bluuebunny/crossref_metadata_2025 huggingface dataset:
High-dimensional generalized median adaptive lasso with application to omics data
Authors: Liu Yahang , Gao Qian , Wei Kecheng , Huang Chen , Wang Ce , Yu Yongfu , Qin Guoyou , Wang Tong
Published: March 2024

Recently, there has been a growing interest in variable selection for causal inference within the context of high-dimensional data. However, when the outcome exhibits a skewed distribution, ensuring the accuracy of variable selection and causal effect estimation might be challenging. Here, we introduce the generalized median adaptive lasso (GMAL) for covariate selection to achieve an accurate estimation of causal effect even when the outcome follows skewed distributions. A distinctive feature of our proposed method is that we utilize a linear median regression model for constructing penalty weights, thereby maintaining the accuracy of variable selection and causal effect estimation even when the outcome presents extremely skewed distributions. Simulation results showed that our proposed method performs comparably to existing methods in variable selection when the outcome follows a symmetric distribution. Besides, the proposed method exhibited obvious superiority over the existing methods when the outcome follows a skewed distribution. Meanwhile, our proposed method consistently outperformed the existing methods in causal estimation, as indicated by smaller root-mean-square error. We also utilized the GMAL method on a deoxyribonucleic acid methylation dataset from the Alzheimer’s disease (AD) neuroimaging initiative database to investigate the association between cerebrospinal fluid tau protein levels and the severity of AD.
RNAdvisor: a comprehensive benchmarking tool for the measure and prediction of RNA structural model quality
Authors: Bernard Clement , Postic Guillaume , Ghannay Sahar , Tahi Fariza
Published: March 2024

RNA is a complex macromolecule that plays central roles in the cell. While it is well known that its structure is directly related to its functions, understanding and predicting RNA structures is challenging. Assessing the real or predictive quality of a structure is also at stake with the complex 3D possible conformations of RNAs. Metrics have been developed to measure model quality while scoring functions aim at assigning quality to guide the discrimination of structures without a known and solved reference. Throughout the years, many metrics and scoring functions have been developed, and no unique assessment is used nowadays. Each developed assessment method has its specificity and might be complementary to understanding structure quality. Therefore, to evaluate RNA 3D structure predictions, it would be important to calculate different metrics and/or scoring functions. For this purpose, we developed RNAdvisor, a comprehensive automated software that integrates and enhances the accessibility of existing metrics and scoring functions. In this paper, we present our RNAdvisor tool, as well as state-of-the-art existing metrics, scoring functions and a set of benchmarks we conducted for evaluating them. Source code is freely available on the EvryRNA platform: https://evryrna.ibisc.univ-evry.fr.
Benchmarking enrichment analysis methods with the disease pathway network
Authors: Buzzao Davide , Castresana-Aguirre Miguel , Guala Dimitri , Sonnhammer Erik L L
Published: March 2024

Enrichment analysis (EA) is a common approach to gain functional insights from genome-scale experiments. As a consequence, a large number of EA methods have been developed, yet it is unclear from previous studies which method is the best for a given dataset. The main issues with previous benchmarks include the complexity of correctly assigning true pathways to a test dataset, and lack of generality of the evaluation metrics, for which the rank of a single target pathway is commonly used. We here provide a generalized EA benchmark and apply it to the most widely used EA methods, representing all four categories of current approaches. The benchmark employs a new set of 82 curated gene expression datasets from DNA microarray and RNA-Seq experiments for 26 diseases, of which only 13 are cancers. In order to address the shortcomings of the single target pathway approach and to enhance the sensitivity evaluation, we present the Disease Pathway Network, in which related Kyoto Encyclopedia of Genes and Genomes pathways are linked. We introduce a novel approach to evaluate pathway EA by combining sensitivity and specificity to provide a balanced evaluation of EA methods. This approach identifies Network Enrichment Analysis methods as the overall top performers compared with overlap-based methods. By using randomized gene expression datasets, we explore the null hypothesis bias of each method, revealing that most of them produce skewed P-values.
scDOT: enhancing single-cell RNA-Seq data annotation and uncovering novel cell types through multi-reference integration
Authors: Xiong Yi-Xuan , Zhang Xiao-Fei
Published: March 2024

The proliferation of single-cell RNA-seq data has greatly enhanced our ability to comprehend the intricate nature of diverse tissues. However, accurately annotating cell types in such data, especially when handling multiple reference datasets and identifying novel cell types, remains a significant challenge. To address these issues, we introduce Single Cell annotation based on Distance metric learning and Optimal Transport (scDOT), an innovative cell-type annotation method adept at integrating multiple reference datasets and uncovering previously unseen cell types. scDOT introduces two key innovations. First, by incorporating distance metric learning and optimal transport, it presents a novel optimization framework. This framework effectively learns the predictive power of each reference dataset for new query data and simultaneously establishes a probabilistic mapping between cells in the query data and reference-defined cell types. Secondly, scDOT develops an interpretable scoring system based on the acquired probabilistic mapping, enabling the precise identification of previously unseen cell types within the data. To rigorously assess scDOT’s capabilities, we systematically evaluate its performance using two diverse collections of benchmark datasets encompassing various tissues, sequencing technologies and diverse cell types. Our experimental results consistently affirm the superior performance of scDOT in cell-type annotation and the identification of previously unseen cell types. These advancements provide researchers with a potent tool for precise cell-type annotation, ultimately enriching our understanding of complex biological tissues.
Artificial intelligence in medicine: mitigating risks and maximizing benefits via quality assurance, quality control, and acceptance testing
Authors: Mahmood Usman , Shukla-Dave Amita , Chan Heang-Ping , Drukker Karen , Samala Ravi K , Chen Quan , Vergara Daniel , Greenspan Hayit , Petrick Nicholas , Sahiner Berkman , Huo Zhimin , Summers Ronald M , Cha Kenny H , Tourassi Georgia , Deserno Thomas M , Grizzard Kevin T , Näppi Janne J , Yoshida Hiroyuki , Regge Daniele , Mazurchuk Richard , Suzuki Kenji , Morra Lia , Huisman Henkjan , Armato Samuel G , Hadjiiski Lubomir
Published: March 2024

The adoption of artificial intelligence (AI) tools in medicine poses challenges to existing clinical workflows. This commentary discusses the necessity of context-specific quality assurance (QA), emphasizing the need for robust QA measures with quality control (QC) procedures that encompass (1) acceptance testing (AT) before clinical use, (2) continuous QC monitoring, and (3) adequate user training. The discussion also covers essential components of AT and QA, illustrated with real-world examples. We also highlight what we see as the shared responsibility of manufacturers or vendors, regulators, healthcare systems, medical physicists, and clinicians to enact appropriate testing and oversight to ensure a safe and equitable transformation of medicine through AI.
Nosocomial Infections in Adults Receiving Extracorporeal Membrane Oxygenation: A Review for Infectious Diseases Clinicians
Authors: Marcus Joseph E , Shah Aditya , Peek Giles J , MacLaren Graeme
Published: March 2024

Over the past 10 years, there has been a rapid expansion in the use of extracorporeal membrane oxygenation (ECMO) in the care of patients with refractory cardiac or respiratory failure. Infectious diseases clinicians must reconcile conflicting evidence from limited studies as they develop practices at their own institutions, which has resulted in considerably different practices globally. This review describes infection control and prevention as well as antimicrobial prophylaxis strategies in this population. Data on diagnostics and treatment for patients receiving ECMO with a focus on diagnostic and antimicrobial stewardship is then examined. This review summarizes gaps in the current ECMO literature and proposes future needs, including developing clear definitions for infections and encouraging transparent reporting of practices at individual facilities in future clinical trials.
BotGSL: Twitter Bot Detection with Graph Structure Learning
Authors: Wei Chuancheng , Liang Gang , Yan Kexiang
Published: March 2024

Twitter bot detection is an important and meaningful task. Existing methods can be bypassed by the latest bots that disguise themselves as genuine users and evade detection by mimicking them. These methods also fail to leverage the clustering tendencies of users, which is the most important feature for detecting bots at the community level. Moreover, they neglect the implicit relations between users that contain crucial clues for detection. Furthermore, the user relation graphs, which are essential for graph-based methods, may be unreliable due to noise and incompleteness in datasets. To address these issues, a bot detection framework with graph structure learning is proposed. The framework constructs a heterogeneous graph with users and their relations, extracts multiple features to characterise user intent and establishes a feature similarity graph using metric learning. Implicit relations are discovered to derive an implicit relation graph. Additionally, a semantic relation graph is generated by aggregating relation semantics among users. The graphs are then fused and embedded into a Graph Transformer for training with partially known user labels. The framework demonstrated a 91.92% average detection accuracy on three real-world benchmark, outperforming state-of-the-art methods, while also showcasing the effectiveness and necessity of each module.
Deep Learning-Based Cyberbullying Detection in Kurdish Language
Authors: Badawi Soran
Published: March 2024

Cyberbullying is a significant concern in this digital age due to its harmful effects on individuals and society. Sadly, social media platforms have only exacerbated the problem, making it imperative to find effective ways to identify and prevent offensive content. While previous research has extensively focused on English and explored machine learning techniques to tackle this issue. To address this gap, this paper introduces a new hybrid deep learning model called Gray Wolf Algorithm-convolutional neural network (GWA-CNN), explicitly designed to detect cyberbullying in the Kurdish language on Twitter. The proposed model combines the CNN framework with an optimised GWA version to improve CNN’s parameters and reduce training time. We evaluated GWA-CNN thoroughly utilizing the first-ever manually annotated Kurdish dataset of 30k tweets that have been meticulously curated and divided into three categories, namely sexism, racism and neutral expressions, and compared its performance to those of state-of-the-art algorithms such as Naïve Bayes, K-Nearest Neighbors, Recurrent Neural Networks, Gated Recurrent Units and attention-based transformer. The experimental results demonstrate that GWA-CNN exhibited superior performance in all scenarios, outperforming other approaches in detecting cyberbullying on Twitter.
Functional characterization of HNF4A gene variants identify promoter and cell line specific transactivation effects
Authors: Kaci Alba , Solheim Marie Holm , Silgjerd Trine , Hjaltadottir Jorunn , Hornnes Lorentze Hope , Molnes Janne , Madsen Andre , Sjøholt Gry , Bellanné-Chantelot Christine , Caswell Richard , Sagen Jørn V , Njølstad Pål R , Aukrust Ingvild , Bjørkhaug Lise
Published: March 2024

Hepatocyte nuclear factor-4 alpha (HNF-4A) regulates genes with roles in glucose metabolism and β-cell development. Although pathogenic HNF4A variants are commonly associated with maturity-onset diabetes of the young (MODY1; HNF4A-MODY), rare phenotypes also include hyperinsulinemic hypoglycemia, renal Fanconi syndrome and liver disease. While the association of rare functionally damaging HNF1A variants with HNF1A-MODY and type 2 diabetes is well established owing to robust functional assays, the impact of HNF4A variants on HNF-4A transactivation in tissues including the liver and kidney is less known, due to lack of similar assays. Our aim was to investigate the functional effects of seven HNF4A variants, located in the HNF-4A DNA binding domain and associated with different clinical phenotypes, by various functional assays and cell lines (transactivation, DNA binding, protein expression, nuclear localization) and in silico protein structure analyses. Variants R85W, S87N and R89W demonstrated reduced DNA binding to the consensus HNF-4A binding elements in the HNF1A promoter (35, 13 and 9%, respectively) and the G6PC promoter (R85W ~10%). While reduced transactivation on the G6PC promoter in HepG2 cells was shown for S87N (33%), R89W (65%) and R136W (35%), increased transactivation by R85W and R85Q was confirmed using several combinations of target promoters and cell lines. R89W showed reduced nuclear levels. In silico analyses supported variant induced structural impact. Our study indicates that cell line specific functional investigations are important to better understand HNF4A-MODY genotype–phenotype correlations, as our data supports ACMG/AMP interpretations of loss-of-function variants and propose assay-specific HNF4A control variants for future functional investigations.
Sweden, NATO and the gendered silencing of feminist foreign policy
Authors: Wright Katharine A M , Rosamond Annika Bergman
Published: March 2024

Sweden was the first state to adopt a Feminist Foreign Policy (FFP) in 2014, drawing on its state feminist tradition and support for the United Nations' Women, Peace and Security (WPS) agenda. Yet following the full-scale Russian invasion of Ukraine in February 2022 and Sweden's move to seek NATO membership—abandoning its policy of non-alignment—a gendered silence on FFP pervaded. Significantly, this therefore predated the official abandonment of FFP following the election of a new government in October 2022. NATO membership was viewed as incompatible with FFP. Yet, NATO has long sought to project itself as a gender-just actor, including through engagement with the WPS agenda culminating in its inclusion in the 2022 Strategic Concept. Further, Sweden—as a NATO partner—had been a stalwart of the alliance's work on WPS. This article contributes to understanding the role of gendered silences in shaping strategic narratives, in this case concerning Sweden's NATO membership bid. It provides insight for policy-makers and diplomats on the impact gendered silence can have on the wider efficacy of FFP and WPS, even during processes such as NATO enlargement which might otherwise be viewed as ‘gender neutral’, particularly when imbued with urgency.
How peacekeeping has reshaped Latin America
Authors: Jenne Nicole
Published: March 2024

The United Nations Stabilization Mission in Haiti (MINUSTAH, 2004–2017) was an unprecedented effort of Latin American peacekeeping. Nine countries contributed the majority of troops to the mission in which regional governments sought to handle a security crisis in their neighbourhood rather than leaving the lead to western countries. However, when the mission came to an end after thirteen years, peacekeeping faded from the regional and national security agendas, with the exception of Uruguay. How and why did MINUSTAH impact the region's current hesitation to engage in peace operations? To answer this question, the article draws on assemblage theory and uses data from policy documents, academic literature and previous research on peacekeeping in Latin America. I argue that contrary to what Latin America's current, limited peacekeeping engagement suggests, MINUSTAH produced significant changes in the region's political landscape. While these could have paved the way to greater involvement in peace operations, however, parallel developments shaped Latin American security policies and military planning at the expense of the region's future participation in UN peacekeeping. The article adds to existing scholarship by probing the conditions that drive the temporality of assemblages and provides a new perspective on Latin American peacekeeping.
Arbuscular mycorrhizae status of host plant affects offspring’s phenotype and transcriptome expression in a low-phosphorus environment
Authors: Liu Shijun , Xu Jing , Huang Hong , Tang Jianjun , Chen Xin
Published: March 2024

Although the effects of arbuscular mycorrhizal fungi (AMF) on host plants have been well documented, whether the effects of AMF on parental generations affect offspring performance is not fully clear. We conducted a common garden experiment to determine whether AMF status of host plants (Medicago truncatula) affects phenotype and transcriptome expression of their offspring. Seeds from four type parental treatments (low-phosphorus (P) soil without AMF, low-P soil with AMF, high-P soil without AMF and high-P soil with AMF) were grown under low-P (LPS) and normal-P soil (OHS) conditions. The flowering pattern of LP offspring was similar to their parents, such that plants with AMF flowered earlier than those without AMF under OHS condition but were opposite under LPS condition. The transcriptome differential analysis showed that some differential transcripts (45 for parental plants growing under low-P condition and 3 for parental plants growing under high-P condition) expression patterns between offspring were comparable, and that only affected by parental AMF status regardless of the P environment that offspring was grown. Others (146 for parental plants growing under low-P condition and 2 for parental plants growing under high-P condition), however, were affected both by the parental AMF status and the offspring P environment. In addition, the number of differential transcripts between offspring whose parental plants grew under high-P condition was far less than under low-P condition. These results indicate that AMF may not only affect the current generation of host plants but also affect the offspring especially when their parents have experienced a stressful environment.
Estimating the size of undeclared work from partially misclassified survey data via the Expectation–Maximization algorithm
Authors: Arezzo Maria Felice , Guagnano Giuseppina , Vitale Domenico
Published: March 2024

Undeclared work (UW) is pervasive in economies. This explains the interest of public authorities in knowing its size and drivers. Unfortunately, this is a very complex task because several issues often arise in the collected data, due to the sensitivity of the topic. In sample surveys, one major problem is misclassification. Without appropriate adjustments, inference would provide biased estimates, the reason being the concealing of undeclared status. In order to overcome such problem, we developed a methodology based on a Expectation–Maximization algorithm that accounts for misclassification due to dishonest answering. Through the proposed approach, we are able to estimate the prevalence of UW and its determinants. The reliability of the methodology is validated through an extensive simulation study. An application to the Special Eurobarometer survey no. 402 on UW is provided.
Illuminating stomatal responses to red light: establishing the role of Ci-dependent versus -independent mechanisms in control of stomatal behaviour
Authors: Taylor Georgia , Walter Julia , Kromdijk Johannes
Published: March 2024

The stomatal response to red light appears to link stomatal conductance (gs) with photosynthetic rates. Initially, it was suggested that changes in intercellular CO2 concentration (Ci) provide the main cue via a Ci-dependent response. However, evidence for Ci-independent mechanisms suggests an additional, more direct relationship with photosynthesis. While both Ci-dependent and -independent mechanisms clearly function in stomatal red light responses, little is known regarding their relative contribution. The present study aimed to quantify the relative magnitude of Ci-dependent and -independent mechanisms on the stomatal red light response, to characterize their interplay and to assess the putative link between plastoquinone redox state and Ci-independent stomatal responses. Red light response curves measured at a range of Ci values for wild-type Arabidopsis (Col-0) and the CO2 hyposensitive mutant ca1ca4 allowed deconvolution of Ci-dependent and -independent pathways. Surprisingly, we observed that both mechanisms contribute equally to stomatal red light responses, but Ci-independent stomatal opening is suppressed at high Ci. The present data are also consistent with the involvement of the plastoquinone redox state in coordinating the Ci-independent component. Overall, it seems that while Ci-independent mechanisms are distinct from responses to Ci, interplay between these two pathways is important to facilitate effective coordination between gs and photosynthesis.
FLOWERING LOCUS T-mediated thermal signalling regulates age-dependent inflorescence development in Arabidopsis thaliana
Authors: González-Suárez Pablo , Walker Catriona H , Lock Thomas , Bennett Tom
Published: March 2024

Many plants show strong heteroblastic changes in the shape and size of organs as they transition from juvenile to reproductive age. Most attention has been focused on heteroblastic development in leaves, but we wanted to understand heteroblastic changes in reproductive organ size. We therefore studied the progression of reproductive development in the model plant Arabidopsis thaliana, and found strong reductions in the size of flowers, fruit, seed, and internodes during development. These did not arise from correlative inhibition by older fruits, or from changes in inflorescence meristem size, but seemed to stem from changes in the size of floral organ primordia themselves. We hypothesized that environmental conditions might influence this heteroblastic pattern and found that the ambient temperature during organ initiation strongly influences organ size. We show that this temperature-dependent heteroblasty is dependent on FLOWERING LOCUS T (FT)-mediated signal integration, adding to the repertoire of developmental processes regulated by this pathway. Our results demonstrate that rising global temperatures will not affect just fertility, as is widely described, but also the size and seed number of fruits produced. However, we also show that such effects are not hard-wired, and that selective breeding for FT expression during reproductive development could mitigate such effects.
Integrating multi-modal imaging in radiation treatments for glioblastoma
Authors: Breen William G , Aryal Madhava P , Cao Yue , Kim Michelle M
Published: March 2024

Advances in diagnostic and treatment technology along with rapid developments in translational research may now allow the realization of precision radiotherapy. Integration of biologically informed multimodality imaging to address the spatial and temporal heterogeneity underlying treatment resistance in glioblastoma is now possible for patient care, with evidence of safety and potential benefit. Beyond their diagnostic utility, several candidate imaging biomarkers have emerged in recent early-phase clinical trials of biologically based radiotherapy, and their definitive assessment in multicenter prospective trials is already in development. In this review, the rationale for clinical implementation of candidate advanced magnetic resonance imaging and positron emission tomography imaging biomarkers to guide personalized radiotherapy, the current landscape, and future directions for integrating imaging biomarkers into radiotherapy for glioblastoma are summarized. Moving forward, response-adaptive radiotherapy using biologically informed imaging biomarkers to address emerging treatment resistance in rational combination with novel systemic therapies may ultimately permit improvements in glioblastoma outcomes and true individualization of patient care.
Establishing the relationship between wildfire smoke and performance metrics on finished beef cattle in Western Rangelands
Authors: Macias Franco Arturo , Elins Moreira da Silva Aghata , Holton Graham , Brody Tio , Alves Fonseca Mozart
Published: March 2024

Identifying causal relationships is complicated. Researchers usually overlook causality behind relationships which can generate misleading associations. Herein, we carefully examine the parametric relationship and causality between wildfire smoke exposure and animal performance and behavior metrics over a period of 2 yr in Reno, Nevada. The animals in the 2020 smoke season were grain-finished (n = 12) and grass-finished (n = 12), whereas the animals during the 2021 season were fed under the same diet but finished with either a hormonal implant (n = 9), or without (n = 9). The dataset included daily records of feed intake (FI), body weight (BW), water intake (WI), average daily gain (ADG), and WI behavior (time spent drinking [TSD]; water intake events [WIE]; no-WIE [NWIE]). Variable tree length Bayesian additive regression trees (BART) were utilized to investigate the relationships between air quality index (AQI), particulate matter 2.5 μm (PM2.5) and 10 μm (PM10), NO2, SO2, Ozone, and CO levels in the air (sensors < 1.6 km from animals) with the animal data. Additionally, linear mixed models with a 7-d lag were used to evaluate parametric relationships among the same variables. All statistical analyses were performed on R Statistical Software (R Core Team 2023). Under the linear mixed model with a 7-d lag, significant positive and negative associations were found for all parameters examined (P < 0.05). Negative associations were found between FI, WI, ADG, BW, WIE, NWIE, TSD, and PM2.5 (P < 0.05) for at least one animal group. Positive linear associations between wildfire smoke parameters and the metrics evaluated were more variable and dependent on year, treatment, and smoke parameters. When examining the credible intervals and the variable importance in the BART, relationships were more difficult to identify. However, some associations were found for Ozone, AQI, NO2, CO, and PM10 (P < 0.05). Overall, our results carefully examine the relationship between smoke parameters and cattle performance and present interesting pathways previously unexplored that could guide early culling/finishing of animals to avoid economic losses associated with performance decrease in response to wildfire smoke exposure. Though interesting associations are found under linear mixed models, causality is difficult to establish, which highlights the need for controlled exposure experiments.
Relevant dimensions to give meaning to pension decisions
Authors: Strikwerda Jelle , Holleman Bregje , Hoeken Hans
Published: March 2024

Pension participants face complex decisions. Information about the decision alternatives often contains the exact monetary amounts associated with the alternatives. Grounded in Fuzzy-Trace Theory (FTT), we argue that informed decision making requires participants to (accurately) understand meaningful differences between decision alternatives, rather than to rely on purely numerical differences in amounts. The objective of this study was to identify, for three decisions Dutch participants can make regarding their old-age pension, what dimensions participants take into account when giving meaning to the decision alternatives. We conducted 39 semi-structured in-depth interviews with Dutch pension participants in which we discussed the considerations of participants to choose for the decision alternatives. These interviews were analyzed using thematic analysis. Our analysis shows that a number of dimensions are taken into account, partially overlapping for the three decisions: life expectancy, (in)sufficient income, financial maximization, work–life balance, and job satisfaction. According to FTT, participants can be supported in extracting meaningful representations by providing cues about the dimensions that might be affected by the various decision alternatives. The dimensions identified in this paper can serve as a useful starting point for such support.
Toward a Microbe-Assisted Crop Production
Authors: Sessitsch Angela , Trivedi Pankaj , van der Heijden Marcel
Published: March 2024

For a long time, microbial applications in crop production focused primarily on the symbiosis between mycorrhizal fungi and plants and the relationship between N2-fixing rhizobia and legumes. However, plant-associated microorganisms and microbiomes in general have lately gained immense attention, and the available information on the ecology and functions of microbiomes in the soil and plant environment exploded in the last decade. With this understanding, researchers as well as the industry have realized the vast potential of microorganisms to be used in agriculture and most importantly, to make farming more sustainable. Microorganisms have been shown to be applicable for plant protection and to improve plant nutrition. As a consequence, microbiome management can help to replace agrochemicals and increase environmental and human health. Furthermore, agriculture is facing various challenges related to climate change such as drought or emerging pathogens. Also, for these scenarios, microorganisms may find application to alleviate various abiotic and biotic stresses.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Increasing Sweep Gas Flow Reduces Respiratory Drive and Dyspnea in Nonintubated Venoarterial Extracorporeal Membrane Oxygenation Patients: A Pilot Study
Authors: Bureau Côme , Schmidt Matthieu , Chommeloux Juliette , Rivals Isabelle , Similowski Thomas , Hékimian Guillaume , Luyt Charles-Edouard , Niérat Marie-Cécile , Dangers Laurence , Dres Martin , Combes Alain , Morélot-Panzini Capucine , Demoule Alexandre
Published: March 2024

Background

Data on assessment and management of dyspnea in patients on venoarterial extracorporeal membrane oxygenation (ECMO) for cardiogenic shock are lacking. The hypothesis was that increasing sweep gas flow through the venoarterial extracorporeal membrane oxygenator may decrease dyspnea in nonintubated venoarterial ECMO patients exhibiting clinically significant dyspnea, with a parallel reduction in respiratory drive.

Methods

Nonintubated, spontaneously breathing, supine patients on venoarterial ECMO for cardiogenic shock who presented with a dyspnea visual analog scale (VAS) score of greater than or equal to 40/100 mm were included. Sweep gas flow was increased up to +6 l/min by three steps of +2 l/min each. Dyspnea was assessed with the dyspnea-VAS and the Multidimensional Dyspnea Profile. The respiratory drive was assessed by the electromyographic activity of the alae nasi and parasternal muscles.

Results

A total of 21 patients were included in the study. Upon inclusion, median dyspnea-VAS was 50 (interquartile range, 45 to 60) mm, and sweep gas flow was 1.0 l/min (0.5 to 2.0). An increase in sweep gas flow significantly decreased dyspnea-VAS (50 [45 to 60] at baseline vs. 20 [10 to 30] at 6 l/min; P < 0.001). The decrease in dyspnea was greater for the sensory component of dyspnea (−50% [−43 to −75]) than for the affective and emotional components (−17% [−0 to −25] and −12% [−0 to −17]; P < 0.001). An increase in sweep gas flow significantly decreased electromyographic activity of the alae nasi and parasternal muscles (−23% [−36 to −10] and −20 [−41 to −0]; P < 0.001). There was a significant correlation between the sweep gas flow and the dyspnea-VAS (r = −0.91; 95% CI, −0.94 to −0.87), between the respiratory drive and the sensory component of dyspnea (r = 0.29; 95% CI, 0.13 to 0.44) between the respiratory drive and the affective component of dyspnea (r = 0.29; 95% CI, 0.02 to 0.54) and between the sweep gas flow and the alae nasi and parasternal (r = −0.31; 95% CI, −0.44 to −0.22; and r = −0.25; 95% CI, −0.44 to −0.16).

Conclusions

In critically ill patients with venoarterial ECMO, an increase in sweep gas flow through the oxygenation membrane decreases dyspnea, possibly mediated by a decrease in respiratory drive.

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Perceived Barriers and Strategies to Increasing the BSN-Prepared Nursing Workforce
Authors: Clark Terri A.
Published: March 2024

Care provided by Bachelor of Science in Nursing (BSN)-prepared Registered Nurses (RNs) has been shown to lead to more positive patient outcomes compared to care provided by non-BSN-prepared RNs. A Fall 2021 study explored barriers of requiring a BSN degree of staff nurses from the perspective of hospital and long-term care facility nurse leaders in Tennessee (N = 89), strategies to increase the number of nurses with BSNs, and association between leadership goals and the number of BSN-prepared nurses in the facilities. Seven barriers to requiring the BSN and nine strategies to increase BSNs were identified. Significant association was found between having plans to increase the number of BSN nurses and the percentage of nurses in the facility with BSN degrees.
Loving and Giving to Others
Authors: Tanasirijiranont Rattanaporn , Chawaphanth Sarinthip , Sennun Panida , Langkarpint Prathana , LeSeure Peeranuch , Rojanasupot Poonpilat , Sukkheo Theepprapin
Published: March 2024

The “Spirit of the Second Mile Nursing” (SSMN) has been cultivated in nurses who graduated from McCormick Faculty of Nursing, Thailand. These nurses were taught and they practice to care for clients, family members, and colleagues with compassion, consideration, love, enthusiasm, and willingness throughout the program. This study aimed to explore the SSMN concept using a Grounded Theory Methodology (GTM). The findings show that the SSMN concept is based on “Loving and Giving for others” principles. It consisted of three categories: the Spirit of the Second Mile nurse characteristics, nursing care, and consequences of the SSMN. Knowledge from this study provides nurses with a better understanding of the SSMN concept within the context of a Thai and American Christian view.
Plastic Surgery or Facial Plastic Surgery: Can the Public Tell the Difference?
Authors: Pyon Rachel E. , Sayadi Lohrasb R. , Pakvasa Mikhail , Vyas Raj M. , Wang Eric D.
Published: March 2024

Background:

Social media and online advertising are increasingly used by plastic surgeons (PSs) to educate patients and obtain referrals, but it remains unclear whether the general public can distinguish the difference in training and accreditation among medical professionals advertising online. Our study elucidates the public’s expectations regarding the distinction between plastic surgery and facial plastic surgery.

Methods:

A survey was distributed via MTurk, an Amazon surveying service, to collect information about demographics and assumptions that would be made solely based on the terminology “facial PS” (FPS) and “PS.” Participants were restricted to those residing in the United States.

Results:

A total of 253 responses were collected. Based on the term FPS, respondents on average moderately to strongly agreed that they would expect an FPS to have completed a plastic and reconstructive surgery residency program (mean = 1.81; scale from 1= strongly agree to 5= strongly disagree) and would feel moderately to strongly misled if they visited an FPS for a consultation and later learned that the provider did not complete a plastic and reconstructive surgery residency (mean = 3.62; scale from 1 = not misled at all to 5 = extremely misled).

Conclusions:

Despite increasing advocacy by professional societies and the member societies of the American Board of Medical Specialties, this study demonstrated that the lay public is unaware of factually different training and certification pathways given similarity in nomenclature. This study was notably not designed to draw conclusions or imply superiority of one specialty, certifying board, or training model over the other.
Standardization development of traditional Chinese medicine in Beijing from the aspect of standard development contribution index
Authors: Chen Meng , Fu Qiang
Published: March 2024

The standardization of traditional Chinese medicine (TCM), occupying a critical position in the development of TCM, is a basic, strategic, and overall work. In this study, we initially referred to data from the National Public Service Platform for Standards Information, the National Group Platform for Standards Information, and the collection of materials from the National Library of Standards, and then performed a comprehensive analysis of 1426 pieces of TCM standards related information among them. Based on the analytic results, the number of releases, the regional distribution of drafting institutions, and the standard contribution index of 3 major categories (basic general, technology, and management) of TCM and their 16 subcategories were systematically exhibited. According to the ranking of the drafting unit in the standard, the corresponding standard development contribution index is given, and with the standard development contribution index as the main line, the current situation and existing problems of standardization development in Beijing are analyzed. Suggestions were put forward to improve the framework of the Chinese medicine standard system, optimize the industrial structure of Chinese medicine, promote the interactive development of Chinese medicine science and technology innovation and standardization, and promote the implementation and application of Chinese medicine standards.
Chronic hepatitis B baseline viral load and on-treatment liver cancer risk: A multinational cohort study of HBeAg-positive patients
Authors: Choi Won-Mook , Yip Terry Cheuk-Fung , Kim W. Ray , Yee Leland J. , Brooks-Rooney Craig , Curteis Tristan , Clark Laura J. , Jafry Zarena , Chen Chien-Hung , Chen Chi-Yi , Huang Yi-Hsiang , Jin Young-Joo , Jun Dae Won , Kim Jin-Wook , Park Neung Hwa , Peng Cheng-Yuan , Shin Hyun Phil , Shin Jung Woo , Yang Yao-Hsu , Wong Grace Lai-Hung , Lim Young-Suk
Published: March 2024

Background and Aims:

A single-nation study reported that pretreatment HBV viral load is associated with on-treatment risk of HCC in patients who are HBeAg-positive without cirrhosis and with chronic hepatitis B initiating antiviral treatment. We aimed to validate the association between baseline HBV viral load and on-treatment HCC risk in a larger, multinational cohort.

Approach and Results:

Using a multinational cohort from Korea, Hong Kong, and Taiwan involving 7545 adult patients with HBeAg-positive, without cirrhosis and with chronic hepatitis B who started entecavir or tenofovir treatment with baseline HBV viral load ≥5.00 log10IU/mL, HCC risk was estimated by baseline viral load. HBV viral load was analyzed as a categorical variable. During continuous antiviral treatment (median, 4.28 y), HCC developed in 200 patients (incidence rate, 0.61 per 100 person-years). Baseline HBV DNA level was independently associated with on-treatment HCC risk in a nonlinear pattern. HCC risk was lowest with the highest baseline viral load (≥8.00 log10IU/mL; incidence rate, 0.10 per 100 person-years), but increased sharply as baseline viral load decreased. The adjusted HCC risk was 8.05 times higher (95% CI, 3.34–19.35) with baseline viral load ≥6.00 and <7.00 log10IU/mL (incidence rate, 1.38 per 100 person-years) compared with high (≥8.00 log10IU/mL) baseline viral load (p<0.001).

Conclusions:

In a multinational cohort of adult patients with HBeAg-positive without cirrhosis and with chronic hepatitis B, baseline HBV viral load was significantly associated with HCC risk despite antiviral treatment. Patients with the highest viral load who initiated treatment had the lowest long-term risk of HCC development.
Continuous versus interrupted anastomotic technique for the Hepaticojejunostomy-a prospective cohort study
Authors: Yadav Tek Narayan , Pandit Narendra , Deo Kunal Bikram , Awale Lalijan , Neupane Durga , Adhikary Shailesh
Published: March 2024

Background:

Interrupted sutures is the gold standard technique of Hepaticojejunostomy (HJ) for bilioenteric anastomosis. This study compares the safety and early complications of continuous and interrupted suture HJ.

Methods:

A prospective study involving all elective HJ between September 2019 and June 2021 was conducted. Patients with type IV or V biliary strictures, duct diameter <8 mm and/or associated vascular injury, and bilateral HJ were excluded. The study patients were divided into two random groups; interrupted and continuous anastomotic technique. Patient demographics, preoperative parameters including pathology (benign vs. malignant), HJ leak, suture time, and postoperative morbidity were recorded.

Results:

Total 34 patients were enrolled. Eighteen (52.9%) were into interrupted and 16 (47.1%) patients into the continuous group. Both the groups were comparable with regards to demographics, hemoglobin, serum albumin, preoperative cholangitis and biliary stenting. Total three (8.8%) patients in the entire study developed bile leak; interrupted-2 and continuous-1, which was not significant statistically (P=1.0). Similarly, total number of sutures used and the mean operating time to complete anastomosis in the continuous group was significantly lesser than the interrupted group (2.3±0.5 vs. 9.6±1.6, P<0.001) and (16.2±3.1 vs. 38.6±9.2 min, P<0.001) respectively. There were three (18.8%) re-exploration in the continuous anastomotic technique. Among them, only one re-operation was due to HJ anastomosis failure without mortality, remaining had re-exploration for bleeding (non-HJ).

Conclusions:

Both the techniques is safe with comparable morbidity. Further, continuous has an added advantage of decreased anastomotic time and cost.
Low-energy shock waves promote the cisplatin chemosensitivity of human osteosarcoma MNNG/HOS cells via the P2X7/Akt/mTOR pathway
Authors: Gai Ning , Ju Wei-na , Yu Tie-cheng , Qi Bao-chang
Published: March 2024

Background:

The current dilemma of osteosarcoma treatment is the resistance of chemotherapeutic drugs after long-term usage, which also introduces life-threatening side effects.

Methods and results:

To minimize chemoresistance in osteosarcoma patients, the authors applied shock waves (SWs) to human osteosarcoma MNNG/HOS cells, then evaluated the cell viability and extracellular ATP levels, and further investigated the effect of SWs on cisplatin (DDP) cytotoxicity in MNNG/HOS cells. The authors’ results showed that 400 SW pulses at 0.21 mJ/mm2 exhibited little influence on the MNNG/HOS cell viability. In addition, this SW condition significantly promoted the extracellular ATP release in MNNG/HOS cells. Importantly, low-energy SWs obviously increased Akt and mammalian target of rapamycin (mTOR) phosphorylation and activation in MNNG/HOS cells, which could be partially reversed in the presence of P2X7 siRNA. The authors also found that low-energy SWs strongly increased the DDP sensitivity of MNNG/HOS cells in the absence of P2X7.

Conclusions:

For the first time, the authors found that SW therapy reduced the DDP resistance of MNNG/HOS osteosarcoma cells when the ATP receptor P2X7 was downregulated. SW therapy may provide a novel treatment strategy for chemoresistant human osteosarcoma.
Knowledge and attitude toward total knee arthroplasty among senior medical students in comparison to public population in Saudi Arabia: cross-sectional study
Authors: Makhdom Asim M. , Jan Mohammed Anwar
Published: March 2024

Background:

Total knee arthroplasty (TKA) is currently considered one of the most common and successful orthopaedic procedures. It plays an essential role in the long-term treatment of osteoarthritis and enhances the patient’s quality of life. Very little is known about public and medical students’ perceptions of this procedure. The purpose of the current study was to assess the knowledge and attitudes toward TKA among medical students in comparison with the general population in Saudi Arabia.

Method:

A cross-sectional study was conducted between February and March 2023. Senior-year (interns and the fifth and sixth year) medical school students (Group A) as well as the general population (Group B) were surveyed online. The distributed questionnaire was divided into three main segments: demographics, knowledge, and the prognosis of TKA. The answers were statistically compared among participants.

Results:

Three hundred thirty-one participants were involved in this study, of whom 202 were from the general population and 128 were medical students. Most of the participants were males (68.3%), and the mean age was 32.95±15.22. The results were divided into three groups: demographic, knowledge, and prognosis. Medical students demonstrated a higher knowledge score (111.25±42.38) compared to the general population knowledge score (64.68±44.29), (P<0.001).

Conclusion:

Senior-year medical school students and the general population showed a low level of knowledge regarding TKA. However, the students had a better awareness of the procedure. The authors recommend frequent public education programs for the benefits of TKA. In addition, medical schools are encouraged to emphasize the benefits of TKA as a treatment choice for end-stage knee arthritis in their curriculum and training.