bluuebunny/crossref_metadata_2025 huggingface dataset:
Expectant Casualty Care Training Needs for Future Conflicts
Authors: Cole Rebekah , Keenan Sean , Tadlock Matthew D , Grover Shawna , Givens Melissa , Rudinsky Sherri L
Published: August 2024

Introduct ion

The demands of future large-scale combat operations may require medics and corpsmen to increasingly perform expectant casualty care (ECC). However, no detailed guidelines currently exist for providing ECC within military medicine. To guide the development of education and training guidelines and advance team training of both medics and non-medics, an in-depth understanding is first needed regarding caregivers’ experiences providing ECC in recent conflicts as well as perceived training gaps. Therefore, this study explored the experiences of medics and physicians providing ECC and investigated their perceptions of training needs in this area for future conflicts characterized by large-scale combat operations and prolonged casualty care operational settings.

Materials and Methods

We conducted an engaged qualitative phenomenological study to explore ECC training needs for future conflicts. We interviewed 9 senior health care professionals (medics and physicians) who had extensive combat and deployment experiences and served primarily in the Role 1 environment. The interviews averaged 45 min each and were conducted via phone. To analyze this interview data, we reviewed the interview transcripts and then noted terms, phrases, and concepts within the interview transcripts that we found to be salient to answering the research question. Our team then met to review these codes and grouped them into categories. These categories served as the themes of this study that illustrated the participants’ perceptions and experiences.

Results

Five themes emerged from our data: (1) There is a current gap in ECC training for enlisted Role 1 caregivers throughout the military; (2) ECC training is needed to shift organizational culture; (3) ECC training should be comprehensive; (4) ECC training should be deliberate; and (5) Time is the greatest challenge to implementing ECC training. Our participants noted that developing guidelines and filling training gaps is not only critical for preparing Role 1 providers for effective and ethical military medical decision-making but also for addressing death and dying on the battlefield and building moral resilience across the medical corps.

Conclusion

Our results provide direction for development of ECC clinical guidance and collective team training recommendations. Following these guidelines may increase life-saving capabilities on the far-forward battlefield and equip medical directors and medics to provide ethical and compassionate care to those who cannot be saved in the setting of limited resources and evacuation opportunities.
Annelid Comparative Genomics and the Evolution of Massive Lineage-Specific Genome Rearrangement in Bilaterians
Authors: Lewin Thomas D , Liao Isabel Jiah-Yih , Luo Yi-Jyun
Published: August 2024

The organization of genomes into chromosomes is critical for processes such as genetic recombination, environmental adaptation, and speciation. All animals with bilateral symmetry inherited a genome structure from their last common ancestor that has been highly conserved in some taxa but seemingly unconstrained in others. However, the evolutionary forces driving these differences and the processes by which they emerge have remained largely uncharacterized. Here, we analyze genome organization across the phylum Annelida using 23 chromosome-level annelid genomes. We find that while many annelid lineages have maintained the conserved bilaterian genome structure, the Clitellata, a group containing leeches and earthworms, possesses completely scrambled genomes. We develop a rearrangement index to quantify the extent of genome structure evolution and show that, compared to the last common ancestor of bilaterians, leeches and earthworms have among the most highly rearranged genomes of any currently sampled species. We further show that bilaterian genomes can be classified into two distinct categories—high and low rearrangement—largely influenced by the presence or absence, respectively, of chromosome fission events. Our findings demonstrate that animal genome structure can be highly variable within a phylum and reveal that genome rearrangement can occur both in a gradual, stepwise fashion, or rapid, all-encompassing changes over short evolutionary timescales.
Highly efficient and stable binary and ternary organic solar cells using polymerized nonfused ring electron acceptors
Authors: Wang Xiaodong , Wei Nan , Chen Ya-nan , Ran Guangliu , Zhang Andong , Lu Hao , Wei Zhengdong , Liu Yahui , Zhang Wenkai , Bo Zhishan
Published: August 2024

This study reports the successful design and synthesis of two novel polymerized nonfused ring electron acceptors, P-2BTh and P-2BTh-F, derived from the high-performance nonfused ring electron acceptor, 2BTh-2F. Prepared via Stille polymerization, these polymers feature thiophene and fluorinated thiophene as π-bridge units. Notably, P-2BTh-F, with difluorothiophene as the π-bridge, exhibits a more planar backbone and red-shifted absorption spectrum compared with P-2BTh. When employed in organic solar cells (OSCs) with PBDB-T as the donor material, P-2BTh-F-based devices demonstrate an outstanding power conversion efficiency (PCE) of over 11%, exceeding the 8.7% achieved by P-2BTh-based devices. Furthermore, all-polymer solar cells utilizing PBDB-T:P-2BTh-F exhibit superior storage stability. Additionally, P-2BTh-F was explored as a functional additive in a high-performance binary system, enhancing stability while maintaining comparable PCE (19.45%). This strategy offers a cost-effective approach for fabricating highly efficient and stable binary and ternary organic solar cells, opening new horizons for cost-effective and durable solar cell development.
The Association Between Serum Mature and Precursor Brain-Derived Neurotrophic Factor and Neurocognitive Function in People With Human Immunodeficiency Virus: A Longitudinal Study
Authors: Michael Henry U , Rapulana Antony M , Smit Theresa , Xulu Njabulo , Danaviah Sivapragashini , Ramlall Suvira , Oosthuizen Frasia
Published: August 2024

Background

Despite antiretroviral therapy (ART), human immunodeficiency virus (HIV)–associated neurocognitive impairment persists. We investigated the association between serum levels of mature brain-derived neurotrophic factor (mBDNF), precursor brain-derived neurotrophic factor (proBDNF), and neurocognitive changes over time among adults with HIV in sub-Saharan Africa, seeking to elucidate the interplay between neurotrophic factors and neurocognitive outcomes post-ART.

Methods

Utilizing data from the ACTG 5199 study in Johannesburg and Harare, serum mBDNF and proBDNF levels were measured via enzyme-linked immunosorbent assay. Neurocognitive performance was assessed at baseline and 24, 48, and 96 weeks using neuropsychological tests. The Friedman test and linear mixed-effects models were used to assess changes in mBDNF, proBDNF, and neurocognitive performance over time, accounting for individual variability and adjusting for multiple comparisons.

Results

Among 155 participants, there were significant cognitive improvements (P < .001) and a rise in mBDNF levels from baseline to 96 weeks. The proBDNF levels initially remained stable (P = .57) but notably increased by 48 weeks (P = .04). Higher mBDNF levels were positively associated with enhanced neurocognitive performance at 48 weeks (β = .16, P = .01) and 96 weeks (β = .32, P < .001). Similarly, higher proBDNF levels were positively associated with neurocognitive performance at 96 weeks (β = .25, P < .001).

Conclusions

This study highlights the significant association between serum BDNF levels and neurocognitive improvement post-ART in adults with HIV. However, more research is needed to replicate these findings, establish causal relationships, and explore whether BDNF-enhancing activities can improve neurocognitive outcomes in people with HIV.
Spiral magnetic fields and their role on accretion dynamics in the circumnuclear disk of Sagittarius A*: Insight from λ = 850 μm polarization imaging
Authors: Sato Kazuki , Shinnaga Hiroko , Furuya Ray S , Suzuki Takeru K , Kakiuchi Kensuke , Ott Jürgen
Published: August 2024

We showcase a study on the physical properties of the circumnuclear disk (CND) surrounding the supermassive black hole (SMBH) Sgr A* of the Galactic Center, emphasizing the role of magnetic field ($\boldsymbol {B}$ field) with $0.50\,$pc spatial resolution. Based on the sensitive $\lambda = 850\, \mu$m polarization data taken with the JCMT SCUBA2/POL2 (James Clerk Maxwell Telescope Submillimetre Common-User Bolometer Array 2), we analyzed ancillary datasets: CS $J = 2$–1 emission taken with ALMA (Atacama Large Millimeter/submillimeter Array), continuum emissions taken at $\lambda = 6\,$cm and at $\lambda = 37\, \mu$m taken with the VLA (Very Large Array) and SOFIA (the Stratospheric Observatory for Infrared Astronomy telescope). The $\boldsymbol {B}$ field within the CND exhibits a coherent spiral pattern. Applying the model described by Wardle and Königl (1990, ApJ, 362, 12; the WK model) to the observed $\boldsymbol {B}$ field pattern, it favors gas-pressure-dominant models without dismissing a gas-and-$\boldsymbol {B}$ field comparable model, leading us to estimate the $\boldsymbol {B}$-field strength in the ionized cavity around Sgr A* as $0.24^{+0.06}_{-0.04}\,$mG. Analysis based on the WK model further allows us to derive representative $\boldsymbol {B}$-field strengths for the radial, azimuthal, and vertical components as $(B_r, B_\phi , B_z) = (0.4 \pm 0.1, -0.7 \pm 0.2, 0.2 \pm 0.05)\,$mG, respectively. A key finding is that the $|B_\phi |$ component is dominant over $B_r$ and $B_z$ components, consistent with the spiral morphology, indicating that the CND’s $\boldsymbol {B}$-field is predominantly toroidal, possibly shaped by accretion dynamics. Considering the turbulent pressure, estimated plasma $\beta$ values indicate that the effective gas pressure should surpass the magnetic pressure. Assessing the CND of our MWG in the toroidal-and-vertical stability parameter space, we propose that such an “effective” magneto-rotational instability (MRI) may likely be active. The estimated maximum unstable wavelength, $\lambda _{\rm max} = 0.1 \pm 0.1\,$pc, is smaller than the CND’s scale height ($0.2 \pm 0.1\,$pc), which indicates the potential for the effective MRI intermittent cycles of $\sim 10^6\,$yr, which should profoundly affect the CND’s evolution, considering the estimated mass accretion rate of $10^{-2} M_{\odot }\,$yr$^{-1}$ to the SMBH.
The effectiveness of interventions to reduce the transmission of acute respiratory infections in care homes: a systematic review
Authors: Willcox Merlin L , Lavu Deepthi , Yousaf Usaid , Dalton Sam , Roberts Nia , Plüddemann Annette
Published: August 2024

Background

Care home residents are at high risk from outbreaks of respiratory infections, such as influenza and COVID-19. We conducted a systematic review of randomized controlled trials, to determine which interventions (apart from vaccines) are effective at reducing transmission of acute respiratory illnesses (ARIs) in care homes.

Methods

We searched CINAHL, Medline, Embase and Cochrane for randomized controlled trials (RCTs) of interventions to prevent transmission of ARIs in care homes (excluding vaccines), to April 2023.

Results

A total of 21 articles met inclusion criteria. Two infection control interventions significantly reduced respiratory infections. Oseltamivir significantly reduced risk of symptomatic laboratory-confirmed influenza (OR 0.39, 95%CI 0.16–0.94, three trials), and influenza-like illness (OR 0.50, 95%CI 0.36–0.69), even in a vaccinated population. High dose vitamin D supplementation reduced incidence of ARIs (incidence rate ratio 0.60; 95%CI 0.38–0.94, one trial). Nine other RCTs of vitamin, mineral, probiotic and herbal supplements showed no significant effect.

Conclusion

Transmission of respiratory infections in care homes can be reduced by educational interventions to improve infection control procedures and compliance by staff, by antiviral prophylaxis soon after a case of influenza has been detected, and by supplementation with high-dose Vitamin D3. Further research is needed to confirm the effect of high-dose Vitamin D3.
Longitudinal analysis of serum urate in prediabetic phase
Authors: Marrugo Javier , Santacroce Leah M , Paudel Misti L , Fukui Sho , Tedeschi Sara K , Solomon Daniel H
Published: August 2024

Objectives

Despite the well-established association between prediabetes and hyperuricaemia, knowledge about serum urate (SU) trends during the prediabetic phase is limited. Therefore, we aimed to assess the longitudinal changes of SU in individuals with prediabetes.

Methods

Individuals with prediabetes, defined by initial haemoglobin A1c (HbA1c) levels between 5.7% and 6.4%, were identified using electronic health records from an academic health system (2007–2022). We required at least one SU test before and after the prediabetes diagnosis. The primary outcome was the longitudinal SU trends during the follow-up period, estimated with a multivariable mixed-effects model. Patients were censored at diabetes onset. Marginal effects of covariates on SU changes were estimated. Subsequent analyses examined SU variations in subgroups stratified by age, sex, BMI, HbA1c, estimated glomerular filtration rate and metformin use.

Results

Out of 25 526 individuals with prediabetes, 1521 met the SU cohort requirements, contributing to 6832 SU observations. At baseline, median age was 63 years and 40% were female. Median values were SU 6.3 mg/dl, HbA1c 5.9% and BMI 30 kg/m2. Median follow-up was 7.4 years. Older age, male sex, greater BMI and higher HbA1c were significant predictors of increased longitudinal SU levels. Individuals with a BMI ≥30 kg/m2 exhibited higher SU levels compared with those with lower BMI values.

Conclusion

Among individuals with prediabetes, several baseline variables were significant predictors of increased SU levels over time. These longitudinal trends in SU, support the potential for early intervention during the prediabetic phase, possibly reducing the risk of gout.
Mealworm larvae and black soldier fly larvae as novel protein supplements for cattle consuming low-quality forage
Authors: Carrasco Mikael N , Drewery Merritt L
Published: August 2024

The global population is projected to increase, indicating that there will be greater demand for animal protein to meet the associated food needs. This demand will place additional pressure on livestock systems to increase output while also minimizing natural resource inputs. Insect protein has emerged as a potential alternative to conventional protein feeds, such as soybean meal. Mealworm larvae (MWL; Tenebrio molitor) have been studied in poultry and swine as an alternative protein source; however, there is no research currently evaluating MWL for cattle. Black soldier fly larvae (BSFL; Hermetia illucens) have also received attention for their potential use in livestock feed due to their scalability and nutritional value, but research in cattle is limited. The objective of this study was to evaluate the effects of whole-dried MWL and defatted BSFL as protein supplements for cattle consuming forage. Five ruminally cannulated steers were utilized in a 5 × 5 Latin square experiment to determine how MWL and BSFL supplementations affect forage utilization. Steers consuming ad libitum low-quality forage (76.5% neutral detergent fiber [NDF], 4.2% crude protein) were provided one of the five treatments each period: 1) control with no supplement (CON), 2) soybean meal (CONV), 3) BSFL, 4) MWL, or 5) 50/50 by-weight blend of BSFL and MWL (MIX). All treatments were provided at 100 mg N/kg BW and periods included 8 d for treatment adaptation, 5 d for intake and digestion, and 1 d for ruminal fermentation measures. Protein supplementation stimulated forage organic matter intake (FOMI; P ≤ 0.01) relative to CON (3.28 kg/d). There was a significant difference in FOMI (P ≤ 0.01) between BSFL (4.30 kg/d) and CONV (4.71 kg/d), but not between CONV and MWL (P = 0.06, 4.43 kg/d). Total digestible OM intake (TDOMI) was also stimulated by the provision of protein (P ≤ 0.01), from 1.94 kg/d for CON to an average of 3.24 kg/d across protein supplements. Organic matter digestibility (OMD) and NDF digestibility (NDFD) were not affected by treatment (P ≥ 0.37), for an average OMD of 66.5% and NDFD of 62.7%. There was also no treatment effect on ruminal volatile fatty acid (P = 0.96) or ammonia-N (P = 0.22) concentrations. These data indicate that MWL may stimulate forage utilization by beef cattle to a greater extent than BSFL, but both are viable protein supplements.
Adolescent exposure to a mixture of per- and polyfluoroalkyl substances (PFAS) depletes the ovarian reserve, increases ovarian fibrosis, and alters the Hippo pathway in adult female mice
Authors: Clark Kendra L , George Jitu W , Davis John S
Published: August 2024

Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals known for their environmental persistence and resistance to biodegradation. This study investigated the impact of adolescent exposure to a PFAS mixture on adult ovarian function. Female CD-1 mice were orally exposed to vehicle control or a PFAS mixture (comprised of perfluorooctanoic acid, perfluorooctanesulfonic acid, undecafluoro-2-methyl-3-oxahexanoic acid, and perfluorobutanesulfonic acid) for 15 d. After a 42-d recovery period, reproductive hormones, ovarian fibrosis, and ovarian gene and protein expression were analyzed using ELISA, Picrosirius red staining, qPCR, and immunoblotting, respectively. Results revealed that PFAS exposure did not affect adult body or organ weight, although ovarian weight slightly decreased. PFAS-exposed mice exhibited a disturbed estrous cycle, with less time spent in proestrus than control mice. Follicle counting indicated a reduction in primordial and primary follicles. Serum analysis revealed no changes in steroid hormones, follicle-stimulating hormone, or anti-Müllerian hormone, but a significant increase in luteinizing hormone was observed in PFAS-treated mice. Ovaries collected from PFAS-treated mice had increased mRNA transcripts for steroidogenic enzymes and fatty acid synthesis-related genes. PFAS exposure also increased collagen content in the ovary. Additionally, serum tumor necrosis factor-α levels were higher in PFAS-treated mice. Finally, transcripts and protein abundance for Hippo pathway components were upregulated in the ovaries of the PFAS-treated mice. Overall, these findings suggest that adolescent exposure to PFAS can disrupt ovarian function in adulthood.
Comparative analysis of water-use strategies in three subtropical mangrove species: a study of sap flow and gas exchange monitoring
Authors: Wu Sipan , Gu Xiaoxuan , Peng Xiufan , Chen Luzhen
Published: August 2024

Water-use strategies play a crucial role in the adaptive capabilities of mangroves to the saline intertidal conditions, yet the intricacies of daily water-use patterns in mangrove species, which are pivotal for maintaining water balance, remain poorly understood. In this comprehensive study, we aimed to clarify the water use strategies of three co-occurring mangrove species, Avicennia marina, Aegiceras corniculatum and Kandelia obovata, through stem sap flow monitoring, leaf gas exchange and stem diameter change measurements. Our findings revealed that the daily sap flow density of Avicennia and Aegiceras reached the peak about 1 h earlier than that of Kandelia. When transpiration was strong, Kandelia and Aegiceras used stem storage to meet water demand, while Avicennia synchronized stem water storage. These three mangrove species adopted cross-peak water used and unique stem water storage to regulate their water balance. In Kandelia, the daily sap flow in per sapwood area was significantly lower, while water-use efficiency was significantly higher than those of Avicennia and Aegiceras, indicating that Kandelia adopted a more conservative and efficient water-use strategy. Sap flow in Avicennia was the most sensitive to environmental changes, while Kandelia limited water dissipation by tightly controlling stomata. Meteorological factors (photosynthetically active radiation, vapor pressure deficit and air temperature) were the main driving factors of sap flow. The increase of soil temperature can promote the water use of mangrove species, while the increase of salinity resulted in more conservative water use. Our results highlight the diversity of daily water-use strategies among the three co-occurring mangrove species, pinpointing Kandelia as the most adaptive at navigating the changing conditions of intertidal habitats in the future climate. In conclusion, our findings provide a mesoscale perspective on water-use characteristics of mangroves and also provides theoretical basis for mangroves afforestation and ecological restoration.
“Praise in Public; Criticize in Private”: Unwritable Assessment Comments and the Performance Information That Resists Being Written
Authors: Gingerich Andrea , Lingard Lorelei , Sebok-Syer Stefanie S. , Watling Christopher J. , Ginsburg Shiphra
Published: August 2024

Purpose

Written assessment comments are needed to archive feedback and inform decisions. Regrettably, comments are often impoverished, leaving performance-relevant information undocumented. Research has focused on content and supervisor’s ability and motivation to write it but has not sufficiently examined how well the undocumented information lends itself to being written as comments. Because missing information threatens the validity of assessment processes, this study examined the performance information that resists being written.

Method

Two sequential data collection methods and multiple elicitation techniques were used to triangulate unwritten assessment comments. Between November 2022 and January 2023, physicians in Canada were recruited by email and social media to describe experiences with wanting to convey assessment information but feeling unable to express it in writing. Fifty supervisors shared examples via survey. From January to May 2023, a subset of 13 participants were then interviewed to further explain what information resisted being written and why it seemed impossible to express in writing and to write comments in response to a video prompt or for their own “unwritable” example. Constructivist grounded theory guided data collection and analysis.

Results

Not all performance-relevant information was equally writable. Information resisted being written as assessment comments when it would require an essay to be expressed in writing, belonged in a conversation and not in writing, or was potentially irrelevant and unverifiable. In particular, disclosing sensitive information discussed in a feedback conversation required extensive recoding to protect the learner and supervisor-learner relationship.

Conclusions

When documenting performance information as written comments is viewed as an act of disclosure, it becomes clear why supervisors may feel compelled to leave some comments unwritten. Although supervisors can be supported in writing better assessment comments, their failure to write invites a reexamination of expectations for documenting feedback and performance information as written comments on assessment forms.
Impact of Predictive Hemodynamic Monitoring on Intraoperative Hypotension and Postoperative Complications in Multi-level Spinal Fusion Surgery
Authors: Carreon Leah Y. , Glassman Steven D. , Chappell Desiree , Garvin Steven , Lavelle Anna M. , Gum Jeffrey L. , Djurasovic Mladen , Saasouh Wael
Published: August 2024

Study Design.

Prospective longitudinal comparative cohort.

Objectives.

To determine if the use of predictive hemodynamic monitoring (PHM) during elective multi-level posterior instrumented spine fusions decreases episodes of intraoperative hypotension (IOH) and complications.

Background.

A recent study showed an association between complications and duration of IOH in patients undergoing multi-level spine fusions. Whether the use of PHM to maintain hemodynamic stability intraoperatively decreases postoperative complications has not been evaluated.

Methods.

Adults undergoing elective multi-level posterior thoracolumbar fusion with arterial line blood pressure monitoring were identified and stratified into those in which predictive hemodynamic monitoring (PHM) was used and those in which it was not. Number of minutes of hypotension (MAP <65 mm Hg) and hypertension (MAP ≥100 mm Hg), volume of fluids, blood products and vasopressors administered intraoperatively and within the first 4 hours postoperatively as well as the number and type of postoperative complications were collected.

Results.

The 47 cases in the PHM group and 70 in the non-PHM group had similar demographic and operative characteristics. A shorter duration of IOH was seen in the PHM group (8.13 min) compared with the non-PHM group (13.28 min, P=0.029); and a shorter duration of intraoperative hypertension seen in the PHM group (0.46 min) compared with the non-PHM group (1.38 min, P=0.032). There was a smaller number of patients in the PHM group who had a surgical site infection (2.% vs. 13%, P=0.027), postoperative nausea and vomiting (0 vs. 14%, P=0.004) and postoperative cognitive dysfunction (6% vs. 19%, P=0.049) compared with the non-PHM group. There was also a statistically significant shorter length of hospitalization in the PHM (4.62 d) compared with the non-PHM group (5.99 d, P=0.017)

Conclusion.

Predictive hemodynamic monitoring to manage intraoperative hemodynamic instability is associated with a shorter duration of intraoperative hypotension, a lower prevalence of complications, and a decreased hospital stay in multi-level spinal fusion surgery.
Healthcare Use and Expenditures in Rural Survivors of Hospitalization for Sepsis*
Authors: Stinehart Kyle R. , Hyer J. Madison , Joshi Shivam , Brummel Nathan E.
Published: August 2024

OBJECTIVES:

Sepsis survivors have greater healthcare use than those surviving hospitalizations for other reasons, yet factors associated with greater healthcare use in this population remain ill-defined. Rural Americans are older, have more chronic illnesses, and face unique barriers to healthcare access, which could affect postsepsis healthcare use. Therefore, we compared healthcare use and expenditures among rural and urban sepsis survivors. We hypothesized that rural survivors would have greater healthcare use and expenditures.

DESIGN, SETTING, AND PATIENTS:

To test this hypothesis, we used data from 106,189 adult survivors of a sepsis hospitalization included in the IBM MarketScan Commercial Claims and Encounters database and Medicare Supplemental database between 2013 and 2018.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We identified hospitalizations for severe sepsis and septic shock using the International Classification of Diseases, 9th Edition (ICD-9) or 1CD-10 codes. We used Metropolitan Statistical Area classifications to categorize rurality. We measured emergency department (ED) visits, inpatient hospitalizations, skilled nursing facility admissions, primary care visits, physical therapy visits, occupational therapy visits, and home healthcare visits for the year following sepsis hospitalizations. We calculated the total expenditures for each of these categories. We compared outcomes between rural and urban patients using multivariable regression and adjusted for covariates. After adjusting for age, sex, comorbidities, admission type, insurance type, U.S. Census Bureau region, employment status, and sepsis severity, those living in rural areas had 17% greater odds of having an ED visit (odds ratio [OR] 1.17; 95% CI, 1.13–1.22; p < 0.001), 9% lower odds of having a primary care visit (OR 0.91; 95% CI, 0.87–0.94; p < 0.001), and 12% lower odds of receiving home healthcare (OR 0.88; 95% CI, 0.84–0.93; p < 0.001). Despite higher levels of ED use and equivalent levels of hospital readmissions, expenditures in these areas were 14% (OR 0.86; 95% CI, 0.80–0.91; p < 0.001) and 9% (OR 0.91; 95% CI, 0.87–0.96; p < 0.001) lower among rural survivors, respectively, suggesting these services may be used for lower-acuity conditions.

CONCLUSIONS:

In this large cohort study, we report important differences in healthcare use and expenditures between rural and urban sepsis survivors. Future research and policy work is needed to understand how best to optimize sepsis survivorship across the urban-rural continuum.
The Role of Progenitor Cells in the Pathogenesis of Arteriosclerosis
Authors: Zhang Yuesheng , Guan Ziyin , Gong Hui , Ni Zhichao , Xiao Qingzhong , Guo Xiaogang , Xu Qingbo
Published: August 2024

The increasing incidence of arteriosclerosis has become a significant global health burden. Arteriosclerosis is characterized by the thickening and hardening of arterial walls, which can lead to the narrowing or complete blockage of blood vessels. However, the pathogenesis of the disease remains incompletely understood. Recent research has shown that stem and progenitor cells found in the bone marrow and local vessel walls play a role in the development of arteriosclerosis by differentiating into various types of vascular cells, including endothelial cells, smooth muscle cells, fibroblasts, and inflammatory cells. This review aims to provide a comprehensive understanding of the role of stem and progenitor cells in the pathogenesis of arteriosclerosis, shedding light on the underlying mechanisms and potential therapeutic approaches for this disease.
Long-distance Tele-robotic-assisted Percutaneous Coronary Intervention: A Case Report of First-in-patient in China
Authors: Xu Kai , Cao Xuebin , Liu Haiwei , Zhou Shenghua , Liu Zhaochuan , Wang Xianghe , Jing Quanmin , Han Yaling
Published: August 2024

Robotic-assisted percutaneous coronary intervention (R-PCI) is an innovative way of performing percutaneous coronary intervention (PCI) whereby the operator can manipulate coronary intraluminal guidewires and catheter devices by using remotely controlled technology. Performing tele-R-PCI from a remote location via fifth generation network communication technology has never been reported in China; however, if this were possible, the technique could be used to treat many patients with coronary artery disease who would otherwise not have the opportunity of treatment. The case of a 73-year-old male patient with coronary artery disease who underwent successful tele-R-PCI at 800 km from the operators is presented. Performing long-distance tele-R-PCI in patients with coronary artery disease is feasible with predictably successful outcomes when reliable network connectivity and local cardiac catheterization facilities are present.
Double-Cannula Maneuver for the Double-Roll Configuration of Donor Descemet Membrane Outside Recipient Anterior Chamber During Descemet Membrane Endothelial Keratoplasty
Authors: Kim Eun Chul , HA Minji , Kim Da Ran , Yoon Young Chae , Whang Woong-Joo , Na Kyung-Sun , Kim Hyun-Seung , Kim Man Soo , Hwang Ho Sik
Published: August 2024

Purpose:

The purpose of this study was to present a new surgical technique to convert a single roll of Descemet membrane (DM) into a double roll using 2 cannulas in a balanced salt solution–filled Petri dish during DM endothelial keratoplasty.

Methods:

A single DM roll stained with trypan blue was placed in a balanced salt solution–filled Petri dish. Two cannulas (28G) were introduced from opposite ends of the single roll, inserted into the roll, and slowly spread apart to change the single roll into a double roll. The DM was aspirated into the modified Jones tube and loaded, maintaining a double-roll configuration with endothelium-down orientation in a bevel-up position. The modified Jones tube with the bevel down was inserted into the recipient anterior chamber through the main wound. The modified Jones tube was rotated to the bevel-up orientation. After checking the graft orientation, the DM was inserted into the recipient anterior chamber. The double-roll DM was easily unfolded by tapping the center of the cornea using a cannula. A 28G cannula was inserted under the DM, and the anterior chamber was filled with air.

Results:

Three months after surgery, the patient's corrected visual acuity in the right eye was 6/7.5 and the endothelial cell count was 1095/mm2. The corneal thickness was 533 μm, and the cornea was clear.

Conclusions:

The double-cannula maneuver mechanically changes the single roll of the donor DM to a double roll outside the recipient anterior chamber, making DM unfolding easier and minimizing the risk of upside-down apposition of the donor DM.
Treatment of Corneal Neovascularization Before Deep Anterior Lamellar Keratoplasty
Authors: Mansur Shabnam , Cheung Albert Y.
Published: August 2024

Purpose:

Corneal neovascularization (CNV) can cause intraoperative concerns with deep anterior lamellar keratoplasty (DALK) given the inherent interface. We reviewed the effectiveness of CNV treatments before DALK in minimizing intraoperative and postoperative complications.

Methods:

A retrospective chart review was conducted on all eyes that 1) underwent DALK and 2) had significant CNV on exam before DALK. Eyes were divided into 2 groups: those that received CNV treatment before DALK (argon laser with subconjunctival bevacizumab/dexamethasone [ABD] and/or mitomycin intravascular chemoembolization [MICE]) and those that did not. Outcome measures included intraoperative complications, postoperative CNV recurrence, and keratoplasty rejection/failure.

Results:

This analysis included 16 eyes from 16 patients. Ten eyes had prior CNV treatment, whereas 6 did not. The CNV treatment group had no bleeding-related intraoperative complications and no interface blood occurred. The intraoperative bleeding grade was significantly less in the CNV treatment group (P = 0.024). In the 8 eyes where a big bubble (BB) was attempted (n = 6 ABD only, n = 2 MICE), there was difficulty obtaining a BB in 17% (1 of 6) that underwent ABD only, and 100% (2 of 2) that underwent MICE. Postoperatively, 4 CNV treatment eyes had CNV recurrence; in 3 of these patients, no large caliber vessels recurred. Two patients required additional ABD after DALK to treat the recurrent CNV.

Conclusions:

Treatments for CNV before DALK were effective in minimizing intraoperative bleeding and recurrence of large caliber vessels. However, recurrence of CNV after DALK is possible and may necessitate ongoing treatment.
CADS as a Decision-making Tool: Developing an Oculoplastic Management Algorithm for Facial Nerve Palsy
Authors: Yao Anthony , Jayawickrema Nirodha , Malhotra Raman
Published: August 2024

Purpose:

The Cornea, Asymmetry, Dynamic, Synkinesis (CADS) score is a validated grading score for periocular involvement in facial nerve palsy (FNP). We conducted a retrospective review of FNP cases, including initial CADS scores and subsequent ophthalmic interventions. The results were used to inform the development of an oculoplastic management algorithm for FNP.

Methods:

Single-center retrospective cohort study of patients with FNP referred to a tertiary unit between 2016 and 2022. Data collected included demographic data, etiology of FNP, treatment initiated, and CADS grading at each visit. Adult patients with ≥6 months of follow-up were included, and cases were excluded if ocular surface or oculoplastic procedures were performed elsewhere prior to the initial review by the unit.

Results:

Of 408 consecutive new patients with FNP, 80 fulfilled inclusion criteria (mean age 57 years, range 21–83 years). Presentations of FNP were unilateral in 98.8% (79/80), with an underlying preganglionic etiology in 75.0% (60/80). At the initial review, surgery was recommended for 61.3% (49/80) of cases. Subgroup analysis of surgical cases for each CADS domain showed 46.9% (23/49) had C-score ≥2, which was predictive of upper lid surgery requirement (e.g., upper lid platinum segment chain; levator recession). About 63.2% (31/49) had an A-score ≥1 which predicted for lower lid surgery requirement (e.g., retractor recession, lower lid sling, medial canthal tendon plication, and lower lid full thickness skin graft) as well as a brow lift. Almost 79.6% (39/49) had a D-score ≥2, which was associated with both upper lid and lower lid surgery requirements. Also, 59.2% (29/49) had an S-score of ≥1 however, this was not associated with the surgical requirement, highlighting a different approach compared with the other CADS domains.

Conclusion:

This study represents a large cohort of patients followed up with a validated ophthalmic-specific FNP grading scale. This was utilized to develop a CADS-based management algorithm to help guide decision-making for surgical intervention versus medical management in FNP.
Intraventricular Tigecycline
Authors: Nnakwue Elizabeth C. , Charlier Jacques Christian , Jackson Toni M. , Chan Austin W. , Patel Manish
Published: August 2024

This case report discusses a novel therapeutic strategy in managing a severe intracranial infection caused by multidrug-resistant Stenotrophomonas maltophilia utilizing intraventricular tigecycline. The favorable clinical outcome observed suggests a potential promising role of intraventricular tigecycline in treating drug-resistant S. maltophilia meningitis, underscoring the necessity for further investigation and validation.
Navigating Complexities
Authors: Al Hennawi Hussam , Barney Kaitlyn , Qamar Zahra
Published: August 2024

Bartonella endocarditis is an exceedingly rare cause of culture-negative endocarditis in the United States and is associated with significant morbidity and mortality. Recent reports suggest growing prevalence in developing countries, emphasizing a high degree of suspicion. We present a case of a formerly homeless patient with Bartonella quintana native aortic and mitral valve endocarditis. This case highlights the importance of high clinical suspicion of Bartonella species among other infectious agents in culture-negative endocarditis in the right clinical settings and the importance of early diagnosis.
1, 6-dilauroyl-D-fructofuranose ameliorates lipopolysaccharide-induced septic acute kidney injury via inhibiting caspase 1 mediated pyroptosis formation in rat
Authors: Yu Ping-Hsun , Cheng Yu-Hsuan , Chung Shiu-Dong , Chien Chiang-Ting
Published: August 2024

Background:

Sepsis is a systemic inflammatory state associated with acute kidney injury (AKI) and high mortality. However, sepsis-induced AKI cannot be effectively prevented or treated using current antimicrobial therapies and supportive measures. We explored the therapeutic effect of newly developed fructose esters on sepsis-induced AKI (S-AKI).

Methods:

We used the surface plasmon resonance technique and ultrasensitive chemiluminescence analyzer to characterize the lipopolysaccharide (LPS)/endotoxin binding activity and antioxidant capability of fructose esters. We assessed the extent of fructose ester gastrointestinal digestion using rat intestinal acetone powder. We examined the therapeutic effect of fructose esters on LPS-induced S-AKI by evaluating the blood and renal reactive oxygen species (ROS) amounts, caspase 1 mediated pyroptosis, inflammation, microcirculation, and renal dysfunction.

Results:

Our data showed that the fructose esters are not easily hydrolyzed by the rat intestinal acetone powder, suggesting their high stability in the gastrointestinal tract. 1,6-dilauroyl-D-fructofuranose (FDL) dose-dependently scavenged H2O2 and displayed a higher binding affinity to LPS compared to sialic acid and fructose did. LPS significantly enhanced caspase 1 mediated pyroptosis and increased leukocyte infiltration, blood and renal ROS amount, and blood urea nitrogen (BUN) and creatinine level, whereas FDL significantly depressed these LPS-enhanced parameters. In addition, the increased plasma inflammatory cytokines levels using LPS could be reduced by intravenous fructose ester FDL treatment.

Conclusion:

Our data suggest that FDL, with its antioxidant activity against H2O2, can neutralize LPS toxicity using a high binding affinity, and attenuate S-AKI by inhibiting caspase 1 mediated pyroptosis, thereby ameliorating renal oxidative stress and dysfunction.
Prevalence of integrase strand transfer inhibitor resistance in people living with HIV and virological failure
Authors: Tsai Hung-Chin , Chen I.-Tzu , Chang Hui-Min , Tseng Yu-Ting , Weng Ya-Wei , Chen Yao-Shen
Published: August 2024

Background:

This study aims to delineate the resistance profiles of integrase strand transfer inhibitors (INSTIs) among patients in southern Taiwan who had experienced antiretroviral therapy (ART) failure. We focused on individuals previously treated with highly active ART (HAART) regimens, providing insights into the implications of INSTI resistance in a broader treatment-experienced population.

Methods:

Data were collected from patients failing an INSTI-containing regimen in a medical center in southern Taiwan between 2009 and 2022. Virological failure was defined as a plasma viral load >1000 copies/mL. Reverse transcriptase, protease, and integrase coding regions were sequenced at failure. Resistance-associated mutations included in the 2022 International Antiviral Society (IAS)-USA list were used. Drug resistance was analyzed using the HIV Stanford HIVDB 9.4 edition algorithm. Logistic regression analysis was used to analyze the risk factors associated with INSTI failure.

Results:

A total of 184 patients were enrolled for genotypic drug resistance testing due to virological failure, of whom 104 failed on nonnucleoside reverse transcriptase inhibitors, 58 on protease inhibitors (PIs), and 21 on INSTIs. Among 21 patients who failed INSTI therapy, 6 failed raltegravir-based treatment, 3 elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (EVG/COBI/FTC/TAF), 2 bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF), and 10 abacavir/dolutegravir/lamivudine (ABC/DTG/3TC). Only 10 patients had INSTI drug resistance testing results available, and 40% (4/10) showed INSTI resistance at failure. Among the seven patients who failed on second-generation INSTIs with drug resistance reports available, one harbored E157Q and another with R263K mutations, respectively. Multivariable logistic regression analysis showed that patients with INSTI failure were less likely to have pol resistance (p = 0.007, adjusted odds ratio [OR], 0.176, 95% CI, 0.050-0.618), less previous exposure to NNRTI (p = 0.003, aOR, 0.063, 95% CI, 0.010-0.401), PIs (p = 0.002, aOR, 0.030, 95% CI, 0.003-0.272), and with long duration of HAART (p = 0.018, aOR, 1.02, 95% CI, 1.003-1.037).

Conclusion:

INSTI resistance was uncommon when used as the first-line single tablet regimen in Taiwan. The results confirmed the robustness of ABC/DTG/3TC and BIC/FTC/TAF regarding integrase resistance in cases of virological failure in routine clinical care.
Marriage and Fertility Desire and Associated Factors Among Unmarried People Living With HIV in Jinan, China: A Cross-Sectional Study
Authors: Yu Yong , Li Jiahong , Qin Keke , Xiao Fuqun , Cai Huiling
Published: August 2024

The desires for marriage and fertility among people living with HIV (PLWH) are increasing worldwide because of improved treatment and prognosis; yet they remain understudied in China, which has a family-oriented culture. This study aimed to investigate these desires for marriage and fertility among Chinese PLWH and explore their correlates. A cross-sectional study was conducted among 1,504 Chinese PLWH to assess their desires for marriage, fertility, and other variables through an online questionnaire. Logistic regression models were used to analyze factors associated with desires for marriage and fertility. Among the 1,504 participants, 53.9% aspired to marry at 34.76 ± 5.26 years old, whereas 62.0% desired parenthood at 36.43 ± 5.11 years old. Factors associated with these desires included age, gender, residence, education level, HIV transmission route, CD4+ T-cell count, time since HIV diagnosis, disclosure of HIV status, social support, and mental health indicators.
Optimizing kidney and cardiovascular protection in an era of multiple effective treatments
Authors: Taal Maarten W.
Published: August 2024

Purpose of review

After decades of relying on the control of hypertension and treatment with renin angiotensin system inhibitors as the only evidence-based interventions to slow the progression of chronic kidney disease (CKD), we have entered an era when multiple effective treatment options are available. This review considers the mechanisms and benefits of these novel treatments as well as the challenges associated with achieving optimal combination therapy.

Recent findings

Over the past 5 years, large clinical trials have provided robust evidence that, when added to renin angiotensin system inhibitors, treatment with sodium glucose cotransporter 2 inhibitors reduces the rate of CKD progression and the risk of cardiovascular events in people with CKD with or without diabetes and with or without albuminuria; nonsteroidal mineralocorticoid antagonists and glucagon-like peptide-1 receptor agonists afford similar benefits in people with type 2 diabetes and CKD. The mechanisms of actions of these novel therapies suggest that combination therapy will produce additive benefits, though specific evidence is sparse.

Further trials are warranted to investigate the benefits of combination therapy with novel treatments in people with CKD. Clinical implementation of optimal combination therapy will require reorganization of services to ensure that patients receive adequate education, support and monitoring.
Griscelli syndrome: a diagnostic challenge of a rare disease: a case report
Authors: Abu Ghedda Sedra , Alkadamani Sedra , Sabouni Rami , Mahmoud Jaber
Published: August 2024

Introduction:

Griscelli syndrome (GS) is a rare autosomal recessive genetic disorder that primarily manifests as hair and skin hypopigmentation, with three types differentiated by their specific genetic defects as well as by their clinical features. Clinically, GS type 1 is characterized by early neurological alterations, while GS type 2 is characterized by immunodeficiency and could present with neurological symptoms, and type 3 is characterized by a chromosomal anomaly without a specific clinical profile besides hypopigmentation. This article details the challenges faced in the diagnosis of a patient with GS who presents with neurological symptoms followed by immunological deficits.

Case presentation:

A 7-month-old female presented with complaints of developmental delay following an otitis media infection. Upon examination, she exhibited signs of psychomotor developmental regression and had pale bronze skin and silvery-gray hair, as well as hepatosplenomegaly. The examination of her hair shaft revealed a pattern consistent with GS. During her hospitalization, the patient developed an intermittent fever and signs of hemophagocytic lymphohistiocytosis (HLH). She subsequently developed recurrent seizures treated with phenytoin and Aciclovir. Shortly she succumbed to respiratory distress syndrome and multisystem failure.

Discussion:

The presence of HLH confirms the type of GS. However, in some cases, the HLH criteria could not be fulfilled, presenting a diagnostic challenge.

Conclusion:

The genetic examination is the only way to differentiate GS type 1 from type 2. However, when it is not available, the presence of specific symptoms and features may assist in the classification. Furthermore, treatments should be administered when GS type 2 is suspected since they have the potential to improve life quality through treating HLH, delaying and altering the neurological symptoms.