bluuebunny/crossref_metadata_2025 huggingface dataset:
Dichotomy results for eventually always hitting time statistics and almost sure growth of extremes
Authors: Holland Mark , Kirsebom Maxim , Kunde Philipp , Persson Tomas
Published: March 2024

Suppose

(
f
,

X

,
μ
)

(f,\mathcal {X},\mu )

is a measure preserving dynamical system and

ϕ
:

X

→

R

\phi \colon \mathcal {X}\to \mathbb {R}

a measurable function. Consider the maximum process

M
n

≔
max
{

X
1

,
…
,

X
n

}

M_n≔\max \{X_1,\ldots ,X_n\}

, where

X
i

=
ϕ
∘

f

i
−
1

X_i=\phi \circ f^{i-1}

is a time series of observations on the system. Suppose that

(

u
n

)

(u_n)

is a non-decreasing sequence of real numbers, such that

μ
(

X
1

>

u
n

)
→
0

\mu (X_1>u_n)\to 0

. For certain dynamical systems, we obtain a zero–one measure dichotomy for

μ
(

M
n

≤

u
n

i.o.
)

\mu (M_n\leq u_n\,\text {i.o.})

depending on the sequence

u
n

u_n

. Specific examples are piecewise expanding interval maps including the Gauß map. For the broader class of non-uniformly hyperbolic dynamical systems, we make significant improvements on existing literature for characterising the sequences

u
n

u_n

. Our results on the permitted sequences

u
n

u_n

are commensurate with the optimal sequences (and series criteria) obtained by Klass (1985) for i.i.d. processes. Moreover, we also develop new series criteria on the permitted sequences in the case where the i.i.d. theory breaks down. Our analysis has strong connections to specific problems in eventual always hitting time statistics and extreme value theory.
Job function as determinant of clinker exposure at workplaces during cement production
Authors: Weinbruch Stephan , Scerri Mark , Eduard Wijnand , Thomassen Yngvar , Nordby Karl-Christian , Notø Hilde
Published: March 2024

Objectives

In the cement production industry, exposure to airborne particulate matter is associated with a decline in lung function and increased airway symptoms. Exposure to clinker—the major constituent of cement and supposedly the cause of the observed adverse health effects—was determined recently in 15 cement production plants located in 8 different countries (Estonia, Greece, Italy, Norway, Sweden, Switzerland, Spain, Turkey). It was shown that the median clinker abundance in the thoracic fraction varied between approximately 20% and 70% for individual plants. The present study complements the previous work by investigating the significance of job function as a determinant of clinker exposure.

Methods

The elemental composition (water and acid-soluble fractions separately) of 1,227 personal thoracic workplace samples was analyzed by positive matrix factorization (PMF) to determine the contribution of different sources to the composition of airborne particulate matter and to quantify the clinker content.

Results

Median thoracic mass air concentrations varied for individual job functions between 0.094 and 12 mg/m3 (estimated separately for different plants). The PMF 5-factor solution yielded median relative clinker abundances in the personal thoracic samples between 7.6% and 81% for individual job functions. Thoracic clinker air concentrations are highest for cleaning, production, and maintenance work, and lowest for administration and other work. Foremen and laboratory personnel show intermediate exposure levels. The plant was found to have a much higher contribution to the total variance of the thoracic clinker air concentrations than the job function. Thoracic clinker air concentrations (medians between 0.01 and 5.5 mg/m3) are strongly correlated with the thoracic mass air concentrations and to a lesser extent with the relative clinker abundance in an aerosol sample.

Conclusions

Job function is an important predictor of exposure to clinker in the cement production industry. As clinker is suspected to be the causal agent for the observed adverse health effects among cement production workers, the clinker air concentration may be a better exposure metric than thoracic air mass concentration despite the strong correlation between the two. Reduction strategies should focus on the most exposed job categories cleaning, production, and maintenance work.
Biological Testing and Interpretation of Laboratory Results Associated with Detecting Newborns with Substance Exposure
Authors: McMillin Gwendolyn A , Morad Anna W , Boyd Jessica M , Johnson-Davis Kamisha L , Metz Torri D , Smid Marcela C , Krasowski Matthew D
Published: March 2024

Background

Substance use during pregnancy is common, as is biological testing that is intended to help identify prenatal exposures. However, there is no standardized requirement for biological testing with either maternal or newborn specimens, nor is there standardization related to when testing occurs, how frequently testing occurs, what specimen(s) to test, what substances to test for, or how to perform testing.

Content

We review common specimen types tested to detect maternal and newborn substance exposure with a focus on urine, meconium, and umbilical cord tissue. We also review common analytical methods used to perform testing, including immunoassay, and mass spectrometry platforms. Considerations regarding the utilization of testing relative to the purpose of testing, the drug analyte(s) of interest, the specific testing employed, and the interpretation of results are emphasized to help guide decisions about clinical utilization of testing. We also highlight specific examples of unexpected results that can be used to guide interpretation and appropriate next steps.

There are strengths and limitations associated with all approaches to detecting substance exposure in pregnant persons as well as biological testing to evaluate a newborn with possible substance exposure. Standardization is needed to better inform decisions surrounding evaluation of substance exposures in pregnant people and newborns. If biological sampling is pursued, testing options and results must be reviewed in clinical context, acknowledging that false-positive and -negative results can and do occur.
Private Equity in Distress and the Incentives of Collateralised Loan Obligations
Authors: Paterson Sarah
Published: March 2024

This article explores the problem that both modern private equity (PE) firms, and collateralised loan obligation (CLO) lenders to PE portfolio companies, have incentives to avoid a formal restructuring of PE portfolio companies in financial distress. The author is concerned that this may lead to negative social costs for suppliers, employees, customers and even government agencies. She explores how and why the problem arises, and the ways in which corporate and corporate insolvency law might be able to respond to it. Some suggestions are made, but it is accepted that any solution involves a sensitive balance that needs to be approached with considerable care.
The bile–gut axis and metabolic consequences of cholecystectomy
Authors: Lange Andreas H , Pedersen Miriam G , Ellegaard Anne-Marie , Nerild Henriette H , Brønden Andreas , Sonne David P , Knop Filip K
Published: March 2024

Cholelithiasis and cholecystitis affect individuals of all ages and are often treated by surgical removal of the gallbladder (cholecystectomy), which is considered a safe, low-risk procedure. Nevertheless, recent findings show that bile and its regulated storage and excretion may have important metabolic effects and that cholecystectomy is associated with several metabolic diseases postoperatively. Bile acids have long been known as emulsifiers essential to the assimilation of lipids and absorption of lipid-soluble vitamins, but more recently, they have also been reported to act as metabolic signaling agents. The nuclear receptor, farnesoid X receptor (FXR), and the G protein–coupled membrane receptor, Takeda G protein–coupled receptor 5 (TGR5), are specific to bile acids. Through activation of these receptors, bile acids control numerous metabolic functions. Cholecystectomy affects the storage and excretion of bile acids, which in turn may influence the activation of FXR and TGR5 and their effects on metabolism including processes leading to metabolic conditions such as metabolic dysfunction–associated steatotic liver disease and metabolic syndrome. Here, with the aim of elucidating mechanisms behind cholecystectomy-associated dysmetabolism, we review studies potentially linking cholecystectomy and bile acid–mediated metabolic effects and discuss possible pathophysiological mechanisms behind cholecystectomy-associated dysmetabolism.
Code-Switching and Polylingual Reality: An Aesthetics of Translation in Nancy Huston’s Trois fois septembre and Danse noire
Authors: Mole Christopher
Published: March 2024

If literary code-switching allows authors to play out the plurality of linguistic reality, and crucially the articulation of selfhood and difference in textual representations of polylingual reality, the work of Nancy Huston provides a fruitful space for discussion. Polylingual reality is portrayed in the author’s heterolingual novels in which different languages are represented on the levels of both the story and the text. Huston’s novel Danse noire is a somewhat experimental text in which readers are confronted with linguistic representational hybridity. In contrast to this experiment, Huston’s novel Trois fois septembre, which sees the character Solange translate letters in English to her French-speaking mother, only gives readers access to the French translation by the character, even though there are metacommentaries on the translation process by both characters. This article will work through those features that allow Huston to portray the dynamic use of language at the level of the story and its characters.
Molecular phylogenetics of the Umbelopsis genus—identification of new species and evaluation of their oil application value
Authors: Hou Donghai , Tang Dexiang , Wang Yao , Zhu Juye , Luo Run , Liu Zuoheng , Lu Yingling , Sun Tao , Ma Yanhong , Zhang Yuyao , Yu Hong
Published: March 2024

Aims

The aim of this study was to reconstruct the evolutionary framework of the genus Umbelopsis by using modern taxonomic strategies and evaluating the quality of oil and prospective uses of three distinct species.

Methods and results

Three species of Umbelopsis were identified based on morphological characteristics and phylogenetic evidence obtained from three genes (ITS, LSU, and ACT). A new species of Umbelopsis was described and illustrated, and subsequently named U. ophiocordycipiticola. The characteristics of U. ophiocordycipiticola exhibited sporangia with a diameter ranging from 8 to 17 µm. and sporangiospores that were oval to ellipsoidal in shape, irregularly angular, with dimensions of ∼1.9–2.9 × 1.7–3.0 µm. Gas chromatography and mass spectrometry (GC–MS) were used to examine the composition of fatty acids. Notably, U. ophiocordycipiticola showed a significantly higher oil content of 50.89% in dry cell weight (DCW) compared to U. vinacea and U. ramanniana. The mean proportion of polyunsaturated fatty acids (PUFAs) in U. ophiocordycipiticola was 32.38%, and the maximum levels of γ-linolenic acid (GLA), arachidonic acid (ARA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) in U. ophiocordycipiticola were found to be 14.51, 0.24, 0.54, and 0.53%, respectively. The biodiesel quality from all three species complied with applicable standards set by the American Association for Testing and Materials (ASTM 6751) and the Brazilian National Petroleum Agency (ANP 255).

Conclusions

The establishment of a novel species, U. ophiocordycipiticola, was strongly supported by morphological and molecular evidence. Umbelopsis ophiocordycipiticola exhibited a high-value PUFA content. Additionally, three Umbelopsis species demonstrated good quality for biodiesel production.
The neonatal liver hosts a spontaneously occurring neutrophil population, exhibiting distinct spatial and functional characteristics from adults
Authors: da Silva Júnior Wanderson Ferreira , Lopes Maria Alice de Freitas , Antunes Maísa Mota , Costa Karen Marques de Oliveira , Diniz Ariane Barros , Nakagaki Brenda Naemi Lanza , de Miranda Camila Dutra Moreira , Oliveira Hortência Maciel de Castro , Reis Alesandra Corte , Libreros Stephania , de Paula Cristina Maria Pinto , Rezende Rafael Machado , Menezes Gustavo Batista
Published: March 2024

The elusive nature of the liver immune system in newborns remains an important challenge, casting a shadow over our understanding of how to effectively treat and prevent diseases in children. Therefore, deeper exploration into the intricacies of neonatal immunology might be crucial for improved pediatric healthcare. Using liver intravital microscopy, we unveiled a significant population of granulocytes in the hepatic parenchyma of fetuses and newborns. Utilizing high-dimensional immunophenotyping, we showed dynamic alterations predominantly in granulocytes during neonatal development. Liver intravital microscopy from birth through adulthood captures real-time dynamics, showing a substantial presence of Ly6G+ cells that persisted significantly up to 2 wk of age. Using time-of flight mass cytometry, we characterized neonatal Ly6G+ cells as neutrophils, confirmed by morphology and immunohistochemistry. Surprisingly, the embryonic liver hosts a distinct population of neutrophils established as early as the second gestational week, challenging conventional notions about their origin. Additionally, we observed that embryonic neutrophils occupy preferentially the extravascular space, indicating their early establishment within the liver. Hepatic neutrophils in embryos and neonates form unique cell clusters, persisting during the initial days of life, while reduced migratory capabilities in neonates are observed, potentially compensating with increased reactive oxygen species release in response to stimuli. Finally, in vivo imaging of acute neutrophil behavior in a newborn mouse, subjected to focal liver necrosis, unveils that neonatal neutrophils exhibit a reduced migratory response. The study provides unprecedented insights into the intricate interplay of neutrophils within the liver, shedding light on their functional and dynamic characteristics during development.
A comparative study of dust grain polarization efficiencies in the interstellar and intracluster mediums towards anticentre galaxy
Authors: Bijas N , Eswaraiah Chakali , Sandhyarani Panigrahy , Jose Jessy , Gopinathan Maheswar
Published: March 2024

Dust polarization observations at optical wavelengths help understand the dust grain properties and trace the plane-of-the-sky component of the magnetic field. In this study, we make use of published optical polarization data acquired with AIMPOL along with distances (d) and extinction (AV) data. We study the variation of polarization efficiency (P/AV) as a function of AV in the diffuse interstellar medium (ISM) and intracluster mediums (ICM) using the already published polarization data of six clusters. Among these clusters, NGC 2281, NGC 1664, and NGC 1960 are old; while Stock 8, NGC 1931, and NGC 1893 are young. We categorize stars towards each cluster into foreground, background, and cluster members by employing two clustering algorithms GMM and DBSCAN. Thus, classified field stars and cluster members are used to reveal the polarization properties of ISM and ICM dust, respectively. We find that the dust grains located in the diffuse ISM show higher polarization efficiencies when compared to those located in the ICM of younger clusters.
Magnetic fields and velocity gradients in L1551: the role of stellar feedback
Authors: Liu Mingrui , Hu Yue , Lazarian Alex
Published: March 2024

Magnetic fields play a crucial role in star formation, yet tracing them becomes particularly challenging, especially in the presence of outflow feedback in protostellar systems. We targeted the star-forming region L1551, notable for its apparent outflows, to investigate the magnetic fields. These fields were probed using polarimetry observations from the Planck satellite at 353 GHz/849 μm, the Stratospheric Observatory for Infrared Astronomy's (SOFIA) High-resolution Airborne Wide-band Camera (HAWC+ ) measurement at 214 μm, and the James Clerk Maxwell Telescope's (JCMT) Submillimetre Common-User POLarimeter (SCUPOL) 850 μm survey. Consistently, all three measurements show that the magnetic fields twist towards the protostar IRS 5. Additionally, we utilized the velocity gradient technique on the 12CO (J = 1–0) emission data to distinguish the magnetic fields directly associated with the protostellar outflows. These were then compared with the polarization results. Notably, in the outskirts of the region, these measurements generally align. However, as one approaches the centre of IRS 5, the measurements tend to yield mostly perpendicular relative orientations. This suggests that the outflows might be dynamically significant from a scale of ∼0.2 pc, causing the velocity gradient to change direction by 90°. Furthermore, we discovered that the polarization fraction p and the total intensity I correlate as p ∝ I−α. Specifically, α is approximately 1.044 ± 0.06 for SCUPOL and around 0.858 ± 0.15 for HAWC+. This indicates that the outflows could significantly impact the alignment of dust grains and magnetic fields in the L1551 region.
Super-enhancer-driven LIF promotes the mesenchymal transition in glioblastoma by activating ITGB2 signaling feedback in microglia
Authors: Xie Han , Jiang Yanyi , Xiang Yufei , Wu Baoming , Zhao Jiajia , Huang Ruixiang , Wang Mengting , Wang Yunlong , Liu Jun , Wu Dejun , Tian Dasheng , Bian Erbao
Published: March 2024

Background

The mesenchymal (MES) subtype of glioblastoma (GBM) is believed to be influenced by both cancer cell-intrinsic alterations and extrinsic cellular interactions, yet the underlying mechanisms remain unexplored.

Methods

Identification of microglial heterogeneity by bioinformatics analysis. Transwell migration, invasion assays, and tumor models were used to determine gene function and the role of small molecule inhibitors. RNA sequencing, chromatin immunoprecipitation, and dual-luciferase reporter assays were performed to explore the underlying regulatory mechanisms.

Results

We identified the inflammatory microglial subtype of tumor-associated microglia (TAM) and found that its specific gene integrin beta 2 (ITGB2) was highly expressed in TAM of MES GBM tissues. Mechanistically, the activation of ITGB2 in microglia promoted the interaction between the SH2 domain of STAT3 and the cytoplasmic domain of ITGB2, thereby stimulating the JAK1/STAT3/IL-6 signaling feedback to promote the MES transition of GBM cells. Additionally, microglia communicated with GBM cells through the interaction between the receptor ITGB2 on microglia and the ligand ICAM-1 on GBM cells, while an increased secretion of ICAM-1 was induced by the proinflammatory cytokine leukemia inhibitory factor (LIF). Further studies demonstrated that inhibition of cyclin-dependent kinase 7 substantially reduced the recruitment of SNW1 to the super-enhancer of LIF, resulting in transcriptional inhibition of LIF. We identified notoginsenoside R1 as a novel LIF inhibitor that exhibited synergistic effects in combination with temozolomide.

Conclusions

Our research reveals that the epigenetic-mediated interaction of GBM cells with TAM drives the MES transition of GBM and provides a novel therapeutic avenue for patients with MES GBM.
The oncolytic adenovirus Delta-24-RGD in combination with ONC201 induces a potent antitumor response in pediatric high-grade and diffuse midline glioma models
Authors: de la Nava Daniel , Ausejo-Mauleon Iker , Laspidea Virginia , Gonzalez-Huarriz Marisol , Lacalle Andrea , Casares Noelia , Zalacain Marta , Marrodan Lucía , García-Moure Marc , Ochoa Maria C , Tallon-Cobos Antonio Carlos , Hernandez-Osuna Reyes , Marco-Sanz Javier , Dhandapani Laasya , Hervás-Corpión Irati , Becher Oren J , Nazarian Javad , Mueller Sabine , Phoenix Timothy N , van der Lugt Jasper , Hernaez Mikel , Guruceaga Elizabeth , Koschmann Carl , Venneti Sriram , Allen Joshua E , Dun Matthew D , Fueyo Juan , Gomez-Manzano Candelaria , Gallego Perez-Larraya Jaime , Patiño-García Ana , Labiano Sara , Alonso Marta M
Published: March 2024

Background

Pediatric high-grade gliomas (pHGGs), including diffuse midline gliomas (DMGs), are aggressive pediatric tumors with one of the poorest prognoses. Delta-24-RGD and ONC201 have shown promising efficacy as single agents for these tumors. However, the combination of both agents has not been evaluated.

Methods

The production of functional viruses was assessed by immunoblotting and replication assays. The antitumor effect was evaluated in a panel of human and murine pHGG and DMG cell lines. RNAseq, the seahorse stress test, mitochondrial DNA content, and γH2A.X immunofluorescence were used to perform mechanistic studies. Mouse models of both diseases were used to assess the efficacy of the combination in vivo. The tumor immune microenvironment was evaluated using flow cytometry, RNAseq, and multiplexed immunofluorescence staining.

Results

The Delta-24-RGD/ONC201 combination did not affect the virus replication capability in human pHGG and DMG models in vitro. Cytotoxicity analysis showed that the combination treatment was either synergistic or additive. Mechanistically, the combination treatment increased nuclear DNA damage and maintained the metabolic perturbation and mitochondrial damage caused by each agent alone. Delta-24-RGD/ONC201 cotreatment extended the overall survival of mice implanted with human and murine pHGG and DMG cells, independent of H3 mutation status and location. Finally, combination treatment in murine DMG models revealed a reshaping of the tumor microenvironment to a proinflammatory phenotype.

Conclusions

The Delta-24-RGD/ONC201 combination improved the efficacy compared to each agent alone in in vitro and in vivo models by potentiating nuclear DNA damage and in turn improving the antitumor (immune) response to each agent alone.
The making of towns, the making of polities: Towns and lords in late medieval Europe
Authors: Liddy Christian D
Published: March 2024

The relationship between towns and lords was fundamental both to the making of towns and to the making of polities in the late Middle Ages. The European literature on state growth has led historians to focus on the role of towns in historicizing narratives of state formation and national exceptionalism. These different narratives have depended on urban typologies that emphasize the importance of the self-governing town at the expense of the town that operated under conditions of lordship. Yet the relationship between towns and lords was an essential, and inescapable, aspect of urban life.

The experiences of the English town of Walsall, in the historic county of Staffordshire, are set within a European context. Walsall’s small size made it typical of the majority of urban centres in late medieval Europe. In an enduring pattern, the late medieval town was a site of continuing political experimentation, and urban development necessitated lordship. The complex entanglements between towns and lords also shaped polities. The article makes a case for the comparability of local political landscapes in different parts of Europe.
Subgroups of Clinical High Risk for Psychosis Based on Baseline Antipsychotic Exposure: Clinical and Outcome Comparisons Across a 2-Year Follow-up Period
Authors: Pelizza Lorenzo , Di Lisi Alessandro , Leuci Emanuela , Quattrone Emanuela , Azzali Silvia , Pupo Simona , Paulillo Giuseppina , Pellegrini Pietro , Menchetti Marco
Published: March 2024

Background and Hypothesis

Antipsychotic (AP) prescription in clinical high risk for psychosis (CHR-P) subjects remains a divisive issue. Although official guidelines currently discourage AP treatment in CHR-P, it is common in clinical practice, especially for psychosis prevention. The aim of this study was to investigate whether baseline AP need (especially in high-dose) indexes a CHR-P subgroup with poorer prognosis and differs from AP-naïve subjects in terms of sociodemographic, clinical, and outcome parameters across a 2-year follow-up.

Study Design

CHR-P participants were treated within an “Early Intervention in Psychosis” program and completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale both at baseline and every 12 months. Individuals with baseline AP prescription were included in the high-dose or low-dose CHR-P-AP+ subgroup. The others were grouped as AP-naïve. Cox regression analyses and mixed-design ANOVA were performed.

Study Results

180 CHR-P individuals were enrolled (32 high-dose, 60 low-dose, and 88 AP-naïve). Compared to AP-naive, CHR-P AP+ subgroups showed older age and more severe clinical presentation. High-dose subgroup also had grater functioning decline at entry and poorer functional recovery at follow-up. No inter-group differences in psychosis transition and symptomatic remission were found. Significant improvement in clinical outcomes were found over time in all subgroups. Baseline AP prescription was specifically associated with a more relevant improvement in PANSS total score, and in negative and disorganized symptoms.

Conclusions

Our results suggest that baseline AP need is an important prognostic parameter in CHR-P and should be considered in risk/benefit calculators.
Characterizing the Pathogenicity and Mycotoxin Production Capacity of Fusarium spp. Causing Root Rot of Angelica sinensis in China
Authors: Mu Rongrong , Liu Yang , Lan Qingqing , Zhou Qian , Wang Xuetao , Wang Yali , Su Xu , Tian Yongqiang
Published: March 2024

Root rot is a very destructive soil-borne disease, which severely affects the quality and yield of Angelica sinensis in major planting areas of Gansu Province, China. Twelve Fusarium strains were identified from root rot tissue and infected soil in the field by comparing each isolate strain internal transcribed spacer, translation elongation factor 1-α sequence and RNA polymerase second largest subunit gene with the sequences of known fungal species in the NCBI database. Of these isolates, four were F. acuminatum, followed by three F. solani, two F. oxysporum, and one each of F. equiseti, F. redolens, and F. avenaceum. Under greenhouse conditions, pathogenicity testing experiment was carried out using five strains: two F. acuminatum, one F. solani, one F. oxysporum, and one F. equiseti. Among them, the incidence of F. acuminatum–induced root rot on A. sinensis was 100%; hence, it was the most aggressive. Liquid chromatography was used to show that F. acuminatum could produce neosolaniol (NEO), deoxynivalenol, and T-2 toxins. Of these, the level of NEO produced by F. acuminatum was high compared with the other two toxins. By isolating Fusarium spp. and characterizing their toxin-producing capacity, this work provides new information for effectively preventing and controlling A. sinensis root rot in the field as well as improving the quality of its medicinal materials.
Proportion of Angle Closure Glaucoma in Tamale, Ghana
Authors: Liu Catherine K. , Ali Omair , Murdoch Ian , Simon Judith
Published: March 2024

Précis:

In the largest clinic-based study to date, our review of 588 patients presenting with glaucoma in Northern Ghana revealed 36% of these had primary angle closure glaucoma (PACG).

Objective:

Glaucoma is the second leading cause of blindness worldwide. In Africa, glaucoma is an established public health problem, and PACG is not commonly discussed. Recognizing it is important because of its negative impact on visual morbidity, and also because its treatment is different from primary open angle glaucoma. In response to the observation of many PACG cases at the Northern Community Eye Hospital in Tamale, Ghana, we investigated the proportion of those attending with a first diagnosis of glaucoma who had PACG.

Patients and Methods:

Using the electronic records, we identified 976 patients who attended with a first diagnosis of glaucoma between January 2021 and October 2022. Of these, 588 met the inclusion criterion of a clear glaucoma subtype diagnosis.

Results:

Of these 316 (53.7%) had primary open angle glaucoma, 210 (35.7%) PACG, and 62 (10.5%) secondary glaucoma. Thus, over a third of presenting glaucomas had PACG.

Conclusion:

This study highlights that PACG is present in about a third of patients presenting to our clinic in North Ghana. Our study demonstrates the importance of a clear diagnostic pathway including gonioscopy in the assessment of glaucoma patients and the consideration of wider training on angle closure glaucoma diagnosis and management.
Impact of FilmArray respiratory panel test for hospitalized pediatric respiratory tract infection in Taiwan: A 3-year single-center cohort study
Authors: Hu Jen-Jan , Wang Da-Ling , Tzeng I-Shiang
Published: March 2024

Respiratory tract infections are prevalent and clinically significant in pediatric populations globally. However, pathogen testing often involves time-consuming processes, resulting in delays in diagnosis. To date, commercial testing machines, such as the FilmArray respiratory panel, have been proposed for hospitals. Therefore, this study aimed to investigate the impact of the FilmArray respiratory panel at a single center. This study utilized the medical records of our hospital to select pediatric inpatients with respiratory tract infections who underwent the FilmArray respiratory panel between September 2020 and April 2021 and those who did not undergo nucleic acid detection (a rapid test group) between September 2019 and April 2020. FilmArray is a polymerase chain reaction-based diagnostic tool. The FilmArray respiratory panel group was scheduled to recruit 150 patients (final 137 patients), whereas the rapid test group was scheduled to recruit 300 patients (final 267 patients). Differences in continuous variables between the 2 groups were analyzed using independent Student t tests. The FilmArray respiratory panel group had a longer length of inpatient days, longer duration of antibiotic use, and higher proportion of pathogens that tested positive, with significant differences than those in the rapid test group. Fever duration showed no significant difference between the 2 groups. For the polymerase chain reaction method, respiratory syncytial virus was the most commonly detected pathogen causing pneumonia, followed by human rhinovirus/enterovirus and parainfluenza virus. Mycoplasma was detected using the rapid test but not with the FilmArray respiratory panel. The FilmArray respiratory panel provides clinicians with a rapid and useful diagnostic tool. The effect was quite good for virus detection, but not for bacteria. Given its limited adoption, the tool may not aid clinicians in the diagnosis of mild cases.
Diagnostic criteria and scoring systems for thyroid storm: An evaluation of their utility – comparative review
Authors: Elendu Chukwuka , Amaechi Dependable C. , Amaechi Emmanuel C. , Chima-Ogbuiyi Nkechi L. , Afuh Rechner N. , Arrey Agbor Divine B. , Abdi Mohamed Abdirahman , Nwachukwu Nwachukwu O. , Oderinde Oluwatobi O. , Elendu Tochi C. , Elendu Ijeoma D. , Akintunde Akinbayo A. , Onyekweli Samuel O. , Omoruyi Gloria O.
Published: March 2024

A thyroid storm is a life-threatening endocrine emergency characterized by severe hyperthyroidism and many systemic manifestations. Prompt recognition and treatment are essential for patient survival. This study evaluates the utility of existing diagnostic criteria and scoring systems for thyroid storm. A comprehensive literature review encompassed articles published up to December 2023. Various diagnostic criteria and scoring systems, such as the Burch–Wartofsky Point Scale and the Japanese Thyroid Association criteria, were critically assessed based on their sensitivity, specificity, and clinical applicability. Our findings reveal that existing diagnostic criteria and scoring systems, although valuable tools, exhibit limitations. They may lack sensitivity in identifying milder cases of thyroid storm or fail to differentiate it from other critical conditions. Furthermore, some criteria rely heavily on subjective clinical Judgment, which can vary among healthcare providers. Future research should focus on refining existing criteria and developing more objective and universally applicable diagnostic tools to address these limitations. Incorporating advanced laboratory markers and modern imaging techniques may enhance diagnostic accuracy. Additionally, a standardized scoring system approach could improve clinical practice consistency. In conclusion, while current diagnostic criteria and scoring systems provide a foundation for identifying thyroid storm, their utility has shortcomings. Advancements in diagnostic methods and a collaborative effort to establish standardized criteria are imperative to enhance the accuracy and reliability of thyroid storm diagnosis, ultimately improving patient outcomes.
Molecular mechanisms underlying the therapeutic effects of Linggui Zhugan decoction in stroke: Insights from network pharmacology and single-cell transcriptomics analysis
Authors: Sun Di , Luo Fang , Fang Chengbing , Zhu Qingyan , Li Chong
Published: March 2024

Linggui Zhugan decoction (LZD), a traditional Chinese medicine formula, has demonstrated significant therapeutic effects in managing poststroke cognitive impairment and hemiplegia. However, the precise molecular mechanisms underlying its efficacy remain incompletely elucidated. The active ingredients and target proteins of LZD were retrieved from the traditional Chinese medicine systems pharmacology database and analysis platform database, which is specifically designed for traditional Chinese medicine research. The stroke-related genes were obtained from publicly available databases. Protein–protein interaction, enrichment analysis, and single-cell data analysis were conducted to identify key cells, targets, and pathways. Molecular docking was employed to assess the binding affinity between key components and targets. Network pharmacology analysis identified 190 active ingredients and 248 targets in LZD. These targets were significantly enriched in processes and pathways such as cellular response to lipid, orexin receptor pathway, and were significantly associated with Cerebral infarction and Middle Cerebral Artery Occlusion. Intersection analysis with 2035 stroke-related genes revealed 144 potential targets, which exhibited 2870 interactions and were significantly enriched in signaling pathways such as PI3K-AKT single pathway, MAPK single pathway, and tumor necrosis factor single pathway. Gene set variation analysis showed that the targets of LZD exhibited higher enrichment scores in microglia, M2 macrophages, endothelial cells, and neutrophils, while lower enrichment scores were observed in oligodendrocytes. Furthermore, molecular docking demonstrated a strong binding affinity between key active ingredients and targets. Network pharmacology and single-cell sequencing analysis elucidated the key cells, pathways, targets, and components involved in the therapeutic mechanism of LZD for the treatment of stroke.
The association between serum albumin and alkaline phosphatase in cancer patients
Authors: Jiang Yiqian , Cai Yong , Ding Yingying , Kong Xiangyang , Li Zhaoyang
Published: March 2024

The role of serum albumin (ALB) has been extensively studied in patients with cancer; however, research on its effect on bone metastasis in these patients remains limited. This study aimed to investigate the relationship between serum ALB and alkaline phosphatase (ALP) levels in patients with tumors. Using data from the National Health and Nutrition Examination Survey 2011 to 2018, we assessed the correlation between serum ALB and ALP levels using a weighted multivariate linear regression model, whereas a weighted generalized additive model and smooth curve fitting were used to address potential nonlinearities. A total of 1876 patients with cancer were included in our study. In the subgroup analysis stratified by sex, race/ethnicity, and liver disease, the negative correlation of ALB with ALP remained for most groups, except in blacks (β = −1.755, 95%CI: [−3.848, 0.338], P = .103) and patients with gout (β = −0.676, 95%CI: [−2.061, 0.709], P = .340). In black people and patients with gout, the relationship between ALB and ALP showed an inverted U-shaped curve, with an inflection point at approximately 42 g/dL. Our study showed an inverse correlation between ALB and ALP levels in most patients with tumors, but not in black patients and those with gout. The measurement of ALB levels can serve as a screening tool for bone metastases while guiding therapeutic intervention strategies.
Case report: A case of Paget disease outside the axillary breast
Authors: Zhou Zhibing , Zhou Bing , Wu Xiaobo , Wei Wensong
Published: March 2024

Background:

Extramammary Paget disease is a relatively rare and less malignant intraepithelial adenocarcinoma. t is found in areas with abundant distribution of apocrine sweat glands such as the external genitalia, external genitalia, and perianal area, with fewer armpits. The disease progresses slowly and is prone to misdiagnosis in clinical practice.

Methods:

We retrospectively analyzed a female patient. She had a left axillary mass for more than 2 years. Recently, the mass increased and the surface skin was ulcerated. Then she went to Jiangxi Provincial Dermatology Hospital for left axillary lesion resection, and the postoperative pathology showed Paget disease outside the breast. For further diagnosis and treatment, she came to our hospital. We diagnosed a tumor with uncertain or unknown dynamics in the left axillary breast. Under general anesthesia, left subaxillary mass resection, freezing and left breast cancer breast conserving surgery was performed.

Results:

The postoperative pathology of the left axillary mass combined with morphological and immunohistochemical results was consistent with Paget disease. Postoperative immunohistochemistry showed estrogen receptor (+, 20%), progesterone receptor (−), human epidermal growth factor receptor-2 (3+), Ki-67 (30%), cytokine7 (+), and p63 (−). Following up for 22 months, there has been no local recurrence, no swelling of the right axillary lymph node, no distant metastasis found on follow-up, and no complications such as upper limb lymphedema, upper limb sensory abnormalities, or motor disorders have been observed.

Conclusion:

Paget disease outside the axillary breast is relatively rare, and surgical resection is the best choice. The prognosis is good, and the recurrence rate is low.
Severe hyponatremia and diabetes insipidus caused by low-dose cyclophosphamide in breast cancer patients: A case report and literature review
Authors: Chen Yanfang , Li Liye , Ou Ruilian , Wu Yulan , Pan Baoying , Luo Linying
Published: March 2024

Rationale:

Cyclophosphamide (CTX) is widely used in the treatment of malignancies and autoimmune diseases. Although severe hyponatremia caused by low-dose CTX chemotherapy is uncommon, it can lead to serious complications and even death.

Patient concerns:

A 44-year-old woman with left-sided breast cancer suddenly experienced headaches, disorientation and weakness after receiving low-dose neoadjuvant chemotherapy combined with CTX and doxorubicin.

Diagnoses:

The patient pathology showed invasive breast carcinoma. She developed severe hyponatremia and a generalized seizure after completing the first cycle of neoadjuvant chemotherapy with CTX and doxorubicin. Laboratory tests showed a serum sodium of 118 mmol/L (normal range 135–145 mmol/L) and potassium sodium 3.16 mmol/L (normal range 3.5–5.5 mmol/L). Subsequently, the patient developed secondary diabetes insipidus 4 hours after sodium supplementation, her 24-hour urine volume was 4730 mL (normal range 1000–2000 mL/24 hours), and the urine specific gravity decreased to 1.005.

Interventions:

The patient was given intravenous sodium chloride (500 mL of 3%NaCl, 100 mL/hour) and potassium chloride (500 mL of 0.3%KCl, 250 mL/hour). Meanwhile, she was advised to reduce her water intake, and pituitrin was administered to prevent dehydration caused by diabetes insipidus.

Outcomes:

The patient completely recovered after correcting of the serum sodium concentration (137 mmol/L) without any neurological deficits. After discontinuing pituitrin, her 24-hour urine volume was 2060 mL and the urine specific gravity was 1.015.

Lessons:

This is a typical case of severe hyponatremia induced by low-dose CTX. Clinicians and healthcare providers should be aware of this potential toxicity, and appropriate monitoring should be implemented.
Efficacy, safety, and cost-effectiveness analysis of Cerebrolysin in acute ischemic stroke: A rapid health technology assessment
Authors: Wan Miaomiao , Yang Ke , Zhang Gonghao , Yang Chunxia , Wei Yuqing , He Yeqian , Jiang Xia
Published: March 2024

This study conducts a rapid health technology assessment to systematically evaluate the effectiveness, safety, and cost-effectiveness of Cerebrolysin as an adjunctive therapy for acute ischemic stroke to provide evidence-based medicine for clinical decisions of Cerebrolysin. All systematic reviews/meta-analyses, pharmacoeconomic studies, and health technology assessment reports of Cerebrolysin for the treatment of acute ischemic stroke before August 17, 2023, were retrieved from PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, Weipu, Sinomed database and the official website of health technology assessment. According to the inclusion and exclusion criteria, 2 researchers independently carried out screening, data extraction, and quality evaluation and descriptively analyzed the results of the included studies. A total of 14 pieces of literature were incorporated, comprising 8 systematic reviews/meta-analyses and 6 pharmacoeconomic studies. In terms of effectiveness, compared to control groups, the use of Cerebrolysin as a treatment for acute ischemic stroke demonstrates certain advantages, including enhancement in total efficacy rate, neurological function, upper limb motor dysfunction, and facilitation of the recovery of activities of daily living. Especially in patients with moderate to severe acute ischemic stroke, Cerebrolysin has demonstrated the ability to enhance neurological function recovery and ameliorate disabilities. Regarding safety, adverse reactions were mild or comparable to those in the control group. The primary findings of economic studies reveal that advocating for the use of Cerebrolysin offers certain cost-effectiveness advantages. Cerebrolysin contributes to improved clinical efficacy and evaluation indexes while demonstrating favorable safety and economic benefits.
Challenging diagnosis of male intraductal papilloma masquerading as eccrine hidradenoma in the breast: Case report
Authors: Liu Xinyue , Du Jie , Zhao Lirong
Published: March 2024

Rationale:

This article presents a challenging case involving an elderly male patient with a misdiagnosed intraductal mammary papilloma initially identified as a sweat adenoma through ultrasound imaging. The study aims to explore the histopathology, clinical presentations, and sonographic features of both conditions, emphasizing the contributing factors to the diagnostic misstep.

Patient Concerns:

A 61-year-old male reported a persistent left breast mass, along with pain and swelling, spanning a 6-month duration.

Diagnoses:

Ultrasound examination indicated a deep, square, mixed-echo mass in the left nipple, initially suggestive of a sweat adenoma. However, subsequent pathological analysis following resection under general anesthesia confirmed an intraductal papilloma.

Intervention:

The patient underwent surgical resection of the left breast mass under general anesthesia.

Outcome:

Post-surgery, the patient exhibited satisfactory recovery; however, regrettably, he was lost to follow-up.

Lessons:

This study underscores the challenge in differentiating between clear cell sweat adenoma and male intraductal mammary papilloma solely based on ultrasonic characteristics. It emphasizes the susceptibility of ultrasound-based diagnoses to misinterpretation, highlighting the critical need for a comprehensive pathological examination to establish a definitive diagnosis.
Association between serum ferritin level and lipid profile among diabetic patients: A retrospective cohort study
Authors: Alqahtani Saif Aboud M , Alsaleem Mohammed Abadi , Ghazy Ramy Mohamed
Published: March 2024

High serum ferritin (SF) levels have been linked to obesity, metabolic syndrome, atherosclerosis, diabetes, dyslipidemia, and cancer. This study aimed to investigate the association between SF and dyslipidemia in adults diagnosed with diabetes mellitus. This cross-sectional study retrospectively analyzed the electronic medical records of eligible patients from 3 primary locations in Saudi Arabia namely – Abha, Khamis Mushyt, and Jeddah – from 2010 to 2020. The study included adult patients aged 18 years or older who were diagnosed with diabetes mellitus and identified with an HbA1c level of ≥6.5. This study involved 3674 participants, with males accounting for 26.6% of the total. The mean age of the studied population was 48.0 ± 18.4 years. The median [interquartile range] of SF among males was higher than females, however, this difference was not statistically significant (60.0 [23.4–125.8] vs 55.4 [24.0–113.4], P = 0.204). On the other hand, age and region were significantly associated with SF (P = .032 and 0.035). SF had a significant positive correlation with cholesterol (r = 0.081, P < .001), low-density lipoprotein cholesterol (r = .087, P < .001), and triglycerides (r = 0.068, P < .001) and negative correlation with high-density lipoprotein cholesterol (r = −0.13, P < .001). Multivariate analysis revealed that age, sex, residence, and HbA1c were significantly affecting the lipid profile. Clinicians should consider including SF testing as part of the comprehensive evaluation of patients with diabetes and dyslipidemia.
A 42-year-old patient with renal cell carcinoma presenting as low back pain: A case report
Authors: Shim Ga Yang , Kim Min-Su , Kim Hong Jun , Park Yewan , Kim So-Woon , Yoo Myung Chul
Published: March 2024

Rationale:

Renal cell carcinoma (RCC) is the most common renal neoplasm, accounting for 2.4% of all cancers in Korea. Although the usual clinical manifestations of RCC include flank pain, hematuria, and palpable mass, RCC is generally characterized by a lack of early warning signs and is mostly discovered incidentally in advanced stage. This case report describes a 42-year-old Korean man diagnosed with giant RCC who presented with simple back pain.

Patient concerns:

The clinical manifestation of a 42-year-old Korean man was chronic back pain.

Diagnoses:

Contrast-enhanced computed tomography showed a 19.1-cm sized heterogeneous enhancing mass on the right kidney and tumor thrombosis extending into inferior vena cava.

Intervention:

Due to the large size of the tumor and extensive tumor thrombosis, the multidisciplinary team decided to administer neoadjuvant chemotherapy and an anticoagulant. Following 12 cycles of treatment with nivolumab and cabozantinib, he underwent a right radical nephrectomy with an adrenalectomy and tumor thrombectomy.

Outcomes:

Treatment was successful and posttreatment he started a cancer rehabilitation program. He was followed-up as an outpatient and no longer complains of back pain.

Lessons:

RCC can manifest clinically as back pain, with diagnosis being difficult without appropriate imaging modalities. RCC should be included in the differential diagnosis of patients with low back pain, even at a young age.