bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of High-Energy Distal Radius Fractures
Authors: LIAO Janice Chin-Yi , LIM Amaris , TAN David Meng-Kiat , CHONG Alphonsus Khin-Sze
Published: August 2024

Background: High-energy distal radius fractures have not been as well studied as the more common osteoporotic fractures. Differences between these two groups of fractures have implications on the prevention and clinical management of such injuries.

Methods: A retrospective review was conducted of all patients in our institution who presented with distal radius fractures within the period of a year. Demographic data, injury mechanism, fracture classification, associated injuries and work-related status were obtained and analysed.

Results: High energy fractures made up 27.1% of the cases. Falls from height were the most common cause, followed by motor vehicle accidents. These high-energy fractures were more commonly seen in males, younger patients (average age 41 vs. 61 years), and in workplace accidents. These injuries were also more likely to be bilateral and associated with an additional ipsilateral upper extremity injury. The high-energy group was also more likely to have an AO type B fracture.

Conclusions: A substantial proportion of distal radius fractures seen in our population are high-energy injuries. Their contrasting patient and injury profiles suggest that they should be considered separately from osteoporotic fractures.

Level of Evidence: Level IV (Therapeutic)
A Surgical Approach to a Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injury without Dividing the Adductor Aponeurosis
Authors: GOUBAU Yannick , BALCAEN Romy , VANHOVE Wim
Published: August 2024

An injury to the ulnar collateral ligament (UCL) of the metacarpophalangeal joint (MCPJ) of the thumb is a common injury, widely referred to as a skier’s thumb. The rupture usually occurs at the distal insertion. In the classical technique, the adductor aponeurosis is divided to access the torn UCL and the MCPJ and repaired after ligament repair/reinsertion. We describe a surgical approach to the UCL that does not require division of the adductor aponeurosis.

Level of Evidence: Level V (Therapeutic)
Symptomatic Congenital Coalition of the Pisiform and Hamate – A Case Report
Authors: SUWANNAPHISIT Sitthiphong , IIDA Akio , KAWAMURA Kenji , OMOKAWA Shohei
Published: August 2024

We describe a 13-year-old boy with piso-hamate coalition confirmed by X-ray. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed type 1 coalition according to the classification of DeVilliers Minnaar. Piso-hamate coalition is rare, and suspicions should be raised in instances of chronic ulnar-sided wrist pain, particularly in individuals with a history of elevated hand usage, especially amongst athletes engaging in intensive hand grip activities. Surgical resection of the synchondrosis site between the pisiform and the hamate is an efficacious intervention that can mitigate pain.

Level of Evidence: Level V (Therapeutic)
Structured Chain-of-Thought Prompting for Code Generation
Authors: Li Jia , Li Ge , Li Yongmin , Jin Zhi
Published: August 2024

Large Language Models (LLMs) have shown impressive abilities in code generation. Chain-of-Thought (CoT) prompting is the state-of-the-art approach to utilizing LLMs. CoT prompting asks LLMs first to generate CoTs (i.e., intermediate natural language reasoning steps) and then output the code. However, the accuracy of CoT prompting still cannot satisfy practical applications. For example, gpt-3.5-turbo with CoT prompting only achieves 53.29% Pass@1 in HumanEval. In this article, we propose Structured CoTs (SCoTs) and present a novel prompting technique for code generation named SCoT prompting. Our motivation is that human developers follow structured programming. Developers use three programming structures (i.e., sequential, branch, and loop) to design and implement structured programs. Thus, we ask LLMs to use three programming structures to generate SCoTs (structured reasoning steps) before outputting the final code. Compared to CoT prompting, SCoT prompting explicitly introduces programming structures and unlocks the structured programming thinking of LLMs. We apply SCoT prompting to two LLMs (i.e., gpt-4-turbo, gpt-3.5-turbo, and DeepSeek Coder-Instruct-

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1.3B, 6.7B, 33B

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) and evaluate it on three benchmarks (i.e., HumanEval, MBPP, and MBCPP). SCoT prompting outperforms CoT prompting by up to 13.79% in Pass@1. SCoT prompting is robust to examples and achieves substantial improvements. The human evaluation also shows human developers prefer programs from SCoT prompting.
S
3
Agent: Unlocking the Power of VLLM for Zero-Shot Multi-modal Sarcasm Detection
Authors: Wang Peng , Zhang Yongheng , Fei Hao , Chen Qiguang , Wang Yukai , Si Jiasheng , Lu Wenpeng , Li Min , Qin Libo
Published: August 2024

Multi-modal sarcasm detection involves determining whether a given multi-modal input conveys sarcastic intent by analyzing the underlying sentiment. Recently, vision large language models have shown remarkable success on various of multi-modal tasks. Inspired by this, we systematically investigate the impact of vision large language models in zero-shot multi-modal sarcasm detection task. Furthermore, to capture different perspectives of sarcastic expressions, we propose a multi-view agent framework, S
3
Agent, designed to enhance zero-shot multi-modal sarcasm detection by leveraging three critical perspectives:
superficial expression
,
semantic information
, and
sentiment expression
. Our experiments on the MMSD2.0 dataset, which involves six models and four prompting strategies, demonstrate that our approach achieves state-of-the-art performance. Our method achieves an average improvement of 13.2% in accuracy. Moreover, we evaluate our method on the text-only sarcasm detection task, where it also surpasses baseline approaches.
Decoding the Foodome: Molecular Networks Connecting Diet and Health
Authors: Menichetti Giulia , Barabási Albert-László , Loscalzo Joseph
Published: August 2024

Diet, a modifiable risk factor, plays a pivotal role in most diseases, from cardiovascular disease to type 2 diabetes mellitus, cancer, and obesity. However, our understanding of the mechanistic role of the chemical compounds found in food remains incomplete. In this review, we explore the “dark matter” of nutrition, going beyond the macro- and micronutrients documented by national databases to unveil the exceptional chemical diversity of food composition. We also discuss the need to explore the impact of each compound in the presence of associated chemicals and relevant food sources and describe the tools that will allow us to do so. Finally, we discuss the role of network medicine in understanding the mechanism of action of each food molecule. Overall, we illustrate the important role of network science and artificial intelligence in our ability to reveal nutrition's multifaceted role in health and disease.
Addressing Strain and Porosity Changes of Battery Electrodes Due to Reversible Expansion through DEM Simulations
Authors: Teel Hunter , Garrick Taylor R. , Srinivasan Srikant , Wang Fengkun , Zeng Yangbing , Shimpalee Sirivatch
Published: August 2024

In this work, discrete element method (DEM) simulations were used to probe changes in electrode porosity, electrode strain, and the resultant pressure changes for composite electrodes comprised of active material and binder particles. Through the results acquired by these simulations, three cases that are representative of two limiting cases for electrode operation, and one case for realistic electrode face pressure during operation were captured and the implications on design and performance are discussed. Predicting changes in the porosity is a unique insight that is difficult if not impossible to capture experimentally but is important for predicting changes in electrochemical performance during cycling, and should be addressed early on in the design phase for automotive and grid storage battery design and performance.
A new approach to peripheral nerve block education with the Anatomage Table as a learning adjunct
Authors: Shenoy Varun , Ghimire Arjun Kumar , Gopalan Chaya
Published: August 2024

We implemented the Anatomage Table (AT) and portable ultrasound to teach neuraxial landmarks for performing peripheral nerve blocks (PNB), an anesthetic technique for Certified Registered Nurse Anesthetist (CRNA) students. The workshop significantly increased student confidence in identifying the relevant neuraxial landmarks for performing PNBs. Our results support the use of the AT in clinical education as a supplement.
Identification of NET formation and the renoprotective effect of degraded NETs in lupus nephritis
Authors: Jin Yong , Wang Yutong , Ma Xu , Li Hongbin , Zhang Manling
Published: August 2024

The mechanisms by which immune cells cause kidney injury in lupus nephritis are poorly understood. We integrated and analyzed the transcriptomic features of PBMCs and renal tissues from the GEO database to identify key molecular markers associated with neutrophil activation. We confirmed that neutrophil extracellular traps (NETs) formed by neutrophil activation promoted the upregulation of key genes in cell and animal models. Targeted degradation of NETs significantly ameliorated kidney injury in MRL/lpr mice.
A brief harvesting-freezing delay significantly alters the kidney metabolome and leads to false positive and negative results
Authors: Alsawaf Yahya , Maksimovic Igor , Zheng Jamie , Zhang Song , Vuckovic Ivan , Dzeja Petras , Macura Slobodan , Irazabal Maria V.
Published: August 2024

Our study shows that a brief harvesting-freezing delay associated with organ collection and freezing can significantly alter the kidney metabolic profile of both male and female wild-type and a genetic model of chronic kidney disease. Importantly, given that the effect of this delay differs among genotypes, it is not safe to assume that equally delaying harvesting-freezing in wild-type and polycystic kidney disease kidneys adequately controls this effect, ultimately leading to false positive and negative results among different renal diseases.
Distal convoluted tubule-specific disruption of the COP9 signalosome but not its regulatory target cullin 3 causes tubular injury
Authors: Maeoka Yujiro , Bradford Tanner , Su Xiao-Tong , Sharma Avika , Yang Chao-Ling , Ellison David H. , McCormick James A. , Cornelius Ryan J.
Published: August 2024

CUL3 degrades WNK4, which prevents activation of NCC in the DCT. CSN regulation of CUL3 is impaired in the disease FHHt, causing accumulation of WNK4. Short-term DCT-specific disruption of CUL3 or the CSN in mice resulted in activation of the WNK4-SPAK-NCC pathway but not hyperkalemic metabolic acidosis found in FHHt. Tubule injury was observed only after long-term CSN disruption. The data suggest that disruption of other cullins may be the cause for the injury.
Optimizing renal transporter immunodetection: consequences of freeze-thaw during sample preparation
Authors: Hartman-Houstman Hannah L. , Ralph Donna L. , Nelson Jonathan W. , Palmer Lawrence G. , Faulkner Jessica E. , Sullivan Jennifer C. , Moronge Desmond M. , McDonough Alicia A.
Published: August 2024

Freeze-thawing kidneys before homogenization is widely accepted in renal research. This study demonstrates that if kidneys are freeze-thawed just once before homogenization, immunoblot signals are reduced in a transporter-specific manner in rats and mice dependent on sex and that immunoblot signals can be partially recovered by adding additional protease inhibitors. These findings underscore the critical importance of assessing the impact of sample preparation, including freeze-thaw versus fresh, to ensure robust rigor and reproducibility.
Improved COVID‐19 Diagnosis Using a Hybrid Transfer Learning Model with Fuzzy Edge Detection on CT Scan Images
Authors: Salarabadi Hassan , Iraji Mohammad Saber , Salimi Mehdi , Zoberi Mehdi
Published: August 2024

CT imaging provides detailed and comprehensive visualization of lung abnormalities associated with the disease, aiding in accurate and timely diagnosis. Medical specialists often recommend the use of CT scans for COVID‐19 diagnosis, particularly in the second week of illness when there is a high suspicion of infection, due to the unique lung patterns observed in COVID‐19 patients. Consequently, there is a need for a quick recognition system based on deep learning techniques to detect COVID‐19 infection and prevent its spread. In this study, a novel fusion method incorporating dropout, data augmentation, transfer learning, and edge detection using the fuzzy technique was employed, resulting in improved model accuracy and reduced overfitting. In addition, CT images of 300 patients from the Fariabi Hospital in Kermanshah Province were collected and classified into two groups based on lung involvement. Critical frames, essential for decision‐making, were separated and used for disease diagnosis by the designed models under specialist supervision. The findings demonstrate that the proposed hybrid transfer learning model utilizing the fuzzy technique achieves significant performance improvement, with 97% accuracy on the training set and 88% accuracy on the test set.
BioSolutions for Green Agriculture: Unveiling the Diverse Roles of Plant Growth‐Promoting Rhizobacteria
Authors: Ehinmitan Emmanuel , Losenge Turoop , Mamati Edward , Ngumi Victoria , Juma Patrick , Siamalube Beenzu
Published: August 2024

The extensive use of chemical pesticides and fertilizers in conventional agriculture has raised significant environmental and health issues, including the emergence of resistant pests and pathogens. Plant growth‐promoting rhizobacteria (PGPR) present a sustainable alternative, offering dual benefits as biofertilizers and biocontrol agents. This review delves into the mechanisms by which PGPR enhance plant growth, including nutrient solubilization, phytohormone production, and pathogen suppression. PGPR’s commercial viability and application, particularly under abiotic stress conditions, are also examined. PGPR improves plant growth directly by enhancing nutrient uptake and producing growth‐promoting substances and indirectly by inhibiting phytopathogens through mechanisms such as siderophore production and the secretion of lytic enzymes. Despite their potential, the commercialization of PGPR faces challenges, including strain specificity, formulation stability, and regulatory barriers. The review highlights the need for ongoing research to deepen our understanding of plant‐microbe interactions and develop more robust PGPR formulations. Addressing these challenges will be crucial for integrating PGPR into mainstream agricultural practices and reducing reliance on synthetic agrochemicals. The successful adoption of PGPR could lead to more sustainable agricultural practices, promoting healthier crops and ecosystems.
Laboratory Evaluation of Vibration Isolation of Dynamic Loads Caused by Machine Foundations by Surface Trenches
Authors: Bazoobandi Sajjad , Shamekhi Amiri Mohammad , Keramati Mohsen
Published: August 2024

Measures should be taken to prevent the effects of vibration caused by dynamic loads of machines. Research has shown that trenches can effectively reduce vibrations caused by machine foundations. It has been determined that the open trench provides the best performance against vibration, but it is not practical due to operational limitations. Considering environmental concerns and vibration absorption, rubber crumb can effectively combine with sand in trenches. Combining rubber crumbs and sandy soil in the trenches reduces vibration from industrial machines and promotes the reuse of rubber waste. This article examines how surface trenches filled with a sand and rubber crumb mixture can reduce the vibrations of industrial foundations. This research focuses more on vibrations and high strains, and vibrating foundations have been used for vibration. The study aimed to determine the impact of trench dimensions on insulation levels. The results indicated that trench length and depth had a significant effect, while thickness did not have a noticeable impact. The study also examined different trenches with varying combinations of crumb rubber to determine their isolation level. The trenches contained 30%, 20%, and 10% crumb rubber by weight, and the average isolation values were 58.20%, 56.33%, and 50.29%, respectively. The results were then compared with each other.
Effects of Starvation and Refeeding on the Compensatory Growth of Juvenile Epinephelus coioides
Authors: Yang Yukai , Yu Wei , Duan Yafei , Lin Heizhao , Huang Zhong , Huang Xiaolin , Li Tao
Published: August 2024

The purpose of this study was to investigate the adaptive strategies and compensatory growth mechanisms of juvenile Epinephelus coioides under starvation stress. The fish with an initial body weight of 8.88 ± 0.06 g were starved for 0 day (F0, control), 3 days (F3), 6 days (F6), 9 days (F9), 12 days (F12), and 15 days (F15), followed by feeding periods of 30 days, 27 days, 24 days, 21 days, 18 days, and 15 days, respectively. The results are shown as follows: (1) E. coioides could achieve complete or partial compensatory growth by improving both feeding rate and feed conversion efficiency. (2) The viscerosomatic index and the hepatosomatic index of the test fish decreased linearly with the duration of starvation (P < 0.05), while the condition factor did not significantly decrease (P > 0.05). At the end of feeding, all the physical body indicators of the test fish recovered or exceeded the control levels. (3) The lipid and glycogen contents of the test fish decreased continuously throughout the entire starvation process, with noticeable protein consumption occurring in the later stages of starvation (P < 0.05). At the end of the feeding period, apart from a significant reduction in crude lipid contents in the F12 and F15 groups compared to the control group (P < 0.05), the biochemical composition of the test fish was restored or even surpassed that of the control group. (4) The activity of digestive enzymes could be stimulated by starvation, enabling the efficient utilization of energy storage substances. In conclusion, it is advisable to limit the period of starvation for juvenile E. coioides to 12 days, which means that the ratio of starvation period to feeding period should not exceed two‐thirds.
Live-Cell Invasive Phenotyping Uncovers ALK2 as a Therapeutic Target in LKB1-Mutant Lung Cancer
Authors: Koo Junghui , Seong Chang-Soo , Parker Rebecca E. , Herrera Amy , Dwivedi Bhakti , Arthur Robert A. , Dinasarapu Ashok Reddy , Johnston Henry Richard , Claussen Henry , Tucker-Burden Carol , Ramalingam Suresh S. , Fu Haian , Zhou Wei , Marcus Adam I. , Gilbert-Ross Melissa
Published: August 2024

The acquisition of invasive properties is a prerequisite for tumor progression and metastasis. Molecular subtypes of KRAS-driven lung cancer exhibit distinct modes of invasion that contribute to unique growth properties and therapeutic susceptibilities. Despite this, preclinical strategies designed to exploit growth within the context of invasion are lacking. To address this, we designed an experimental system to screen for targetable signaling pathways linked to active early 3D invasion phenotypes in different molecular subtypes of KRAS-driven lung adenocarcinoma. Combined live-cell imaging of human bronchial epithelial cells in a 3D invasion matrix and transcriptomic profiling identified mutant LKB1-specific upregulation of BMP6. LKB1 loss increased BMP6 signaling, which induced the canonical iron regulatory hormone hepcidin. Intact LKB1 was necessary to maintain BMP6 signaling homeostasis and restrict ALK2/BMP6-fueled growth. Preclinical studies in a Kras/Lkb1-mutant syngeneic mouse model and in a xenograft model showed potent growth suppression by inhibiting the ALK2/BMP6 signaling axis with single-agent inhibitors that are currently in clinical trials. Lastly, BMP6 expression was elevated in tumors of patients with LKB1-mutant early-stage lung cancer. These results are consistent with those of a model in which LKB1 acts as a “brake” to iron-regulated growth and suggest that ALK2 inhibition can be used for patients with LKB1-mutant tumors.

Significance: Three-dimensional invasion-linked gene expression analysis reveals a therapeutic vulnerability to inhibition of ALK2/BMP6 signaling in LKB1-mutant lung cancer that can be rapidly translated to the clinic.
Social, Behavioral, and Clinical Risk Factors Are Associated with Clonal Hematopoiesis
Authors: Young Corey D. , Hubbard Aubrey K. , Saint-Maurice Pedro F. , Chan Irenaeus C.C. , Cao Yin , Tran Duc , Bolton Kelly L. , Chanock Stephen J. , Matthews Charles E. , Moore Steven C. , Loftfield Erikka , Machiela Mitchell J.
Published: August 2024

Background:

Risk factors including smoking, alcohol intake, physical activity (PA), and sleep patterns have been associated with cancer risk. Clonal hematopoiesis (CH), including mosaic chromosomal alterations and clonal hematopoiesis of indeterminate potential, is linked to increased hematopoietic cancer risk and could be used as common preclinical intermediates for the better understanding of associations of risk factors with rare hematologic malignancies.

Methods:

We analyzed cross-sectional data from 478,513 UK Biobank participants without hematologic malignancies using multivariable-adjusted analyses to assess the associations between lifestyle factors and CH types.

Results:

Smoking was reinforced as a potent modifiable risk factor for multiple CH types, with dose-dependent relationships persisting after cessation. Males in socially deprived areas of England had a lower risk of mosaic loss of chromosome Y (mLOY), females with moderate/high alcohol consumption (2–3 drinks/day) had increased mosaic loss of the X chromosome risk [OR = 1.17; 95% confidence interval (CI), 1.09–1.25; P = 8.31 × 10−6] compared with light drinkers, active males (moderate-high PA) had elevated risks of mLOY (PA category 3: OR = 1.06; 95% CI, 1.03–1.08; P = 7.57 × 10−6), and men with high body mass index (≥40) had reduced risk of mLOY (OR = 0.57; 95% CI, 0.51–0.65; P = 3.30 × 10−20). Sensitivity analyses with body mass index adjustment attenuated the effect in the mLOY–PA associations (IPAQ2: OR = 1.03; 95% CI, 1.00–1.06; P = 2.13 × 10−2 and IPAQ3: OR = 1.03; 95% CI, 1.01–1.06; P = 7.77 × 10−3).

Conclusions:

Our study reveals associations between social deprivation, smoking, and alcohol consumption and CH risk, suggesting that these exposures could contribute to common types of CH and potentially rare hematologic cancers.

Impact:

This study underscores the impact of lifestyle factors on CH frequency, emphasizing social, behavioral, and clinical influences and the importance of sociobehavioral contexts when investigating CH risk factors.
Prostate Cancer Disparities in Clinical Characteristics and Survival among Black and Latino Patients Considering Nativity: Findings from the California Cancer Registry
Authors: Freedland Alexis R. , Sanchez Mendez Joel , Liu Lihua , Hamilton Ann S. , Zhang Juanjuan , Hwang Amie E. , Ballas Leslie , Abreu Andre Luis , Deapen Dennis , Stern Mariana C.
Published: August 2024

Background:

We investigated clinical characteristics and prostate cancer survival patterns among Latino patients considering nativity compared with non-Latino Black (NLB) and non-Latino White (NLW) patients.

Methods:

We used data from the California Cancer Registry (1995–2021), which included 347,540 NLW, 50,032 NLB, and 75,238 Latino patients with prostate cancer. Frequencies of sociodemographic and clinical variables were assessed using χ2 tests. Multivariable regression models were fitted to evaluate determinants of treatment reception, Gleason upgrade, and survival differences. Exploratory analyses were conducted grouping Latino cases into US born and non–US born by country of origin.

Results:

Compared with NLW, NLB cases had the greatest proportion of younger patients, whereas non–US-born Latino patients had the greatest proportion of low socioeconomic status and uninsured patients. Non–US-born Latinos showed a greater proportion of diagnoses completed with <6 core biopsies, Gleason >8, stage IV tumors, and metastasis. Multivariable analyses showed that compared with NLW, Latino patients were as likely to receive treatment, whereas NLB cases were less likely (OR = 0.81; 95% confidence interval, 0.67–0.98; P = 0.029). Compared with NLW, non–US-born Latino cases were less likely to die of prostate cancer (HR = 0.78; 95% confidence interval, 0.64–0.94; P = 0.011), with no difference reported for NLB cases.

Conclusions:

Considering sociodemographic and clinical characteristics, non–US-born Latino patients with prostate cancer had better survival than NLW. This highlights the need to identify key determinants of these survival differences and the importance of sociodemographic and clinical determinants in survival disparities.

Impact:

Our study emphasizes the importance of considering nativity among Latino patients to understand prostate cancer disparities and outcomes in this population.
Reducing Distress from Auditory Verbal Hallucinations: A Multicenter, Parallel, Single-Blind, Randomized Controlled Feasibility Trial of Relating Therapy
Authors: Lincoln Tania Marie , Schlier Björn , Müller Rebecca , Hayward Mark , Fladung Anne-Katharina , Bergmann Niklas , Böge Kerem , Gallinat Jürgen , Mahlke Candelaria , Gonther Uwe , Lang Thomas , Exner Cornelia , Buchholz Anika , Stahlmann Katharina , Zapf Antonia , Rauch Geraldine , Pillny Matthias
Published: August 2024

Introduction: There is a significant demand for interventions that reduce distress related to auditory verbal hallucinations (AVHs). AVH distress is associated with the way voice hearers relate with AVHs. We aimed to establish the feasibility of a randomized controlled trial to demonstrate that adding “Relating Therapy” (RT) to treatment as usual (TAU) is superior to TAU in reducing AVH distress. Methods: We conducted a multicenter, parallel, single-blind, randomized controlled feasibility trial in five mental health centers in Germany. Participants were ≥19 years of age, had persistent and distressing AVHs, and had a diagnosis of a schizophrenia-spectrum disorder. RT was delivered over a maximum of 16 sessions within 5 months. Blind assessments were conducted at baseline and at 5 and 9 months. Feasibility outcomes were the number of patients recruited and retained, and safety and therapist adherence. The primary endpoint was the distress factor score of the AVH subscale of the Psychotic Symptoms Rating Scales at 9 months. Results: Eighty-five of 177 enrolled participants were randomized into RT + TAU (n = 43) or TAU (n = 42). Feasibility was excellent with 87% retention at 9 months, 86% reaching treatment uptake criteria, 98% therapist adherence, and no unexpected serious adverse reactions. Compared to TAU, RT + TAU showed nonsignificant trends toward less AVH distress (b = −2.40, SE = 1.52, p = 0.121, 90% CI (−4.94 to 0.15) and stronger improvement on all but one of the secondary outcomes. Conclusion: A randomized controlled trial of RT is feasible, safe, and well accepted. Our results provide an encouraging basis to further test the efficacy of RT in a definitive multicenter trial.
Building a Neurogastroenterology Unit: Why, Where, and How?
Authors: Frieling Thomas
Published: August 2024

Background: Disorders of the gut-brain axis are public diseases (“Volkskrankheiten”) and are among the most frequent reasons to visit a doctor. Despite their great medical and socio-economic importance, patients suffering from these disorders are often not taken seriously and, therefore, do not receive sufficient diagnostic evaluation, or a diagnosis, in conformity with the relevant guidelines. In addition, the inadequate compensation of services makes handling of neurogastroenterological disorders increasingly unattractive. As a result, neurogastroenterology is under-represented in medical curricula, with a decreasing number of scientists in academia who are familiar with this field in Germany. Summary: The prevalence of neurogastroenterological diseases, which is associated with the need for medical care, should create corresponding care as a “bottom-up” development. However, this is not possible in the German healthcare system, due to the inadequate reimbursement structures. Therefore, a “top-down” strategy must be developed through health policy directives, directing the establishment of neurogastroenterology units based on quality parameters and need. These centers must form comprehensive network structures and share essential information on neurogastroenterological diseases with general practitioners, clinicians, and patients. Appropriate apps that also focus on interdisciplinary care with the involvement of various specialist disciplines (e.g., gastroenterology, neurology, gynecology, urology, psychology, psychosomatics, nutritional medicine) would be helpful for this purpose. Key Messages: Neurogastroenterology units are important and should be interdisciplinary and located in tertiary centers. Due to the lack of incentives in the German healthcare system, they must be instituted through health policy directives from the top down.
Characteristics and Impact of Long COVID at a Neurology Clinic
Authors: Oh Juyeon , Chung Eun Joo , Jung Jin Ho , Lee Jin San , Oh Seong-il
Published: August 2024

Introduction: Long COVID can also lead to neurological sequelae that affect existing diseases. This study explored how COVID-19 infection affects neurological patients and the relationship between long COVID and exacerbating factors. Methods: This retrospective study was conducted on 85 patients with neurological diseases after COVID-19 at the Neurology Department, Inje University Busan Paik Hospital, Korea. The data were collected between August and October 2022. The patients had a medical history, including COVID-19 infection, and completed symptom questionnaires. A long COVID questionnaire consisting of 35 inquiries in 10 categories was completed. Anxiety, depression, fatigue, functional difficulties, QOL, and health status changes were assessed. Results: The analysis comprised 85 participants (age: 56.4 ± 15.2 years; 63.5% women). Of the categories, neurological symptoms (68.2%) were the most prevalent, followed by systemic symptoms (64.7%) and cardiopulmonary symptoms (56.5%). Anxiety, depression, and fatigue symptoms were reported by 36.5%, 34.1%, and 42.4% of the participants. Subjective neurological deterioration after COVID-19 was reported in 28 participants (28/81, 34.6%). Anxiety, depression, and fatigue were influenced by long COVID symptoms and the subjective deterioration of neurological conditions. Conclusion: This study analyzed the long COVID symptoms in patients with preexisting neurological conditions and their impact on mental health and quality of life. One-third of the participants reported a subjective worsening of their preexisting neurological conditions. This study highlights the need for comprehensive follow-ups and a multidisciplinary approach for patients with neurological conditions and prolonged COVID-19 symptoms.
Clinical Characteristics and Outcomes of Patients Suffering Acute Decompensated Heart Failure Complicated by Cardiogenic Shock
Authors: Kyriakopoulos Christos P. , Sideris Konstantinos , Taleb Iosif , Maneta Eleni , Hamouche Rana , Tseliou Eleni , Zhang Chong , Presson Angela P. , Dranow Elizabeth , Shah Kevin S. , Jones Tara L. , Fang James C. , Stehlik Josef , Selzman Craig H. , Goodwin Matthew L. , Tonna Joseph E. , Hanff Thomas C. , Drakos Stavros G.
Published: August 2024

BACKGROUND:

Cardiogenic shock (CS) can stem from multiple causes and portends poor prognosis. Prior studies have focused on acute myocardial infarction-CS; however, acute decompensated heart failure (ADHF)-CS accounts for most cases. We studied patients suffering ADHF-CS to identify clinical factors, early in their trajectory, associated with a higher probability of successful outcomes.

METHODS:

Consecutive patients with CS were evaluated (N=1162). We studied patients who developed ADHF-CS at our hospital (N=562). Primary end point was native heart survival (NHS), defined as survival to discharge without receiving advanced HF therapies. Secondary end points were adverse events, survival, major cardiac interventions, and hospital readmissions within 1 year following index hospitalization discharge. Association of clinical data with NHS was analyzed using logistic regression.

RESULTS:

Overall, 357 (63.5%) patients achieved NHS, 165 (29.2%) died, and 41 (7.3%) were discharged post advanced HF therapies. Of 398 discharged patients (70.8%), 303 (53.9%) were alive at 1 year. Patients with NHS less commonly suffered cardiac arrest, underwent intubation or pulmonary artery catheter placement, or received temporary mechanical circulatory support, had better hemodynamic and echocardiographic profiles, and had a lower vasoactive-inotropic score at shock onset. Bleeding, hemorrhagic stroke, hemolysis in patients with mechanical circulatory support, and acute kidney injury requiring renal replacement therapy were less common compared with patients who died or received advanced HF therapies. After multivariable adjustments, clinical variables associated with NHS likelihood included younger age, history of systemic hypertension, absence of cardiac arrest or acute kidney injury requiring renal replacement therapy, lower pulmonary capillary wedge pressure and vasoactive-inotropic score, and higher tricuspid annular plane systolic excursion at shock onset (all
P
<0.05).

CONCLUSIONS:

By studying contemporary patients with ADHF-CS, we identified clinical factors that can inform clinical management and provide future research targets. Right ventricular function, renal function, pulmonary artery catheter placement, and type and timing of temporary mechanical circulatory support warrant further investigation to improve outcomes of this devastating condition.
Proteomics Identify Clinical Phenotypes and Predict Functional Outcomes in Heart Failure With Preserved Ejection Fraction: Insights From VITALITY-HFpEF
Authors: deFilippi Christopher R. , Shah Palak , Shah Sanjiv J. , Alemayehu Wendimagegn , Lam Carolyn S.P. , Butler Javed , Roessig Lothar , O’Connor Christopher M. , Westerhout Cynthia M. , Armstrong Paul W. ,   for the VITALITY-HFpEF Study Group
Published: August 2024

BACKGROUND:

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome that may emerge from overlapping systemic processes associated with comorbidities. We assessed whether unique clusters of circulating proteins are associated with specific clinical characteristics and functional status at baseline and follow-up in a well-phenotyped cohort of patients with HFpEF.

METHODS:

We evaluated 368 proteins associated with cardiovascular disease and inflammation in prerandomization blood samples from 763 VITALITY-HFpEF (Vericiguat to Improve Physical Functioning in Daily Living Activities of Patients With HFpEF) participants who had a left ventricular ejection fraction ≥45% and a heart failure decompensation event within 6 months. Proteins were clustered, and their associations with clinical characteristics, baseline, and 24-week functional outcomes (Kansas City Cardiomyopathy Questionnaire Physical Limitation Score, 6-minute walk distance [6MWD], and Fried frailty phenotype) were estimated with linear regression. Elastic net regression was used to derive a proteomic summary composite to predict changes in 24-week functional outcomes.

RESULTS:

Four unique protein clusters were identified, containing 24, 66, 197, and 81 proteins. At baseline, 2 protein clusters with the hub proteins caspase-3 and Dickkopf-related protein 1 were associated with increased frailty, whereas the cluster with tumor necrosis factor receptor 1 as a hub protein was associated with lower Kansas City Cardiomyopathy Questionnaire Physical Limitation Score and shorter 6MWD. By contrast, the cluster with protein C as a hub protein was associated with less frailty and longer a 6MWD. The 24-week increase in 6MWD was negatively correlated with the protein cluster with caspase-3; the protein C cluster was correlated with less frailty at 24 weeks. The baseline proteomic summary composite predicted observed changes in Kansas City Cardiomyopathy Questionnaire Physical Limitation Score and 6MWD at 24 weeks (r=0.42 and 0.30;
P
<0.001 for both).

CONCLUSIONS:

Proteomics differentiate specific baseline functional traits associated with HFpEF and may facilitate phenotyping in a heterogeneous disease. These proteins also provide insights into the diverse pathophysiology of HFpEF and which patients may improve functional status during follow-up.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03547583.
Use of Palliative Care Among Adults With Newly Diagnosed Heart Failure: Insights From a US National Insured Patient Sample
Authors: Zhang Zidong , Subramaniam Divya S. , Howard Steven W. , Johnston Kenton J. , Frick William H. , Enard Kimberly , Hinyard Leslie
Published: August 2024

Background

Despite the known benefits for individuals with heart failure (HF), incomplete data suggest a low use of palliative care (PC) for HF in the United States. We aimed to investigate the national PC use for adults with HF by determining when they received their first PC consultation (PCC) and the associations with clinical factors following diagnosis of HF.

Methods and Results

We conducted a retrospective cohort study in a national all‐payer electronic health record database to identify adults (aged ≥18 years) with newly diagnosed HF between 2011 and 2018. The proportion of those who received PCC within 5 years following a diagnosis of HF, and associations of time to first PCC with patient characteristics and HF‐specific clinical markers were determined. We followed 127 712 patients for a median of 792 days, of whom 18.3% received PCC in 5 years. Shorter time to receive PCC was associated with diagnoses of HF in 2016 to 2018 (compared with 2010–2015: adjusted hazard ratio [aHR], 1.421 [95% CI, 1.370–1.475]), advanced HF (aHR, 2.065 [95% CI, 1.940–2.198]), cardiogenic shock (aHR, 2.587 [95% CI, 2.414–2.773]), implantable cardioverter‐defibrillator (aHR, 5.718 [95% CI, 5.327–6.138]), and visits at academic medical centers (aHR, 1.439 [95% CI, 1.381–1.500]).

Conclusions

Despite an expanded definition of PC and recommendations by professional societies, PC for HF remains low in the United States. Racial and geographic variations in access and use of PC exist for patients with HF. Future studies should interrogate the mechanisms of PC underusage, especially before advanced stages, and address barriers to PC services across the health care system.
Associations of Placental Inflammation and Oxidative Stress Biomarkers with Glucolipid Metabolism in Children: A Birth Cohort Study in China
Authors: Zhou Jixing , Teng Yuzhu , Ouyang Jiajun , Wu Penggui , Tong Juan , Gao Guopeng , Yan Shuangqin , Tao Fangbiao , Huang Kun
Published: August 2024

Background

The maternal intrauterine immune environment may affect offspring long‐term health. We aimed to investigate the association between the intrauterine placental immunological milieu and glycolipid metabolic health in children.

Methods and Results

This study enrolled 1803 mother–child pairs from the Ma'anshan birth cohort (2013–2014). Placental mRNA expression of inflammatory cytokines (interleukin‐1β [IL‐1β], IL‐10, monocyte chemoattractant protein‐1, tumor necrosis factor‐α, IL‐4, IL‐6, IL‐8, C‐reactive protein, and interferon‐γ) and oxidative stress biomarkers (heme oxygenase‐1, hypoxia‐inducible factor‐1alpha, and glucose‐related protein 78) was quantified using real‐time quantitative polymerase chain reaction. Fasting blood glucose, insulin, triglycerides, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, and total cholesterol were assessed at 5 to 6 years old. Statistical analyses included multiple linear regression, binary logistic regression, restricted cubic spline model, and the Bayesian kernel machine regression model. Placental inflammatory cytokines (IL‐1β, monocyte chemoattractant protein‐1, C‐reactive protein, IL‐6, IL‐8, IL‐10) and oxidative stress biomarkers (heme oxygenase‐1, hypoxia‐inducible factor‐1alpha, glucose‐related protein 78) showed positive associations with children's fasting blood glucose levels. Heme oxygenase‐1 and glucose‐related protein 78 exhibited negative correlations with children's fasting insulin levels. Elevated IL‐6, heme oxygenase‐1, hypoxia‐inducible factor‐1alpha, and glucose‐related protein 78 were associated with increased risk of prediabetes in children. Overall upregulation of placental proinflammatory cytokines and oxidative stress factors mRNA expression correlated with higher prediabetes risk in children. Bayesian kernel machine regression analysis indicated a joint positive effect of the 12 placental inflammation and oxidative stress mixtures on children's risk of high fasting blood glucose.

Conclusions

This exploratory study underscores significant correlations between maternal intrauterine placental inflammation, oxidative stress markers, and offspring fasting blood glucose and insulin levels. These findings highlight the potential role of intrauterine holistic immunity in shaping offspring glucose metabolism health.
Kumon In: The Recent, Rapid Rise of Private Tutoring Centers
Authors: Kim Edward , Goodman Joshua , West Martin R.
Published: August 2024

The increasing prevalence of private tutoring has received minimal scholarly attention in the United States. We use over 25 years of geocoded data on the universe of U.S. private tutoring centers to estimate the size and growth of this industry and to identify predictors of tutoring center locations. We document four important facts. First, from 1997 to 2022, the number of centers more than tripled, from about 3,000 to 10,000, with steady growth through 2015 before a more recent plateau. Second, the location and growth of private tutoring is heavily concentrated in areas with high income and parental education. More than half of tutoring centers are in areas in the top quintile of income. Third, even conditional on income and parental education, private tutoring centers tend to locate in areas with many Asian American families, suggesting differences in demand by ethnic or cultural identity. Fourth, we see only marginal evidence that the private tutoring market tracks K–12 school markets (i.e., charter, magnet, or private school options). The rapid rise in high-income families’ demand for this form of private educational investment mimics phenomena observed in other spheres of education and family life, with potentially important implications for inequality in student outcomes.
Turning the Tide on Remnants of War at Sea? Toward the Principles for Protection of the Environment in Relation to Armed Conflicts
Authors: Graham Kimberley J
Published: August 2024

For a long time, the full impacts of armed conflicts on the marine environment have been ill-defined and largely neglected. World War I and II-era remnants of war at sea pose increasing threats to human and marine life, particularly over the coming decade, as they contaminate, pollute, or detonate toxic and hazardous substances into coastal and benthic ecosystems. The International Law Commission’s Principles for Protection of the Environment in Relation to Armed Conflicts aim to enhance protections for the marine environment before, during, and after conflict. In practice, this means navigating an uncoalesced legal regime and relying on established principles of international environmental law – particularly the duty to cooperate and share information. However, considerable knowledge gaps need to be addressed to remedy the vast legacy of war in the ocean, as the majority of remnants of war at sea remain under-assessed, in part, due to financial and technical constraints.
A Success Story? Fifty Years of MARPOL
Authors: Ehlers Peter
Published: August 2024

The International Convention for the Prevention of Pollution from Ships (MARPOL 73/78) is the core of a comprehensive international legal regime for the prevention of pollution from ships. Over the past fifty years, it has developed a dynamic and comprehensive set of regulations, continuously amended and updated by sixty-six resolutions of Marine Environment Protection Committee and tacitly accepted by the Contracting Parties. In order to supplement and effectively apply the MARPOL requirements, the International Maritime Organization has produced extensive secondary legislation in the form of codes and guidelines, which by reference are incorporated into the Convention as binding law. MARPOL 73/78 has proven to be a suitable instrument for largely preventing discharges of harmful substances from ship operations and, in the event of accidents, for limiting the release quantity. However, it remains necessary to constantly adapt the regulations to new developments, in particular further reduction of CO2 emissions in shipping.
Government Recognition and the Dispute over the Venezuelan Gold Reserves in the Bank of England
Authors: Sanchez-Lasaballett Eliezer , Gonzalez T. Ybiskay
Published: August 2024

Public international law cloaks the process of government recognition with neutrality. It does this by concealing its political, discretional nature and disregarding the far-reaching consequences for the citizens of the country concerned. The dispute over Venezuelan gold in the Bank of England provides a case study as the gold reserves or its proceeds remain out of the reach of the Venezuelan people. It presents unique features as the UK courts have to determine which of the two competing governments represents Venezuela’s legitimate interest. This article focuses on the relationship between government recognition and coloniality to illustrate how the law reproduces neocolonial rationalities under the guise of neutrality. It conceals a morally superior self-perception of those advancing an international political order dehumanising the lives of ‘the other’. Ultimately, government recognition has far-reaching implications for the international order since it risks becoming a discretionary practice to support or boycott regimes.
A new genus and species representing the first Mesozoic eurymeline leafhopper (Hemiptera: Cicadellidae: Eurymelinae: Macropsini)
Authors: DIETRICH CHRISTOPHER H. , WANG MENG-LIN
Published: August 2024

Eurymacropsis yanzhenae gen. et sp. nov. is described and illustrated based on a well-preserved adult male embedded in mid-Cretaceous Myanmar amber and tentatively placed in Macropsini Evans, 1935 (Eurymelinae Amyot & Audinet-Serville, 1843) based on head structure, wing venation and leg chaetotaxy. This fossil is the first member of this subfamily recorded from the Mesozoic, consistent with molecular divergence time estimates placing the origin of this lineage, along with most other major lineages (subfamilies) of leafhoppers, in the lower Cretaceous. The fossil exhibits traits not found in modern Macropsini, including the presence of stout anteroventral setae on the front femur and a dense ventral brush of setae on the first hind tarsomere, somewhat similar to those found in some modern Eurymelini.