bluuebunny/crossref_metadata_2025 huggingface dataset:
Perspectives on green hydrogen in Europe—during an energy crisis and towards future climate neutrality
Authors: Münster Marie , Bramstoft Rasmus , Kountouris Ioannis , Langer Lissy , Keles Dogan , Schlautmann Ruth , Mörs Friedemann , Saccani Cesare , Guzzini Alessandro , Pellegrini Marco , Zauner Andreas , Böhm Hans , Markova Darja , You Shi , Pumpa Martin , Fischer Frank , Sergi Francesco , Brunaccini Giovanni , Aloisio Davide , Ferraro Marco , Mulder Machiel , Rasmusson Hans
Published: February 2024

Hydrogen and regional energy infrastructure are significant for the European Green Deal and was the focus of the SuperP2G research Project (Synergies Utilising renewable Power Regionally by means of Power to Gas). Five national projects (Denmark, Netherlands, Germany, Austria, and Italy) cooperated to investigate power-to-gas feasibility. The energy crisis due to the war in Ukraine peaked during the project. The demand for green hydrogen increased as natural gas was reduced. In 2022, the cost of blue hydrogen was 9.5–12.6 €/kg. Higher electricity prices impacted the cost of green hydrogen less. Considering the 2021–22 level of electricity and gas prices, and the potential flexibility of electrolysers, electrolytic hydrogen was on a par with blue hydrogen. On the long term, green hydrogen is assumed to be competitive around 2030. A fast ramping up and favourable electricity cost development could halve the hydrogen production cost until 2040 with investment being the major contributor to a cost reduction. Meanwhile, the smart operation of a wind/electrolyser system might achieve 24% reduction of its operation cost. The following measures are recommended to introduce green hydrogen on a large scale: 1) certification of green and low carbon hydrogen and a uniform CO2 price; 2) ensuring a level playing field across markets; 3) enabling policies to enhance European security of supply by increasing domestic production and diversifying imports; 4) fast ramping of renewable electricity generation; and 5) coordinated planning of hydrogen, methane, and electricity infrastructures.
Mitogen-activated protein kinases MPK3 and MPK6 phosphorylate receptor-like cytoplasmic kinase CDL1 to regulate soybean basal immunity
Authors: Zhang Lei , Zhu Qun , Tan Yuanhua , Deng Miaomiao , Zhang Lei , Cao Yangrong , Guo Xiaoli
Published: February 2024

Soybean cyst nematode (SCN; Heterodera glycines Ichinohe), one of the most devastating soybean (Glycine max) pathogens, causes significant yield loss in soybean production. Nematode infection triggers plant defense responses; however, the components involved in the upstream signaling cascade remain largely unknown. In this study, we established that a mitogen-activated protein kinase (MAPK) signaling module, activated by nematode infection or wounding, is crucial for soybeans to establish SCN resistance. GmMPK3 and GmMPK6 directly interact with CDG1-LIKE1 (GmCDL1), a member of the receptor-like cytoplasmic kinase (RLCK) subfamily VII. These kinases phosphorylate GmCDL1 at Thr-372 to prevent its proteasome-mediated degradation. Functional analysis demonstrated that GmCDL1 positively regulates immune responses and promotes SCN resistance in soybeans. GmMPK3-mediated and GmMPK6-mediated phosphorylation of GmCDL1 enhances GmMPK3 and GmMPK6 activation and soybean disease resistance, representing a positive feedback mechanism. Additionally, 2 L-type lectin receptor kinases, GmLecRK02g and GmLecRK08g, associate with GmCDL1 to initiate downstream immune signaling. Notably, our study also unveils the potential involvement of GmLecRKs and GmCDL1 in countering other soybean pathogens beyond nematodes. Taken together, our findings reveal the pivotal role of the GmLecRKs–GmCDL1–MAPK regulatory module in triggering soybean basal immune responses.
Cryo-EM structure of HQNO-bound alternative complex III from the anoxygenic phototrophic bacterium Chloroflexus aurantiacus
Authors: Xin Jiyu , Min Zhenzhen , Yu Lu , Yuan Xinyi , Liu Aokun , Wu Wenping , Zhang Xin , He Huimin , Wu Jingyi , Xin Yueyong , Blankenship Robert E , Tian Changlin , Xu Xiaoling
Published: February 2024

Alternative complex III (ACIII) couples quinol oxidation and electron acceptor reduction with potential transmembrane proton translocation. It is compositionally and structurally different from the cytochrome bc1/b6f complexes but functionally replaces these enzymes in the photosynthetic and/or respiratory electron transport chains (ETCs) of many bacteria. However, the true compositions and architectures of ACIIIs remain unclear, as do their structural and functional relevance in mediating the ETCs. We here determined cryogenic electron microscopy structures of photosynthetic ACIII isolated from Chloroflexus aurantiacus (CaACIIIp), in apo-form and in complexed form bound to a menadiol analog 2-heptyl-4-hydroxyquinoline-N-oxide. Besides 6 canonical subunits (ActABCDEF), the structures revealed conformations of 2 previously unresolved subunits, ActG and I, which contributed to the complex stability. We also elucidated the structural basis of menaquinol oxidation and subsequent electron transfer along the [3Fe–4S]-6 hemes wire to its periplasmic electron acceptors, using electron paramagnetic resonance, spectroelectrochemistry, enzymatic analyses, and molecular dynamics simulations. A unique insertion loop in ActE was shown to function in determining the binding specificity of CaACIIIp for downstream electron acceptors. This study broadens our understanding of the structural diversity and molecular evolution of ACIIIs, enabling further investigation of the (mena)quinol oxidoreductases–evolved coupling mechanism in bacterial energy conservation.
Growth kinetics of amyloid-like fibrils: An integrated atomistic simulation and continuum theory approach
Authors: Zhang Ruoyao , Jalali Sharareh , Dias Cristiano Luis , Haataja Mikko P
Published: February 2024

Amyloid fibrils have long been associated with many neurodegenerative diseases. The conventional picture of the formation and proliferation of fibrils from unfolded proteins comprises primary and secondary nucleation of oligomers followed by elongation and fragmentation thereof. In this work, we first employ extensive all-atom molecular dynamics (MD) simulations of short peptides to investigate the governing processes of fibril growth at the molecular scale. We observe that the peptides in the bulk solution can bind onto and subsequently diffuse along the fibril surface, which leads to fibril elongation via either bulk- or surface-mediated docking mechanisms. Then, to guide the quantitative interpretation of these observations and to provide a more comprehensive picture of the growth kinetics of single fibrils, a continuum model which incorporates the key processes observed in the MD simulations is formulated. The model is employed to investigate how relevant physical parameters affect the kinetics of fibril growth and identify distinct growth regimes. In particular, it is shown that fibrils which strongly bind peptides may undergo a transient exponential growth phase in which the entire fibril surface effectively acts as a sink for peptides. We also demonstrate how the relevant model parameters can be estimated from the MD trajectories. Our results provide compelling evidence that the overall fibril growth rates are determined by both bulk and surface peptide fluxes, thereby contributing to a more fundamental understanding of the growth kinetics of amyloid-like fibrils.
Polysomnographic characteristics of excessive daytime sleepiness phenotypes in obstructive sleep apnea: results from the international sleep apnea global interdisciplinary consortium
Authors: Thorarinsdottir Elin H , Pack Allan I , Gislason Thorarinn , Kuna Samuel T , Penzel Thomas , Yun Li Qing , Cistulli Peter A , Magalang Ulysses J , McArdle Nigel , Singh Bhajan , Janson Christer , Aspelund Thor , Younes Magdy , de Chazal Philip , Tufik Sergio , Keenan Brendan T
Published: February 2024

Study Objectives

Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnea (OSA). Traditional polysomnographic (PSG) measures only partially explain EDS in OSA. This study analyzed traditional and novel PSG characteristics of two different measures of EDS among patients with OSA.

Methods

Sleepiness was assessed using the Epworth Sleepiness Scale (>10 points defined as “risk of dozing”) and a measure of general sleepiness (feeling sleepy ≥ 3 times/week defined as “feeling sleepy”). Four sleepiness phenotypes were identified: “non-sleepy,” “risk of dozing only,” “feeling sleepy only,” and “both at risk of dozing and feeling sleepy.”

Results

Altogether, 2083 patients with OSA (69% male) with an apnea–hypopnea index (AHI) ≥ 5 events/hour were studied; 46% were “non-sleepy,” 26% at “risk of dozing only,” 7% were “feeling sleepy only,” and 21% reported both. The two phenotypes at “risk of dozing” had higher AHI, more severe hypoxemia (as measured by oxygen desaturation index, minimum and average oxygen saturation [SpO2], time spent < 90% SpO2, and hypoxic impacts) and they spent less time awake, had shorter sleep latency, and higher heart rate response to arousals than “non-sleepy” and “feeling sleepy only” phenotypes. While statistically significant, effect sizes were small. Sleep stages, frequency of arousals, wake after sleep onset and limb movement did not differ between sleepiness phenotypes after adjusting for confounders.

Conclusions

In a large international group of patients with OSA, PSG characteristics were weakly associated with EDS. The physiological measures differed among individuals characterized as “risk of dozing” or “non-sleepy,” while “feeling sleepy only” did not differ from “non-sleepy” individuals.
Chilean Botrytis cinerea Isolates with Reduced Sensitivity to Fludioxonil Exhibit Low to Null Fitness Penalties
Authors: Esterio Marcela , Osorio-Navarro Claudio , Rodríguez Daniela , Copier Charleen , Rubilar Mauricio , Azócar Madelaine , Estrada Verónica , Auger Jaime
Published: February 2024

The main phytosanitary problem for table grape production in Chile is gray mold caused by the fungus Botrytis cinerea. To manage this issue, the primary method utilized is chemical control. Fludioxonil, a phenylpyrrole, is highly effective in controlling B. cinerea and other plant pathogens. Consistently, there have been no field reports of reduced efficacy of fludioxonil; however, subpopulations with reduced sensitivity to fludioxonil are on the rise globally, as per increasing reports. Our study involved a large-scale evaluation of B. cinerea’s sensitivity to fludioxonil in the Central Valley of Chile’s primary table grape production area during the growing seasons from 2015 to 2018. Out of 2,207 isolates, only 1.04% of the isolates (n = 23) exceeded the sensitivity threshold value of 1 μg/ml. Remarkably, 95.7% are concentrated in a geographic region (Valparaíso Region). Isolates with reduced sensitivity to fludioxonil showed growth comparable with sensitive isolates and even more robust growth under nutritional deficit, temperature, or osmotic stress, suggesting greater environmental adaptation. When table grape detached berries were stored at 0°C, isolates less sensitive to fludioxonil caused larger lesions than sensitive isolates (2.82 mm compared with 1.48 mm). However, the lesions generated by both types of isolates were equivalent at room temperature. This study found no cross-resistance between fludioxonil and fenhexamid, an essential fungicide integrated with fludioxonil in Chilean B. cinerea control programs. All the Chilean isolates with reduced sensitivity to fludioxonil were controlled by the fludioxonil/cyprodinil mixture, a commonly employed form of fludioxonil. The cyprodinil sensitivity in the isolates with reduced sensitivity to fludioxonil explains their low field frequency despite their null fitness penalties. However, the emergence of fludioxonil-resistant isolates inside the Chilean B. cinerea population demands a comprehensive analysis of their genetic bases, accompanied by monitoring tools that allow the permanence of field fludioxonil efficacy.
Changes in Multiple Aspects of Pain Outcomes After Rehabilitation
Authors: Uthaikhup Sureeporn , Sremakaew Munlika , Treleaven Julia , Jull Gwendolen , Barbero Marco , Falla Deborah , Cescon Corrado
Published: February 2024

Objectives:

To examine changes in pain outcomes to fully evaluate the effect of adding sensorimotor training to manual therapy and exercise in patients with chronic neck pain and sensorimotor deficits. Concordance was examined between pain distribution and pain intensity and patient-reported outcomes.

Methods:

Participants (n=152) were randomly allocated into four intervention groups: One group received local neck treatment (NT) comprising manual therapy and exercise and the other three groups received additional sensorimotor training (either joint position sense/oculomotor exercises, balance exercises or both). Treatment was delivered twice a week for six weeks. Pain and patient-reported outcomes were measured at baseline, post-treatment and 3-, 6- and 12-month follow-ups.

Results:

There were greater changes in pain location, extent and intensity at 6- and 12-month follow-ups in the sensorimotor training groups compared to the NT group (P<0.05). A greater number of patients in the sensorimotor training groups gained ≥ 50% reduction in pain extent and intensity relative to the NT group at 6- and 12-months (P<0.05). Clinical improvement in pain extent was concordant with pain intensity (adjusted kappa=056-0.66, %agreement=78.3-82.9, P<0.001) and disability (adjusted kappa=0.47-0.58, %agreement=73.7-79.0, P<0.01) at 3-, 6- and 12-month follow-ups, but not with function and well-being. The concordance tended to decline with time.

Discussion:

Multiple aspects of the pain experience improved in the longer term by adding sensorimotor training to NT for patients with neck pain and sensorimotor deficits. The concordance between pain and patient-reported outcomes was not always evident and varied over time, suggesting the need for multidimensional assessments of pain.
Enabling Technologies for Gynecologic Vaginal Surgery
Authors: Balgobin Sunil , Balk Ethan M. , Porter Anne E. , Misal Meenal , Grisales Tamara , Meriwether Kate V. , Jeppson Peter C. , Doyle Paula J. , Aschkenazi Sarit O. , Miranne Jeannine M. , Hobson Deslyn T. , Howard David L. , Mama Saifuddin , Gupta Ankita , Antosh Danielle D. ,   for the Society of Gynecologic Surgeons Systematic Review Group
Published: February 2024

OBJECTIVE:

To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures.

DATA SOURCES:

We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from January 1990 to May 2022.

METHODS OF STUDY SELECTION:

Comparative and single-arm studies with data on contemporary tools or technologies facilitating intraoperative performance of vaginal gynecologic surgical procedures for benign indications were included. Citations were independently double screened, and eligible full-text articles were extracted by two reviewers. Data collected included study characteristics, technology, patient demographics, and intraoperative and postoperative outcomes. Risk of bias for comparative studies was assessed using established methods, and restricted maximum likelihood model meta-analyses were conducted as indicated.

TABULATION, INTEGRATION, AND RESULTS:

The search yielded 8,658 abstracts, with 116 eligible studies that evaluated pedicle sealing devices (n=32), nonrobotic and robotic vaginal natural orifice transluminal endoscopic surgery (n=64), suture capture devices (n=17), loop ligatures (n=2), and table-mounted telescopic cameras (n=1). Based on 19 comparative studies, pedicle sealing devices lowered vaginal hysterectomy operative time by 15.9 minutes (95% CI, −23.3 to −85), blood loss by 36.9 mL (95% CI, −56.9 to −17.0), hospital stay by 0.2 days (95% CI, −0.4 to −0.1), and visual analog scale pain scores by 1.4 points on a subjective 10-point scale (95% CI, −1.7 to −1.1). Three nonrandomized comparative studies and 53 single-arm studies supported the feasibility of nonrobotic vaginal natural orifice transluminal endoscopic surgery for hysterectomy, adnexal surgery, pelvic reconstruction, and myomectomy. Data were limited for robotic vaginal natural orifice transluminal endoscopic surgery, suture capture devices, loop ligatures, and table-mounted cameras due to few studies or study heterogeneity.

CONCLUSION:

Pedicle sealing devices lower operative time and blood loss for vaginal hysterectomy, with modest reductions in hospital stay and pain scores. Although other technologies identified in the literature may have potential to facilitate vaginal surgical procedures and improve outcomes, additional comparative effectiveness research is needed.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42022327490.
Pilot Trial on Ischemic Conditioning of the Gastric Conduit in Esophageal Cancer: Feasibility and Impact on Anastomotic Leakage (TIGOAL-I)
Authors: Fernández-Moreno María-Carmen , Barrios Carvajal María Eugenia , López Mozos Fernando , Martí Obiol Roberto , Guijarro Rozalén Jorge , Casula Elisabetta , Ortega Joaquín
Published: February 2024

Objective:

To evaluate the feasibility, safety, and effectiveness of gastric conditioning using preoperative arterial embolization (PAE) before McKeown esophagectomy at a tertiary university hospital.

Background:

Cervical anastomotic leakage (AL) is a common complication of esophagectomy. Limited clinical evidence suggests that gastric conditioning mitigates this risk.

Methods:

This pilot randomized clinical trial was conducted between April 2016 and October 2021 at a single-center tertiary hospital. Eligible patients with resectable malignant esophageal tumors, suitable for cervical esophagogastrostomy, were randomized into 2 groups: one receiving PAE and the other standard treatment. The primary endpoints were PAE-related complications and incidence of cervical AL.

Results:

The study enrolled 40 eligible patients. PAE-related morbidity was 10%, with no Clavien-Dindo grade III complications. Cervical AL rates were similar between the groups (35% vs 25%, P = 0.49), even when conduit necrosis was included (35% vs 35%, P = 1). However, AL severity, including conduit necrosis, was higher in the control group according to the Clavien-Dindo ≥IIIb (5% vs 30%, P = 0.029) and Comprehensive Complication Index (20.9 vs 33.7, P = 0.01). No significant differences were found in other postoperative complications, such as pneumonia or postoperative mortality.

Conclusions:

PAE is a feasible and safe method for gastric conditioning before McKeown minimally invasive esophagectomy and shows promise for preventing severe AL. However, further studies are required to confirm its efficacy.
Predictive value of thyroid function in severe aplastic anemia patients treated with immunosuppressive therapy
Authors: Liu Yilin , Huo Jiali , Ge Meili , Li Xingxin , Huang Jinbo , Ren Xiang , Wang Min , Nie Neng , Zhang Jing , Jin Peng , Shao Yingqi , Zheng Yizhou
Published: February 2024

To explore the predictive value of thyroid function in severe aplastic anemia (SAA) patients treated with immunosuppressive therapy (IST), 149 SAA patients in our center were enrolled between February 2015 and June 2020 in this study. We assessed the thyroid function of 134 patients without primary thyroid diseases, and discovered that 89 patients were accompanied by abnormal thyroid hormone, especially low triiodothyronine (T3). Patients with higher pretreatment-free T3 (FT3) levels (>5 pmol/L) demonstrated superior response rates at 3 and 6 months after IST compared to those with lower FT3 levels (54.5% vs 35.4%, P = .020; 67.3% vs 46.9%, P = .020). Multivariate analysis indicated that shorter disease duration (≤56 days) and response at 6 months were independent favorable factors of overall survival (relative risk [RR] = 2.66, 95% confidence interval [CI] = 1.03–6.90, P = .040; RR = 30.10, 95% CI = 4.02–225.66, P = .001). The 6-year failure-free survival (FFS) was 53.8% (95% CI = 40.9%–65.1%). Multivariate analysis revealed that patients with a response at 6 months, shorter duration (≤56 days) and receiving rabbit antithymocyte globulin (ATG) had better FFS outcomes than those without a response at 6 months, with a longer duration and receiving porcine ATG (RR = 22.6, 95% CI = 7.9–64.9, P < .001; RR = 2.4, 95% CI = 1.3–4.5, P = .006; RR = 2.5, 95% CI = 1.1–5.8, P = .030). In conclusion, FT3 levels reflect the severity of SAA, and patients with higher FT3 levels (>5 pmol/L) had superior response rates than those with lower ones.
Associations Between Family-Assessed Quality-of-Dying-and-Death Latent Classes and Bereavement Outcomes for Family Surrogates of ICU Decedents
Authors: Wen Fur-Hsing , Prigerson Holly G. , Hu Tsung-Hui , Huang Chung-Chi , Chou Wen-Chi , Chuang Li-Pang , Chiang Ming Chu , Tang Siew Tzuh
Published: February 2024

Objectives:

To examine associations between family surrogates’ bereavement outcomes and four previously determined quality of dying and death (QODD) latent classes (high, moderate, poor-to-uncertain, and worst).

Design:

Prospective, longitudinal, observational study.

Setting:

Medical ICUs at two academically affiliated medical centers in Taiwan.

Patients/Participants:

Three hundred nine family surrogates responsible for decision-making for critically ill patients at high risk of death (Acute Physiology and Chronic Health Evaluation II scores > 20) from a disease.

Interventions:

None.

Measurements and Main Results:

Participants were assessed by the depression and anxiety subscales of the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, 11 items of the Prolonged Grief Disorder (PGD) scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey at 1, 3, 6, 13, 18, and 24 months post-loss. We simultaneously examined associations of four QODD latent classes with physical and mental health-related quality of life (HRQOL) and symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and PGD assessed over 24 bereavement months using multivariate hierarchical linear modeling. Surrogates’ distinct QODD latent classes assessed at 1-month post-loss were significantly associated with bereavement outcomes, except for physical HRQOL and PGD symptoms. Significantly more depressive symptoms and worse mental HRQOL (β [95% CI]) were reported by bereaved surrogates in the moderate (1.958 [1.144–2.772], –2.245 [–3.961 to –0.529]), poor-to-uncertain (2.224 [1.438–3.010], –7.026 [–8.683 to –5.369]), and worst (2.081 [1.215–2.964], –4.268 [–6.096 to –2.440]) QODD classes than those in the high QODD class. Bereaved surrogates in the moderate (2.095 [1.392–2.798]) and poor-to-uncertain (0.801 [0.123–1.480]) QODD classes reported more anxiety symptoms, whereas those in the poor-to-uncertain QODD class suffered more PTSD symptoms (2.889 [1.005–4.774]) than those in the high QODD class.

Conclusions:

The four distinct QODD latent classes were significantly associated with ICU family surrogates’ bereavement outcomes, suggesting targets to improve end-of-life care quality in ICUs.
A fatal outcome due to a continuous dosage of gentamicin: a case report
Authors: Ronda-Roca Gerard , Sancho-López Aránzazu , Ruiz-Antorán Belén , Montero-Hernández Esther , San Martin-Espinosa Alicia
Published: February 2024

Gentamicin, an aminoglycoside antibiotic, exerts its bactericidal effect primarily through the inhibition of ribosomes in Gram-negative bacteria. It has a concentration-dependent pharmacodynamic effect, making an extended-interval dosage preferable. The total dose is, therefore, usually administered as a single daily dose instead of divided portions two or three times a day. This dosage has shown an excellent efficacy because an appropriate peak concentration is obtained, whilst the risk of nephrotoxicity is reduced as this is correlated with the residual concentration of gentamicin. In the European Medicines Agencies Summary of Products Characteristics, it is stated that deterioration of kidney function could be expected in 1/10 to 1/100 patients treated with gentamicin. We present a 92-year-old female patient with a weight of 39 kg, history of chronic kidney disease (CKD) and chronic heart failure that presented a fatal nephrotoxicity due to a prescription error of gentamicin.
Giant Cell Tumor of Bone, Rare Inferior Orbit Location
Authors: Garcia Jasmine , Bryson Staci , Mansueto Lisa A.
Published: February 2024

Giant cell tumor of bone (GCTB) typically presents in the epiphysis of long bones and occurs in the skull in less than 1% of cases. When GCTB is diagnosed in the skull, it is primarily seen in the temporal and sphenoid bones. GCTB is an osteoclastic stromal tumor that is locally aggressive and tends to recur. We present a case of a 43-year-old woman with slowly progressive, left-sided proptosis, eyelid swelling, photophobia, epiphora, and pressure sensation. Computed tomography and magnetic resonance imaging revealed an enhancing tumor in the left inferior orbit with infiltration into the maxillary sinus roof. Histological examination was conclusive for a giant cell tumor of the maxillary bone presenting as an inferior orbital mass. Gross total surgical resection was performed via an inferior anterior orbitotomy, and the patient had resolution of symptoms without recurrence in her postoperative course to date. This report contributes to the scarce literature available on this type of tumor of skull bones, specifically presenting the first case in the maxillary bone of the floor of the orbit.
Modeling the Lifetime Impact of Reconstructive Plastic Surgery Training: Implications for Building Capacity in Global Surgery
Authors: Cai Lawrence , Meyers Natalie , Chang James
Published: February 2024

Background:

Training local surgeons and building local surgical capacity is critical to closing the gap in unmet surgical burden in low- and middle-income country (LMIC) settings. We propose a conceptual framework to quantify the impact of a single surgeon’s training across multiple generations of trainees.

Methods:

A literature review was conducted to identify existing models for quantifying the impact of training. A model to estimate the attributable impact of surgical training was devised, based on a surgeon’s attributable impact on a trainee and the lifetime number of cases trainees would perform. A quantitative survey was sent to high-income country and LMIC-based surgeons to determine the model’s inputs across eight index procedures in reconstructive plastic surgery.

Results:

We found no existing models for quantifying the multigenerational impact of training in surgery, medicine, or nonmedical fields. Twenty-eight US-based academic plastic surgeons and 19 LMIC-based surgeons representing 10 countries provided responses. The lifetime impact of multigenerational surgical training ranged from 4100 attributable cases (skin graft) to 51,900 attributable cases (cleft lip repair) in high-income countries and from 18,200 attributable cases (carpal tunnel release) to 134,300 attributable cases (cleft lip repair) in LMICs.

Conclusions:

There is a sizeable impact in the first generation of training, and this impact is even greater in the second generation of training, highlighting the importance of a “multiplier effect,” particularly in LMIC settings. Given the paucity of surgeons, this multiplier effect is critical in closing the surgical gap, as efforts are underway to train new cohorts of reconstructive plastic surgeons.
Cardiac Rehabilitation Use After Heart Failure Hospitalization Associated With Advanced Heart Failure Center Status
Authors: Thompson Michael P. , Hou Hechuan , Fliegner Max , Guduguntla Vinay , Cascino Thomas , Aaronson Keith D. , Likosky Donald S. , Sukul Devraj , Keteyian Steven J.
Published: February 2024

Purpose:

Cardiac rehabilitation (CR) is an evidence-based, guideline-endorsed therapy for patients with heart failure with reduced ejection fraction (HFrEF) but is broadly underutilized. Identifying structural factors contributing to increased CR use may inform quality improvement efforts. The objective here was to associate hospitalization at a center providing advanced heart failure (HF) therapies and subsequent CR participation among patients with HFrEF.

Methods:

A retrospective analysis was performed on a 20% sample of Medicare beneficiaries primarily hospitalized with an HFrEF diagnosis between January 2008 and December 2018. Outpatient claims were used to identify CR use (no/yes), days to first session, number of attended sessions, and completion of 36 sessions. The association between advanced HF status (hospitals performing heart transplantation or ventricular assist device implantations) and CR participation was evaluated with logistic regression, accounting for patient, hospital, and regional factors.

Results:

Among 143 392 Medicare beneficiaries, 29 487 (20.6%) were admitted to advanced HF centers (HFCs) and 5317 (3.7%) attended a single CR session within 1 yr of discharge. In multivariable analysis, advanced HFC status was associated with significantly greater relative odds of participating in CR (OR = 2.20: 95% CI, 2.08-2.33; P < .001) and earlier initiation of CR participation (–8.5 d; 95% CI, –12.6 to 4.4; P < .001). Advanced HFC status had little to no association with the intensity of CR participation (number of visits or 36 visit completion).

Conclusions:

Medicare beneficiaries hospitalized for HF were more likely to attend CR after discharge if admitted to an advanced HFC than a nonadvanced HFC.
Deep Learning Models Used in the Diagnostic Workup of Keratoconus: A Systematic Review and Exploratory Meta-Analysis
Authors: Bodmer Nicolas S. , Christensen Dylan G. , Bachmann Lucas M. , Faes Livia , Sanak Frantisek , Iselin Katja , Kaufmann Claude , Thiel Michael A. , Baenninger Philipp B.
Published: February 2024

Purpose:

The prevalence of keratoconus in the general population is reported to be up to 1 of 84. Over the past 2 decades, diagnosis and management evolved rapidly, but keratoconus screening in clinical practice is still challenging and asks for improving the accuracy of keratoconus detection. Deep learning (DL) offers considerable promise for improving the accuracy and speed of medical imaging interpretation. We establish an inventory of studies conducted with DL algorithms that have attempted to diagnose keratoconus.

Methods:

This systematic review was conducted according to the recommendations of the PRISMA statement. We searched (Pre-)MEDLINE, Embase, Science Citation Index, Conference Proceedings Citation Index, arXiv document server, and Google Scholar from inception to February 18, 2022. We included studies that evaluated the performance of DL algorithms in the diagnosis of keratoconus. The main outcome was diagnostic performance measured as sensitivity and specificity, and the methodological quality of the included studies was assessed using QUADAS-2.

Results:

Searches retrieved 4100 nonduplicate records, and we included 19 studies in the qualitative synthesis and 10 studies in the exploratory meta-analysis. The overall study quality was limited because of poor reporting of patient selection and the use of inadequate reference standards. We found a pooled sensitivity of 97.5% (95% confidence interval, 93.6%–99.0%) and a pooled specificity of 97.2% (95% confidence interval, 85.7%–99.5%) for topography images as input.

Conclusions:

Our systematic review found that the overall diagnostic performance of DL models to detect keratoconus was good, but the methodological quality of included studies was modest.
Pain in Parkinson disease: a deep phenotyping study
Authors: Salabasidou Elena , Binder Tobias , Volkmann Jens , Kuzkina Anastasia , Üçeyler Nurcan
Published: February 2024

In our prospective cross-sectional study, we comprehensively characterized Parkinson disease (PD)–related pain in monocentrically recruited patients with PD using standardized tools of pain assessment and categorization. One hundred fifty patients were systematically interviewed and filled in questionnaires for pain, depression, motor, and nonmotor symptoms. Patients with PD-related pain (PD pain), patients without PD-related pain (no PD pain), and patients without pain (no pain) were compared. Pain was present in 108/150 (72%) patients with PD, and 90/150 (60%) patients were classified as having PD-related pain. Most of the patients with PD (67/90, 74%) reported nociceptive pain, which was episodic (64/90, 71%), primarily nocturnal (56/90, 62%), and manifested as cramps (32/90, 36%). Parkinson disease–related pain was most frequently located in the feet (51/90, 57%), mainly at the toe joints (22/51, 43%). 38/90 (42%) patients with PD-related pain received analgesic medication with nonsteroidal anti-inflammatory drugs being the most frequently used (31/42, 82%) and opioids most effective (70% pain reduction of individual maximum pain intensities, range 22%-100%, confidence interval 50%-90%). All patients received oral PD treatment; however, levodopa equivalent dose showed no correlation with mean pain intensities (Spearman ρ = 0.027, P > 0.05). Our data provide a comprehensive analysis of PD-related pain, giving evidence for mainly non-neuropathic podalgia, which bears the potential to rethink assessment and analgesic treatment of pain in PD in clinical practice.
High-speed imaging of evoked rodent mechanical behaviors yields variable results that are not predictive of inflammatory injury
Authors: Rodríguez García Dianise M. , Szabo Aniko , Mikesell Alexander R. , Zorn Samuel J. , Tsafack Ulrich Kemmo , Sriram Anvitha , Waltz Tyler B. , Enders Jonathan D. , Mecca Christina M. , Stucky Cheryl L. , Sadler Katelyn E.
Published: February 2024

Few analgesics identified using preclinical models have successfully translated to clinical use. These translational limitations may be due to the unidimensional nature of behavioral response measures used to assess rodent nociception. Advances in high-speed videography for pain behavior allow for objective quantification of nuanced aspects of evoked paw withdrawal responses. However, whether videography-based assessments of mechanical hypersensitivity outperform traditional measurement reproducibility is unknown. First, we determined whether high-speed videography of paw withdrawal was reproducible across experimenters. Second, we examined whether this method distinguishes behavioral responses exhibited by naive mice and mice with complete Freund's adjuvant (CFA)-induced inflammation. Twelve experimenters stimulated naive C57BL/6 mice with varying mechanical stimuli. Paw withdrawal responses were recorded with high-speed videography and scored offline by one individual. Our group was unable to replicate the original findings produced by high-speed videography analysis. Surprisingly, ∼80% of variation was not accounted for by variables previously reported to distinguish between responses to innocuous and noxious stimuli (paw height, paw velocity, and pain score), or by additional variables (experimenter, time-of-day, and animal), but rather by unidentified factors. Similar high-speed videography assessments were performed in CFA- and vehicle-treated animals, and the cumulative data failed to reveal an effect of CFA injection on withdrawal as measured by high-speed videography. This study does not support using paw height, velocity, or pain score measurements from high-speed recordings to delineate behavioral responses to innocuous and noxious stimuli. Our group encourages the continued use of traditional mechanical withdrawal assessments until additional high-speed withdrawal measures are validated in established pain models.
Relationship between the behavior change model and salt intake in hypertensive patients: a single non-specialized hypertension clinic prospective observational study
Authors: Sekizuka Hiromitsu , Ishii Toshiya , Miyake Hitoshi
Published: February 2024

We investigated whether changes in salt reduction readiness are associated with changes in estimated daily salt intake and blood pressure (BP). We divided 86 hypertensive patients into groups with high and low readiness for salt-reducing behavior [an up (UP) and a down (DN) groups, respectively] based on the transtheoretical model (TTM) over a 12-month observation period. We then investigated the relationships between changes in the TTM stage and changes in daily salt intake and BP over 12 months. The patients in the UP group had significantly increased urine potassium concentrations (from 51.2 ± 23.3 mEq/L at baseline to 56.9 ± 25.5 mEq/L at 12 months; P = 0.048) and significantly decreased estimated 24-h urinary salt excretion (from 9.7 ± 2.9 g/day at baseline to 8.4 ± 2.8 g/day at 12 months; P = 0.045). In addition, they also had significantly lower changes in urine sodium concentration (−13.1 ± 46.1 vs. −6.6 ± 59.7 mEq/L; P = 0.048), significantly increased changes in urine potassium concentration (5.7 ± 20.1 vs. −4.8 ± 28.6 mEq/L; P = 0.030), and significantly decreased changes in estimated 24-h urinary salt excretion (−1.3 ± 2.6 vs. −0.1 ± 2.6 g/day; P = 0.045) compared with patients in the DN group. However, their home BP did not improve over 12 months. The hypertensive patients who increased their readiness or maintained a high readiness for salt reduction over 12 months showed a significant increase in daily potassium intake and significant decrease in daily salt intake.
Autoimmune thyroid disease in patients with type 1 diabetes mellites: A cross-sectional study from Syria
Authors: Alhaj Hazzaa Alghaith , Alsultan Mohammad , Kabalan Younes , Alourfi Zaynab
Published: February 2024

The present study aimed to investigate the occurrence of autoimmune thyroid disease (AITD) in patients with type 1 diabetes mellitus (T1DM) by the presence of antithyroid peroxidase (anti-TPO Ab). Furthermore, we studied the relationship of clinical and thyroid ultrasound (US) characteristics with anti-TPO Ab. This cross-sectional study was performed in Al- Mowasat and Al-Assad University Hospitals from 2021 to 2023. Clinical, laboratories, and US features were collected and analyzed between positive compared to negative anti-TPO Ab. Of 76 patients, anti-TPO Ab was positive in 12 patients (15.7%) with female predominance [n = 10 (83.3%)]. Gender showed a difference between anti-TPO Ab groups (P = .026). DM duration showed a difference (P = .034), which was dominant for a group of positive anti-TPO Ab (median = 9). The age at DM diagnosis also showed a difference (P = .048), where most patients were under 10- years old at diagnosis [n = 39 (51.3%)] and the highest number of anti-TPO Ab positive patients [n = 7 (58.3%)] were in this age category. US findings showed a significant difference (P = .001). Regarding positive anti-TPO Ab patients, the most frequent US finding was immune pattern [7 (58.3%)], which was more common than in the negative group (12.5%). Age, hemoglobin A1c (HBA1c), and body mass index (BMI) did not present differences (P = .391, 0.692, and 0.453, respectively), however, all anti-TPO Ab positive patients were older than ten years and had HBA1c more than 8. Thyroid-stimulating hormone (TSH) was abnormal in 2 patients (16.6%) and both in anti-TPO Ab positive group. This study suggests that anti-TPO Ab appears in older patients and with longer MD duration. Also, data support using US and anti-TPO Ab as earlier markers for AITDs, and further recommending regular annual monitoring by US and anti-TPO Ab in all patients with T1DM for AITDs diagnosis, especially in females.
Comparing verum and sham acupoint catgut embedding for adults with obesity: A systematic review and meta-analysis of randomized clinical trials
Authors: Yue Jin-huan , Li Xiao-ling , Zhang Yu-ying , Yang Guan-hu , Mah Jeffrey Zhong-xue , Li Ang , Zhao Wei-wei , Wang Yu-lin , Zhang Qin-hong , Huang Jia-qi
Published: February 2024

Background:

Previous clinical trials have reported that acupoint catgut embedding (ACE) is a useful modality for weight loss. However, no study has specifically investigated the effectiveness and safety of comparing verum and sham ACE in adults with obesity. Thus, this study aimed to evaluate the effectiveness and safety of comparing verum and sham ACE in obese adults.

Methods:

A comprehensive literature search was conducted in the electronic databases of PUBMED, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, and China Biomedical Literature Service System from inception to April 1, 2022. Randomized clinical trials that focused on evaluating the effectiveness of comparing verum and sham ACE in adults with obesity were included. The primary outcomes included reduction in body weight, body mass index, hip circumference, and waist circumference. The secondary outcomes consisted of a decrease in body fat percentage and the occurrence rate of adverse events. The methodological quality of the included randomized clinical trials was evaluated using the Cochrane Risk-of-bias tool. Statistical analysis was performed using RevMan 5.4 software.

Results:

Six trials involving 679 adults with obesity were included in this study and entered in the data analysis of systematic review and meta-analysis. Results of the meta-analysis revealed significant reduction in body weight (mean difference [MD] = −1.68, 95% confidence intervals (CI) [−2.34, −1.01], I
2 = 51%, P < .001), body mass index (MD = −0.51, 95% CI [−0.81, −0.21], I
2 = 74%, P < .001), hip circumference (MD = −1.11, 95% CI [−1.67, −0.55], I
2 = 0%, P < .001), waist circumference (MD = −2.42, 95% CI [−3.38, −1.45], I
2 = 68%, P < .001), and decrease in body fat percentage (MD = −0.83, 95% CI [−1.30, −0.36], I
2 = 16%, P < .001) in comparing verum and sham ACE. However, no significant difference was identified in AEs (odds ratio = 1.53, 95% CI [0.80, 2.95], I
2 = 0%, P = .20) between the 2 groups.

Conclusion:

ACE is effective in the treatment of obesity in adults with safety profile. Further studies with higher quality and larger sample size are warranted to confirm the current findings.
Clinical application of metagenomic next-generation sequencing in patients with different organ system infection: A retrospective observational study
Authors: Zhang Haiyan , Zhou Fengli , Liu Xiaoyun , Huang Jiabao
Published: February 2024

Microbiological identification is essential for appropriate treatment, but conventional methods are time-consuming and have a low sensitivity. In contrast, metagenomic next-generation sequencing (mNGS) is a culture-free and hypothesis-free technique that can detect a wide array of potential pathogens. This study aimed to reveal the overall diagnostic value of mNGS for infectious diseases of different organ systems and compare the sensitivity and specificity of mNGS with conventional methods. In a retrospective cohort study, 94 patients with mNGS results were enrolled, and clinical data were recorded and analyzed to compare the positive rate of mNGS with traditional methods including as smears, serological tests, and traditional PCR, etc. In this study, mNGS and culture were both positive in 12.77% cases and were both negative in 23.4% cases. There were positive results in 56 cases (54.26%) only by mNGS and 4 cases (4.26%) were positive only by culture. There were significant differences in sensitivity of pathogen detection between of ID and NID group for mNGS (χ2 = 10.461, P = .001)and conventional methods(χ2 = 7.963, P = .005). The positive predictive values and negative predictive values of diagnosing infectious disease by mNGS were 94.12% and 30.77%, respectively. mNGS increased the sensitivity rate by approximately 53.66% compared with that of culture (78.05% vs24.39%; χ2 = 47.248, P < .001) and decreased the specificity rate by 12.5% compared with that of culture (66.67% vs 100.0%; χ2 = 4.8, P = .028). mNGS can identify emerging or rare pathogen and further guide treatment regimens. mNGS has advantages in identifying overall pathogens and bacteria, however, there was no obvious advantage in identifying fungi, virus and tuberculosis. mNGS has higher specificity than conventional methods in identifying pathogens and advantages in detecting emerging or rare pathogens.
Successful treatment of refractory ascites in a patient with liver cirrhosis combined with hepatic artery-portal vein malformation: A case report
Authors: Ge Zhenyu , Wang Kai , Zhang Zhaomei , Zhang Xiaoqian , Sun Peng , Chen Ning , Tan Yang , Shen Tingting , Dai Hongsheng , Li Wenwen
Published: February 2024

Introduction:

Hepatic artery-portal vein malformation is rarely encountered in clinical practice. Here, we reported a case of liver cirrhosis combined with hepatic artery-portal vein malformation with refractory ascites as the main symptom. And it was successfully treated by us. The present case demonstrates the role of hepatic artery-portal vein malformation in cirrhotic ascites and the importance of early diagnosis and interventional treatment. This article may provides some experience for the treatment of such patients.

Patient concerns:

The patient was a 72-year-old woman with a 40-year history of Hepatitis B virus surface antigen positivity who sought medical advice with a chief complaint of abdominal distension for 1 week.

Diagnoses:

Enhanced abdominal computed tomography imaging of this patient revealed liver cirrhosis, splenomegaly, esophageal and gastric varices, massive ascites, and a low-density area in the S4 segment of the liver with an ambiguous boundary. Widening of the left branch of the portal vein was evident, and the portal vein was highlighted in the arterial phase and the venous phase. Digital subtraction angiography revealed substantial thickening of the left hepatic artery, and the administered contrast agent drained through the malformed vascular mass to the thickened left portal vein. Liver cirrhosis combined with hepatic artery-portal vein malformation were diagnosed. And we considered that the artery-portal vein malformation in this patient might be caused by cirrhosis.

Interventions:

The patient was applied diuretics, entecavir and transcatheter embolization.

Outcomes:

The patient ascites did not resolve significantly when treated with diuretics alone. After the transcatheter embolization, the patient ascites relieved remarkably.

Conclusion:

The patient underwent transcatheter embolization for hepatic artery-portal vein malformation, after which her ascites resolved with good short-term curative efficacy. So, the patients who suffered from liver cirrhosis combined with hepatic artery-portal vein malformation and refractory ascites, should be active on transcatheter embolization.
Research progress and perspectives of noncoding RNAs in adrenocortical carcinoma: A review
Authors: Xu Changfen , Xu Peiyao , Zhang Jiaqi , He Sheng , Hua Tingting , Huang Aiwu
Published: February 2024

Adrenocortical carcinoma (ACC) is a rare and highly aggressive endocrine malignancy. Although surgery can cure localized disease, but the majority of patients experience recurrence of ACC. The 5-year survival rate of patients with metastatic ACC is <15%, and the prognosis is poor. Therefore, it is urgent to explore the potential diagnostic markers and therapeutic targets for ACC. Recently, it has been proved that non-coding RNA (ncRNAs) is widely involved in pathological and physiological processes, including tumorigenesis and development. Aberrantly expressed ncRNAs have been found to be involved in the pathogenesis of ACC. Here, we summarized the expression patterns and the molecular mechanism of the involvement of microRNAs (miRNAs), long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs) in ACC development. To explore the clinical value of ncRNAs as noninvasive biomarkers of ACC, we also displayed the relationship between the expression level of ncRNAs and the diagnosis and prognosis of patients with ACC.