the importance of differentiating between specific religious traditions for understanding spatial and temporal patterns in crime.
Comparative Analyses of Compatible and Incompatible Host-Pathogen Interactions Provide Insight into Divergent Host Specialization of Closely Related Pathogens
Authors: Haueisen Janine , Möller Mareike , Seybold Heike , Small Corinn , Wilkens Mira , Jahneke Lovis , Pachinger Leonhard , Thynne Elisha , Stukenbrock Eva H.
Published: February 2025

Host-pathogen co-evolutionary dynamics drive constant changes in plant pathogens to thrive in their plant host. Factors that determine host specificity are diverse and range from molecular and morphological strategies to metabolic and reproductive adaptations. We applied an experimental approach and conducted comparative microscopy, transcriptome analyses, and functional analyses of selected pathogen traits to identify determinants of host specificity in an important wheat pathogen. We included three closely related fungal pathogens Zymoseptoria tritici, Z. pseudotritici, and Z. ardabiliae that establish compatible and incompatible interactions with wheat. Although infections of the incompatible species induce plant defenses during invasion of stomatal openings, we found a conserved early-infection program among the three species whereby only 9.2% of the 8,885 orthologous genes are significantly differentially expressed during initial infection. The genes up-regulated in Z. tritici likely reflect specialization to wheat, while upregulated genes in the incompatible interaction may reflect processes to counteract cellular stress associated with plant defenses. We selected nine candidate genes encoding putative effectors and host-specificity determinants in Z. tritici and deleted these to study their functional relevance. Despite the particular expression patterns of the nine genes, only two mutants were impaired in virulence. We further expressed the Z. tritici proteins in Nicotiana benthamiana to investigate protein function and assess cell death reaction. Hereby, we identify three effectors with cell-death-inducing properties. From the functional analyses, we conclude that the successful infection of Z. tritici in wheat relies on an extensive redundancy of virulence determinants.
Morbidity and mortality rates among children aged 0–59 months: a cross-sectional study from Mogadishu, Somalia
Authors: Malin Jibril Abdi , Mohamud Hafsa Mohamed , Hassan-Tuuryare Sakariye Abdullahi , Mohamed Suleyman Abdullahi , Kimutai Timothy Kiprotich
Published: February 2025

Background:

The under-five mortality rate is the likelihood of a child passing away before reaching the age of 5, calculated based on the number of deaths per 1,000 live births. High under-five mortality rates often reflect inadequate access to healthcare, sanitation, and nutrition, while low rates indicate a more favorable environment for child survival. The child mortality rate in Somalia is among the highest in the world.

Methods:

This cross-sectional study examined morbidity and mortality rates among children aged 0–59 months at a referral hospital in Mogadishu, Somalia. With a total sample size of 1675 patients, we analyzed leading causes of mortality and admissions among children aged 0–59 months to identify urgent healthcare needs in this vulnerable population.

Results

The results showed that preterm birth (26.00%), acute respiratory diseases (18.50%), and birth asphyxia (17.40%) were the leading causes of admission among newborns. Gastrointestinal diseases were the leading cause of admission among infants and children, accounting for 43.80% of cases among those aged 6 months to 1 year and 44.90% among those aged 1–5 years. The mortality rate was highest among newborns, with a rate of 22.40%, and decreased with age. The leading causes of death were preterm birth (60 deaths, 30.80% of preterm cases), birth asphyxia (50 deaths, 38.50% of asphyxia cases), and meconium aspiration syndrome (24 deaths, 20.50% of MAS cases), accounting for a significant proportion of deaths. Congenital diseases represented 1.60% of admissions with approximately 14.80% of children under five with congenital disorders dying from related complications. Overall, the study found that 10.30% of pediatric patients under 5 years old died, highlighting the need for targeted interventions to address these leading causes of morbidity and mortality.

Conclusions:

This study highlights the urgent need for comprehensive strategies to reduce preterm births, enhance neonatal care, and tackle the leading causes of infant mortality. By implementing targeted interventions and strengthening healthcare systems, we can alleviate the burden of infant mortality and promote healthier futures for children globally.
Near infrared spectroscopy in the pediatric cardiac intensive care unit: accurately interpreting the data
Authors: Iliopoulos Ilias , Flores Saul , Loomba Rohit
Published: February 2025

Purpose of review

Near infrared spectroscopy (NIRS) has been increasingly adopted as standard monitoring in postoperative care of pediatric cardiac patients. Several reports have established its association with both markers of perfusion and adverse outcomes. The correlation with markers of perfusion is not strong and exhibits wide limit of agreement, making the determination of critical thresholds and its integration in treatment algorithms challenging.

Recent findings

A growing body of literature support the use of NIRS for hemodynamic monitoring in pediatric cardiac patients. Recent reports corroborate prior findings of weak to moderate correlation of NIRS with markers of global and regional perfusion and confirm its association with adverse outcomes. The challenge of lack of treatment thresholds remains, limiting clinical utility. Evidence of improvement of outcomes with the use of NIRS remains limited.

NIRS is a useful monitor of regional and global perfusion and can inform management decisions but cannot be used as the sole decision-making tool. Large, randomized studies are needed to define its use as decision making tool and facilitate its integration in treatment algorithms.
Mitigating heart failure risk in patients with diabetes and chronic kidney disease
Authors: Kowalczyk Nicholas S. , Prochaska Megan
Published: February 2025

Purpose of review

Patients with chronic kidney disease and diabetes are at high risk of cardiovascular disease, including heart failure. Risk mitigation requires a comprehensive approach with lifestyle modifications, blood pressure management, renin-angiotensin blockade, and sodium-glucose cotransporter 2 inhibitors. Recent trials have shown that nonsteroidal mineralocorticoid receptor antagonists (ns-MRA) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) should also be components of this approach. This review will discuss the comprehensive approach to mitigating risk in these high-risk patients and highlight the recent trials of ns-MRAs and GLP-1 RA.

Recent findings

In recent years, large, randomized controlled trials of ns-MRA and GLP-1 RA have shown benefit in kidney and cardiovascular outcomes for patients with chronic kidney disease and diabetes.

The substantial benefits and overall favorable safety profiles for ns-MRA and GLP-1 RA in patients with chronic kidney disease and diabetes demonstrate that these medications should be considered as a part of a comprehensive approach to cardiovascular risk reduction in this high-risk population. Future studies should consider different combination therapies and guide how and when to initiate these therapies.
Advances in the management of obesity and heart failure: latest evidence from clinical trials
Authors: Costa Thomaz Alexandre , Harrington Josephine L.
Published: February 2025

Purpose of review

Obesity is an important risk factor for heart failure with preserved ejection fraction (HFpEF). In patients who already have HFpEF, obesity contributes to high symptom burden and increased risk for heart failure (HF) hospitalization. This review examines the latest clinical trials assessing the efficacy of pharmacological interventions in the treatment of obesity-related HFpEF.

Recent findings

Recent results from randomized clinical trials (RCTs) suggest that incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) (e.g., semaglutide) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RAs (e.g., tirzepatide), can improve quality of life, exercise tolerance, and markers of HF severity while promoting weight loss in patients with obesity and HFpEF. Some evidence also suggests that these therapies may reduce risk for HF hospitalizations. Additionally, exploratory analyses of the nonsteroidal mineralocorticoid receptor antagonist finerenone has been associated with reduced cardiovascular mortality and total worsening HF events across all body mass index (BMI) levels, with greater benefits observed in patients with higher BMIs.

Antiobesity medications such as semaglutide and tirzepatide may represent important treatment options for patients with obesity-related HFpEF. Additional evidence suggests that certain other HF medications may have increased efficacy in patients with obesity.
A failure to launch: blood pressure control after stroke in a regional health system
Authors: Forman Rachel , Xin Xin , Kim Chungsoo , Kernan Walter N. , Sheth Kevin N. , Krumholz Harlan M. , de Havenon Adam , Spatz Erica , Lu Yuan
Published: February 2025

The objective of this report is to characterize BP control among patients six months post stroke and measure time to first visit. Patients were discharged from the Yale New Haven Health System (YNHHS) and had visits in the EPIC system supported by YNHHS. The primary outcome was systolic blood pressure (SBP) values ≥140 mmHg or diastolic blood pressure (DBP) >90 mmHg during the visit closest to and before 6 months from hospitalization. The analysis included 3339 patients. The average proportion of patients with SBP values ≥140 mmHg or ≥DBP 90 mmHg was 31%. The average proportion of SBP values ≥130 mmHg or ≥DBP 80 mmHg mm Hg was 61%. Among patients who had a primary care professional visit within 1 year, 55.3% did not have any visit with a neurologist within 1 year. To the best of our knowledge, this study is the first to report poststroke BP control from a regional health system that is not self-insured or operating under a global budget.
Dosimetry Testing for a New In Vivo X-ray Fluorescence Measurement System
Authors: Burgos Chandler J. , Read Daniel E. , Grier Thomas R. , Khan Maruf , Weisskopf Marc G. , Taylor Kathryn M. , Specht Aaron J.
Published: February 2025

Lead exposure poses severe health risks to individuals, impacting cognitive function, growth, learning, and behavior. Current lead detection methods, primarily blood testing and x-ray fluorescence (XRF) of bone, have limitations. This study introduces a novel in vivo XRF measurement system using K-shell energies of lead, addressing limitations of previous methods. The study aimed to characterize beam directionality, subject radiation dose, and operator occupational exposure. Using a high-energy x-ray tube and room-temperature detectors, various parameters were assessed with bone and tissue phantoms. Dose measurements were taken by altering voltage, current, and shielding. Scatter and spatial measurements highlighted increased scatter with bone and tissue presence, emphasizing the safest positions for bystanders and operators. Results exhibited expected dose rate changes with varying parameters, showcasing the impact of bone and tissue on scatter radiation. The system’s total body effective dose (with an 8-mm molybdenum shielding indicating minimal risk compared to established public dose limits) for an adult was 1.94 μSv; for a child aged 10 y, it was 3.28 μSv. This system demonstrates promising capabilities for lead exposure monitoring, offering negligible occupational exposure and minimal risk to individuals being scanned. Its safety and efficacy position it as a valuable tool in assessing lead exposure, potentially improving preventive measures.
Exercise Tolerance in Pediatric Concussion: An 8-Year Longitudinal Study
Authors: Cassimatis Maree , Orr Rhonda , Fyffe Andrew , Browne Gary
Published: February 2025

Objectives:

To determine the relationship between exercise tolerance and post-concussion symptom deficits, cognitive function, and recovery duration; (2) examine the longitudinal effect of exercise tolerance on symptom burden over the clinical timecourse of a child’s recovery from concussion; and (3) explicate whether exercise intolerance is a significant determinant of recovery in pediatric concussion.

Setting:

Pediatric tertiary referral concussion clinic.

Participants:

Children and adolescents (aged 6-18 years) presenting to the concussion clinic between January 2015 and December 2022.

Design:

Retrospective longitudinal study.

Main Measures:

Graded exercise test (GXT) data, derived from a standardized treadmill test (Bruce Protocol), was used to measure exercise tolerance following concussion. Based on initial GXT times, participants were dichotomized into 2 groups: (1) exercise tolerant (GXT time ≥9 minutes), or (2) exercise intolerant (GXT time <9 minutes). Symptom burden, cognitive function, and recovery duration were compared between groups. A subgroup analysis of participants requiring multiple clinic visitations was conducted to explore the longitudinal effect of post-concussion exercise tolerance over time.

Results:

Of the 603 children presenting to the concussion clinic, 313 participants (mean age ± SD: 13 ± 2 years, 79% male) were eligible. Exercise-intolerant participants (mean GXT [95% confidence interval, CI], 6.9 [6.5-7.3] minutes) reported 2 times greater initial symptom severity (P < .001) and performed poorly in visual memory (P = .002) and reaction time (P = .02) cognitive domains compared to exercise-tolerant participants (mean GXT [95% CI], 12.3 [12.0-12.5] minutes). Recovery time was longer in exercise-intolerant participants than exercise-tolerant participants (mean recovery time [95% CI], 94 [71-116] vs 69 [57-81] days, P = .002). Participants requiring multiple clinic visitations showed improvements in exercise tolerance and symptom burden over time (P < .001). Significant predictors of prolonged concussion recovery were delayed presentation time (P < .001), high initial symptom burden (P < .001), and exercise intolerance (P < .001).

Conclusion:

GXT is a clinically relevant measure to identify children and adolescents at risk of a prolonged concussion recovery.
Maximizing oral intake tolerance in malignant gastric outlet obstruction – a Markov decision tree analysis comparing duodenal stenting, endoscopic ultrasound-guided gastroenterostomy and surgical gastrojejunostomy based on a meta-analysis of randomized controlled trials
Authors: Chue Koy Min , Douglass Benjamin Robert , Lin Lester Ong Wei , Hui Jeremy Tan Tian , Teh Jonathan Guo Xiang , Putera Martin , Kwan Clarence Kah Wai , Wong Wai Keong , Man Baldwin Yeung Po
Published: February 2025

Introduction:

Malignant gastric outlet obstruction (GOO) has a significant impact on quality of life. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has shown promising results. Traditional isolated outcome measures do not sufficiently address critical considerations for end-of-life patients like oral intake tolerance. This study aimed to determine via a probabilistic approach, the optimal management strategy for GOO patients that maximizes their oral intake tolerance.

Methods:

A Markov decision model was developed, with input variables based on a systematic review and meta-analysis of randomized controlled trials (RCT) comparing duodenal stenting (DS), EUS-GE and surgical gastrojejunostomy (GJ). A prospective cohort study with a comparator group was also included for EUS-GE model given the scarcity of RCTs. Model assumption was a patient with malignant GOO, with equal probabilities of being allocated to 1 of 3 treatment options. Each data point was evaluated using pooled probabilities from the meta-analysis of clinical outcomes. Primary outcome was successful oral intake tolerance at various time points of 1–6 months post-intervention.

Results:

Fifteen studies were included into the Markov model. Based on 10 000 simulations in each arm, at a survival of 1-month, DS and EUS-GE had the highest likelihood of oral intake (81.2% and 80.4%) compared to GJ (75.5%). However, at a survival of 6-month, EUS-GE and GJ were better at palliating GOO, with likelihood of oral intake at 23.8% and 25.2%, compared to 21.3% for DS.

Conclusion:

For patients with a prognosis of more than 1-month, a surgical GJ, or EUS-GE if technical expertise is available, is preferred for GOO palliation.
Differences in the Clinicopathologic and Radiological Characteristics of Patients with Microcystic and Macrocystic Serous Cystadenoma of the Pancreas
Authors: Lu Xiaozhi , Dai Yuran , Liu Xinchun , Jiang Lei , Zhang Kai , Wu Junli , Gao Wentao , Jiang Kuirong , Dai Cuncai , Miao Yi , Li Mingna , Wei Jishu
Published: February 2025

Objectives

To elucidate the clinicopathological characteristics, imaging features, and surgical outcomes of patients with serous cystic neoplasms (SCNs), and to compare the features between microcystic (MiC) and macrocystic (MaC) SCNs.

Methods

In this single-center retrospective study, information of patients with SCN between 2016 and 2022 at our institution was collected and analyzed.

Results

A total of 105 patients with SCNs were identified, including 58 (55.2%) with MiC type and 47 (44.8%) with MaC type. Patient age and American Society of Anesthesiologists (ASA) grade in the MiC group were significantly higher than those in the MaC group. The overall preoperative diagnostic accuracy was 7.6%, with no patients in the MaC group correctly diagnosed before surgery. In imaging examinations, almost all (97.1%) exhibited a lobulated pattern. Internal septation, honeycomb pattern, central scar, and calcification were common, with a significantly higher incidence in the MiC group. No in-hospital deaths occurred, and the incidence of major complications were comparable in both groups.

Conclusions

Although many patients presented with typical imaging features, accurate diagnosis of SCN remained difficult. Except for older age and higher ASA grade in the MiC group, there were no significant differences in the clinicopathological characteristics between MiC and MaC SCN patients.
Student and Educator Evaluation of the Five-Minute Peer Writing Activity
Authors: Richards Andrew J. , Hall Zachary
Published: February 2025

Background:

Educators look for practical and engaging classroom assessment techniques (CATs) to enhance the learning experience.

Problem:

Many CATs are individual activities that only engage learners at lower levels of Bloom’s Taxonomy. The Five-Minute Peer Writing Activity (FMPWA) was developed to address this problem. This study compared student grades, engagement, and satisfaction between the FMPWA and One-Minute Paper (OMP) CAT and the effectiveness and acceptability of the FMPWA among nurse educators.

Approach:

Nursing students completed the OMP and FMPWA and rated both by engagement and satisfaction. Nurse educators attending conference workshops experienced the OMP and FMPWA and had the opportunity to complete a short survey.

Outcomes:

This innovative CAT showed a statistically significant increase in student grades, engagement, and satisfaction scores. Educators reported higher engagement, satisfaction, and likelihood of trying the FMPWA.

Conclusions:

The FMPWA is an effective strategy to engage nursing students in the classroom.
Associations between HIV serostatus and coronary artery plaque volume progression
Authors: Whelton Seamus P. , Haberlen Sabina A. , Zhang Long , Herrschaft Ryan , Witt Mallory D. , Jacobson Lisa P. , Margolick Joseph B. , Magnani Jared W. , Palella Frank J. , Brown Todd T. , Budoff Matthew , Post Wendy S.
Published: February 2025

Objective:

Men with HIV have more coronary atherosclerosis than men without HIV. We examined whether plaque progression differed based on HIV serostatus.

Design:

We examined plaque progression over a median of 4.5 years (IQR 3.9-4.9) among 548 men with (n = 313) or without (n = 235) HIV from the Multicenter AIDS Cohort Study using coronary CT angiography.

Methods:

Change in coronary plaque volume was calculated for 1) total, 2) calcified, 3) noncalcified, and 4) low attenuation plaque and categorized by tertile. Multinomial logistic regression models estimated the association between HIV and coronary plaque progression.

Results:

The median age was 53 years old and 30% were Black. Total plaque volume regressed among 2%, 20% remained without plaque, and 78% had progression with a median progression of 34 mm3 (IQR 3-106). Compared to men without HIV, men with HIV had a statistically significant 1.99 higher odds of calcified plaque progression (95%CI:1.16,3.44, p = 0.01) and elevated odds for progression in total plaque (OR1.62, 95%CI:0.94,2.77, p = 0.08) and noncalcified plaque volume (OR1.64, 95%CI:0.97,2.79, p = 0.07), although the latter findings did not meet the cutpoint for statistical significance. The progression of low attenuation plaque did not significantly differ by HIV serostatus (OR1.34, 95%CI:0.88,2.05, p = 0.18). HIV was significantly associated with the progression of total, calcified, and noncalcified plaque among nonBlack participants, but not Black participants.

Conclusions:

These results suggest that men with HIV may have greater plaque progression, which may contribute to the observed higher incidence of coronary heart disease among men with HIV.
The Role of 18F-FDG PET/CT Combined With MPI in Cogan’s Syndrome With Multiple Arteritis and Coronary Involvement: A Case Report
Authors: Zhang Ying , Han Xu , Nan Nan , Dong Wei , Mi Hongzhi
Published: February 2025

We present a case of a 49-year-old woman who complained of chest pain after activity for 3 months. She had undergone percutaneous coronary intervention (PCI) on the left main (LM) and right coronary artery (RCA) for acute myocardial infarction (AMI) 1 year ago. At this admission, a coronary angiogram (CAG) revealed stent restenosis. Then, 99mTc-Sestamibi myocardial perfusion imaging (MPI) and 18F-FDG PET/CT showed multiple arteritis involving the coronary artery with no obvious myocardial ischemia. This suggests that the patient should be treated with anti-inflammatory measures instead of repeating revascularization caused by persistent stent stenosis, making this an extremely rare case of Cogan’s syndrome (CS).
Posterior Vault Distraction Osteogenesis: A Systematic Review and Single-Arm Metanalysis
Authors: Franco-Mesa Camila , De La Cruz Ku Gabriel , Palackic Alen , DeJesus Jana E. , Konofaos Petros
Published: February 2025

Introduction:

The purpose of this study is to describe the technique and outcomes of posterior vault distraction osteogenesis (PVDO) in patients with syndromic and nonsyndromic craniosynostosis.

Methods:

Studies from MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched for patients with posterior cranial vault distraction osteogenesis. Inclusion criteria encompassed all studies with 3 or more patients per cohort who underwent posterior cranial vault distraction osteogenesis and had a follow-up of at least 1 month. Patients with both syndromic and nonsyndromic synostosis were included. The risk of bias in nonrandomized studies of intervention tool (ROBINS-I) was applied.

Results:

A total of 19 manuscripts with 403 patients met the criteria. All but one study included patients with syndromic craniosynostosis. In total, 5.9% of cases used one distractor, 72.5% two, 3.7% three, and 7.4% four. The distraction achieved ranged from 18.7 to 35 mm with an average of 23.54 mm. Distraction protocol was, on average, 1 mm/d. The duration of the distractors from placement to extraction was 10.1 weeks. Follow-up after surgery was 27.09 months on average. Ninety-nine (26.3%) complications in 376 patients were reported, of which 31 required unplanned surgical intervention. Single-arm metanalysis of the complications associated with PVDO revealed 13.71 events (CI: 8.9–19.8) per 50 cases with moderate heterogeneity per Cochrane Q test (χ2=47.12 P<0.01) and I
2 test (68%).

Conclusions:

PVDO is an effective technique to increase cranial vault volume. Factors such as distraction protocol selected based on the patient's needs and age at the time of surgery are crucial for successful outcomes. Furthermore, distraction protocols can be tailored to specific needs, permitting a patient-centered approach. Complications are variable both in incidence as well as severity.
Efficacy of Bone Morphogenetic Protein-2 Peptide-Modified Nano-Hydroxyapatite Alginate Hydrogel in Vertebral Bone Defect Repair
Authors: Zhao Xuchen , Xu Dingli , Luo Jianguang
Published: February 2025

For the effective treatment of vertebral bone defects (BDs), the authors constructed an innovative hydroxyapatite (HAP) nanoparticle–hyaluronic acid (HA)–alginate (ALG) scaffold loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2). The particle size of HAP was around 80 to 100 nm, and its addition markedly reduced the swelling rate and degradability of the HA-ALG scaffold while enhancing its compression resistance, enabling it to better support the BD site and provide a good proliferation environment for osteoblasts. Furthermore, HAP-HA-ALG effectively extended the half-life of rhBMP-2 by nearly 50-fold, allowing it to exert its osteogenic effects more consistently. In cellular experiments, the authors found that rhBMP-2@HAP-HA-ALG significantly enhanced the activity and migration ability of bone marrow mesenchymal stromal cells, as well as the expression level of related osteogenic proteins in cells, which better exerted osteoinductive and osteoconductive functions. In animal tests, rhBMP-2@HAP-HA-ALG could better facilitate the generation of new bone and bone trabecula at BD sites and markedly enhance the bone density level, thus shortening the repair time of BDs. Therefore, rhBMP-2@HAP-HA-ALG shows great potential in the restoration of vertebral BDs.
How many minutes matter: Association between time saved with air medical transport and survival in trauma patients
Authors: Boland Sebastian , Lu Liling , Silver David S. , Byrd Tamara , Guyette Francis X. , Brown Joshua B.
Published: February 2025

BACKGROUND

Air medical transport (AMT) offers a survival advantage to trauma patients for several reasons, including time-savings over ground transport. Triage guidelines suggest AMT use when there are significant time-savings, but how much time needs to be saved to confer a benefit is unclear. Our objective was to define the time-savings threshold for which AMT has a survival benefit over ground transport.

METHODS

Retrospective cohort of adult trauma patients transported ≤40 miles by ground or air in the Pennsylvania Trauma Outcomes Study 2000 to 2017. Geographic information system network analysis generated the counterfactual transport mode times, and we calculated a time-savings of AMT for each patient. We used restricted cubic splines to allow for non-linear effects of time-saved within multilevel logistic regression to identify a threshold of AMT time-savings associated with survival. Subgroups of patients meeting physiologic or anatomic criteria from the National Field Triage Guidelines (NFTG) and those with a positive Air Medical Prehospital Triage (AMPT) Score were analyzed.

RESULTS

There were 280,271 patients included. The NFTG subgroup had survival advantage starting at 13 minutes of AMT time-saved (adjusted odds ratio, 1.14; 95% confidence interval, 1.01–1.30). The AMPT subgroup had survival advantage starting at 23 minutes with the greatest magnitude of improvement (adjusted odds ratio, 1.22; 95% confidence interval, 1.01–1.48). Among patients that did not meet either NFTG criteria or the AMPT score, no amount of time-saved by AMT was associated with survival (p > 0.05). Sensitivity analysis accounting for injury severity in scene time showed the survival benefit starting at 17 minutes of AMT time-saved for the NFTG subgroup and remained 23 minutes in the AMPT subgroup.

CONCLUSION

Among patients meeting physiologic or anatomic NFTG criteria, a ≥ 13- to 17-minute AMT time-savings threshold was associated with improved survival. There is heterogeneity among this threshold among different patient groups that may be due to other benefits of AMT, such as advanced capabilities. These findings can inform AMT triage guidelines.

LEVEL OF EVIDENCE

Therapeutic; Level IV.