bluuebunny/crossref_metadata_2025 huggingface dataset:
Fecal indicator bacteria and sewage-associated marker genes are associated with nitrate and environmental parameters in two Florida freshwater systems
Authors: Brandt Amanda M , Senkbeil Jacob K , Lobos Aldo E , Defillips Carley , Lewis David B , Harwood Valerie J
Published: February 2025

Aim

Identify relationships among microbial variables [fecal indicator bacteria (FIB) and microbial source tracking (MST) marker genes] and nutrients to improve source identification in two polluted, freshwater streams in Florida.

Methods and results

Water and sediment were sampled at Bullfrog Creek (BFC) and Sweetwater Creek (SWC), which varied in land use and expected sources of fecal pollution. Escherichia coli and enterococci were cultured, sewage-associated HF183 and bird-associated GFD genetic markers were assessed by quantitative polymerase chain reaction (qPCR), and organic and inorganic nutrients were analyzed. Escherichia coli and enterococci exceeded recreational water quality criteria in 47% and 85% of samples, respectively, at less urbanized BFC, and in 8% and 62% of samples at more urbanized SWC. HF183, but not GFD, was positively associated with surface water nitrate by multivariate analysis and binary logistic regression. Sediment organic matter was lowest at urbanized sites in both streams and inversely associated with surface water FIB.

Conclusions

Measuring nutrients alongside FIB and MST revealed that nitrate levels in water, but not phosphorus or organic carbon levels, were predictive of sewage pollution.
Every Gain Comes With Loss: Ecological and Physiological Shifts Associated With Polyploidization in a Pygmy Frog
Authors: Chen Qiheng , Zhu Wei , Chang Liming , Zhang Meihua , Wang Shouhong , Liu Jiongyu , Lu Ningning , Li Cheng , Xie Feng , Wang Bin , Jiang Jianping
Published: February 2025

Polyploidization plays a pivotal role in vertebrate evolution and diversification. However, the effects of polyploidization on animals across various biological levels, and how these differences drive ecological shifts, remain unclear. Through karyotype analysis and whole-genome sequencing, we identified an autotetraploid Microhyla fissipes from Hainan Island, which shows reproductive isolation and geographic differentiation from its diploid counterpart. Tetraploids exhibited larger cell size, improved tadpole growth rates, and greater whole-body size, along with reduced cell cycle activity. Rather than being simple scaled-up diploids, tetraploids showed shifts in physiological performance, organ allometry, gene expression profiles, and metabolic patterns. Tetraploid adults demonstrated superior jumping ability and increased reproductive investment (e.g. larger gonads and steeper slopes in the relationship between gonadal weight and body weight), suggesting a potential competitive advantage over diploids. However, tetraploids exhibited higher energy expenditure at elevated temperatures, reduced hepatic energy storage, and altered pulmonary regulatory metabolites at 25 °C. Males had smaller relative heart sizes, and females showed flatter slopes in the relationship between heart and lung weight and body weight, indicating reduced investment in cardiopulmonary system. These variations suggest an increased risk of metabolic constraints under heat stress, putting tetraploids at a disadvantage in warmer regions. Importantly, the physiological tradeoffs associated with polyploidization help explain the geographical differentiation between diploids and tetraploids, which reflects a climatic boundary, with tetraploids occupying cooler northeastern areas. Our findings identify an autotetraploid frog, report the first autotetraploid genome in amphibians, and demonstrate how vertebrate polyploids physiologically and ecologically diverge from their diploid counterparts.
Establishment and validation of a nomogram for predicting IDH-wildtype glioblastomas in non-enhancing adult-type diffuse gliomas
Authors: He Lei , Fei Fan , Zhou Chengzhi , Bai Xiaoyan , Yu Shuqing , Wang Lei , Xu Ruxiang , Liu Hanjie
Published: February 2025

Background and purpose

Approximately 8.94% to 44.44% of non-enhancing adult-type diffuse gliomas are identified as glioblastomas. Our purpose is to develop a nomogram that can predict glioblastomas from non-enhancing adult-type diffuse gliomas.

Materials and Methods

Non-enhancing adult-type diffuse gliomas were collected from Beijing Tiantan Hospital and TCIA public database. Univariate and multivariate logistic regression were performed to screen features on the training set. The features with P<0.05 in multivariate logistic regression were used to establish the prediction model. The testing and validation sets were used to test the model.

Results

A total of 557 and 67 non-enhancing adult-type diffuse gliomas were collected from Beijing Tiantan Hospital and TCIA, respectively. The T2-FLAIR mismatch sign exhibited 100% specificity but low sensitivity (< 30%) in ruling out glioblastoma. Age, tumor location, rADC(kurtosis), and rADC(median) were identified as independent predictors and employed for developing the prediction model. The AUC of the model was 0.901, 0.861, and 0.945 in the training, testing, and validation set, respectively. The best cutoff value of nomoscore was 138.5, which achieved sensitivity of 0.935, 0.714, and 0.895, specificity of 0.777, 0.782, and 0.8775 in the training, testing, and validation sets, respectively. Survival analysis shown that patients with nomoscore above 138.5 had significantly poorer survival time than those with scores below 138.5.

Conclusions

Positive T2-FLAIR mismatch sign can effectively rule out glioblastoma in non-enhancing adult-type diffuse gliomas with high specificity. Non-enhancing adult-type diffuse gliomas with nomoscore above 138.5 are highly suspicious for glioblastoma or non-glioblastoma with a poor prognosis.
Interpretation of Positive Metagenomic Sequencing Reports Improves the Infection Diagnosis in Patients with Hematological Disorders
Authors: Xu Chunhui , Shen Yuyan , Chen Shulian , Liu Teng , Chen Xin , Yu Yuetian , Liu Li , Ma Runzhi , Zhang Lining , Liu Xin , Zhou Lukun , Zhu Guoqing , Feng Sizhou
Published: February 2025

Background

Metagenomic Next-Generation Sequencing (mNGS) has become a crucial diagnostic tool for infectious diseases in patients with hematological disorders. However, despite the abundant microbial information provided by positive mNGS reports, interpreting these results remains challenging due to the lack of standardized criteria.

Methods

We surveyed 92 clinicians to identify common challenges in understanding mNGS reports. Microbiologists then provided additional ‘Interpretation Reports Cards (RIC)’ for positive mNGS results alongside original reports. RIC aimed to determine whether each detected microorganism was likely cause of infection. After a 3-month period, a panel of clinical experts retrospectively reviewed 281 cases, involving 728 detected microorganisms, to assess RIC accuracy.

Results

In total, 82.6% (76/92) of clinicians experienced difficulties in interpreting mNGS reports. After receiving RIC, clinician satisfaction reached 97.8% (90/92). The overall concordance rates between interpretation and adjudication in the 281 cases was 79.0% (222/281). In 203 cases where multiple microorganisms were detected, 37.9% (77/203) and 37.4% (76/203) were interpreted and adjudicated as mixed infections. Among the 728 microorganisms, interpretation and adjudication revealed concordance rates of 93.9% (154/164), 95.7% (88/92), and 72.3% (339/469) for bacterial, fungal, and viral, respectively. In the cases, mNGS positively influenced pathogen diagnosis in 68.7% (193/281).

Conclusions

Not all microorganisms detected by mNGS are responsible for infection, and appropriate interpretation is essential. The provision of interpretations by microbiologists aids clinicians in accurately utilizing mNGS for infection diagnosis.
The endoplasmic reticulum luminal Ca2+ regulates cardiac Ca2+ pump function
Authors: Bovo Elisa , Nikolaienko Roman , Kahn Daniel , Espinoza-Fonseca L Michel , Zima Aleksey V
Published: February 2025

The type 2a sarcoplasmic/endoplasmic reticulum Ca2+-ATPase (SERCA2a) plays a central role in Ca2+ signaling of cardiomyocytes. The speed at which SERCA2a pumps Ca2+ from the cytosol into the sarcoplasmic reticulum (SR) determines the diastolic relaxation rate. SERCA2a activity also sets SR Ca2+ load, which determines the amplitude of SR Ca2+ release and the systolic contraction strength. While SERCA2a controls the SR luminal [Ca2+] ([Ca2+]SR), less is known about how dynamic changes in [Ca2+]SR affect SERCA2a function. By measuring the endoplasmic reticulum [Ca2+] ([Ca2+]ER) with the Ca2+ sensor R-CEPIA1er, we characterized the function of recombinant human and native mouse SERCA2a. We found that despite low endoplasmic reticulum (ER) Ca2+ gradient, SERCA2a-mediated Ca2+ transport was significantly slower at low [Ca2+]ER than at intermediate [Ca2+]ER. It appears that certain [Ca2+]ER is required for optimal SERCA2a Ca2+ transport. We tested whether negatively charged amino acids within the luminal loop between transmembrane helices M7 and M8 contribute to SERCA2a regulation by [Ca2+]ER. We found that the triple mutation E877L/D878L/E883L in the M7–M8 loop reduces SERCA2a Ca2+ transport particularly at intermediate [Ca2+]ER. Destabilizing the M7–M8 loop by breaking a disulfide bond between cysteines 875 and 887 abolished ER Ca2+ transport. Complementary molecular dynamics simulations showed that the triple mutant E877L/D878L/E883L stabilizes a Ca2+-bound E2 state of the pump, slowing down release of Ca2+ from the transport sites into the ER compared with the wild-type SERCA2a. These results revealed, for the first time, that SERCA2a Ca2+ transport is regulated by the luminal Ca2+ by interacting with the M7–M8 loop.
An Imaging Primer on Simultaneous Pancreas and Kidney Transplantation
Authors: Yao Christopher , Rhode David , DeVoss Marley , Patel Shreekar , Surabhi Divya Meher , Xie Karen L.
Published: February 2025

Patients with insulin-dependent diabetes mellitus and chronic kidney disease suffer from increased morbidity and mortality. Simultaneous pancreas and kidney (SPK) transplantation has been demonstrated to improve quality of life significantly and life expectancy in these patients. Routine imaging during postoperative management is important for early detection of potential complications. Characterizing posttreatment imaging findings is crucial to determine future management, graft viability, and function.
Building Competencies
Authors: White Tracie , Suttle Becky , Holland Aimee , Dailey Kelly , Hafley Sherrie , Smith Tedra , Bordelon Curry
Published: February 2025

For this simulation experience, doctor of nursing practice students present their proposed quality improvement (QI) projects to an embedded participant. The project requires students to refine their skills in QI design, leadership, critical thinking, team building, and effective communication, crucial for navigating the complexities of modern health care settings. Positive feedback from 11 cohorts underscores the simulation’s efficacy in enhancing preparedness, fostering teamwork, and enhancing communication.
Assessing ChatGPT Responses to Frequently Asked Questions Regarding Pediatric Supracondylar Humerus Fractures
Authors: Li Austin W. , Adelstein Jeremy M. , Li Lambert T. , Sinkler Margaret A. , Mistovich R. Justin
Published: February 2025

Background:

The internet and standard search engines are commonly used resources for patients seeking medical information online. With the advancement and increasing usage of artificial intelligence (AI) in health information, online AI chatbots such as ChatGPT may surpass traditional web search engines as the next go-to online resource for medical information. This study aims to assess the ability of ChatGPT to answer frequently asked questions regarding pediatric supracondylar humerus (SCH) fractures.

Methods:

Seven (7) frequently asked questions (FAQs) regarding SCH fractures were presented to ChatGPT. Initial responses were recorded and rated as either “excellent requiring no clarification (0 items need clarification),” “satisfactory requiring minimal clarification (1 to 2 items need clarification),” “satisfactory requiring moderate clarification (3 to 4 items need clarification),” or “unsatisfactory requiring substantial clarification (>4 items need clarification or response contains false information).”

Results:

While 4 responses met satisfactory ratings with either moderate (2 responses) or minimal (2 responses) clarification, 3 of the 7 FAQs yielded a response from ChatGPT that were unsatisfactory. There were no responses that required no further clarification.

Conclusions:

ChatGPT provided some satisfactory responses to FAQs regarding pediatric SCH fractures, but required substantial clarification about treatment algorithms, casting and return to sport timelines, and the utility of physical therapy. Therefore, ChatGPT is an unreliable resource for information on treating SCH fractures. Parents of children who experience SCH fractures should continue to communicate with their doctors for the most accurate medical information.

Level of Evidence:

Level V—expert opinion on ChatGPT responses.
Prediction of Intensive Care Length of Stay for Surviving and Nonsurviving Patients Using Deep Learning
Authors: Brochini Ludmila , Liu Xinggang , Atallah Louis , Amelung Pamela , French Robin , Badawi Omar
Published: February 2025

Objectives:

Length of stay (LOS) models support evaluating ICU care; however, current benchmarking models fail to consider differences in LOS between surviving and nonsurviving patients, which can lead to biased predictions toward the surviving population. We aim to develop a model addressing this as well as documentation bias to improve ICU benchmarking.

Design:

The Critical Care Outcomes Prediction Model (CCOPM) LOS uses patient characteristics, vitals, and laboratories during the first 24 hours of ICU admission to predict LOS in the hospital and ICU using a deep learning framework for modeling time to events with competing risk. Data was randomly divided into training, validation, and test (hold out) sets in a 2:1:1 ratio.

Setting:

Electronic ICU Research Institute database from participating tele-critical care programs.

Patients:

Six hundred sixty-nine thousand eight hundred seventy-six ICU admissions pertaining to 628,815 patients from 329 ICUs in 194 U.S. hospitals, from 2017 to 2019.

Interventions:

None.

Measurements and Main Results:

Model performance was assessed using the coefficient of determination (R
2), concordance index, mean absolute error, and calibration. For individual stays in the test set, the ICU LOS model presented R
2 = 0.29 and 0.23 for surviving and nonsurviving populations, respectively, at the individual level and R
2 = 0.48 and 0.23 at the ICU level. Conversely, hospital LOS model presented R
2 = 0.46 and 0.52 at the individual level and R
2 = 0.71 and 0.64 at the ICU level. In the subset of the test set containing predictions from Acute Physiology and Chronic Health Evaluation (APACHE) IVb, R
2 of ICU LOS for surviving and nonsurviving populations was, respectively, 0.30 and 0.23 for the CCOPM and 0.16 and zero for APACHE IVb. For hospital LOS, the values were R
2 = 0.39 and 0.40 for the CCOPM and 0.27 and zero for APACHE IVb.

Conclusions:

This novel LOS model represents a step forward in achieving more equitable benchmarking across diverse ICU settings with varying risk profiles.
Relation between dabrafenib plus trametinib-induced pyrexia and age in BRAF V600-mutated metastatic melanoma patients: A post hoc analysis of the real-world ELDERLYMEL study
Authors: González-Barrallo Inés , Castellón Rubio Victoria Eugenia , Medina Javier , España Fernández Sofia , Mujika Karmele , Majem Margarita , Aguado Carlos , Cabrera Suárez Miguel Ángel , Palacio Isabel , Osterloh Lisa , Martínez-Fernández Alejandro , García-Castaño Almudena
Published: February 2025

Pyrexia is the most common adverse event in patients treated with dabrafenib plus trametinib. However, the pathogenesis of pyrexia and factors to identify patients at higher risk of developing pyrexia remain unknown. The ELDERLYMEL study was a multicenter, noninterventional, retrospective, real-world study comparing the effectiveness and safety of dabrafenib plus trametinib between elderly (≥75 years, n = 29) and younger (<75 years, n = 130) advanced melanoma BRAF V600-mutated patients in Spain. Surprisingly, pyrexia was significantly less frequent in elderly patients (13.8%) than in younger (42.3%). The post hoc analysis presented here aimed to investigate the relationship between age and pyrexia, applying logistic regression models. Patients <75 years had 4.59 more possibilities to develop pyrexia than elderly patients. The possibility of developing pyrexia increased by 1.03 as age decreased by 1 year. Receiver operating characteristics curves identified 61.5 years as the optimal cutoff value to predict the onset of pyrexia. The age-adjusted regression model revealed that patients <61.5 years had 2.53 more possibilities to develop pyrexia than those ≥61.5. This study demonstrates, for the first time, that age significantly influences the development of pyrexia in patients with BRAF V600-mutated advanced melanoma receiving dabrafenib plus trametinib. Age should be considered in the management and follow-up of these patients but should not limit treatment decisions. These findings provide important insights for clinical practice and contribute to a better understanding of pyrexia in elderly patients. The constructed nomogram based on age could serve as a useful tool for estimating the risk of pyrexia in patients receiving this treatment.
Addressing Ethics in Plastic and Aesthetic Surgery: Società Italiana di Chirurgia Plastica Ricostruttiva ed Estetica’s Social Media Policy
Authors: Schonauer Fabrizio , Scarabosio Anna , Tettamanzi Matilde , Zena Monica , Cavaliere Annachiara , Tornambene Roberta , Pozzi Mirco , Tarantino Giulio , Matta Daniele , Macchi Dorina , De Fazio Stefania
Published: February 2025

Background:

The pervasive influence of social media on plastic surgery necessitates a robust ethical framework to guide professional conduct online. The Società Italiana di Chirurgia Plastica Ricostruttiva ed Estetica (SICPRE) recognized the need for an ethical code that addresses the unique challenges posed by social media in the field of plastic surgery.

Methods:

A dedicated group, referred to as the Social Media Chat, was formed within SICPRE in November 2022. The group comprised members with varying levels of expertise, including the SICPRE president, plastic surgeons, professors, and residents. Through a comprehensive review of existing ethical codes and social media policies from 26 national and international plastic surgery societies, the group identified key ethical considerations. Virtual meetings facilitated discussions and the creation of content for SICPRE’s official social channels.

Results:

The analysis revealed that only a few societies had formal social media policies, whereas many had generic ethical codes with minimal guidance on social media use. SICPRE’s ethical code, formulated through collaborative efforts and multiple revisions, includes 10 fundamental points addressing professionalism, transparency, patient privacy, and ethical marketing. The code was integrated into SICPRE’s broader ethical guidelines to ensure consistency and comprehensiveness.

Conclusions:

SICPRE’s ethical code offers a detailed framework for navigating the intersection of plastic surgery and social media, emphasizing honesty, transparency, and respect for patient dignity. By aligning with best practices and addressing gaps in existing policies, this initiative aimed to enhance professional standards and patient trust in the digital age. Future updates will ensure the policy remains relevant amid evolving digital communication landscapes.
Impact of Race and Social Determinants on Operative Management of Distal Radius Fractures in Medicare Patients
Authors: Newman-Hung Nicole J. , Agarwal Amil R. , Paulson Ambika E. , Srikumaran Uma , Laporte Dawn , Wessel Lauren E.
Published: February 2025

Background:

Operative fixation of distal radius fractures (DRFs) in high-demand patients may provide functional benefit, particularly in the setting of significant displacement. Whether social determinants of health (SDOH) and race impact treatment remain unclear. The purpose of this study was to determine whether adverse SDOH modifiers and race are independent predictors of surgical intervention for DRF.

Methods:

A retrospective analysis was conducted using the Medicare Standard Analytical Files of the PearlDiver database of patients with a DRF from 2007 to 2016. Univariate and multivariable regression analyses were performed to observe whether race and adverse SDOH variables were independent predictors of undergoing open reduction internal fixation (ORIF) within 3 weeks of a new diagnosis of DRF after controlling for age and fracture type.

Results:

The average patient age was 76.3 years. A total of 10,697 (13.1%) patients underwent ORIF. Patients who underwent ORIF were less likely to have negative economic and social modifiers of SDOH and had lower odds of being non-White. Patients who underwent surgery also had higher odds of being younger, White, female, and having a type III open fracture.

Conclusions:

In the Medicare population, non-White race and adverse economic and social modifiers of SDOH were independent predictors of undergoing nonoperative treatment of DRF after controlling for age and fracture type. Future studies are needed to further elucidate the nuanced effects of race and SDOH on the management of DRFs.
Improved Outcomes in Lower Eyelid Reconstruction With Biodegradable Implant: A Comparative Study
Authors: Jonnazarov Eldor , Cervatiuc Maria , Reshetov Igor V. , Saakyan Svetlana V. , Chuchueva Natalia D.
Published: February 2025

Background:

Eyelid reconstruction is essential for patients who have undergone radical surgery to treat eyelid malignancies. The primary goal of this surgery is to restore both the functional and aesthetic aspects of the eyelid. Traditionally, various grafts from other parts of the body have been used for reconstruction. However, these methods may be limited by the availability of donor sites and the potential for associated complications.

Methods:

The study included 61 patients 58–91 years of age who underwent lower eyelid reconstruction. The patients were divided into 2 groups: a treatment group of 31 patients who received the biodegradable implant in addition to standard surgical techniques and a control group of 30 patients who underwent reconstruction without the implant. All patients were followed up for 1 year.

Results:

The study demonstrated that the use of the biodegradable membrane offered several advantages over the traditional approach without an implant. These advantages included faster healing times, as evidenced by cytological analysis; improved blood flow to the reconstructed eyelid, as measured by laser Doppler flowmetry; and a reduced incidence of eyelid complications, such as ectropion (outward turning of the eyelid). There were no statistically significant differences in tear osmolarity or pH between the 2 groups.

Conclusions:

The findings of this study suggest that the use of a biodegradable implant for lower eyelid reconstruction following malignant tumor surgery is a safe and effective method. It may lead to faster healing, improved blood flow, and fewer complications compared with traditional techniques.
The Four-line Algorithm for the Treatment of Unilateral Cleft Lip
Authors: Paredes Franklin J. , Alvarez Edwar C. , Jones Emily M. , Paredes Valeri K.
Published: February 2025

Background:

Several factors affect the outcome of a repaired unilateral cleft lip (UCL). Some of these, like the surgeon’s expertise, are hard to evaluate, whereas others can be better evaluated objectively using the cleft severity index and the surgical technique used.

Methods:

This study includes patients of Operation Smile Ecuador and was done in 2 parts. The retrospective part uses the medical records of 298 patients with UCL treated by Operation Smile Ecuador from January 2015 to December 2017. The correlation of the photographed measurements, surgical technique, and evolution of the patients was studied. In the prospective part, the participant surgeons of this article applied the algorithm to 136 patients treated from January 2018 to December 2019.

Results:

In the retrospective study, the resulting symmetry varied significantly among most Unilateral Cleft Asymmetry Index presurgical classifications, and 34% of the results were deficient. The four-line algorithm was developed using the case-technique analysis of the retroactive study. The algorithm was applied in the prospective part, which resulted in no deficient cases and 81% optimal results. There were significantly better results after applying the four-line algorithm for patients classified as Unilateral Cleft Asymmetry Index degrees III and IV (P < 0.001 and P = 0.041, respectively).

Conclusions:

Even though the cleft severity in the UCL is an important prognostic factor, the results of this study show that there are no universal surgical techniques to achieve optimal results. The four-line algorithm proposes to use a case-specific surgical technique to achieve the best functional and aesthetic result for our patients.
Cross-Lagged Associations Among Sleep, Headache, and Pain in Pediatric Mild Traumatic Brain Injury: An A-CAP Study
Authors: Dharsee Safira , Hassan Ali , Noel Melanie , Bender Amy M. , Beauchamp Miriam H. , Craig William , Doan Quynh , Freedman Stephen B. , Gravel Jocelyn , Zemek Roger , Yeates Keith Owen
Published: February 2025

Objective:

To test cross-lagged associations among sleep, headache, and pain in pediatric mild traumatic brain injury (mTBI).

Setting, Participants, Design:

Children and adolescents aged 8.0 to 16.9 years who sustained a mTBI and presented to 1 of 5 pediatric emergency departments across Canada completed assessments at 1-week, 3 months, and 6 months post-injury as part of a larger prospective cohort study.

Main Measures:

Sleep disturbance was measured using 7 sleep items from the Child Behaviour Checklist. Sleep duration was measured using average weekday and weekend sleep from the Healthy Lifestyle Behaviours Questionnaire. Pain intensity was measured using an 11-point numerical rating scale. Headache severity and associated functional impairment were measured using the Headache Impact Test and 1 item from the Health and Behaviour Inventory. Analyses included trivariate-indicator random-intercept cross-lagged panel models.

Results:

Of 633 recruited children, 563 were included in the current study. Headache showed significant within-person, bidirectional, cross-lagged associations with sleep disturbance and duration, as well as with pain intensity. More specifically, worse headache predicted greater sleep disturbance (1-week to 3 months and 3 months to 6 months: Bs = .47, Ps ≤ .013) and shorter sleep duration (1-week to 3 months: B = −.21, P = .006), while greater sleep disturbance predicted worse headache (1-week to 3 months: B = .08, P = .001). Worse headache also predicted higher pain intensity (1-week to 3 months & 3 months to 6 months: Bs ≥ 1.27, P
s < .001), while higher pain intensity predicted worse headache (3 months to 6 months: Bs ≥ .03, Ps ≤ .042). No cross-lagged associations involving sleep disturbance or duration with pain intensity were significant.

Conclusions:

Significant bi-directional, cross-lagged associations exist between headache and both sleep and pain. The findings suggest that early intervention for headaches may help prevent later sleep disturbance and pain after pediatric mTBI.
Understanding Patient–Provider Relationships: A Qualitative Study of Rural HIV Care in a Low-Prevalence Mountain West State in the United States
Authors: Fertaly Kaitlin , Javorka McKenzie
Published: February 2025

Supportive relationships between people living with HIV (PLWH) and their health care providers are crucial for treatment adherence and communication about health needs. This study explored key elements of patient–provider relationships (PPRs) among PLWH in a predominantly rural, Mountain West state with a low HIV prevalence. We analyzed in-depth interviews conducted with 17 PLWH. We identified 4 key themes related to PPR: (a) providers' limited competencies in HIV and lesbian, gay, bisexual, transgender and queer issues, (b) patients' desire for empathetic and nonjudgmental care, (c) patients' experiences of dismissal or dehumanization by providers or the health care system, and (d) experiences and fear of stigma. Our findings underscore the role that PPR plays in addressing or exacerbating barriers for PLWH in rural areas, emphasizing the need for both interpersonal (e.g., provider-focused) and structural interventions to increase providers' HIV knowledge, decrease stigma, and foster positive PPR.
Combining Prostate MRI and Microultrasound to Omit Systematic Biopsy
Authors: Luca Dan , Roy Arkaprava , Pensa Jake W. , Ashouri Rani , Nguyen Brianna , Walsh Kevin J. , Zhang Zhongyue , Grajo Joseph R. , Falzarano Sara Moscovita , O'Malley Padraic G. , Crispen Paul L. , Lee Ji-Hyun , Brisbane Wayne G.
Published: February 2025

Purpose:

The diagnosis of prostate cancer often includes MRI-guided biopsy. Many surgeons perform targeted and systematic biopsies to compensate for registration errors between MRI and conventional ultrasound (5-7 mHz). Using 29 mHz, microultrasound visualizes prostate cancers, enabling visual confirmation of target sampling. We sought to evaluate whether an MRI + microultrasound targeted biopsy could omit systematic biopsy.

Methods:

We retrospectively evaluated 155 men undergoing transperineal prostate biopsy at the University of Florida. Eighty-three men met inclusion criteria: MRI prior, microultrasound guidance, and targeted and systematic biopsy. The MRI target was visualized with microultrasound and biopsied. We graded each region of interest (ROI) using Prostate Imaging Reporting & Data System (PI-RADS) and Prostate Risk Identification using Micro-Ultrasound (PRI-MUS) scores. We considered cores containing Grade Group ≥ 2 (GG ≥ 2) as clinically significant prostate cancer. The primary endpoint was the GG ≥ 2 cancer detection rate (CDR = GG ≥ 2 targeted cores/GG ≥ 2 all cores).

Results:

Patients with PI-RADS and PRI-MUS scores ≥ 3 had a targeted-only CDR of 93.3%. Those with scores ≥ 4 (dual imaging visible) had a CDR of 97.4%. Systematic without targeted cores had CDR of 61.5%. One patient (1.2%) had GG ≥ 2 detected on systematic biopsy alone. Area under the curve (AUC) values for PI-RADS, PRI-MUS, and dual imaging visible lesions were 0.73, 0.69, and 0.73, respectively (P = NS).

Conclusions:

Only 1 patient, with a dual imaging visible ROI, had GG ≥ 2 detected on systematic biopsy but not in the ROI. Otherwise, > 97% of clinically significant prostate cancer were detected with targeted biopsies alone. In dual imaging visible ROIs, surgeons may consider omitting systematic biopsy.
Prevalence of Eating Disorders Among Adults With Irritable Bowel Syndrome
Authors: Ordaz-Alvarez Hector Ricardo , Priego-Parra Bryan Adrian , Reyes-Diaz Sara Alejandra , Garcia-Zermeño Karla Rocio , del Rocio Francisco Maria , Amieva-Balmori Mercedes , Lemus-Chavarria Melvy Priscilla , Roesch-Ramos Laura , Cano-Contreras Ana Delfina , Roesch-Dietlen Federico Bernhardo , Remes-Troche José Maria
Published: February 2025

Goal:

To investigate the prevalence of eating disorder (ED) symptoms among Mexican adults with irritable bowel syndrome (IBS).

Background:

The relationship between IBS and EDs is complex, yet understudied, particularly in Latin America.

Methods:

In this cross-sectional study, 369 Mexican adults (18 to 69  y), comprising 133 IBS patients and 236 healthy controls (HCs), were evaluated using the Rome IV criteria, The Spanish version of the Eating Disorder Examination Questionnaire (S-EDE-Q), the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS) and the Hospital Anxiety and Depression Scale (HADS). Statistical analysis included the Student t test or the Wilcoxon Rank-sum test for group comparisons, the Kruskal-Wallis test for multiple comparisons, and logistic regression, with a significance threshold set at a P-value of <0.05.

Results:

IBS individuals were at an increased risk for clinically significant S-EDE-Q when compared with HCs (12.8% vs. 3.8%, odds ratio OR 3.6, 95% CI: 1.5-8.5; P=0.001), especially among younger individuals. IBS individuals displayed a higher risk for dietary restraint and heightened concerns about eating, body shape, and weight. In addition, binge-eating episodes occurred more frequently within the IBS group. Notably, there were no significant differences in body mass index between individuals with clinically significant S-EDE-Q and those with normal scores. IBS individuals with severe symptoms had higher S-EDE-Q scores; furthermore, those with IBS and clinically significant S-EDE-Q exhibited higher levels of anxiety and depression.

Conclusions:

Our study reveals a significantly higher risk for ED in IBS individuals compared with HCs. This highlights the crucial importance of conducting ED screenings before dietary interventions, particularly among younger individuals and those displaying elevated levels of anxiety and depression.
Implications of Neoadjuvant Therapy on Prognostic Factors in Pancreatic Ductal Adenocarcinoma: A Path Towards Personalized Prognostication
Authors: Javed Ammar A. , Habib Joseph R. , Andel Paul C.M. , Campbell Brady A. , Rompen Ingmar F. , Mahmud Omar , Fatimi Asad , van Goor Iris W.J.M. , Schouten Thijs J. , Stoop Thomas F. , Salinas Camila Hidalgo , van Santvoort Hjalmar C. , Koerkam Bas Groot , Molenaar I. Quintus , Wolfgang Christopher L. , Besselink Marc G. , He Jin , Daamen Lois A ,   for the Dutch Pancreatic Cancer Group and the PANC-PALS Consortium
Published: February 2025

Objective:

The aim of the study was to investigate prognostic factors in context of neoadjuvant therapy (NAT) and develop tools that can allow for accurate and personalized patient prognostication.

Summary of Background Data:

NAT might impact the prognostic ability of well-established clinicopathological factors in resected pancreatic ductal adenocarcinoma (PDAC).

Methods:

Patients after resection for PDAC were identified from the Dutch Pancreatic Cancer Group Recurrence Database and institutional databases at NYU Langone Health and the Johns Hopkins Hospital (2014-2019). Patients were stratified into NAT and chemo-naïve groups. Overall survival (OS), calculated from the time of resection, was estimated using Kaplan-Meier and compared using log-rank tests. Prognostic factors associated with OS were assessed in both groups using univariable and multivariable Cox-regression analyses and presented using hazard ratios (HR) with corresponding 95% confidence intervals (95%CI). Predictive models were developed and an interactive tool was created to predict survival independently in both groups.

Results:

Of 2,760 patients with resected PDAC, 778 patients (28%) received NAT. Independent predictors for worse OS in chemo-naïve patients included age ≥65 years, markedly elevated CA19-9 (≥500 U/mL) at diagnosis, higher AJCC-T stage (T3/4 vs T1/2), worsening AJCC N-stage (N2 vs. N1 vs. N0), poor tumor differentiation, perineural invasion, and microscopically positive resection margin (R1 vs. R0). Contrastingly, predictors for worse OS in NAT patients included non-normalization of CA19-9 after NAT (<37 U/mL), presence of nodal disease (N1/2 vs. N0 given no statistical difference between N1 and N2 disease), and grade of treatment response (moderate/poor vs. complete/near complete).

Conclusion:

Prognostic factors for OS in patients with resected PDAC differ between chemo-naïve and NAT patients. Personalized prediction tools for OS in resected PDAC based on these specific factors are available online (www.pancpals.com/tools).
Effect of Aging and Sex on Clot Formation, Structure, and Lysis in Trauma Patients
Authors: Piplani Charoo , Gosselin Andrew , Bargoud Christopher , Macor Marie , Choron Rachel L , Hanna Joseph S , Tutwiler Valerie , Goswami Julie
Published: February 2025

Background:

The dynamics of blood clotting are influenced by age and sex, potentially impacting treatment outcomes and susceptibility to complications in trauma patients. This study aimed to identify how age and sex impact clot formation and resolution kinetics, and network structure in trauma patients, exploring their potential implications for personalized treatment strategies.

Study Design:

Trauma patients meeting the highest level of trauma designation had plasma isolated after emergency department admission prior to any resuscitative fluid administration. Thrombin generation kinetics, rheological clot mechanics, fibrin network properties and optical density were measured in patient plasma.

Results:

Sixty-three patients were included in this study. The majority (76%) were male, and the age range was 18 to 87 years old, with median age of 38. Older patients had increased mortality at similar ISS as young patients, while exhibiting greater clot stiffness and increased time to thrombin generation. Increasing patient age was associated with increased thrombin lag time, time to peak thrombin and fibrinogen normalized stiffness. Male and female patients had similar mortality rates and Injury Severity Scores but exhibited significant differences in clot stiffness and lysis as they age.

Conclusions:

This study suggests that aging in trauma patients correlates with prolonged clot formation rate despite the presence of stiffer clots and reduced fibrinolysis in older males. Our findings highlight the importance of age and sex when developing resuscitation protocols and tailoring treatment strategies for acute traumatic coagulopathy in trauma patients. Further research is needed to effectively develop and implement such protocols to optimize clinical outcomes in this patient population.
An open-source, externally validated neural network algorithm to recognize daily-life gait of older adults based on the lower-back sensor
Authors: Zhang Yuge , Bruijn Sjoerd M. , Punt Michiel , Helbostad Jorunn L. , Pijnappels Mirjam , David Sina
Published: February 2025

Background

Accurate gait recognition from daily physical activities is a critical first step for further fall risk assessment and rehabilitation monitoring based on inertial sensors. However, most openly available models are based on healthy young adults ambulating in structured conditions.

Objective

This study aimed to develop an open-source and externally validated algorithm for daily-life gait recognition of older adults based on acceleration and angular velocity, as well as acceleration data only, and explore the effect of the use of data augmentation in the model training.

Methods

A convolutional neural network was trained for gait recognition. The data for model training was lower-back inertial sensor data from 20 older adults (mean age 76 years old), with annotated synchronized activity labels in semi-structured and daily-life conditions. The data was randomly split into training, validation, and testing datasets by participants, and the model was trained multiple times using these different splits. The model was trained based on data from six channels (accelerations and angular velocities) and three channels (accelerations only) under conditions with and without data augmentation, respectively. External validation was evaluated based on lower-back sensor data collected from 47 stroke survivors (mean age 72.3 years old) in balance and walking tests.

Results

For the testing dataset, the median accuracy ranged from 94 % to 98 %, precision from 63 % to 85 %, sensitivity from 95 % to 97 %, F1-score from 76 % to 90 %, and specificity from 94 % to 98 %. For the external validation dataset, the median accuracy ranged from 97 % to 100 %, precision from 99.9 % to 100 %, sensitivity from 71 % to 100 %, F1-score from 83 % to 100 %, and specificity 100 %.

Conclusions

Based on lower-back-worn inertial sensor data, we provide an accurate, open-source, and externally validated daily-life gait recognition algorithm for older adults, with one model for six-axis input data and another for three-axis input data. Besides, we found when training the model, the use of data augmentation is especially helpful on the model based on acceleration data only.
Loss of white matter tracts and persistent microglial activation in the chronic phase of ischemic stroke in female rats and the effect of miR-20a-3p treatment
Authors: Sampath Dayalan , Zardeneta Macy E. , Akbari Zara , Singer Jacob , Gopalakrishnan Balaji , Hurst David Austin , Villarreal Monserrat , McDaniel Erin A. , Noarbe Brenda Patricia , Obenaus Andre , Sohrabji Farida
Published: February 2025

Our previous studies showed that intravenous injections of the small non-coding RNA mir-20a-3p is neuroprotective for stroke in the acute phase and attenuates long-term cognitive impairment in middle-aged female rats. In this study, we evaluated postmortem brain pathology at 100+d after stroke in a set of behaviorally characterized animals. This included Sham (no stroke) controls or stroke animals that received either mir20a-3p at 4h, 24h and 70d iv post stroke (MCAo+mir20a-3p) or a scrambled oligo (MCAo+Scr). Brain volumetric features were analyzed with T2 weighted and Diffusion Tensor magnetic resonance imaging (MRI) followed by histological analysis. Principal component analysis of Fractional Anisotropy (FA)-diffusion tensor MRI measures showed that MCAo+Scr and MCAo+mir20a-3p groups differed significantly in the volume of white matter but not gray matter. Weil myelin-stained sections confirmed decreased volume of the corpus callosum, internal capsule and the anterior commissure in the ischemic hemisphere of MCAo+Scr animals compared to the non-ischemic hemisphere, while sham and MCAo+Mir-20a-3p showed no hemispheric asymmetries. The MCAo+Scr group also exhibited asymmetry in hemisphere and lateral ventricle volumes, with ventricular enlargement in the ischemic hemisphere as compared to the non-ischemic hemisphere. The numbers of microglia were significantly elevated in white matter tracts in the MCAo+Scr group, with a trend towards increased myelin phagocytic microglia in these tracts. Regression analysis indicated that performance on an episodic memory test (novel object recognition test; NORT) was associated with decreased white matter volume and increased microglial numbers. These data support the hypothesis that stroke-induced cognitive impairment is accompanied by white matter attrition and persistent microglial activation and is consistent with reports that cognitive deterioration resulting from vascular diseases, such as stroke, is associated with secondary neurodegeneration in regions distal from the initial infarction.
Topological Analysis ofMacaca mulatta’s Cortical Structures Through the Lens of Poincaré Duality
Authors: Tozzi Arturo
Published: February 2025

Poincaré duality from algebraic topology describes how shapes and spaces interrelate across different dimensions, linking structures of one scale to complementary structures at another. This suggests that densely packed neurons in certain brain areas may correspond to broader connectivity patterns, balancing local processing with global communication. Applying this framework to cortical histological images ofMacaca mulatta, we analysed neuronal clustering, connectivity graphs and intensity distributions to identify self-dual structural patterns and reveal the contribution of local organization to large-scale network activity. Using image processing techniques such as contrast enhancement, edge detection and graph-theoretic modeling, we examined how dense neuron clusters correspond to functionally sparse regions and vice versa. We found that high-density neuronal zones form closed-loop topological structures that correspond to homology cycles, while sparser areas function as large-scale integrators, aligning with cohomology properties. Local connectivity hubs in neuron-dense regions support regional specialization, while large-scale, sparser areas, though less connected, facilitate global communication by acting as pathways for long-range integration. Graph-theoretic analysis of connectivity patterns confirmed a reciprocal relationship between clustering coefficients and global centrality. Statistical analysis using Kolmogorov-Smirnov tests revealed conserved topological distributions across different cortical regions, supporting the hypothesis that cortical connectivity maintains structural invariance under local perturbations. These findings provide insights into the mathematical principles governing brain architecture, suggesting that topological methods can enhance our understanding of cortical function. Future research may extend these approaches to higher-dimensional embeddings, network theory in primate brains, functional neuroimaging, human disease modeling and artificial intelligence.
Well, or Well Enough? An exploration of the need for guidance addressing clinician wellbeing and fitness to practice in UK Clinical Psychologists
Authors: Birkett L. , Hagan A. J. , Verity S.J.
Published: February 2025

Practitioner Psychologists in the UK are required to meet standards of practice pertinent to their professional grouping to maintain registration with the Health and Care Professional Council. Updated guidance in effect from 1stSeptember 2023 states that registrants are now required to develop and adopt clear strategies for physical and mental self-care, thus requiring registrants to be agentic in implementing active methods of well-being management. A survey of 301 UK based Clinical Psychologists sought to determine whether a self-assessment tool to identify risk factors for wellbeing would be of benefit. The majority of participants endorsed the potential utility, necessity, and benefit of such a measure. Limitations of a self-assessment wellbeing measure are discussed, as well as systemic issues that impact well-being. This paper supports the development of a self-assessment wellbeing tool for those working within clinical psychology.
Xuefu Zhuyu Oral Liquid as Adjunctive Therapy on Stable Angina: A Randomized Clinical Trial
Authors: Cao Wencong , Liao Shaojun , Zhou Li , Li Geng , Jiang Junwen , Lv Weihui , Dong Bo , Liu Li , Zhang Jie , Wang Yanchun , Ouyang Wenwei , Du Yi , Wen Zehuai
Published: February 2025

Background

Stable angina (SA) is a leading cause of disability worldwide, and there is increasing interest in nonpharmacological treatments. Xuefu Zhuyu oral liquid (XZOL) is a Chinese medicine that has been approved in China for the treatment of SA, but further studies are needed to establish its efficacy and safety. We aimed to provide a reliable assessment of the safety and efficacy of XZOL in patients with SA.

Methods

We did a multi-centre, randomised, double-blind, placebo-controlled trial at 6 hospitals in China. Participants were randomized into 2 treatment groups, and allocated to receive of either XZOL or matching placebo over 12 weeks and were followed-up for 12 weeks. The primary efficacy outcome was the average pain intensity of angina, which was measured by the change from baseline to week 12 on a 10-cm visual analogue scale.

Results

Of 263 patients screened, 148 participants were randomly assigned with primary outcome data in the ITT (intention-to-treat) population (74 in the XZOL group and 74 in the placebo group), and 99 participants in the PP (per-protocol) population (48 in the XZOL group and 51 in the placebo group). Mean change in VAS at week 12 were −2.27 in the XZOL group and −1.85 in the placebo group (difference - 0.52, 95% CI −0.99 to −0.05;P= 0.029) among the ITT population, and −2.54 in the XZOL group and −1.79 in the placebo group (difference −0.81, 95% CI −1.40 to −0.22;P= 0.007) among the PP population. The neutral results were shown in adjusted and sensitivity analyses. There was no significant difference in adverse events.

Conclusion

This randomised, placebo-controlled, double-blind, clinical trial showed XZOL was associated with a significantly greater reduction in the levels of pain intensity of angina over 12 weeks and was superior to placebo in alleviating SA.