bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial intelligence applied to electrocardiogram to rule out acute myocardial infarction: the ROMIAE multicentre study
Authors: Lee Min Sung , Shin Tae Gun , Lee Youngjoo , Kim Dong Hoon , Choi Sung Hyuk , Cho Hanjin , Lee Mi Jin , Jeong Ki Young , Kim Won Young , Min Young Gi , Han Chul , Yoon Jae Chol , Jung Eujene , Kim Woo Jeong , Ahn Chiwon , Seo Jeong Yeol , Lim Tae Ho , Kim Jae Seong , Choi Jeff , Kwon Joon-myoung , Kim Kyuseok ,   ROMIAE study group, Park Jong Eun , Chung Heajin , Jeong Jin Hee , Park Sung-Jun , Ahn Sejoong , Jung Haewon , Ko Seok Hoon , Choi Han Sung , Kim June-sung , Rhee Bangshill , Kim Keon , Kim So Eun , Bu Ji Hwan , Kim Jae Hwan , Kim Dong Won , Cho Yongil , Lee Yonghee , Choi Kihwan , Choi Sangchun , Son Jeong Min , Kang Sora , Lee Hak Seung , Kim Min-yeong , Shin Nuri , Jang Jong-Hwan , Jo Yong-Yeon
Published: February 2025

Background and Aims

Emerging evidence supports artificial intelligence–enhanced electrocardiogram (AI-ECG) for detecting acute myocardial infarction (AMI), but real-world validation is needed. The aim of this study was to evaluate the performance of AI-ECG in detecting AMI in the emergency department (ED).

Methods

The Rule-Out acute Myocardial Infarction using Artificial intelligence Electrocardiogram analysis (ROMIAE) study is a prospective cohort study conducted in the Republic of Korea from March 2022 to October 2023, involving 18 university-level teaching hospitals. Adult patients presenting to the ED within 24 h of symptom onset concerning for AMI were assessed. Exposure included AI-ECG score, HEART score, GRACE 2.0 score, high-sensitivity troponin level, and Physician AMI score. The primary outcome was diagnosis of AMI during index admission, and the secondary outcome was 30 day major adverse cardiovascular event (MACE).

Results

The study population comprised 8493 adults, of whom 1586 (18.6%) were diagnosed with AMI. The area under the receiver operating characteristic curve for AI-ECG was 0.878 (95% CI, 0.868–0.888), comparable with the HEART score (0.877; 95% CI, 0.869–0.886) and superior to the GRACE 2.0 score, high-sensitivity troponin level, and Physician AMI score. For predicting 30 day MACE, AI-ECG (area under the receiver operating characteristic, 0.866; 95% CI, 0.856–0.877) performed comparably with the HEART score (0.858; 95% CI, 0.848–0.868). The integration of the AI-ECG improved risk stratification and AMI discrimination, with a net reclassification improvement of 19.6% (95% CI, 17.38–21.89) and a C-index of 0.926 (95% CI, 0.919–0.933), compared with the HEART score alone.

Conclusions

In this multicentre prospective study, the AI-ECG demonstrated diagnostic accuracy and predictive power for AMI and 30 day MACE, which was similar to or better than that of traditional risk stratification methods and ED physicians.
Chaperone dysfunction in motor neuron disease: new insights from studies of the SMN complex
Authors: Matera A Gregory
Published: February 2025

Spinal muscular atrophy and amyotrophic lateral sclerosis are devastating neurodegenerative diseases characterized by motor neuron loss. Although these 2 disorders have distinct genetic origins, recent studies suggest that they share common etiological mechanisms rooted in proteostatic dysfunction. At the heart of this emerging understanding is the survival motor neuron (SMN) complex.
Modeling the mechanical properties of rock at different pore and confining pressures using the grain-based stress corrosion model
Authors: Fu Teng-Fei , Zhu De-Fu , Li Ya-Tao
Published: February 2025

A grain-based stress corrosion model is built from 3DEC-GBM (i.e. a 3-D discrete element grain-based model). The model employs the effective stress law and stress corrosion theory to study the time-dependent and time-independent deformation at the mesoscale of the sandstone with varying confining and pore pressures. The simulations adequately explain complex macroscopic time-independent behaviour in terms of the mesoscale interaction of grains, and tension cracks were the dominant crack propagation pattern in the simulation for different confining and pore pressures. The traditional creep behaviour observed in laboratory brittle creep experiments could also be accurately reproduced by the proposed model. The simulations show that the percentage of tension cracks in rock fractures decreases with increasing confining pressure and pore pressures. Increasing the applied differential stress and reducing the effective pressure can shorten time-to-failure and increase the creep strain rate, respectively. We conclude that the proposed model is an appropriate tool to analyse the deformation behaviour of sandstone under coupled hydromechanical loading in both the short and long term.
Outcomes of surgical management for Kommerell’s diverticulum associated with type B aortic dissection
Authors: Ahmad Nouman , Huang Lingjin , Chen Xuliang , Huang Yingjie , Li Jiawei , Xie Zhongshang
Published: February 2025

OBJECTIVES

Kommerell’s diverticulum presents a distinctive challenge in clinical management due to its rarity and diverse clinical manifestations, particularly when concurrent with type B aortic dissection. However, a consensus on the optimal treatment strategy has yet to be established. This study presents our experience with an open surgical approach to treating Kommerell’s diverticulum associated with type B aortic dissection.

METHODS

This retrospective study evaluated 10 patients who underwent surgical repair for Kommerell’s diverticulum with concurrent type B aortic dissection. Through median sternotomy, under cardiopulmonary bypass and deep hypothermic circulatory arrest + retrograde cerebral perfusion, a frozen elephant trunk stent graft was deployed in the descending thoracic aorta to address the type B aortic dissection and Kommerell’s diverticulum. Aberrant subclavian arteries were reconstructed by bypassing the distal portion into the native ascending aorta or carotid artery, accompanied by proximal ligation of the aberrant artery.

RESULTS

The median age of the patient was 49 years (interquartile range: 42.2–58.5). There were no in-hospital or 30-day postoperative deaths. All patients were discharged with a median hospital stay of 8.5 days (interquartile range: 7.75–10.5). No cases of stroke or spinal cord ischaemia were observed. Follow-up was completed for all patients, with a mean duration of 27.4 (standard deviation: 15.3) months, during which no adverse events occurred.

CONCLUSIONS

This surgical approach for managing Kommerell’s diverticulum with type B aortic dissection offers a safe and effective option, yielding favourable short-term outcomes. It may provide a durable alternative to traditional surgical methods and overcome limitations associated with endovascular surgeries.
Innovative balloon-inflatable venous cannula for enhanced cardiopulmonary bypass in minimally invasive cardiac surgery
Authors: Sazzad Faizus , Kim Ki Han , Moideen Irwan Shah Bin Mohd , El Gohary Abdulrahman , Stevens John C , Kofidis Theo
Published: February 2025

OBJECTIVES

Minimally invasive cardiac surgery (MICS) struggles with effective caval isolation and cannulation for cardiopulmonary bypass (CPB). We aimed to develop a novel MICS venous cannula, eliminating external manipulations. The goal of this study is to thoroughly evaluate both the safety and the efficacy of a newly developed venous cannula.

METHODS

The study presents the Aulus venous cannula for MICS, designed with internal balloons to block caval blood flow. Preclinical bench tests with a cardiac biosimulator and large animal studies per ISO10993-2016, evaluated performance and safety.

RESULTS

The heparin-coated Aulus cannula had a post-sterilization comparable density of ∼0.200 μg/cm2. In ex vivo tests, using porcine heart models, the cannula enabled full caval occlusion, with endoscopic views confirming precise positioning. The pressure drop remained below the haemolytic threshold of 100 mmHg, indicated lower values compared to BioMedicus. A non-Good Laboratory Practice (GLP) large animal study included eight ovine models, divided into short- and long-term follow-up groups. Clinical pathology values were consistent CPB procedures, and histopathology indicated favourable tolerance despite short-term vessel injuries and long-term stenosis with fibrosis.

CONCLUSIONS

The Aulus cannula showed effective anticoagulant activity, strong integrity, and good tolerance in vitro and in vivo, highlighting its clinical potential.
Using Trade Provisions to Make Environmental Agreements More Dynamic
Authors: Morin Jean-Frédéric , Laurens Noémie , Brandi Clara , Schwab Jakob
Published: February 2025

This article examines the impact of trade provisions on treaty dynamism. It differentiates between static treaties, which remain unaltered, and dynamic treaties, which generate new commitments, either by bringing about additional rules or attracting new parties. We argue that incorporating trade provisions into multilateral environmental agreements (MEAs) enhances their dynamism. Such provisions can empower interest groups to advocate for new international commitments and can prompt businesses in non-party states to pressure their governments to join the MEA. Analyzing a dataset of 647 MEAs, we find that provisions that restrict trade flows are associated with higher numbers of amendments and accessions. This insight is crucial for resolving the so-called “ambition/participation dilemma” and designing more adaptable treaties, particularly at a time when there is increasing enthusiasm for using trade measures to set up international climate clubs.
Small bowel diverticulum causing primary enterolithiasis: a rare diagnosis with definitive surgical intervention
Authors: Guan Angel , Vignaroli Kendall , Perez Kevin , Kim So Un , Cremat Danielle , Malkoc Aldin , Lam Jasmine , Van Nguyen Ngoc Patrick
Published: February 2025

Primary enterolithiasis is characterized by the formation of stones within the small bowel. The prevalence is estimated to be ~0.3% to 10% in selected populations. Due to its rarity, diagnosis is often delayed. We present the case of a 77 year old male who presented with small bowel obstruction, which was initially thought to be due to intussusception seen on abdominal computed tomography scan. He underwent two diagnostic laparoscopies within 1 month because his small bowel obstruction did not resolve with the initial surgery. The primary enterolith was not discovered until the second surgery where a 5 cm primary enterolith was seen in the small bowel causing early mucosal necrosis. The stone was removed, and the enterotomy was closed. After the enterolith was removed, the patient’s upper gastrointestinal symptoms completely resolved.
Paracoccidioidomycosis-related hospitalization and mortality rates in the state of São Paulo, Brazil: A study using socioeconomic, demographic, and climatic predictors
Authors: Spinelli Isabela , de Macedo Leandro Roberto , Ferreira Gabriella Freitas
Published: February 2025

Paracoccidioidomycosis (PCM) is endemic in impoverished communities in Latin America. This study aimed to understand the impact of sociodemographic, economic, and climatic factors on the number of hospitalizations and deaths due to PCM in São Paulo (SP) state, Brazil. Data on 645 municipalities were collected from government databases between 2006 and 2020. The Spearman’s correlations between sociodemographic variables (population density, Municipal Human Development Index, and number of public health facilities in the municipality) and PCM rates showed the strongest negative correlation coefficients among the other variables. Multiple regression models reinforced the influence of sociodemographic and climatic factors on PCM reports.
2D light distributions of dwarf galaxies – key tests of the implementation of physical processes in simulations
Authors: Watkins A E , Martin G , Kaviraj S , Collins C , Dubois Y , Kraljic K , Pichon C , Yi S K
Published: February 2025

Cosmological simulations provide much of the theoretical framework within which we interpret extragalactic observations. However, even if a given simulation reproduces the integrated properties of galaxies well, it may not reproduce the detailed structures of individual galaxies. Comparisons between the 2D light distributions of simulated and observed galaxies – particularly in the dwarf regime, where key processes like tidal perturbations and baryonic feedback most strongly influence galaxy structure – thus provide an additional valuable test of the simulation’s efficacy. We compare scaling relations derived from mock observations of simulated galaxies, drawn from the two largest haloes in the high-resolution NewHorizon cosmological simulation, with galaxies in the Fornax Cluster. While Fornax is significantly more massive than either group, it is the lowest mass cluster in the local Universe and contains a well-studied population of spatially resolved dwarfs, hence serves as a useful benchmark. Per unit stellar mass, NewHorizon dwarfs are systematically larger in half-light radius, much fainter in surface brightness, and bluer in colour than their Fornax counterparts, albeit with similar light profile shapes. We discuss potential reasons for these discrepancies, including environmental effects, baryonic feedback, resolution, or couplings of these factors. As observations of dwarfs outside of the local Universe become more plentiful through ongoing or upcoming surveys such as Euclid and Legacy Survey of Space and Time, 2D comparisons such as these, where properties are measured in the same way across both simulations and observations, can place strong constraints on processes that alter the spatial distribution of baryons in galaxies.
An Inversion Polymorphism Under Balancing Selection, Involving Giant Mobile Elements, in an Invasive Fungal Pathogen
Authors: Hartmann Fanny E , Rodríguez de la Vega Ricardo C , Demené Arthur , Badet Thomas , Vernadet Jean-Philippe , Rougemont Quentin , Labat Amandine , Snirc Alodie , Stauber Lea , Croll Daniel , Prospero Simone , Dutech Cyril , Giraud Tatiana
Published: February 2025

Recombination suppression can evolve in sex or mating-type chromosomes, or in autosomal supergenes, with different haplotypes being maintained by balancing selection. In the invasive chestnut blight fungus Cryphonectria parasitica, a genomic region was suggested to lack recombination and to be partially physically linked to the mating-type (MAT) locus based on segregation analyses. Using hundreds of available C. parasitica genomes and generating new high-quality genome assemblies, we show that a ca. 1.2 Mb genomic region proximal to the mating-type locus lacks recombination, with the segregation of two highly differentiated haplotypes in balanced proportions in invasive populations. High-quality genome assemblies further revealed an inversion in one of the haplotypes in the invaded range. The two haplotypes were estimated to have diverged 1.5 million years ago, and each harboured specific genes, some of which likely belonging to Starships. These are large transposable elements, mobilized by tyrosine recombinases, able to move accessory genes, and involved in adaptation in multiple fungi. The MAT-proximal region carried genes upregulated under virus infection or vegetative incompatibility reaction. In the native range, the MAT-proximal region also appeared to have a different evolutionary history than the rest of the genome. In all continents, the MAT-Proximal region was enriched in nonsynonymous substitutions, in gene presence/absence polymorphism, in tyrosine recombinases and in transposable elements. This study thus sheds light on a case of a large nonrecombining region partially linked to a mating compatibility locus, likely maintained by balancing selection on differentiated haplotypes, possibly involved in adaptation in a devastating tree pathogen.
Infective Endocarditis in People Who Inject Drugs – a Five-Year Follow-up: “I´ve Seen the Needle and the Damage Done”
Authors: Halavaara Mika , Anttila Veli-Jukka , Järvinen Asko
Published: February 2025

Background

Infective endocarditis (IE) among people who inject drugs (PWID) has been associated with better short-term outcome. Long-term outcome of PWID with IE is poorly known.

Methods

PWID with IE and non-PWID adults with community-acquired IE who were diagnosed and treated in Southern Finland between 2013-2017 and who survived the initial IE episode were included in this retrospective population-based study. All patients were followed for five years. Data on drug use, receipt of medications for opioid use therapy (MOUD), survival, and subsequent IE episode during follow-up were collected.

Results

Seventy-five PWID with IE and 98 patients with community-acquired IE were included. Buprenorphine and amphetamine (or other stimulant) were the most used substances amongst PWID. Sixteen PWID received MOUD before onset of IE and 33 received MOUD at the time of discharge. Most PWID (86%) received addiction specialist consultation during the hospitalization. Fifteen patients in PWID-IE group experienced a new IE episode in 5-year-follow-up and five patients in non-PWID-IE group (OR 4.65, P=0.003). One-year all-cause mortality in PWID-IE was 4.0% (n=3/75) and in non-PWID-IE 4.1% (n=4/98). Five-year all-cause mortality was 18.7% (n=14/75) in PWID-IE and 13.3% (n=13/98) in non-PWID-IE (P=0.399). In multivariate analysis of whole group, injection drug use (OR 12.2), female gender (OR 2.62) and higher age-adjusted comorbidity index were independent factors associated with death during five-year follow-up.

Conclusion

Long-term survival of PWID with IE is poor and they are at increased risk of a new IE episode compared to non-PWID with community-acquired IE. More efforts in the treatment of addiction are needed.
Rapid assessment of crisis response using a new semi-automatic iterative method—how national research systems address the SARS-CoV-2 pandemic
Authors: Baaden Philipp , Hollmann Vanessa , Jovanović Miloš
Published: February 2025

The corona pandemic has had a significant impact on society and posed multiple challenges for national research systems to provide guidance to policy makers in the face of the rapidly changing global crisis situation. However, existing methods generally do not allow for an early and reliable assessment of how national research systems have reacted to a global crisis situation. We show how an expert-based, iterative classification scheme enables the analysis of research trends and country-specific differences at an early stage of the corona pandemic. In doing so, we have extended our focus beyond published research to the actions of research and technology organizations. In the European countries surveyed, a largely consistent but differentiated research landscape can be observed, with the focus shifting over time from medical and prevention-related topics to topics related to the social, environmental and economic impact of the crisis. However, there are country-specific differences, especially in research on social and mental issues, virus detection and diagnostics, and pandemic prevention measures. Thus, our approach provides a valuable framework that is applicable beyond COVID-19 and helps both researchers and policy makers to tackle rapidly evolving crises at an early stage. Our study contributes to existing literature by offering a comprehensive framework that goes beyond traditional publication dynamics, providing insights into the rapid response of national research systems during crises, such as the COVID-19 pandemic.
Electromagnetic exposure level of pure electric vehicle inverter to human body in different seating positions
Authors: Dong XuWei , Ren YuFei , Lu Mai
Published: February 2025

The market share of pure electric vehicle (PEV) as a green transportation steadily increases as the global demand for renewable energy sources and environmentally friendly mobility continues to increase. However, during PEV operation, the inverter system, as the key power conversion device, generates strong electromagnetic field in the local space. Long-term exposure to such electromagnetic environments may have potential effects on human body. In this study, the electromagnetic environment model of the PEV body, human body and simplified inverter is established. The finite element software, COMSOL Multiphysics, is used to calculate and analyse the variations in the induction field in different tissues of the driver and rear passenger, caused by the electromagnetic field generated by the inverter system operating at maximum power. The electromagnetic exposure level of the driver and rear passenger is assessed. Results show significant differences in the electromagnetic exposure levels of different seating positions in the vehicles. The electromagnetic exposure level in the driver’s body is higher than that of the rear passenger, but it does not exceed the exposure limits defined by the International Commission for Non-ionizing Radiation Protection. This finding effectively complements the study on evaluating the safety of the electromagnetic environment of PEV and improves public awareness.
Evaluation of Anthracnose Disease Resistance, Yield Performance, and Fruit Size Distribution of Seedless Watermelon Cultivars in Georgia, 2024
Authors: Kumari Manisha , Dutta Bhabesh , Kaur Navjot , McAvoy Theodore
Published: February 2025

Anthracnose, caused by Colletotrichum orbiculare, is a destructive disease of watermelon. Symptoms include small yellow spots on leaves that spread and darken to black, stem lesions, and fruit rot with sunken, black lesions. This study, conducted at the University of Georgia Tifton Campus in 2024, evaluated eight seedless watermelon cultivars for resistance to anthracnose race 1, with ‘Black Diamond’ as the susceptible check and ‘Charleston Grey’ as the resistant check. Disease severity and yield were assessed. The study revealed no significant differences in disease resistance among cultivars but revealed significant variations in fruit size distribution, highlighting the need for market-based cultivar selection.
Comparative Response of Tomato and Pepper to 1, 3-Dichloropropene and Fluopyram for Root-Knot Nematode Management in Georgia, Spring 2023
Authors: Afroz Tania , Poudel Nabin , Torres Luis , Chowdhury Intiaz Amin
Published: February 2025

Southern root-knot nematodes (Meloidogyne incognita) are sedentary endoparasites that thrive in sandy soils and plasticulture systems, severely impacting vegetable yields. In Georgia, vegetable growers often plant multiple crops on the same plastic mulch across multiple seasons, with tomato (Solanum lycopersicum) or pepper (Capsicum annuum) commonly selected as the first crop. We evaluated the susceptibility of pepper cultivar ‘Regulator’ and tomato cultivar ‘STM2255’ to root-knot nematodes, with and without 1,3-dichloropropene and fluopyram. While pepper treatments had numerically lower nematode density than tomato, both 1,3-dichloropropene and fluopyram significantly reduced nematode density and galling severity at harvest, demonstrating their effectiveness for nematode management.
Clinical Considerations for Engagement and Retention of Nonabstinent Patients in Care
Authors: Boyle Maureen P. , Gibson Eman , Lien Jackie , Manages Samuela , Mohr Sarah , Ryan Colleen , Tsai Gary
Published: February 2025

Despite the overall low rates of treatment participation, patients with substance use disorders (SUD) are regularly dissuaded from initiating treatment until they are willing and able to commit to sustained abstinence from all substances. To improve population outcomes, it is important to reach those who are not engaged in treatment and increase retention of those who do engage in care. To do this, treatment providers must proactively engage individuals in care, including those who are uninterested or ambivalent about treatment, and design services with the intention of increasing patient retention.
Long-term survival of an ALK fusion lung adenocarcinoma patient with high mutation burden and microsatellite instability high: a case report
Authors: Guo Yanrong , Zhai Jinfang , Yang Yanli , Wei Qin , Li Shengshu , Huo Rujie , Tong Guoping , Xu Enwei , Chen Yan , Han Songyan , Chen Deyi
Published: February 2025

Immune checkpoint blockage (ICB) therapy has shown minimal effectiveness in anaplastic lymphoma kinase (ALK)-positive nonsmall cell lung cancer (NSCLC) regardless of Programmed death-ligand 1 expression. ALK fusion accompanied by mismatch repair deficiency or microsatellite instability-high (MMRd/MSI-H) and high tumor mutation burden (TMB-H) are extremely rare in NSCLC, and the efficacy of ALK inhibitors or ICB-based therapies is unclear. Here, we report the case of a 60-year-old female patient with metastatic lung adenocarcinoma accompanied by EML4-ALK fusion, TMB-H, MMRd/MSI-H, and pathogenic mutations in TP53, MLH1, and STK11. The patient experienced progression on initial iruplinalkib and subsequent alectinib therapy within 5 months. After the failure of third-line therapy with cisplatin-pemetrexed combined with bevacizumab, she received sintilimab plus anlotinib which led to a progression-free survival of 6.5 months. She received sintilimab combined with albumin-paclitaxel plus carboplatin and achieved partial response after 6 months. She developed adverse events after one cycle of sintilimab plus albumin-paclitaxel treatment. Then she was continued with sintilimab plus anlotinib as a maintenance therapy due to intolerance to chemotherapy. After progression on ICB-based therapy, the patient was treated with lorlatinib and still under follow-up with overall survival of more than 3 years. Our findings highlight the therapeutic potential of ICB-based regimens in patients with MSI-H and ALK-rearranged NSCLC.
The Professional Agency in Supervision of General Practitioners Before Their Supervisor Training Module: A Narrative Positioning Analysis
Authors: Salokangas Katri , Vehviläinen Sanna , Tusa Nina , Malinen Anita , Mäntyselkä Pekka
Published: February 2025

Introduction:

Supervising in the workplace plays a key role in increasing the skills of the trainee. The shift to competence-based medical education requires both clinical expertise and pedagogical skills from the supervisor. These are distinct types of expertise. We know only a little of how competencies of supervising develop in medical education. The aim of our study is to find out what kind of professional agency in supervision general practitioners describes before their supervisor training. Professional agency refers to the individual's skills, willingness, ability, and responsibility to act with others in the professional context.

Methods:

Our participants wrote a presentation of themselves before starting a supervisor training module. We studied these texts with narrative positioning analysis to examine who they are as supervisors, that is, the kind of professional agency they describe.

Results:

We found three types of descriptions of professional agency: traditional master-apprenticeship supervision, clinical skills supervising with a collegial relationship, and process-oriented dialogical supervision. Supervising is mostly described as supervising the trainee on clinical skills and participants have a will to be a good supervisor, but they also express uncertainty of achieving this goal.

Conclusion:

The variation in general practice supervisors' agency and pedagogical skills poses challenges for training providers in how to tailor the training to suit the best to participants with different skills. However, it gives an excellent opportunity for fruitful peer-to-peer learning. With our findings, it is possible to further develop supervisor training.
Exploring the impact of climatic variations on infectious gastroenteritis and a review of current antiviral vaccines
Authors: Saleem Muhammad Meeran , Noor Ashmal , Hashmi Basil , Zubair Muhammad Siddiq , Hojeij Moussa
Published: February 2025

Weather and seasonal changes are recognized contributors to the prevalence of infectious diseases, including gastroenteritis, particularly in developing countries. Infectious gastroenteritis, characterized by symptoms such as diarrhea, vomiting, and abdominal pain, is predominantly caused by pathogens like rotavirus and norovirus. Environmental changes, such as abrupt temperature drops and heavy rainfall, facilitate the proliferation and transmission of these pathogens. Studies reveal a significant correlation between low temperatures, increased rainfall, and higher hospitalization rates for rotavirus and norovirus infections. Developing countries face compounded challenges due to financial constraints, inadequate healthcare infrastructure, poor sanitation, and malnutrition, which exacerbate disease burden. Preventive measures, particularly vaccinations, have proven effective in mitigating viral gastroenteritis. Rotavirus vaccines, such as RotaTeq™ and Rotarix™, have demonstrated efficacy in reducing disease severity and hospitalization rates. However, norovirus vaccine development remains complex due to genetic diversity, rapid mutation rates, and the absence of standardized models for testing efficacy. Promising candidates like HIL-214, a bivalent VLP vaccine, and novel approaches such as plant-based vaccines and recombinant adenovirus platforms have shown potential in preclinical and early clinical trials. Notable advancements include immunization strategies employing double-stranded RNA adjuvants and the use of gnotobiotic pig models to study vaccine efficacy. This study underscores the urgent need for enhanced research into the interplay between weather patterns and gastroenteritis incidence. Addressing vaccine development challenges is crucial to mitigating the global health burden of infectious gastroenteritis in the face of climate change.
Tracheal Reconstruction With a Clavicle-attached Sternocleidomastoid Muscle Flap Tolerant to Positive Pressure Ventilation
Authors: Uchida Mayuka , Oka Aiko , Watanabe Shiho , Ochiai Hiroko
Published: February 2025

Posttracheostomy wound allows for spontaneous closure of the fistula once it is no longer needed. However, a surgical closure is required when closure does not occur spontaneously. To date, only cases involving patients with spontaneous respiration have been reported. Here, we report successful treatment of a 29-year-old man with extensive tracheal wall tissue defects after tracheostomy, which allowed for the continuation of noninvasive positive pressure ventilation (NPPV) therapy. In this case, the patient presented with loss of spontaneous breathing resulting due to a cervical 4 (C4)-level spinal cord injury. After initial closure of the tracheostomy site, the patient developed an anterior neck abscess and a tracheocutaneous fistula associated with ongoing NPPV therapy. Multiple attempts to close the tracheostomy site resulted in extensive tracheal cartilage defects. In this case, we reconstructed the tracheal wall and neck soft tissue using a clavicle-attached pedicled sternocleidomastoid flap to provide a strong repair of the defect. As a result, the patient was able to continue noninvasive NPPV therapy, with no complications observed over the course of 8 years. This method for tracheal reconstruction provides the necessary strength to withstand NPPV therapy and could be recommended as an effective option in similar cases.
An examination of acrylamide and cadmium as possible mediators of the association between cigarette smoking and chronic musculoskeletal pain
Authors: Djade Codjo Djignefa , Diorio Caroline , Laurin Danielle , Talbot Denis , Carmichael Pierre-Hugues , Dionne Clermont E.
Published: February 2025

Chronic musculoskeletal pain (CMP) causes significant health loss worldwide and is one of the major public health issues of our time. Cigarette smoking is an independent risk factor of CMP. The present study examined the potential mediating role of 2 subproducts of cigarette smoke, acrylamide and cadmium, individually and combined, on the association between cigarette smoking and CMP, using the Inverse Odds Ratio Weighting (IORW) method. Analyses were conducted on data from 3670 adults who participated to National Health and Nutrition Examination Surveys 2003 to 2004. When smoking was measured with serum cotinine levels, there was an association of moderate and heavy smoking {adjusted Odds Ratio [aOR]>30 ng/mL = 1.99 (95% confidence interval [CI]: 1.44-2.74)} with CMP, but no association between light smoking and CMP (aOR1-30 ng/mL = 1.17 [95% CI: 0.75-1.80]) as compared to nonsmoking. Small indirect effects were identified through acrylamide (aOR = 1.24 [95% CI: 0.96-1.61]) and cadmium (aOR = 1.56 [95% CI: 0.92-2.63]) only among moderate and heavy smokers. When both biomarkers were considered together, their indirect effect was larger (aOR = 2.07 [95% CI: 1.32-3.23]). These results suggest that the association between cigarette smoking and CMP is mediated by acrylamide and cadmium and that these substances, also present in food and the environment, may serve as biomarkers of CMP.
Assessing the Impact of Media Coverage of the NordICC Trial on Public Perspectives on Colonoscopy for Colorectal Cancer Screening
Authors: Sharabi Eden , Mathur Kushagra , Choi So Yung , Hollander Barbara , Spiegel Brennan , Almario Christopher V.
Published: February 2025

Introduction:

Screening tests like colonoscopy can prevent colorectal cancer (CRC), yet their effectiveness is often questioned. The Nordic-European Initiative on Colorectal Cancer (NordICC) trial demonstrated that colonoscopy significantly reduces CRC incidence and mortality in per-protocol analysis. However, media coverage of the trial often focused on intention-to-screen findings that showed no change in mortality, possibly contributing to public confusion about colonoscopy benefits. This study aimed to assess whether such media articles undermined public perception and intent to undergo colonoscopic screening.

Methods:

We recruited a US nationally representative sample of unscreened adults aged 45 to 75 years at average CRC risk. Respondents were randomized 1:1 to read either a low-quality or high-quality article on NordICC, as rated by a panel of gastroenterologists. Before and after reading their article, participants reported whether they plan to be screened for CRC with a colonoscopy. Our primary outcome was a negative change in intent to undergo colonoscopic screening.

Results:

Among the 2013 participants who completed the survey, 1531 (76.1%) stated they planned to undergo colonoscopy or were undecided before reading the article. After reading the media report, 90 (12.0%) people in the low-quality article arm no longer planned to undergo colonoscopy versus 73 (9.3%) in the high-quality article arm; the difference was not statistically significant (P=0.08).

Discussion:

A widely promulgated article about NordICC rated as low-quality did not differentially impact attitudes towards colonoscopic CRC screening compared with another mainstream article rated as high-quality. Our study provides reassurance that most people will not summarily change health behaviors after reading a single article, regardless of perceived accuracy.
Interpretation and implementation of adult diagnostic reference levels in nuclear medicine and positron emission tomography in the UK
Authors: Fraser Louise , Parkar Nasreen , Powell Amina , Richardson Mark
Published: February 2025

In the UK, the Administration of Radioactive Substances Advisory Committee (ARSAC) sets National Diagnostic Reference Levels (NDRLs) for diagnostic nuclear medicine (NM) and PET procedures. The NDRLs are published by ARSAC. This article summarises how these NDRLs should be applied and used within the UK and proposes a new model on how they are set. As an exemplar, the results of a recent survey of administered activities in the UK for 18F-fluorodeoxyglucose (FDG) for whole-body tumour imaging and infection inflammation imaging are presented here. ARSAC recommends that the UK NDRLs for NM or PET examinations are set as either a fixed activity (MBq) or by administered activity per body weight (MBq/kg). ARSAC proposes setting the first weight-based activity scaling NDRLs for 18F-FDG whole-body tumour imaging and 18F-FDG infection inflammation imaging to 3.5 MBq/kg.
Knowledge, attitude, and practices regarding use of artificial intelligence for medical writings among doctors of Khyber Pakhtunkhwa, Pakistan: a cross-sectional study
Authors: Sajjad Waseem , Inam Areeba , Ahmed Bilal , Zahir Mohammad , Mujtaba Ali , Khan Zoha , Saddique Muhammad Nabeel , Iqbal Javed , Nasrallah Jamil
Published: February 2025

Background and objectives:

Artificial intelligence (AI) is a cutting-edge technology affecting all eras of science and technology and medicine, which is not an exception. Medical writings play a significant role in improving health standard and patient outcomes owing to their global dissemination. AI has widely affected medical writings. This study aims to determine the knowledge, attitude, and practices among the doctors of Khyber Pakhtunkhwa (KPK) regarding the use of artificial intelligence (AI) in medical writings. Medial writings cover a broad horizon of writings ranging from simple medical reports and prescription and extending to impactful article writings and evidence-based research papers as well as figure and graph generation for these papers using the input data.

Materials and methods:

It is a questionnaire-based cross-sectional study involving convenience non-probability sampling. The questionnaire contained a total of 29 items with subsequent portions of knowledge assessment containing 11 items, the attitude assessment comprised 10 items, and the practice assessment involved eight items. Being the first study of its kind, a conservational approach was adopted for sample size determination, and initially, the calculated sample was 385 using an online sample size calculator. The final sample size adopted was 500 to avoid any discrepancies owing to small sample size. The study setting was KPK, a province of Pakistan, and the study population was the medical doctors practicing in KPK. SPSS 28 was used for data analysis. Frequency, percentage, correlation, and regression analysis were used.

Results:

Out of 500 respondents, 135 were females and 365 were males. The overall data suggest a high level of knowledge regarding AI in medicine (91.2%). The use of AI was about 30.6%, highlighting a gap that needs to be addressed. The majority of doctors agreed on the impact of AI in medical writing (92.5%), indicating a positive attitude toward promotion within the community. The Pearson coefficient showed statistically significant values. Regression analysis with P-value < 0.001 also supported the hypothesis.

Conclusion:

The study revealed a positive perception of AI in medical writing, recognizing its potential for efficiency and quality improvement. However, respondents expressed concerns about AI authorship, ethics, privacy, and bias, leading to low adoption. The findings underscore the necessity for education, training, and clear guidelines to responsibly integrate AI into medical writing, ensuring ethical use and advancing the field with informed practices.
Strategies for reducing child mortality due to sickle cell disease in Uganda: a narrative review
Authors: Obeagu Emmanuel Ifeanyi
Published: February 2025

Sickle cell disease (SCD) remains a significant contributor to child mortality in Uganda, with an estimated 80% of children born with SCD dying before their fifth birthday, largely due to lack of early diagnosis and inadequate access to comprehensive care. Neonatal screening, although critical for early detection, is limited in Uganda, with coverage rates below 10%. This lack of early diagnosis often leads to delayed treatment and higher mortality rates. Data from recent studies highlight that implementing universal newborn screening could reduce SCD-related mortality by up to 50% if coupled with timely interventions such as prophylactic antibiotics, vaccination, and parental education. Comprehensive care, which includes regular health check-ups, preventive care, pain management, and access to blood transfusions, is essential for improving survival rates among children with SCD. However, in Uganda, only 30% of children with SCD receive regular follow-up care, and access to life-saving interventions like blood transfusions remains limited, especially in rural areas. A study conducted in Uganda found that children with SCD who received regular blood transfusions had a 70% lower risk of stroke and other severe complications compared to those who did not. Strengthening healthcare infrastructure and increasing access to these critical services are crucial to reducing mortality. Community engagement and education play a vital role in reducing SCD-related child mortality. Despite the high burden of SCD, awareness levels among Ugandan communities remain low, contributing to delayed healthcare-seeking behavior and high mortality rates.
Lesser Occipital Nerve Decompression Through a Single Vertical Midline Incision Reduces Reoperation Rates
Authors: Remy Katya , Mullen Conor , Hazewinkel Merel HJ , DePamphilis Matthew A. , Austen William G , Hagan Robert R , Gfrerer Lisa
Published: February 2025

Introduction:

Nerve decompression surgery for occipital neuralgia (ON) of the lesser occipital nerve (LON) is oftentimes performed in combination with treatment of the greater and third occipital nerves (GON and TON). The traditional surgical approach requires multiple separate incisions. This study describes combined GON/LON approach through a single vertical midline incision and reports on the postoperative outcomes.

Methods:

Among 1713 patients who were screened for nerve decompression surgery between 2011 and 2023, those who underwent combined GON/LON decompression for treatment of ON were identified retrospectively. Patients who underwent LON decompression through the vertical midline incision were compared to those who underwent LON decompression through a separate incision. Outcomes included postoperative complications, LON reoperation, pain frequency (days/month), intensity (scale 0-10), duration (hours), and Migraine Head Index (MHI) at final follow-up.

Results:

A total of 124 patients underwent 184 combined GON/LON surgeries. LON decompression was performed through a midline incision in 91 (73.4%) patients and through a separate incision in 33 (26.6%). LON reoperation rates for pain recurrence were higher in the separate incision group as compared to the midline incision group (15.2% versus 4.4%, p<0.05). At a median follow-up of 17.9 months after the last intervention, reductions in pain frequency, intensity, duration and MHI were comparable between both techniques (p>0.05). Postoperative complications were not significantly different between both groups (p>0.05).

Conclusion:

During combined GON/LON surgery, approaching the LON through the midline incision is feasible and allows for safe and effective LON decompression or neurectomy, with lower reoperation rates for recurrent pain.
Jointed tails enhance control of three-dimensional body rotation
Authors: Fu Xun , Zhang Bohao , Weber Ceri J. , Cooper Kimberly L. , Vasudevan Ram , Moore Talia Y.
Published: February 2025

Tails used as inertial appendages induce body rotations of animals and robots—a phenomenon that is governed largely by the ratio of the body and tail moments of inertia. However, vertebrate tails have more degrees of freedom (e.g. number of joints and rotational axes) than most current theoretical models and robotic tails. To understand how morphology affects inertial appendage function, we developed an optimization-based approach that finds the maximally effective tail trajectory and measures error from a target trajectory. For tails of equal total length and mass, increasing the number of equal-length joints increased the complexity of maximally effective tail motions. When we optimized the relative lengths of tail bones while keeping the total tail length, mass and number of joints the same, this optimization-based approach found that the lengths matched the pattern found in the tail bones of mammals specialized for inertial manoeuvring. In both experiments, adding joints enhanced the performance of the inertial appendage, but with diminishing returns, largely due to the total control effort constraint. This optimization-based simulation can compare the maximum performance of diverse inertial appendages that dynamically vary in a moment of inertia in three-dimensional space, predict inertial capabilities from skeletal data and inform the design of robotic inertial appendages.
Cohesive urban bicycle infrastructure design through optimal transport routing in multilayer networks
Authors: Lonardi Alessandro , Szell Michael , De Bacco Caterina
Published: February 2025

Bicycle infrastructure networks must meet the needs of cyclists to position cycling as a viable transportation choice in cities. In particular, protected infrastructure should be planned cohesively for the whole city and spacious enough to accommodate all cyclists safely and prevent cyclist congestion—a common problem in cycling cities like Copenhagen. Here, we devise an adaptive method for optimal bicycle network design and for evaluating congestion criticalities on bicycle paths. The method goes beyond static network measures, using computationally efficient adaptation rules inspired by optimal transport on the dynamically updating multilayer network of roads and protected bicycle lanes. Street capacities and cyclist flows reciprocally control each other to optimally accommodate cyclists on streets with one control parameter that dictates the preference of bicycle infrastructure over roads. Applying our method to Copenhagen confirms that the city’s bicycle network is generally well-developed. However, we are able to identify the network’s bottlenecks, and we find, at a finer scale, disparities in network accessibility and criticalities between different neighbourhoods. Our model and results are generalizable beyond this particular case study to serve as a scalable and versatile tool for aiding urban planners in designing cycling-friendly cities.
Angular distribution of fractal temporal correlations supports adaptive responses to wobble board instability
Authors: Schlattmann Brian , Kiyono Ken , Kelty-Stephen Damian G. , Mangalam Madhur
Published: February 2025

Contemporary dynamical models of human postural control propose an intermittent controller regulating the postural centre of pressure (CoP) about a stable saddle-shaped manifold along anatomical anteroposterior (AP) and mediolateral (ML) axes, releasing CoP in an outwards spiral when inactive. Experimental manipulations can evoke this saddle-type topology in fractal temporal correlations along the AP axis and reducing correlations along the ML axis. However, true effects of task demands may often manifest within angular space between anatomical AP and ML axes—a space not typically modelled explicitly. We tested how instability and attentional load influence postural control across the full angular range of fractal variability along the two-dimensional (2D) support surface. Forty-eight healthy young adults performed a suprapostural Trail Making Test (TMT) while standing on a wobble board, inducing continuous perturbations along the ML axis. Stable, quiet standing exhibited classic saddle-like topology, with stronger fractal temporal correlations in CoP displacements along AP axes. The attentional demand of the TMT did not affect angular variation or strength of fractal temporal correlations across the 2Dsupport surface. However, maintaining upright balance on the wobble board reshaped and reoriented the angular distribution of fractal temporal correlations, accentuating saddle-like angular variation and rotating the strongest fractal temporal correlations predominantly along the ML axis. Stabilizing posture in the face of wobble board instability prompted the saddle-type angular distribution of fractal temporal correlations. These findings challenge the traditional dependence of postural control theories exclusively on external force-plate axes and underscore the significance of multifractality in defining control parameters that govern postural stability across the full angular range of the 2D support surface.