bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of taxon through classification with partial reject options
Authors: Karlsson Måns , Hössjer Ola
Published: July 2023

Identification of taxa can significantly be assisted by statistical classification based on trait measurements either individually or by phylogenetic (clustering) methods. In this article, we present a general Bayesian approach for classifying species individually based on measurements of a mixture of continuous and ordinal traits, and any type of covariates. The trait vector is derived from a latent variable with a multivariate Gaussian distribution. Decision rules based on supervised learning are presented that estimate model parameters through blocked Gibbs sampling. These decision regions allow for uncertainty (partial rejection), so that not necessarily one specific category (taxon) is output when new subjects are classified, but rather a set of categories including the most probable taxa. This type of discriminant analysis employs reward functions with a set-valued input argument, so that an optimal Bayes classifier can be defined. We also present a way of safeguarding against outlying new observations, using an analogue of a p-value within our Bayesian setting. We refer to our Bayesian set-valued classifier as the Karlsson–Hössjer method, and it is illustrated on an original ornithological data set of birds. We also incorporate model selection through cross-validation, exemplified on another original data set of birds.
Intraoperative push enteroscopy for treatment of occult small bowel bleed due to hemorrhagic bleed and tumor: a report of two cases
Authors: Sofia Maribona A , Dwight Philip , Zaineb Shatawi , Christopher Seaver
Published: July 2023

Small bowel bleeds, while uncommon, are often challenging with regard to diagnosis and therapeutic intervention. This is primarily due to their occult nature, the location offending lesions and limitations of current technology used to assess them. This review highlights two patients who presented with signs and symptoms of a small bowel bleed, where initial diagnostic workups were inconclusive, and intraoperative enteroscopy served a diagnostic and therapeutic role. We discuss the current literature on intraoperative endoscopy and propose an algorithm that introduces intraoperative enteroscopy earlier as a viable curative option, particularly in a rural setting. This case series proposes considerations for earlier introduction of intraoperative enteroscopy for diagnosis and treatment of small bowel bleeds.
Brassicaceae display variation in efficiency of photorespiratory carbon-recapturing mechanisms
Authors: Schlüter Urte , Bouvier Jacques W , Guerreiro Ricardo , Malisic Milena , Kontny Carina , Westhoff Philipp , Stich Benjamin , Weber Andreas P M
Published: July 2023

Carbon-concentrating mechanisms enhance the carboxylase efficiency of Rubisco by providing supra-atmospheric concentrations of CO2 in its surroundings. Beside the C4 photosynthesis pathway, carbon concentration can also be achieved by the photorespiratory glycine shuttle which requires fewer and less complex modifications. Plants displaying CO2 compensation points between 10 ppm and 40 ppm are often considered to utilize such a photorespiratory shuttle and are termed ‘C3–C4 intermediates’. In the present study, we perform a physiological, biochemical, and anatomical survey of a large number of Brassicaceae species to better understand the C3–C4 intermediate phenotype, including its basic components and its plasticity. Our phylogenetic analysis suggested that C3–C4 metabolism evolved up to five times independently in the Brassicaceae. The efficiency of the pathway showed considerable variation. Centripetal accumulation of organelles in the bundle sheath was consistently observed in all C3–C4-classified taxa, indicating a crucial role for anatomical features in CO2-concentrating pathways. Leaf metabolite patterns were strongly influenced by the individual species, but accumulation of photorespiratory shuttle metabolites glycine and serine was generally observed. Analysis of phosphoenolpyruvate carboxylase activities suggested that C4-like shuttles have not evolved in the investigated Brassicaceae. Convergent evolution of the photorespiratory shuttle indicates that it represents a distinct photosynthesis type that is beneficial in some environments.
Diagnostic and Therapeutic Challenges in a Military Recruit Training Center of the Hellenic Navy: A Retrospective Analysis of the Poros Registry Serving as a Quality Improvement Project for Medical Officers
Authors: Papazoglou Andreas S , Athanaseas Ioannis , Fousekis Konstantinos , Kasotakis Nikolaos , Kolokouris Spyridon , Zisakis Thomas , Kyriakoulis Konstantinos G
Published: July 2023

Introduction

Basic military training (BMT) has been associated with increased morbidity burden. Nevertheless, the exact epidemiology of the encountered cases in the BMT of Greek recruits has never been assessed. The aim of this quality improvement project was to investigate for the first time the clinical patterns, rates, and severity of symptoms leading recruits to visit the infirmary of a recruit training center and use this knowledge to provide a practical guidance for the physicians in charge.

Materials and Methods

All medical cases which were consecutively examined for the time range from November 2021 to September 2022 at the infirmary of the Hellenic Naval recruit training center in Poros, Greece, were retrospectively analyzed. Logistic regression analyses were performed to identify independent predictors of “severe clinical status” (i.e., overnight sick bay confinement and/or transfer to a tertiary hospital within 24 h) and absence from BMT for at least 1 day.

Results

A total of 2,623 medical cases were examined during four recruit seasons from November 2021 to September 2022. Upper respiratory tract infections (URTIs) and musculoskeletal injuries were the most frequent reasons for a recruit’s visit to the infirmary (33.9% and 30.2%, respectively). 6.7% of the total cases were identified as having “severe clinical status.” Specifically, in psychiatric, urological, and cardiovascular cases, febrile events were all independently associated with increased risk of “severe clinical status.” There was a positive association between training week and absence from BMT, while febrile events and spring recruit season were also independently linked with increased probability of absence from BMT for at least 1 day.

Conclusions

URTIs and musculoskeletal complaints were the primary reasons for recruits’ presentation at the infirmary of a Greek recruit training center, leading to severe rates of attrition. Further registries and quality improvement projects are warranted to reach specific conclusions and reduce BMT-related morbidity and its subsequent implications.
Hydrodynamic simulations of the disc of gas around supermassive black holes (HDGAS) – I. Molecular gas dynamics
Authors: Raouf Mojtaba , Viti Serena , García-Burillo S , Richings Alexander J , Schaye Joop , Bemis Ashley , Nobels Folkert S J , Guainazzi Matteo , Huang Ko-Yun , Schaller Matthieu , Impellizzeri Violette , Holdship Jon
Published: July 2023

We present hydrodynamic simulations of the interstellar medium (ISM) within the circumnuclear disc (CND) of a typical active galactic nucleus (AGN)-dominated galaxy influenced by mechanical feedback from an AGN. The simulations are coupled with the CHIMES non-equilibrium chemistry network to treat the radiative-cooling and AGN-heating. A focus is placed on the central 100 pc scale where AGN outflows are coupled to the ISM and constrained by observational Seyfert-2 galaxies. AGN-feedback models are implemented with different wind-velocity and mass-loading factors. We post-process the simulation snapshots with a radiative-transfer code to obtain the molecular emission lines. We find that the inclusion of an AGN promotes the formation of CO in clumpy and dense regions surrounding supermassive black holes (SMBHs). The CO(1-0) intensity maps (<6 Myr) in the CND seem to match well with observations of NGC 1068 with a best match for a model with 5000 km s−1 wind-velocity and a high mass-loading factor. We attempt to discern between competing explanations for the apparent counter-rotating gas disc in the NGC 1068 through an analysis of kinematic maps of the CO line emission. We suggest that mechanical AGN-feedback could explain the alignment-stability of position-angle across the different CND radii around the SMBH through momentum and energy loading of the wind. It is the wind-velocity that drives the disc out of alignment on a 100 pc scale for a long period of time. The position–velocity diagrams are in broad agreement with the predicted Keplerian rotation-curve in the model without AGN, but the AGN models exhibit a larger degree of scatter, in better agreement with NGC 1068 observations.
An enigmatic 380 kpc long linear collimated galactic tail
Authors: Zaritsky Dennis , Crossett Jacob P , Jaffé Yara L , Donnerstein Richard , Karunakaran Ananthan , Khim Donghyeon J , Lourenço Ana C C , Spekkens Kristine , Sun Ming , Vulcani Benedetta
Published: July 2023

We present a serendipitously detected system consisting of an S0/a galaxy, which we refer to as the ‘Kite,’ and a highly collimated tail of gas and stars that extends over 380 kpc and contains pockets of star formation. In its length, narrowness, and linearity the Kite’s tail is an extreme example relative to known tails. The Kite (PGC 1000273) has a companion galaxy, Mrk 0926 (PGC 070409), which together comprise a binary galaxy system in which both galaxies host active galactic nuclei. Despite this systems being previously searched for signs of tidal interactions, the tail had not been discovered prior to our identification as part of the validation process of the SMUDGes survey for low surface brightness galaxies. We confirm the kinematic association between various H α knots along the tail, a small galaxy, and the Kite galaxy using optical spectroscopy obtained with the Magellan telescope and measure a velocity gradient along the tail. The Kite shares characteristics common to those formed via ram pressure stripping (‘jellyfish’ galaxies) and formed via tidal interactions. However, both scenarios face significant challenges that we discuss, leaving open the question of how such an extreme tail formed. We propose that the tail resulted from a three-body interaction from which the lowest mass galaxy was ejected at high velocity.
An ever-present Gaia snail shell triggered by a dark matter wake
Authors: Grand Robert J J , Pakmor Rüdiger , Fragkoudi Francesca , Gómez Facundo A , Trick Wilma , Simpson Christine M , van de Voort Freeke , Bieri Rebekka
Published: July 2023

We utilize a novel numerical technique to model star formation in cosmological simulations of galaxy formation – called superstars – to simulate a Milky Way-like galaxy with ≳108 star particles to study the formation and evolution of out-of-equilibrium stellar disc structures in a full cosmological setting. In the plane defined by the coordinate and velocity perpendicular to the mid-plane [vertical phase space, (Z, VZ)], stars in solar-like volumes at late times exhibit clear spirals qualitatively similar in shape and amplitude to the Gaia ‘snail shell’ phase spiral. We show that the phase spiral forms at a lookback time of ∼6 Gyr during the pericentric passage of an ∼1010$\rm {\rm M}_{\odot }$ satellite on a polar orbit. This satellite stimulates the formation of a resonant wake in the dark matter halo while losing mass at a rate of ∼0.5–1 dex per orbit loop. The peak magnitude of the wake-induced gravitational torque at the solar radius is ∼8 times that from the satellite, and triggers the formation of a disc warp that wraps up into a vertical phase spiral over time. As the wake decays, the phase spiral propagates several gigayears to present day and can be described as ‘ever-present’ once stable disc evolution is established. These results suggest an alternative scenario to explain the Gaia phase spiral, which does not rely on a perturbation from bar buckling or a recent direct hit from a satellite.
Intensive blood pressure control and the progression of IgA nephropathy: a cohort study using marginal structural models
Authors: Tang Chen , Chen Pei , Si Feng-Lei , Yao Yu-Xuan , Lv Ji-Cheng , Shi Su-Fang , Zhou Xu-Jie , Liu Li-Jun , Zhang Hong
Published: July 2023

Background

In chronic kidney disease, current guidelines recommend systolic blood pressure (SBP) below 120 mmHg. However, the renoprotective effect of intensive blood-pressure (BP) lowering on immunoglobulin A nephropathy (IgAN) remains undetermined. We aimed to determine the effect of intensive BP control on the progression of IgAN.

Methods

At Peking University First Hospital, 1530 patients with IgAN were enrolled. An examination of the relationship between baseline and time-updated BP and composite kidney outcomes, defined as development of end-stage kidney disease (ESKD) or a 30% decline in estimated glomerular filtration rate (eGFR), was conducted. Baseline and time-updated BPs were modeled using multivariate causal hazards models and marginal structural models (MSMs).

Results

In a median follow-up of 43.5 (interquartile range 27.2, 72.7) months, 367 (24.0%) patients experienced the composite kidney outcomes. No significant associations were found between baseline BP and the composite outcomes. Using MSMs with time-updated SBP for analysis, a U-shaped association was found. In reference to SBP 110–119 mmHg, hazard ratios (95% confidence intervals) for the SBP categories <110, 120–129, 130–139 and ≥140 mmHg were 1.48 (1.02–2.17), 1.13 (0.80–1.60), 2.21 (1.54–3.16) and 2.91 (1.94–4.35), respectively. The trend was more prominent in patients with proteinuria ≥1 g/day and eGFR ≥60 mL/min/1.73 m2. After analyzing time-updated diastolic BP, no similar trend was observed.

Conclusions

In patients with IgAN, intensive BP control during the treatment period may retard the kidney disease progression, but the potential risk of hypotension still needs to be considered.
Distribution, Trends, and Antimicrobial Susceptibility ofBacteroides,Clostridium,Fusobacterium, andPrevotellaSpecies Causing Bacteremia in Japan During 2011–2020: A Retrospective Observational Study Based on National Surveillance Data
Authors: Kajihara Toshiki , Yahara Koji , Kitamura Norikazu , Hirabayashi Aki , Hosaka Yumiko , Sugai Motoyuki
Published: July 2023

Background

The increasing prevalence of anaerobic bacteremia is a major concern worldwide and requires longitudinal monitoring.

Methods

We present one of the largest and longest longitudinal studies on the prevalence and antimicrobial resistance of Bacteroides, Clostridium, Fusobacterium, and Prevotella spp. isolated from blood culture samples using national comprehensive surveillance data in Japan during 2011–2020 as part of the Japan Nosocomial Infections Surveillance.

Results

Data for 41 949 Bacteroides spp., 40 603 Clostridium spp., 7013 Fusobacterium spp., and 5428 Prevotella spp. isolates were obtained. The incidences of bacteremia caused by Bacteroides fragilis, Clostridium perfringens, and Fusobacterium nucleatum significantly increased during the period (P < .0001). Among the 20 species analyzed, 18 showed no significant changes in susceptibility over time, including B. fragilis, C perfringens, and F. nucleatum. However, resistance to clindamycin increased in B. thetaiotaomicron (P = .0312), and resistance to ampicillin increased in B. ovatus (P = .0008).

Conclusions

Our comprehensive national surveillance data analysis demonstrated a continuous increase in the incidence of anaerobic bacteremia, particularly in B. fragilis, C. perfringens, and F. nucleatum. This may be linked to the increasing number of colorectal cancer cases or advancing methods for species identification and susceptibility testing, requiring cautious interpretation. The discovery of an upsurge in anaerobic bacteremia and potential alterations in susceptibility highlights the necessity for more extensive studies in this field.
Evaluation of Male Breast Cancer and the Application of Sentinel Lymph Node Biopsy: A Multicenter Retrospective Study
Authors: Shang Qingyao , Feng Kexin , Wei Ya , Wang Kaipeng , Yang Chenxuan , Zhao Shuangtao , Liu Jiaxiang , Meng Xiangzhi , Li Yalun , Du Chuang , Wang Jing , Qiao Guangdong , Li Jingruo , Wang Xin , Wang Xiang
Published: July 2023

Sentinel lymph node biopsy (SLNB) is currently used as a routine treatment for patients with breast cancer. However, it may not be applicable for patients with male breast cancer (MBC), because they have notably different clinicopathological features from those occurring in females. There is a lack of evidence of SLNB application and safe exemption from axillary lymph node dissection (ALND) in patients with MBC. This study aimed to evaluate the application of SLNB to provide information for the standardized treatment of patients with MBC. The MBC patient records from 4 institutions ranging from January 2001 to November 2020 were retrospectively reviewed. There were 220 patients with MBC with a median age of 60 (range 24-88) years and an average tumor size of 2.3 cm (range 0.5 cm-6.5 cm). Sixty-six percent of patients underwent SLNB, and 39% of them showed positive results. A total of 157 patients underwent ALND, while only half of them had positive nodes, causing unnecessary complications. For patients in the clinical early stage, we found that the SLNB showed a noninferiority to the ALND treatment in DFS (P = .18) and OS (P = .055). In conclusion, there are certain obstacles to the broad application of SLNB due to the lower proportion of patients with clinically negative lymph nodes. However, it is undeniable that SLNB can safely and effectively exempt patients with MBC at early stage with clinically negative nodes from ALND to reduce subsequent complications. It is still an ideal criterion for the axillary staging of patients with MBC.
Brassinosteroid signaling regulator BIM1 integrates brassinolide and jasmonic acid signaling during cold tolerance in apple
Authors: An Jian-Ping , Liu Zhi-Ying , Zhang Xiao-Wei , Wang Da-Ru , Zeng Fanchang , You Chun-Xiang , Han Yuepeng
Published: July 2023

Although brassinolide (BR) and jasmonic acid (JA) play essential roles in the regulation of cold stress responses, the molecular basis of their crosstalk remains elusive. Here, we show a key component of BR signaling in apple (Malus × domestica), BR INSENSITIVE1 (BRI1)-EMS-SUPPRESSOR1 (BES1)-INTERACTING MYC-LIKE PROTEIN1 (MdBIM1), increases cold tolerance by directly activating expression of C-REPEAT BINDING FACTOR1 (MdCBF1) and forming a complex with C-REPEAT BINDING FACTOR2 (MdCBF2) to enhance MdCBF2-activated transcription of cold-responsive genes. Two repressors of JA signaling, JAZMONATE ZIM-DOMAIN1 (MdJAZ1) and JAZMONATE ZIM-DOMAIN2 (MdJAZ2), interact with MdBIM1 to integrate BR and JA signaling under cold stress. MdJAZ1 and MdJAZ2 reduce MdBIM1-promoted cold stress tolerance by attenuating transcriptional activation of MdCBF1 expression by MdBIM1 and interfering with the formation of the MdBIM1–MdCBF2 complex. Furthermore, the E3 ubiquitin ligase ARABIDOPSIS TÓXICOS en LEVADURA73 (MdATL73) decreases MdBIM1-promoted cold tolerance by targeting MdBIM1 for ubiquitination and degradation. Our results not only reveal crosstalk between BR and JA signaling mediated by a JAZ-BIM1-CBF module but also provide insights into the posttranslational regulatory mechanism of BR signaling.
Origin of the pointed snout inScolelepisand the mouth region in spionid polychaetes (Annelida: Spionidae)
Authors: Radashevsky Vasily I
Published: July 2023

Adult Scolelepis are unique among spionids in having an elongated, pointed snout, used for digging in sediment. Earlier studies have suggested that the pointed part of the larval head was a peristomial extension. Despite this, modern authors characterize larvae and adults of Scolelepis as having an elongated, pointed prostomium. Based on new observations, as well as on literature data, I show that the pointed medioventral process of the head in larvae is formed by lateral peristomial lips, elongated and fused anteriorly, each supported internally by conspicuous fibres. During settlement and metamorphosis, the anterolateral parts of the prostomium extend ventrally and overgrow the basal part of the peristomial process in a tube-like manner, forming a typical adult snout. Thus, in adult Scolelepis, only the wide basal part of the snout is formed by the prostomium, while the anterior, pointed part of the snout (the rostrum) is of peristomial origin. The ventral peristomial lip does not develop in Scolelepis larvae, and the ventral part of the mouth in adults is formed by the anterior extensions of the first and second segments. The diverse composition of the mouth region of different spionids is illustrated, as well as other details of the morphology of Scolelepis.
Evaluation of Hydrangea Cultivars for Tolerance Against Root Rot Caused by Fusarium oxysporum
Authors: Neupane Sandhya , Alexander Lisa , Baysal-Gurel Fulya
Published: July 2023

Root rot caused by Fusarium oxysporum Schltdl. is a newly identified disease in oakleaf hydrangea. Some cultivars such as Pee Wee and Queen of Hearts grown in pot-in-pot container systems showed root rot symptoms after late spring frost in May 2018 with 40 and 60% incidence in the infected nursery, respectively. This experiment was carried out to evaluate the tolerance among different hydrangea cultivars against root rot caused by F. oxysporum. Fifteen hydrangea cultivars from four different species were selected, and rooted cuttings were prepared from new spring flushes. Twelve plants from each cultivar were transplanted in a 1-gallon pot. Half of transplanted plants (six single plants) were inoculated by drenching 150 ml of F. oxysporum conidial suspension to maintain the concentration of 1 × 106 conidia/ml. Half of the plants remain noninoculated (control) and were drenched with sterile water. After 4 months, root rot was assessed using a scale of 0 to 100% root area affected, and recovery of F. oxysporum was recorded by plating 1-cm root sections in Fusarium selective medium. Fusaric acid (FA) and mannitol were extracted from the roots of inoculated and noninoculated plants to see the effect and role on pathogenesis. Further, mannitol concentration was analyzed using absorption wavelength in a spectrophotometer, and FA was analyzed using high-performance liquid chromatography (HPLC). Results indicated that no cultivars were resistant to F. oxysporum. Cultivars from Hydrangea arborescens, H. macrophylla, and H. paniculata were more tolerant to F. oxysporum compared to cultivars from H. quercifolia. Among H. quercifolia, cultivars Snowflake, John Wayne, and Alice were more tolerant to F. oxysporum.
CCR2 inhibitor strengthens the adiponectin effects against myocardial injury after infarction
Authors: Zheng Yue , Gao Wenqing , Qi Bingcai , Zhang Ruiying , Ning Meng , Hu Xiaomin , Li Tong
Published: July 2023

Little evidence demonstrated the effects of nitric oxide (NO) hydrogel with adipocytes in vivo. We aimed to investigate the effects of adiponectin (ADPN) and CCR2 antagonist on cardiac functions and macrophage phenotypes after myocardial infarction (MI) using chitosan caged nitric oxide donor (CSNO) patch with adipocytes. 3T3‐L1 cell line was induced to adipocytes and ADPN expression was knocked down. CSNO was synthesized and patch was constructed. MI model was constructed and patch was placed on the infarcted area. ADPN knockdown adipocytes or control was incubated with CSNO patch, and CCR2 antagonist was also used to investigate the ADPN effects on myocardial injury after infarction. On day 7 after operation, cardiac functions of the mice using CSNO with adipocytes or ADPN knockdown adipocytes improved more than in mice only using CSNO for treatment. Lymphangiogenesis increased much more in the MI mice using CSNO with adipocytes. After treating with CCR2 antagonist, Connexin43+ CD206+ cells and ZO‐1+ CD206+ cells increased, suggesting that CCR2 antagonist promoted M2 polarization after MI. Besides, CCR2 antagonist promoted ADPN expression in adipocytes and cardiomyocytes. ELISA was also used and CKMB expression was much lower than other groups at 3 days after operation. On day 7 after operation, the VEGF and TGFβ expressions were high in the adipocytes CSNO group, illustrating that higher ADPN led to better treatment. In all, CCR2 antagonist enhanced the ADPN effects on macrophage M2 polarization and cardiac functions. The combination used in border zone and infarcted areas may help improve patients' prognosis in surgery, such as CABG.
Neonatal Healthcare Professionals' Experiences When Implementing a Simulation and Debriefing Program in Neonatal Intensive Care Settings
Authors: Quinn Jenny , Quinn Megan , Lieu Brandon , Bohnert Janine , Halamek Louis P. , Profit Jochen , Fuerch Janene H. , Chitkara Ritu , Yamada Nicole K. , Gould Jeff , Lee Henry C.
Published: July 2023

Background:

Simulation-based training (SBT) and debriefing have increased in healthcare as a method to conduct interprofessional team training in a realistic environment.

Purpose:

This qualitative study aimed to describe the experiences of neonatal healthcare professionals when implementing a patient safety simulation and debriefing program in a neonatal intensive care unit (NICU).

Methods:

Fourteen NICUs in California and Oregon participated in a 15-month quality improvement collaborative with the California Perinatal Quality Care Collaborative. Participating sites completed 3 months of preimplementation work, followed by 12 months of active implementation of the simulation and debriefing program. Focus group interviews were conducted with each site 2 times during the collaborative. Content analysis found emerging implementation themes.

Results:

There were 234 participants in the 2 focus group interviews. Six implementation themes emerged: (1) receptive context; (2) leadership support; (3) culture change; (4) simulation scenarios; (5) debriefing methodology; and (6) sustainability. Primary barriers and facilitators with implementation of SBT centered around having a receptive context at the unit level (eg, availability of resources and time) and multidisciplinary leadership support.

Implications for Practice and Research:

NICUs have varying environmental (context) factors and consideration of unit-level context factors and support from leadership are integral aspects of enhancing the successful implementation of a simulation and debriefing program for neonatal resuscitation. Additional research regarding implementation methods for overcoming barriers for both leaders and participants, as well as determining the optimal frequency of SBT for clinicians, is needed. A knowledge gap remains regarding improvements in patient outcomes with SBT.
Construction and evaluation of the functional polygenic risk score for gastric cancer in a prospective cohort of the European population
Authors: Gu Yuanliang , Yan Caiwang , Wang Tianpei , Hu Beiping , Zhu Meng , Jin Guangfu
Published: July 2023

Background:

A polygenic risk score (PRS) derived from 112 single-nucleotide polymorphisms (SNPs) for gastric cancer has been reported in Chinese populations (PRS-112). However, its performance in other populations is unknown. A functional PRS (fPRS) using functional SNPs (fSNPs) may improve the generalizability of the PRS across populations with distinct ethnicities.

Methods:

We performed functional annotations on SNPs in strong linkage disequilibrium (LD) with the 112 previously reported SNPs to identify fSNPs that affect protein-coding or transcriptional regulation. Subsequently, we constructed an fPRS based on the fSNPs by using the LDpred2-infinitesimal model and then analyzed the performance of the PRS-112 and fPRS in the risk prediction of gastric cancer in 457,521 European participants of the UK Biobank cohort. Finally, the performance of the fPRS in combination with lifestyle factors were evaluated in predicting the risk of gastric cancer.

Results:

During 4,582,045 person-years of follow-up with a total of 623 incident gastric cancer cases, we found no significant association between the PRS-112 and gastric cancer risk in the European population (hazard ratio [HR] = 1.00 [95% confidence interval (CI) 0.93–1.09], P = 0.846). We identified 125 fSNPs, including seven deleterious protein-coding SNPs and 118 regulatory non-coding SNPs, and used them to construct the fPRS-125. Our result showed that the fPRS-125 was significantly associated with gastric cancer risk (HR = 1.11 [95% CI, 1.03–1.20], P = 0.009). Compared to participants with a low fPRS-125 (bottom quintile), those with a high fPRS-125 (top quintile) had a higher risk of incident gastric cancer (HR = 1.43 [95% CI, 1.12–1.84], P = 0.005). Moreover, we observed that participants with both an unfavorable lifestyle and a high genetic risk had the highest risk of incident gastric cancer (HR = 4.99 [95% CI, 1.55–16.10], P = 0.007) compared to those with both a favorable lifestyle and a low genetic risk.

Conclusion:

These results indicate that the fPRS-125 derived from fSNPs may act as an indicator to measure the genetic risk of gastric cancer in the European population.
Apical Hypertrophic Cardiomyopathy: Diagnosis, Natural History, and Management
Authors: Rouskas Pavlos , Katranas Sotiris , Zegkos Thomas , Gossios Thomas , Parcharidou Despoina , Tziomalos Georgios , Filippou Natassa , Tsalikakis Dimitrios , Didagelos Matthaios , Kamperidis Vassilios , Karamitsos Theodoros , Ziakas Antonios , Efthimiadis Georgios K.
Published: July 2023

Apical hypertrophic cardiomyopathy (ApHCM) represents a rare variant of hypertrophic cardiomyopathy (HCM) with distinct phenotypic characteristics. The prevalence of this variant varies according to each study’s geographic region. The leading imaging modality for the diagnosis of ApHCM is echocardiography. Cardiac magnetic resonance, however, is the gold standard for ApHCM diagnosis in case of poor acoustic windows or equivocal echocardiographic findings but also in cases of suspected apical aneurysms. The prognosis of ApHCM was reported to be relatively benign, although more recent studies seem to contradict this, demonstrating similar incidence of adverse events compared with the general HCM population. The aim of this review is to summarize the available evidence for the diagnosis of ApHCM, highlight distinctions in comparison to more frequent forms of HCM with regards to its natural history, prognosis, and management strategies.
Comparison between supra-inguinal fascia iliaca and pericapsular nerve group blocks on postoperative pain and functional recovery after total hip arthroplasty
Authors: Carella Michele , Beck Florian , Piette Nicolas , Denys Sébastien , Lecoq Jean-Pierre , Bonhomme Vincent L.
Published: July 2023

BACKGROUND

Pain after a posterolateral approach for total hip arthroplasty (THA) may affect early functional recovery. Supra-inguinal fascia iliaca (SFIB) and pericapsular nerve group (PENG) blocks have been proposed as promising analgesia techniques.

OBJECTIVES

This trial was conducted to compare a PENG with a SFIB for controlling postoperative pain and for providing functional recovery.

DESIGN

Noninferiority monocentric randomised controlled study.

SETTING

One hundred and two patients scheduled for a total hip arthroplasty via the posterolateral approach under spinal anaesthesia were prospectively allocated to two groups. Data acquisition occurred between October 2021 and July 2022 at the University Hospital of Liege.

PATIENTS

One hundred and two patients completed the trial.

INTERVENTIONS

Group SFIB received supra-inguinal fascia iliaca block (SFIB) (40 ml ropivacaine 0.375%), whereas group PENG received a PENG block (20 ml ropivacaine 0.75%).

MAIN OUTCOME MEASURES

Rest and mobilisation pain on a 0 to 10 numeric rating scale at fixed time points: 1 and 6 h after surgery, on day-1 and day-2 at 8 a.m.,1 p.m. and 6 p.m. On day-1 and day-2, evolution of quality-of-recovery-15 score was assessed, and timed-up-and-go, 2 and 6 min-walking tests. The noninferiority margin was set as 1 numeric rating scale point 6 h after surgery.

RESULTS

Six hours after surgery, pain scores in group PENG were noninferior to those of group SFIB, with a difference between medians at 0 (95% CI −0.93 to 0.93). There were no significant differences between the groups regarding rest and dynamic pain trajectories during the first 48 postoperative hours, with no significant effects of group (rest P = 0.800; dynamic P = 0.708) or interaction between group and time (rest P = 0.803; dynamic P = 0.187). Similarly, no significant differences were observed regarding motor and functional recovery as assessed by timed-up-and-go (P = 0.197), 2 min (P = 0.364), and 6 min walking (P = 0.347) tests and quality-of-recovery-15 (P = 0.417) score.

CONCLUSION

Following a total hip arthroplasty via the posterolateral approach, a PENG block is noninferior to SFIB regarding postoperative pain control 6 h after surgery, and functional recovery.

TRIAL REGISTRATION

European Clinical Trial Register under EudraCT-number 2020-005126-28 (https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-005126-28/BE).
Amniotic Membrane Transplantation for Reconstruction of Ocular Surface Lesion Excisions in Pediatric Population
Authors: Bulut Okyanus , Palamar Melis , Yaman Banu , Egrilmez Sait , Yagci Ayse , Barut Selver Ozlem
Published: July 2023

Purpose:

To define the use of human amniotic membrane transplantation (hAMT) for reconstruction of the ocular surface after ocular surface lesion excisions in pediatric population during the last decade in a tertiary eye center.

Methods:

A total of 31 patients who underwent hAMT procedure because of the excision of ocular surface lesions between January 2009 and December 2021 were included in this study. The medical data were retrospectively evaluated.

Results:

The female-to-male ratio was 14/17. The mean age of the patients was 10.1±4.1 (range, 1–18) years. Although a single hAMT was applied to most of the cases (94.4%; 34 eyes), more than one hAMT was applied to 5.6% of cases (2 eyes). The amniotic membrane degradation duration was found to be 21.5±10.8 (range, 13–50) days.

Conclusions:

Amniotic membrane is used as a biomaterial in various ocular surface diseases with its anti-inflammatory, antimicrobial, and wound healing properties. Although widely used, there are only a few studies reporting its clinical efficacy in the pediatric age group. It seems to be safe and effective in pediatric age group for ocular surface reconstruction after ocular surface lesion excisions.
Evaluation of Limbal Stem Cells in Patients With Type 2 Diabetes: An In Vivo Confocal Microscopy Study
Authors: Chen Dan , Wang Leying , Guo Xiaoyan , Zhang Zijun , Xu Xizhan , Jin Zi-Bing , Liang Qingfeng
Published: July 2023

Purpose:

This study aimed to investigate corneal limbus changes in patients with type 2 diabetes mellitus (DM) using in vivo confocal microscopy (IVCM) and explore the correlation between their ocular manifestations and systemic status.

Methods:

Fifty-five patients with type 2 DM and 20 age-matched controls were included. The following IVCM parameters were compared between the 2 groups: palisades of Vogt (POV), corneal epithelial thickness (CET), basal cell density (BCD), subbasal nerve plexus, and dendritic cell density. All subjects underwent blood and urine sampling for laboratory analysis, including fasting blood glucose, glycated hemoglobin, total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, C-reactive protein, urinary albumin-to-creatinine ratio, urine albumin, and urine creatinine. The correlations between IVCM parameters and blood biomarkers were detected. Receiver operating characteristic curve was used for selecting the cutoff value of risk factors for corneal stem cell injury in patients with DM.

Results:

Compared with controls, patients with DM displayed a significant reduction of POV (superior region, P = 0.033; inferior region, P = 0.003; nasal region, P < 0.001; temporal region, P < 0.001), central CET (44.8 ± 3.6 μm vs. 51.9 ± 3.6 μm, P < 0.001), central corneal BCD (7415.5 ± 563.2 cells/mm2 vs. 9177.9 ± 977.8 cells/mm2, P < 0.001), and peripheral corneal BCD (6181.3 ± 416.5 cells/mm2 vs. 8576.3 ± 933.2 cells/mm2, P < 0.001). Dendritic cell density (41.0 ± 33.7 cells/mm2 vs. 24.6 ± 7.8 cells/mm2, P = 0.001) was significantly higher in the DM group. The following weak correlations were shown between IVCM parameters and blood biomarkers: central corneal BCD was negatively correlated with DM duration (r = −0.3, P = 0.024), TC (r = −0.36, P = 0.007), and LDL (r = −0.39, P = 0.004). The presence of POV in the superior region was negatively correlated with TC (r = −0.34, P = 0.011) and LDL (r = −0.31, P = 0.022). Cutoff values of 1.215 mmol/L for HDL, 1.59 mmol/L for TG, or 4.75 mmol/L for TC were established to distinguish patients with a high risk from a low risk for stem cell damage.

Conclusions:

Patients with type 2 DM displayed a lower positive rate of typical POV and a decrease in BCD, CET, and subbasal nerve density. The most relevant indicators for stem cell phenotypes were DM duration, TC, and LDL. Lipid status in diabetic patients could be a predictor of risk for developing corneal limbal stem cell deficiency. Further studies with larger sample sizes or basic research are needed to verify the results.
Warfarin versus direct oral anticoagulants in South Asian octogenarians: a retrospective review
Authors: Ee Samuel Chen En , Rosario Barbara Helen , Mok Zi Huan , Tun Mon Hnin , Razali Siti Shafia Bte Yang , Tan Boon Hian
Published: July 2023

To investigate the efficacy and safety outcomes of warfarin and direct oral anticoagulants in Asian octogenarians. A retrospective study was undertaken in 270 patients aged 80 years old and above, between 15 July 2015 and 21 December 2017, prescribed oral anticoagulation (OAC) with warfarin or direct oral anticoagulant (DOAC). Data collection included demographics, bleeding events, cessation of anticoagulation, mortality and hospital utilization up to 2 years post prescription. Thrombotic and embolic events within 30 days of anticoagulation cessation were reviewed. Data was analysed according to initial prescription of either warfarin or DOAC. There were 134 patients on warfarin and 136 patients on DOAC, of which majority of them were on anticoagulation for atrial fibrillation. In the warfarin group, there was a higher rate of minor bleeding events leading to permanent cessation (12.7 vs. 2.9%, P = 0.035) compared with DOAC. Mortality rate at 2 years was higher in the warfarin group than DOAC (40.3 vs. 28.7%, P = 0.044). There was no difference in major bleeding events, risk of gastrointestinal bleed or ICH between the two groups. There was no difference in rate of thrombotic and embolic events after cessation of anticoagulation and hospital utilization over 2 years was similar in both groups. In Asian octogenarians on anticoagulation, DOAC appears to have benefit over warfarin in terms of minor bleeding risk and mortality.
Development and validation of nonalcoholic fatty liver disease test: a simple sensitive and specific marker for early diagnosis of nonalcoholic fatty liver disease
Authors: Omran Mohamed , Omr Mona , Mohamed Amal A. , Abdelghafour Reem A. , Muharram Nashwa M. , Hassan Mohamed B. , Fangry Abobakrelsedik , Emran Tarek , Arab Juan P. , Arnold Jorge , Diaz Luis Antonio , Zheng Ming-Hua , El-Kassas Mohamed
Published: July 2023

Aim

This study aimed to develop a noninvasive test for identifying patients with nonalcoholic fatty liver disease (NAFLD) based on clinical and routine laboratory data.

Methods

The developed model ‘NAFLD test’ was compared to the most commonly used NAFLD scores and then validated in three groups of NAFLD patients from five centers in Egypt, China, and Chile. Patients were divided into the discovery cohort (n = 212) and the validation study (n = 859). The ROC curve and stepwise multivariate discriminant analysis were used to develop and validate the NAFLD test and evaluate its diagnostic performance, which was then compared to other NAFLD scores.

Results

Elevated C-reactive protein (CRP), cholesterol, BMI, and alanine aminotransferase (ALT) levels were significantly associated with NAFLD (P < 0.0001). NAFLD test is depicted as (−0.695 + 0.031 × BMI + 0.003 × cholesterol + 0.014 × ALT + 0.025 × CRP) to discriminate patients with NAFLD from healthy individuals. The area under the ROC curve (AUC) of the NAFLD test was 0.92 [95% confidence interval (CI): 0.88–0.96]. The NAFLD test was the most accurate diagnostic indicator of NAFLD when compared to widely used NAFLD indices. Upon validating the NAFLD test, its AUC (95% CI) for distinguishing patients with NAFLD from healthy individuals was 0.95 (0.94–0.97), 0.90 (0.87–0.93), and 0.94 (0.91–0.97) in Egyptian, Chinese, and Chilean patients with NAFLD respectively.

Conclusion

The NAFLD test is a new validated diagnostic biomarker that can be utilized for the early diagnosis of NAFLD with high diagnostic performance.
Preferred language and disease severity predict evaluation for liver transplantation among patients admitted with alcohol-associated hepatitis
Authors: Cloonan Daniel J. , Broekhuis Jordan M. , Coe Taylor M. , Criss Steven , Li Sienna , Bartels Stephen J. , Yeh Heidi , Bethea Emily D. , Dageforde Leigh Anne
Published: July 2023

Background:

Liver transplantation (LT) for alcohol-associated hepatitis (AH) is a relatively new practice and limited work exists surrounding the role social determinants of health may play in evaluation. This includes language that defines how patients interact with the healthcare system. We explored characteristics of patients with AH evaluated for LT within an integrated health system.

Methods

Using a system-wide registry, we identified admissions for AH from 1 January 2016 to 31 July 2021. A multivariable logistic regression model was developed to evaluate independent predictors of LT evaluation.

Results

Among 1723 patients with AH, 95 patients (5.5%) underwent evaluation for LT. Evaluated patients were more likely have English as their preferred language (95.8% vs 87.9%, P = 0.020), and had higher INR (2.0 vs 1.4, P < 0.001) and bilirubin (6.2 vs 2.9, P < 0.001). AH patients who underwent evaluation had a lower burden of mood and stress disorders (10.5% vs 19.2%, P < 0.05). Patients with English preferred language had a greater than three times adjusted odds of LT evaluation compared with all others when adjusting for clinical disease severity, insurance status, sex, and psychiatric comorbid conditions (OR, 3.20; 95% CI, 1.14–9.02).

Conclusion

Patients with AH evaluated for LT were more likely to have English as their preferred language, more psychiatric comorbidities, and more severe liver disease. Despite adjustment for psychiatric comorbidities and disease severity, English preferred language remained the strongest predictor of evaluation. As programs expand LT for AH, it is vital to build equitable systems that account for the interaction between language and healthcare in transplantation.
The association between duration of and indications for proton pump inhibitor use and risk of gastric polyps
Authors: Kroupa Radek , Pavlik Tomas , Konecny Stefan , Packova Barbora , Dastych Milan , Pavlovsky Zdenek , Dolina Jiri
Published: July 2023

Objectives

The development of fundic gland polyps (FGPs) is the most common side effect of long-term proton pump inhibitor (PPI) use; however, the effect of drug use characteristics and their impact on the risk of other gastric polyp development remain unclear. We aimed to identify the influence of PPI administration, as well as its duration and dose, in the development of gastric polyps.

Methods

A prospective cohort study was conducted on consecutive patients who underwent gastroscopy between September 2017 and August 2019. Detailed characteristics of gastric polyps, Helicobacter pylori infection, and PPI use were analyzed.

Results

Among the 2723 patients included, gastric polyps (75% FGPs, 22% hyperplastic) were detected in 16.4%, and 60% were prescribed PPI. The risk of FGPs and hyperplastic polyps according to the duration of PPI use were as follows: 2–5 years [odds ratio (95% confidence interval); 2.86 (2.00–4.11) and 2.82 (1.69–4.78)]; 6–9 years [7.42 (5.03–11.01) and 2.32 (1.05–4.78)]; ≥10 years [14.94 (10.36–21.80) and 3.52 (1.67–7.03)]. Multivariate analysis confirmed that the risk of FGPs was 17.16 (11.35–26.23) for ≥10 years of PPI use. Portal hypertension-related conditions were associated with hyperplastic polyps [4.99 (2.71–9.20)].

Conclusion

Duration of and indications for PPI use are the most predictive factors for the development of gastric polyps. Prolonged PPI use increases the risk of polyp development and the number of patients with polyps, which may burden endoscopic practice. Highly selected patients may require particular care despite minimal risk of dysplasia and bleeding generally.
Transjugular intrahepatic portosystemic shunt insertion improves muscle mass but not muscle function or frailty measures
Authors: Hey Penelope , Chapman Brooke , Wong Darren , Gow Paul , Testro Adam , Terbah Ryma , Sinclair Marie
Published: July 2023

Introduction

Sarcopenia in cirrhosis is associated with poor outcomes. While transjugular intrahepatic portosystemic shunt (TIPS) insertion improves radiological measures of muscle mass, its impact on muscle function, performance and frailty has not been evaluated.

Methods

Patients with cirrhosis referred for TIPS were prospectively recruited and followed for 6 months. L3 CT scans were used to calculate skeletal muscle and adipose tissue parameters. Handgrip strength, Liver Frailty Index and short physical performance battery were serially monitored. Dietary intake, insulin resistance, insulin-like growth factor (IGF)-1, and immune function using QuantiFERON Monitor (QFM) were measured.

Results

Twelve patients completed the study with a mean age of 58 ± 9 years and model for end-stage liver disease score of 16 ± 5. At 6 months post-TIPS, skeletal muscle area increased from 139.33 cm2 ± 22.72 to 154.64 ± 27.42 (P = 0.012). Significant increases were observed in the subcutaneous fat area (P = 0.0076) and intermuscular adipose tissue (P = 0.041), but not muscle attenuation or visceral fat. Despite marked changes in muscle mass, no improvements were observed in handgrip strength, frailty, or physical performance. At 6 months post-TIPS, IGF-1 (P = 0.0076) and QFM (P = 0.006) increased compared to baseline. Nutritional intake, hepatic encephalopathy measures, insulin resistance and liver biochemistry were not significantly impacted.

Conclusion

Muscle mass increased following TIPS insertion as did IGF-1, a known driver of muscle anabolism. The lack of improvement in muscle function was unexpected and may relate to impairment in muscle quality and the effects of hyperammonaemia on muscle contractile function. Improvements in QFM, a marker of immune function, may suggest a reduction in infection susceptibility in this at-risk population and requires further evaluation.