bluuebunny/crossref_metadata_2025 huggingface dataset:
Caffeic acid O-methyltransferase-dependent flavonoid defenses promote sorghum resistance to fall armyworm infestation
Authors: Kundu Pritha , Shinde Sanket , Grover Sajjan , Sattler Scott E , Louis Joe
Published: February 2025

Sorghum (Sorghum bicolor), one of the world’s most important monocot crops, suffers severe yield losses due to attack by a polyphagous insect pest, fall armyworm (FAW; Spodoptera frugiperda). Here, we show that the Brown midrib 12 (Bmr12) gene, which encodes the caffeic acid O-methyltransferase (COMT) enzyme, promotes sorghum defense against FAW. Loss of Bmr12 function resulted in increased susceptibility, but enhanced resistance to FAW was observed in Bmr12-overexpression (OE) plants compared with wild-type (RTx430) plants. Although COMT is associated with modulating lignin levels, FAW infestation resulted in comparable lignin levels between bmr12 and Bmr12-OE sorghum plants. On the contrary, evidence presented here indicates that FAW feeding induced the accumulation of flavonoids, which was previously shown to have a negative impact on FAW growth and survival in Bmr12-OE plants compared with bmr12 and RTx430 plants. Furthermore, a combination of phytohormone profiling and transcriptomic analysis uncovered that COMT-mediated resistance to FAW depends on jasmonic acid (JA) and oxidative stress-associated pathways. Exogenous application of FAW oral secretions stimulated flavonoid accumulation in Bmr12-OE plants compared with bmr12 and RTx430 plants, indicating that COMT has an essential function in perceiving FAW oral cues. Taken together, the critical role of COMT in sorghum defense against FAW hinges upon the interplay between JA and its derivatives and hydrogen peroxide, which potentially helps to mount a robust flavonoid-based host defense upon caterpillar attack.
The fermentation broth of Streptomyces noursei strain S86 as a potential biocontrol product for Fusarium crown rot of wheat
Authors: Wang Jing , Xu Chunli , Xiao Wenqing , Wang Miaomiao , Han Xue , Sun Yang , Ge Beibei
Published: February 2025

Fusarium crown rot of wheat, caused by Fusarium pseudograminearum, significantly affects the yield and quality of wheat worldwide. Here, Streptomyces noursei strain S86 (herein referred to as S86), was evaluated for its biocontrol efficacy and biochemical characteristics. Strain S86 was found to secrete cellulase, amylase and other enzymes. Whole genome sequencing and LC-MS analyses confirmed that S86 could produce toyocamycin, nystatin, anisomycin, natamycin, and other antimicrobial metabolites. The fermentation broth of S86 inhibited the growth of F. pseudograminearum and had broad-spectrum inhibitory activity against Rhizoctonia cerealis, Cochliobolus sativus, Fusarium graminearum, and Gaeumannomyces graminis var. graminis. A greenhouse experiment demonstrated that wheat seeds coated with S86 fermentation broth showed better control efficiency against Fusarium crown rot (68.33%), which was 22.63% higher than direct root irrigation with the S86 fermentation broth. These results indicate that S86 fermentation products have the potential to be developed as biological controls of Fusarium crown rot disease in the field.
Early-season predictions of aerial spores to enhance infection model efficacy for Cercospora leaf spot management in sugarbeet
Authors: Hernandez Alexandra P. , Bloomingdale Chris , Ruth Sarah , Cushnie Erica , Trueman Cheryl , Hanson Linda , Willbur Jaime F.
Published: February 2025

Cercospora beticola causes one of the most destructive foliar diseases of sugarbeet in many growing regions. Management of Cercospora leaf spot (CLS) relies heavily on timely and repeated fungicide applications. Current treatment initiation is often supported by models predicting conditions favorable for infection; however, these models lack information of C. beticola presence and abundance. Burkard volumetric mechanical samplers and highly CLS-susceptible sentinel beets (biological samplers) were used to assess early-season aerial C. beticola conidia from sugarbeet fields in Michigan and in Ontario, Canada from 2019-2022. In initial correlation and logistic regression analyses (n=449), duration of leaf wetness, air temperature, and wind speed were found to predict the risk of elevated Cercospora spore concentrations with 67.9% accuracy. In 2022 and 2023, a select model and a limited set of action thresholds, in addition to the BEETcast model, were tested for fungicide application timing. When CLS pressure was high, extending the interval between applications showed reduced management of CLS (P < 0.001), sugar percentage, and RWS (P < 0.05) compared to the grower standard. Model-based programs integrating canopy closure information resulted in CLS, yield, and sugar metrics comparable to the grower standard despite one less fungicide application. In additional training analysis (n=402), an ensemble model included leaf wetness, air temperature, relative humidity, and wind speed variables with a testing accuracy of 73.2% (n=101). Based on model development, refinement, and validation, assessment of elevated early-season C. beticola presence and abundance has potential to improve application timing and efficacy for preventative CLS management.
Physiological Races of Cucurbit Powdery Mildew Pathogen (Podosphaera xanthii) based on Watermelon Differentials
Authors: Kousik Chandrasekar S. , Ikerd Jennifer L.
Published: February 2025

Watermelon is a major cucurbit crop grown across the world and in 44 states in the USA. Powdery mildew (PM) caused by Podosphaera xanthii is an important disease of watermelon that can severely limit fruit production and reduce yield. Extensive work has been done on races of P. xanthii based on melon (Cucumis melo) differential hosts and seven major races of have been identified. However, physiological races of P. xanthii have not been classified for many other cucurbits including watermelon. The objective of this study was to develop a set of watermelon PM race differentials and identify potential races. Ten P. xanthii isolates collected from various states were evaluated using a newly developed set of watermelon (Citrullus lanatus) differentials that included a highly susceptible germplasm line 'USVL677-PMS', a commercial cultivar 'Mickey Lee', two resistant germplasm lines 'USVL608-PMR', 'PI 189225' and resistant pollenizer 'SP5'. The well-studied melon (C. melo) powdery mildew differentials 'Iran H' and 'PMR-45' were also included. All isolates colonized and produced abundant conidia on the melon Iran H, and watermelon USVL677-PMS. SP5 and PI 189225 were resistant to all isolates. USVL608-PMR was resistant to seven of the ten isolates and displayed intermediate resistance to three isolates. Of the ten isolates that grew well on USVL677-PMS, only five colonized and produced abundant conidia on Mickey Lee which was highly resistant to the remaining five. Based on reactions of the ten powdery mildew isolates on Mickey Lee and USVL677-PMS, at least two distinct physiological races (0 and 1) can be identified. These two races based on watermelon differentials did not correlate with race structure based on the two melon differentials. As new watermelon cultivars with resistance to powdery mildew are being released, it will be important to determine their reaction to P. xanthii isolates as a race structure based on watermelon differentials clearly exists.
Bacteria That Cause Cucurbit Yellow Vine Disease Fall Within the Serratia ureilytica Species of the S. marcescens Complex and Can Be Vectored by Cucumber Beetles
Authors: Mphande Kephas , LaSarre Breah , Paulsen Ashley A. , Hartung Renee , Badilla-Arias Sharon , Gleason Mark L. , Beattie Gwyn A.
Published: February 2025

Cucurbit yellow vine disease (CYVD) is an emerging disease that can cause up to 100% cucurbit crop losses. CYVD is transmitted by squash bugs (Anasa tristis), but anecdotal reports indicate the presence of CYVD in cucurbit fields in the apparent absence of squash bugs and presence of cucumber beetles. This study tested the vector competence of two cucumber beetle species (Acalymma vittatum and Diabrotica undecimpunctata howardi) for CYVD and explored the phylogenetic relatedness of CYVD-causing isolates (i.e., CYVD strains) from cucurbits to those from wild cucumber beetles from fields with endemic CYVD. CYVD strains have heretofore been classified as Serratia marcescens; however, pairwise genomic comparisons and phylogenomic analyses using complete genome assemblies of five CYVD strains, including two from wild cucumber beetles, indicate that CYVD strains form a clade in the Serratia ureilytica species, which is a species within the S. marcescens complex. The S. ureilytica isolates from both cucumber beetle species were pathogenic based on their ability to induce CYVD when injected into squash (Cucurbita pepo) plants. Moreover, field-collected cucumber beetles of both species harboring the CYVD pathogen induced CYVD in squash plants in laboratory transmission tests, demonstrating that cucumber beetles can transmit S. ureilytica to plants. Our results support a nomenclature change for the causal agent of CYVD to S. ureilytica and demonstrate that cucumber beetles can both harbor and transmit S. ureilytica CYVD strains. S. ureilytica is thus distinct among phytopathogenic bacteria in its ability to use both hemipterans and coleopterans as vectors for transmission to plants.
A Novel Quantitative Trait Locus (QTL) Reduces Fusarium graminearum Infection in Glycine max Seedlings
Authors: Detranaltes Christopher , Quigley Charles , Song Qijian , Ma Jianxin , Cai Guohong
Published: February 2025

Over the past five years, seedling diseases have caused an average annual loss of $21.8 million dollars’ worth of United States’ soybean (Glycine max (L.) Merr.) production, with Fusarium graminearum (teleomorph Gibberella zeae (Schwein.) Petch) emerging as a significant threat within the seedling disease complex. Its cross-pathogenicity on wheat and maize, along with increasing reports of fungicide resistance, highlights the need for improved genetic resistance in soybean. In a previous germplasm screening and genome-wide association study (GWAS) we identified a significantly resistant accession, PI 438500, from a panel of 208 diverse soybean accessions. This accession carried fewer marker-trait associations (MTAs) and lower predicted resistance than other significantly resistant accessions yet displayed a highly resistant phenotype with low standard deviations. In this study, we developed an F2:3 mapping population from a bi-parental cross between PI 438500 and PI 548631 (highly susceptible to F. graminearum) and identified a quantitative trait locus (QTL) that explains 20.29% of the variation in post-emergent visual severity. This QTL region contains multiple candidate genes with predicted roles in plant defense mechanisms and helps elucidate PI 438500’s significant resistance to F. graminearum. Molecular markers linked and within this QTL region can help facilitate marker-assisted selection for F. graminearum resistance in soybean breeding.
The Role of the Lumbar Paravertebral Muscles in the Development of Short-term Residual Pain after Lumbar Fusion Surgery
Authors: Sun Haifu , Tang Wenxiang , You Xingyu , Deng Lei , Chen Liuyu , Qian Zhonglai , Yang Huilin , Zou Jun , Qiao Yusen , Liu Hao
Published: February 2025

Study design.

A retrospective real-world study.

Objective.

Using machine learning models to identify risk factors for residual pain after PLIF in patients with degenerative lumbar spine disease.

Summary of Background Data.

Residual pain after PLIF is a frequent phenomenon, and the specific risk factors for residual pain are not known.

Materials and Methods.

Between June 2018 and March 2023, 936 patients with lumbar degenerative disease who underwent PLIF surgery were recruited. Group A (n=501) had <7 days of VAS ≥3 pain within 1 month post-PLIF, while Group B (n=435) had ≥7 days. Imaging outcomes included PMI, MMI, MMD, lumbar lordosis (LL), and LL improvement rate. Functional outcomes were assessed by VAS. Univariate and multivariate logistic regression analyses were used to determine the potential risk of short-term postoperative pain. Risk factors were identified using machine learning models and predicted whether residual pain would occur.

Results.

A total of 435 (46.5%) patients experienced residual postoperative pain. Independent risk factors included surgical segment, PMI, MMI, and depression level. The Random Forest Model model had an accuracy of 95.7%, a sensitivity of 96.4%, a specificity of 94.1%, and an F1 score of approximately 95.2% for predicting recurrent pain, indicating high reliability and generalizability.

Conclusions.

Our study reveals risk factors for the development of residual pain after PLIF. Compared to the group with residual pain, the group without pain had more robust paravertebral muscles, improved psychological characteristics and a greater LL improvement rate. These factors may represent targets for pre-operative and peri-operative optimization as a means to minimize the potential for residual pain following PLIF.
Lactated Ringer’s or Normal Saline for Initial Fluid Resuscitation in Sepsis-Induced Hypotension
Authors: Gelbenegger Georg , Shapiro Nathan I. , Zeitlinger Markus , Jilma Bernd , Douglas Ivor S. , Jorda Anselm
Published: February 2025

Objectives:

To assess whether initial fluid resuscitation with lactated Ringer’s solution compared with 0.9% saline is associated with improved clinical outcomes in patients with sepsis-induced hypotension.

Design:

Secondary analysis of the randomized controlled Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) trial.

Setting:

ICUs and emergency departments in 60 U.S. centers from March 2018 to January 2022.

Patients:

Participants from the CLOVERS trial. Adult patients with a suspected or confirmed infection and hypotension caused by sepsis.

Interventions:

Participants received 1–3 L of crystalloid fluid for initial fluid resuscitation before randomization. In this analysis, participants were categorized into a lactated Ringer’s group and a 0.9% saline group based on the fluid type predominantly used for the initial fluid resuscitation (i.e., ≥ 95% of pre-randomization fluid).

Measurements and Main Results:

Of 1563 participants with sepsis-induced hypotension included in the CLOVERS trial, 622 (39.8%) received lactated Ringer’s solution and 690 (44.1%) received 0.9% saline as solution for the initial fluid bolus. Death before discharge home by day 90 occurred in 76 of 622 participants (12.2%) in the lactated Ringer’s group and in 110 of 690 participants (15.9%) in the 0.9% saline group, resulting in an adjusted hazard ratio of 0.71 (95% CI, 0.51–0.99; p = 0.043). Patients receiving lactated Ringer’s solution had more hospital-free days at 28 days than those receiving 0.9% saline (16.6 ± 10.8 vs. 15.4 ± 11.4, respectively; adjusted mean difference, 1.6 d [95% CI, 0.4–2.8 d; p = 0.009]). Treatment with 0.9% saline was associated with higher levels of serum chloride and decreased levels of serum bicarbonate.

Conclusions:

Initial fluid resuscitation with lactated Ringer’s solution, compared with 0.9% saline, might be associated with improved survival in patients with sepsis-induced hypotension.
The Association Between Body Mass Index and Mortality Mediated by Medical and Mechanical Complications in Venovenous Extracorporeal Membrane Oxygenation
Authors: Hatton Kevin W. , Engoren Milo , Furfaro David , McCloskey Colin
Published: February 2025

Objectives:

To estimate the associations between body mass index (BMI) and mortality and between BMI and complications in patients receiving venovenous extracorporeal membrane oxygenation (ECMO) and to estimate if any mortality association was mediated by complications.

Design:

Retrospective analysis of an international, multicenter registry.

Setting:

ICUs.

Patients:

Adults in the Extracorporeal Life Support Organization database who received venovenous ECMO between January 1, 2015, and December 31, 2021.

Interventions:

None.

Measurements and Main Results:

Logistic regression with BMI transformed using fractional polynomials was used to estimate the association between BMI and hospital mortality and between BMI and complications. Mediation analysis was used to estimate if the association between BMI and mortality was a direct effect or was mediated by complications. Of the 24,796 patient runs, 10,361 patients died (48%). After adjusting for confounders, we found nonlinear associations between BMI and mortality. Compared with BMI = 25 kg/m2, a BMI = 20 had an 11% higher risk of dying, odds ratio (OR) =1.11 (95% CI, 1.08–1.15); a BMI = 30 had an 8% lower risk, OR = 0.92 (95% CI, 0.90–0.95); and a BMI = 40 kg/m2 had an 18% lower risk of death OR = 0.82 (95% CI, 0.78–0.87). BMI was also associated with mechanical, renal, pulmonary, and neurologic complications. The association between BMI and mortality was both a direct effect and mediated via pulmonary complications, while mechanical, renal replacement therapy, and neurologic complications were suppressors having a negative association with improved mortality in patients with higher BMI.

Conclusions:

We confirmed that patients with higher BMI requiring venovenous ECMO were less likely to die. This finding was partially mediated by pulmonary complications and partially via a direct association between BMI and mortality. BMI was also associated with mechanical, renal replacement therapy, and neurologic complications that acted as suppressing mediators and were associated with increased mortality for increasing BMI despite the overall trend of improved survival.
p300 upregulates Ikur in atrial cardiomyocytes through activating NLRP3 inflammasome in hypertension
Authors: Zeng Long , Liu Panyue , Rao Fang , Du Zhimin , Xiao Haiyin , Yu Shenghuan , Deng Chunyu , Zhang Mengzhen , Liu Fangzhou , Zhu Rui , Deng Hai , Wu Shulin , Xue Yumei , Fang Xianhong , Wei Wei
Published: February 2025

Background:

The nucleotide-binding oligomerization domain [NOD-], leucine-rich repeats [LRR-], and Pyrin domain-containing protein 3 (NLRP3) inflammasome plays an essential role in hypertension-related atrial fibrillation (AF). p300 is involved in cardiovascular inflammation. In this study, we aimed to investigate the role of p300 in NLRP3 inflammasome activation and its subsequent impact on the Ikur current in angiotensin II (Ang II)-induced HL-1 cells and Ang II-infused mice.

Methods:

Expression levels of p300, Kv1.5, and NLRP3 in left atrial appendage (LAA) tissues from AF and sinus rhythm (SR) patients were detected by Western blot. A hypertension mouse model was established in p300 knockout (p300-KO) mice via Ang II infusion, and AF incidence was assessed by electrocardiogram (ECG) after rapid atrial pacing. In vitro, the expression level of p300 in HL-1 cells was modulated by adenoviral overexpression, curcumin (an inhibitor of p300) treatment, and smal interfering RNA (siRNA) knockdown. NLRP3 inflammasome activation was evaluated by Western blot and enzyme-linked immunosorbent assay, and electrophysiological properties of HL-1 cells were analyzed using whole-cell patch-clamp recordings. Co-immunoprecipitation assays were performed to investigate the interaction between p300 and nuclear factor kappa B (NF-κB).

Results:

The expression levels of p300, Kv1.5, and NLRP3 were found to be significantly higher in the LAA tissue of AF patients compared to SR patients. p300-KO decreased AF incidence in Ang II-infused mice by impairing NLRP3 inflammasome activation. p300-OE facilitated NLRP3 inflammasome activation, which subsequently increased the Ikur density and shortened the action potential duration of HL-1 cells. Both curcumin (p300 inhibitor) and p300-siRNA treatments reversed Ang II-induced atrial electrical remodeling and NLRP3 inflammasome activation. Moreover, co-immunoprecipitation showed that p300 interacts with NF-κB to promote NLRP3 inflammasome activation.

Conclusions:

p300 participates in hypertension-induced AF susceptibility by interacting with NF-κB to activate the NLRP3 inflammasome, which subsequently upregulates the transmembrane current of Ikur in atrial cardiomyocytes.
Outcome Predictors of Hardware Complications in Head and Neck Free Flap Reconstruction
Authors: Talwar Abhinav , Asthana Shravan , Silva-Nash Jennifer , Gharzai Laila A. , Samant Sandeep , Patel Urjeet , Stepan Katelyn
Published: February 2025

Objectives:

Osteocutaneous free flap reconstruction can be complicated by hardware failure. The present study investigates the frequency and predictors of hardware failure in head and neck osteocutaneous reconstruction.

Methods:

Patients who underwent osteocutaneous head and neck free flap reconstruction between the years of 2014 and 2022 were identified at our institution. Hardware failure was defined as hardware infection, screw plate loosening, exposed hardware, migration, deformation, or fracture.

Results:

We identified 47 patients who met the inclusion criteria for this study. Common indications for intervention included squamous cell carcinoma (35, 74%) and osteoradionecrosis (8, 17%). Most operations used fibular flaps (31, 66%) or osteocutaneous radial forearm flaps (12, 26%). The median age at the time of reconstruction was 66 years (IQR: 59 to 72). In total, 17 (36%) patients experienced hardware failure in the postoperative period. On univariable analysis, estimated blood loss (P=0.01) and early postoperative infectious complication (P=0.03) were the only significant predictors of hardware failure. On multivariable analysis, these factors retained significance. Estimated blood loss had an OR of 1.004 (95% CI: 1.001-1.008; P=0.01), and infectious complication had an OR of 5.22 (95% CI: 1.28-24.84; P=0.03).

Conclusion:

The incidence of hardware failure among patients who undergo head and neck osteocutaenous free flap reconstruction is high (36%). Patients with infectious complications and high estimated blood loss may be more likely to develop hardware failure.

Level of Evidence:

Level III.
Anaesthetic implications of psilocybin and lysergic acid diethylamide: what is old is now new
Authors: Dave Mansi , Shore Ron , Cupido Tracy , Haley Chris , Clinkard David
Published: February 2025

Psychedelic drugs, known for their perception-altering properties, are gaining popularity in the treatment of mental health and pain disorders. As exploratory studies demonstrate clinical efficacy with few adverse events, it is expected that more patients will ingest psychedelic drugs. For therapeutic reasons, as with any drug, anaesthesiologists must be aware of its physiological effects and contraindications to ensure the safe provision of anaesthesia.

Psilocybin is a 5HT1A and 5HT2A serotonin receptor agonist thought to act on excitatory and inhibitory neurons in the brain. Acute ingestion causes sympathetic nervous system activation, which can precipitate haemodynamic instability. Activation of the 5HT serotonin receptors can also place the patient at risk of serotonin syndrome. Chronic use increases plasma concentrations of cortisol, which has implications on prophylactic stress-dosing of glucocorticoids preoperatively. Lysergic acid diethylamide (LSD), a synthetic psychoactive substance, is also a 5HT2A agonist. LSD has been shown to potentiate opioid analgesics, and monoamine oxidase (MAO) inhibition. Historical reports suggest that LSD has anticholinesterase activity and can prolong neuromuscular block with depolarising muscle relaxants. Mescaline is a poorly understood psychedelic with similar autonomic effects. Historical studies have shown decreased neuromuscular transmission and an association with malignant hyperthermia.

When managing patients who have consumed psychedelics drugs, it is important to consider delaying surgery whenever possible, to allow acute intoxication to wane. A high degree of suspicion and an understanding of management principles is vital to the safe conduct of anaesthesia. Future research should explore therapeutic doses of psychedelic drugs to understand physiologic effects at various concentrations.
Multidrug-Resistant Organisms and Bacillus cereus Colonization in a Neonatal Intensive Care Unit: A Cohort Study
Authors: Camphuis Marie-Alix , Vincent Marine , Dauwalder Olivier , Dananché Cedric , Pastor-Diez Blandine , Masclef-Imbert Marion , Picaud Jean-Charles
Published: February 2025

Background:

Surveillance of neonate microbiota carriage, particularly multidrug-resistant organisms (MDROs) and Bacillus cereus, could help prevent infection. We evaluated the presence of these in the stools of hospitalized infants, duration of isolation and risk of infection in infants with digestive carriage of MDROs or B. cereus.

Methods:

In a population-based retrospective study, we analyzed the results of weekly stool cultures performed from birth to discharge, in all hospitalized newborns from January 2018 to September 2020, in a single tertiary unit. Information regarding infections was collected.

Results:

In total, 1409 infants were included; 220 (15.6%) were carriers of MDROs and/or B. cereus: 74.1% (163/220) carried MDROs only, 20.5% (45/220) carried B. cereus only and 5.5% (12/220) were cocarriers. Eighteen MDROs were identified; Enterobacter cloacae (43.6%, 82/188) was the most frequent. There was no B. cereus infection in infants with B. cereus in the stool; 7.4% (13/175) of infants with MDROs were infected.

Conclusions:

MDROs and B. cereus were commonly found in stools in a large population of hospitalized neonates. Identification of carriage and duration of this according to the germ can help to adapt the isolation protocol duration to limit constraints for parents and caregivers and to guide antibiotic therapy.
Improving Care for LGBTQ+ Families: A Competency Bundle
Authors: Suttle Becky , Bordelon Curry , Jones Christopher , Talarico Nathan , Nguyen Somali , Bryant Pam
Published: February 2025

Purpose: The purpose of this improvement initiative was to enhance cultural competence among healthcare providers within a Labor and Delivery Unit and Mother-Baby Unit through the implementation of an evidence-based LGBTQ+ competency bundle (CB). Background: The lack of knowledge and cultural competence among healthcare providers for the LGBTQ+ population remain 1 of the leading causes of discrimination in healthcare and a barrier to achieving optimal health, safety, and well-being for individuals in this community. Conscious and unconscious bias of providers further leads to discrimination, oppression, and potential delivery of substandard care. Discussion: The evidence-based LGBTQ+ CB consists of (1) cultural competency assessment using the Ally Identity Measure (AIM) survey, (2) provider training, (3) a sexual orientation/gender identity questionnaire within the electronic health record, and (4) resource bundle. The AIM survey was used to assess the knowledge and skills to support LGBTQ+ persons, awareness of LGBTQ+ oppression, and engagement in action among heterosexual allies to the LGBTQ+ community. AIM scores revealed an overall increase in knowledge and preparedness in providing support for the LGBTQ+ patient/family. The providers’ “Knowledge and Skill” experienced the most increase in AIM scoring followed by “Openness and Support” and “Oppression Awareness,” respectively. Implications for Practice: The implementation of the CB interventions increased health care providers’ knowledge and understanding of LGBTQ individuals while reducing perceived bias.
Small Cluster Invasion Is an Efficient Pathological Predictor for Extraurothelial Recurrence-Free and Overall Survival in Patients With Upper Urinary Tract Urothelial Carcinoma
Authors: Hamamoto Koetsu , Miyai Kosuke , Kawamura Kazuki , Kobayashi Hiroaki , Matsukuma Susumu , Tsuda Hitoshi , Ito Keiichi
Published: February 2025

Purpose:

Histological parameters of tumor invasiveness such as tumor budding (BD) are effective prognostic indicators in various cancer types. However, histological evaluation of BD is sometimes challenging, particularly in the setting of predominantly single tumor cells and/or a mixture of dense inflammatory cells. This study aimed to define small cluster invasions (SCIs) as larger cell clusters than BD, which are observed in the invasive frontal region, and investigate their prognostic effects on upper urinary tract urothelial carcinoma (UUTUC).

Materials and Methods:

This retrospective study included 157 patients with invasive UUTUCs (86 and 71 with renal pelvic and ureteral cancers) who underwent total nephroureterectomy or partial ureteral resection at our institution. The cutoff point for the number of cancer cells composing a single SCI was set at ≥ 5 and < 15; high SCI was defined as ≥ 10 SCIs under ×20 objective magnification. The correlation between SCI status and clinicopathological parameters and the effects of SCI status on recurrence and prognosis were examined.

Results:

The median observation period was 58.8 months. High SCI was observed in 53 (34%) tumors and significantly associated with ureteral location, postoperative chemotherapy, higher pathological T category, lymphovascular invasion, pathological lymph node metastasis, nonpapillary gross finding, positive surgical margin, concomitant subtype histology, and high BD. Using multivariate analysis, only high SCI was independently associated with shorter extraurothelial recurrence-free survival (P < .0001, hazard ratio [HR] = 11.0) and overall survival (P < .0001, HR = 10.7).

Conclusions:

SCI might be a novel prognostic factor in patients with invasive UUTUC.
An Application Based Nomogram to Predict Clinically Significant Diseases in Patients With an Elevated PSA and MRI Prior to Prostate Biopsy
Authors: Amason Reagan , Stratton Kelly L. , Dvorak Justin , Djang Robin , Bouvette Max , Blittschau Benjamin , Gillan Hamza , Cookson Michael S.
Published: February 2025

Introduction and Objective:

A nomogram-based approach can accurately predict the outcome of prostate biopsy (PBx) in biopsy naïve men with an elevated PSA using known traditional risk factors. However, MRI of the prostate has been shown to be of value before performing a PBx. This study aimed to predict clinically significant prostate cancer (csPC) on PBx by combining traditional clinical risk factors with the addition of MRI imaging findings in biopsy naïve men before PBx. An application was then created to improve accessibility to predicted outcomes and aid in decision-making.

Methods:

A cohort of 448 biopsy-naive men with elevated PSA, prostate MRI, and who underwent transrectal ultrasound-guided prostate biopsy were included. Age, race, PSA, prostate volume, PSA density, Prostate Imaging Reporting & Data System, digital rectal examination, and Gleason score were evaluated. CsPC was defined as Gleason Grade Group 2 or higher. Logistical models were created with the aforementioned factors. A nomogram with model performance using 10-fold cross-validation was then developed with subsequent application development. The calibration plot, ROC, and decision curve were developed to evaluate nomogram performance.

Results:

Of the 448 men, 36% were diagnosed with csPC. The mean age of the cohort was 65.97 ± 7.74 years, and 81% of the cohort were White. The mean PSA of the men was 12.60 ± 13.04 ng/mL. An interaction with age was found, so stratified models were developed above and below 67 years of age. The model achieved 82% AUC, with 61% sensitivity, 82% specificity, and 74% overall accuracy.

Conclusions:

The application-based nomogram combines the significant traditional risk factors for prostate cancer with findings on MRI to predict csPC in biopsy naïve men. By combining these variables, the nomogram provides a powerful predictive tool for guiding decision-making in the discovery of csPC. Our model outperformed traditional risk factors in predicting clinically significant cancer before PBx (82% AUC). The nomogram is especially specific (82%) and effective in ruling out the need for biopsy in low-risk patients. In addition, the development of an accurate and user-friendly application increases usefulness to urologists and patients alike.
Ustekinumab for ulcerative colitis: a nationwide real-life observational cohort study
Authors: Molander Pauliina , af Björkesten Clas-Göran , Henricson Hans , Koskela Ritva , Nuutinen Heikki , Käräjämäki Aki , Tillonen Jyrki , Tauriainen Milla-Maria , Kellokumpu Mikko , Eronen Heli , Suhonen Ulla-Maija , Vihriälä Ilkka , Hallinen Taru , Oksanen Minna , Soini Erkki , Koivunen Minni , Kuronen Mervi , Wirth Daniel , Sipponen Taina
Published: February 2025

Objective

This nationwide retrospective chart review study assessed ustekinumab treatment persistence and clinical outcomes of ustekinumab treatment in Finnish patients with ulcerative colitis in a real-world setting.

Methods

Data was collected retrospectively until April 2022 from patient charts for all patients with ulcerative colitis who started ustekinumab between September 2019 and December 2021 in 16 Finnish inflammatory bowel disease centers. The primary outcomes were persistence on ustekinumab and clinical remission/steroid-free clinical remission, defined as partial Mayo score <3 and a combined stool frequency and rectal bleeding subscore of ≤1 at 16 weeks and 1 year.

Results

The study included 221 patients with an average follow-up of 14.7 months and a median disease duration of 5.5 years. Disease status was endoscopically evaluated as severely active in more than 91% of the patients at baseline. Treatment persistence was 87% at 16 weeks and 63% at 1 year. The clinical/steroid-free remission rate was 49%/46% at 16 weeks and 68%/62% at 52 weeks, respectively. Decreases in fecal calprotectin and partial Mayo scores were observed. Concomitant corticosteroid use decreased from 60% at baseline to 28% at 16 weeks and to 16% at 1 year during ustekinumab maintenance therapy. Antibodies to ustekinumab were detected in very few patients (<5, <21%), and discontinuation was observed due to adverse effects even less frequently (<5, <6%).

Conclusion

This real-world study demonstrated that ustekinumab has sustained efficacy in the treatment of ulcerative colitis in a real-world setting.
Correlation of 18F-FDG PET/CT metabolic parameters with Ki-67 expression and tumor staging in nasopharyngeal carcinoma
Authors: Guo ChengMao , Luo JunJia , Liang MeiNa , Xiao JingXing
Published: February 2025

Purpose

The study aimed to investigate the imaging parameters of 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (PET/CT) in nasopharyngeal carcinoma (NPC), specifically examining the relationship between mean standardized uptake value (SUVmean), maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) with Ki-67 expression, T-stage, and tumor node metastasis (TNM) stage.

Methods

A retrospective analysis was conducted on 143 consecutive NPC patients from January 2015 to December 2023 who underwent 18F-FDG PET/CT for initial disease assessment. SUVmax, SUVmean, MTV, and TLG were quantified from PET/CT images. Immunohistochemical staining was used to assess Ki-67 protein expression. Correlations between 18F-FDG PET/CT metabolic parameters, Ki-67 expression, T-stage, and TNM-stage were evaluated using statistical methods, with significance set at P < 0.05.

Results

All primary NPC lesions demonstrated elevated 18F-FDG uptake. Significant positive correlations were observed between SUVmax (r = 0.234, P = 0.005), SUVmean (r = 0.223, P = 0.007), MTV (r = 0.218, P = 0.009), and TLG (r = 0.232, P = 0.005) with Ki-67 labeling index. The univariate analysis indicated that all the parameters (SUVmax, SUVmean, MTV, and TLG) in the group with Ki-67 ≥ 50% were significantly higher than those in the group with Ki-67 < 50% (P = 0.001). Additionally, binary logistic regression analysis revealed that SUVmax was an independent risk factor for the group with Ki-67 ≥ 50% (P = 0.003). The univariate analysis revealed that all parameters (SUVmax, SUVmean, MTV, and TLG) in the T3–4 group and clinical stage IV group were significantly higher than those in the T1–2 group and stages I–III group (P both <0.05), respectively. Furthermore, binary logistic regression analysis demonstrated that MTV was an independent risk factor for both comparisons (P both <0.05).

Conclusion

The metabolic parameters derived from 18F-FDG PET/CT in NPC indirectly reflect tumor biological behavior, suggesting their potential utility in guiding individualized comprehensive treatment strategies.
A Systematic Review on Nurse-Physician Collaboration and Its Relationship With Nursing Workforce Outcomes
Authors: Labrague Leodoro J.
Published: February 2025

OBJECTIVE

This systematic review appraised and synthesized the literature examining the relationship between nurse-physician collaboration and nursing workforce outcomes.

BACKGROUND

Nurse-physician collaboration is vital for effective healthcare delivery, with implications for nursing workforce outcomes. Knowledge of this relationship is crucial when designing strategies and interventions to enhance collaboration and improve nursing practice and outcomes.

METHODS

This is a systematic review of 19 articles. Two independent researchers extracted and analyzed the data from articles that met the inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to ensure transparency and rigor in the review process.

RESULTS

Content analysis identified nursing workforce outcomes of nurse-physician collaboration, which were clustered into motivation-based outcomes (eg, professional autonomy), behavior/performance-based outcomes (eg, job performance, turnover intention), and affective-based outcomes (eg, job satisfaction, moral distress).

CONCLUSION

The findings of this review underscore the value of fostering collaborative relationships between nurses and physicians to improve nursing workforce outcomes and promote a supportive work environment.
Exploring Working Relationships Between Clinical Nurse Specialists and Clinical Nurse Leaders to Better Understand Opportunities for Improvement
Authors: Iseler Jackeline , Luciani Mary , Graham Bridget
Published: February 2025

OBJECTIVE

The aim of this descriptive qualitative study was to describe the experiences between clinical nurse specialists (CNS) and clinical nurse leaders (CNLs) at a Midwestern hospital.

BACKGROUND

Clinical nurse specialists and CNLs are both nurses with advanced degrees yet differing specialties and responsibilities. Both focus on improving nursing and patient care but face challenges such as role definition and resource constraints.

METHODS

A sample of 8 CNSs and 9 CNLs from a Midwestern hospital were recruited to participate in focus groups to explore their experiences working together within the same organization.

RESULTS

Six themes were identified from the interviews: 1) organizational factors; 2) role identity and function; 3) communication practices and challenges; 4) value and visibility; 5) challenges and barriers; and 6) strategies and solutions.

CONCLUSIONS

It is important for administrative leadership to have a clear understanding of the scopes and unique significant contributions that the CNS and CNL each bring to healthcare.
Current status and exploration of nurse-led cardiac telerehabilitation: a narrative review
Authors: Wu Xuejiao , Xu Linqi , Yu Tianzhu , Zhang Xin , Bai Xinyang , Zhang Lijuan , Yu Tianyue , Li Feng
Published: February 2025

Coronary Heart Disease (CHD) remains a leading cause of mortality globally, exerting a significant burden on healthcare systems, particularly in China. Cardiac Rehabilitation (CR), endorsed by major cardiovascular organizations, aims to improve recovery and long-term health outcomes of CHD. Cardiac Telerehabilitation (CTR) uses remote communication technologies to deliver CR, thus enhancing patient engagement by overcoming geographical and socioeconomic barriers. Nurses play crucial roles in CTR, acting as primary care providers and optimizing program implementation. However, it’s still unclear about the implementation of nurse-led CTR. The purpose of this study is to conduct an in-depth analysis of the current application status of nurse-led CTR in patients with CHD and to explore the opportunities and challenges encountered during its implementation. The findings are expected to provide theoretical and practical support for promoting nurse-led CTR implementation and reducing healthcare-related economic burdens. Studies show that nurse-led CTR can effectively improve both physical and psychological outcomes for CHD patients, with sustained benefits over time, particularly in the context of secondary CHD prevention. Successful nurse-led CTR programs have incorporated innovations such as teleconsultations and gamificated interventions, proving remote health care and enhacing patient engagement. These interventions enhance exercise capacity, increase physical activity, improve quality of life, promote healthy behaviors and lifestyle modifications, and provide effective social support. On the other hand, the socioeconomic benefits include faster return-to-work time and increased quality-adjusted life years (QALYs), demonstrating its cost-effectiveness and potential for long-term healthcare savings. Technology and form are the dual challenges for the future implementation of nurse-led CTR . Integrating intelligent methods and hybrid models that combine online and offline interventions can enhance efficiency and patient satisfaction. Behavioral counseling, motivational interviewing, and real-time feedback are key to encouraging adherence. Digital platforms such as WeChat and independently developed telerehabilitation tools have proven effective for CTR delivery, though usability improvements and further technical problem-solving are needed, especially for elderly patients. Future efforts should focus on enhancing the usability of CTR tools, including optimizing the accurate and secure collection of health data via wearable devices. In conclusion, nurse-led CTR offers significant clinical benefits and nurse-involved CTR offers economic benefits, potentially revolutionizing secondary prevention for CHD. Standardization and tailored implementation, especially in resource-constrained settings, could further amplify these benefits, promoting broader and more effective adoption of CTR practices.
Novel Histologic Features in Ameloblastoma With RAS Q61R Mutation
Authors: Stojanov Ivan J. , Trzcinska Anna M. , Qaisi Mohammed , Kmeid Michel , Azzato Elizabeth M. , Shah Akeesha A.
Published: February 2025

Ameloblastoma is characterized histologically by evidence of ameloblastic differentiation and molecularly by MAPK pathway alterations, most frequently BRAF
V600E mutation and RAS mutations, as well as by SMO mutations. This mutational profile is present across all histologic variants, including those occasionally lacking overt histologic evidence of ameloblastic differentiation, such as desmoplastic ameloblastoma and granular cell ameloblastoma. Recently, we have come across 4 cases of maxillary ameloblastoma demonstrating peculiar histologic features not accounted for by recognized histologic variants. Three intraosseous tumors were remarkably similar in histologic appearance and demonstrated a proliferation of spindled to basaloid cells in solid/sheet-like, cystic, and ribbon-like growth patterns within dense fibrous connective tissue. One case had numerous squamous morules and only 1 case, focally, demonstrated ameloblastic differentiation, yet all 3 cases harbored NRAS
Q61R mutation. A fourth case harbored HRAS
Q61R mutation and arose peripherally, in palatal (maxillary) gingiva, as a follicular-patterned neoplasm with bland squamoid morphology and scattered foci of ameloblastic differentiation. RAS Q61R immunohistochemistry was positive in both the tumor and overlying surface epithelium, in support of surface derivation. These 4 cases demonstrate that ameloblastoma may occasionally present with non-traditional histologic features, lacking categorization into known histologic variants and sometimes lacking any evidence of ameloblastic differentiation. In this setting, the differential diagnosis may be broad and include more indolent odontogenic neoplasms such as adenomatoid odontogenic tumor or squamous odontogenic tumor, odontogenic carcinomas, and non-odontogenic neoplasms. A high index of suspicion, followed by confirmatory molecular testing or mutation-specific immunohistochemistry, is necessary for accurate diagnosis.
Increasing Pediatric Palliative Care Consultation for Patients with Heart Disease and Prolonged Cardiac Intensive Care Stay
Authors: Headrick Andrew , Wawrzynski Sarah , Moore Judson , Winder Melissa , Masih Jasmine R. , De Leon Jauregui Michele , Flaherty Brian , Moresco Benjamin , Millar Morgan M. , Codden Rachel R. , Moore Dominic , Delgado-Corcoran Claudia
Published: February 2025

Introduction:

Patients with congenital heart disease are medically complex and experience high rates of morbidity and mortality. Pediatric palliative care (PPC) supports families navigating complex medical scenarios. This study evaluates the effect of quality improvement (QI) interventions towards increasing PPC consultations in patients with heart disease and cardiac intensive care unit (CICU) length of stay (LOS) ≥ 14 days.

Methods:

We conducted a mixed methods QI study using CICU team members and family survey assessments of PPC involvement. Patients with CICU LOS ≥14 days were eligible and comprised our study cohort. Interventions included the implementation of a digital prompt screening for eligible patients sent to CICU and PPC providers, as well as the implementation of weekly huddles to discuss consulted and eligible patients. Through the pre- and postintervention phases, family members of consulted patients and CICU team members were surveyed.

Results:

Preintervention (January 2020 to December 2021), PPC consultation rates were 35% (n = 34) and increased to 63% (n = 43) postintervention (January 2022 to February 2023) (P < 0.01). The timing of consultation was similar between phases. Survey results from family members (n = 19, 39% of 49 participants) and CICU team members (n = 80, 40% of eligible) revealed predominantly positive perceptions regarding PPC involvement.

Conclusions:

QI interventions, including collaborative huddles and digital prompts based on discrete screening criteria, lead to significantly increased rates of PPC consultation in patients with heart disease in the CICU. Survey results support PPC consultation as a positive contribution for families and CICU team members.
Just Autoimmunity? The Role of the Innate Immune Response in Lupus
Authors: Rodriguez Martin A. , Blasini Ana M.
Published: February 2025

Systemic lupus erythematosus is considered a prototype of human autoimmune disease based on the appearance of multiple autoantibodies, some of which can have a direct pathogenic effect on tissues. Most therapeutic modalities aim to check the enhanced humoral responses by targeting T and B cells with conventional or biologic drugs. However, in some cases, the clinical response is limited and frequently takes a high toll of toxicity in patients. The last 2 decades have brought up novel discoveries showing profound disturbances of innate immune cell function in systemic lupus erythematosus, including dysregulated NETosis, increased apoptosis, type 1 interferon, and granulopoiesis signatures that are grounded in basic cell biology abnormalities, including response to excessive oxidative stress, mitochondrial dysfunction, and upregulation of the cGAS-STING pathway. Whether the prominent autoimmunity component of lupus patients is sufficient to drive this chronic disease or follows a breakdown of innate immune homeostasis in response to the environmental factors triggering disease is the subject of this revision.