bluuebunny/crossref_metadata_2025 huggingface dataset:
Repair of Traumatic Uterine Avulsion of a Gravid Uterus
Authors: Psaromatis Kirie M. , Lopez Ashley R. , Murray Amanda M.
Published: February 2025

BACKGROUND:

Although the fundus is the most likely location of rupture in the gravid uterus, the isthmus is the weakest point, leaving it vulnerable to avulsion during blunt pelvic trauma. We describe a case of uterine avulsion in a gravid patient that was repaired in an attempt to preserve future fertility.

CASE:

A 19-year-old primigravid woman in her second trimester presented with uterine body avulsion from the cervix after motor vehicle collision. After evacuation of the pregnancy, repair consisted of circumferential interrupted sutures with digital confirmation of cervical patency. On follow-up imaging, normal anatomy appeared restored, with no residual abnormalities noted. We recommended the use of long-acting reversible contraception postoperatively, as well as special considerations for future pregnancies, such as prelabor caesarean delivery and maternal–fetal medicine subspecialist referral.

CONCLUSION:

A gravid uterus may be particularly prone to avulsion at the isthmus, and similar techniques as those described previously in cases of nongravid uterine avulsion may be used in an attempt to preserve future fertility.
Escalation of Oxygenation Modalities and Mortality in Critically Ill Immunocompromised Patient With Acute Hypoxemic Respiratory Failure: A Clustering Analysis of a Prospectively Multicenter, Multinational Dataset
Authors: Yvin Elise , Kouatchet Achille , Mokart Djamel , Martin-Loeches Ignacio , Taccone Fabio Silvio , Pène Frederic , Bauer Philippe R. , Séguin Amélie , van de Louw Andry , Mabrouki Asma , Bredin Swann , Metaxa Victoria , Klouche Kada , Montini Luca , Mehta Sangeeta , Bruneel Fabrice , Lisboa Tiago , Viana William , Pickkers Peter , Russell Lene , Rusinova Katherina , Rello Jordi , Barbier Francois , Clere-Jehl Raphael , Lafarge Antoine , Lemiale Virginie , Mercat Alain , Azoulay Elie , Darmon Michael
Published: February 2025

Objectives:

Acute hypoxemic respiratory failure in immunocompromised patients remains the leading cause of admission to the ICU, with high case fatality. The response to the initial oxygenation strategy may be predictive of outcome. This study aims to assess the response to the evolutionary profiles of oxygenation strategy and the association with survival.

Design:

Post hoc analysis of EFRAIM study with a nonparametric longitudinal clustering technique (longitudinal K-mean).

Setting and Patients:

Multinational, observational prospective cohort study performed in critically ill immunocompromised patients admitted for an acute respiratory failure.

Interventions:

None.

Measurements and Main Results:

A total of 1547 patients who did not require invasive mechanical ventilation (iMV) at ICU admission were included. Change in ventilatory support was assessed and three clusters of change in oxygenation modality over time were identified. Cluster A: 12.3% iMV requirement and high survival rate, n = 717 patients (46.3%); cluster B: 32.9% need for iMV, 97% ICU mortality, n = 499 patients (32.3%); and cluster C: 37.5% need for iMV, 0.3% ICU mortality, n = 331 patients (21.4%). These clusters demonstrated a high discrimination. After adjustment for confounders, clusters B and C were independently associated with need for iMV (odds ratio [OR], 9.87; 95% CI, 7.26–13.50 and OR, 19.8; 95% CI, 13.7–29.1).

Conclusions:

This study identified three distinct highly performing clusters of response to initial oxygenation strategy, which reliably predicted the need for iMV requirement and hospital mortality.
Association of Hypocalcemia and Mean Arterial Pressure With Patient Outcome in ICU
Authors: Li Fang-yuan , Chen Yan , Zhou Xiang , Su Long-xiang , Long Yun , Weng Li , Du Bin ,   on behalf of China National Critical Care Quality Control Center Group and China Critical Care Clinical Trials Group (CCCCTG)
Published: February 2025

Objectives:

We aimed to verify the relationship between hypocalcemia in the first 24 hours of ICU admission and mortality, we also hypothesized that blood pressure and blood pressure reactivity are associated with ionized calcium (iCa) and might have mediation effects in the iCa-mortality association.

Design:

Retrospective, observational study.

Setting:

ICUs in a general hospital.

Patients:

Nonhypercalcemia adult patients were divided into two groups based on mean iCa within the first 24 hours after ICU admission using a cutoff of 1.1 mmol/L.

Interventions:

None.

Measurements and Main Results:

A total of 4947 patients from Peking Union Medical College Hospital between January 2013 and December 2022 were included in the study, with 2160 (43.7%) suffering from hypocalcemia. Overall, the median (interquartile range) age was 61 years (49–71 yr), with 2824 (57.1%) being female. Time-weighted average mean arterial pressure (TWA-MAP) above 0 and 65 mm Hg, respectively, during the first 24 hours were used to analyze the MAP of each patient and TWA-MAP/norepinephrine (TWA-MAP/NE) dose was calculated to examine blood pressure reactivity. Among 4091 patients eligible for multivariate analysis, iCa was independently associated with ICU mortality (odds ratio, 0.17; 95% CI, 0.04–0.79; p < 0.05). Both the blood pressure parameter (TWA-MAP above 0 mm Hg [TWA-MAP-0]) and pressure reactivity parameter (TWA-MAP-0/weight-adjusted dose of norepinephrine infusion in the first 24 hr after ICU admission [TWA-MAP-0/NE]) mediated the outcome of ICU mortality with a proportion of 4.55% (95% CI, 0.16–17%; p < 0.05) and 2.6% (95% CI, 0.02–11%; p < 0.05), respectively. TWA-MAP-0 correlated positively with iCa (Spearman rank test, ρ = 0.17; p < 0.01) while no significant association was found between iCa and TWA-MAP-0/NE (Spearman rank test, ρ = –0.07; p < 0.01).

Conclusions:

In this retrospective study on nonhypercalcemia patients, iCa of the first 24 hours after admission was independently associated with ICU mortality, which was potentially mediated by TWA-MAP and blood pressure reactivity (TWA-MAP/NE). iCa was also positively associated with TWA-MAP, while no general relationship was found between iCa and TWA-MAP/NE.
One-Year Mortality and Hospital Readmission in Survivors of COVID-19 Critical Illness—A Population-Based Cohort Study
Authors: Fernando Shannon M. , Qureshi Danial , Ante Zharmaine , Talarico Robert , McIsaac Daniel I. , Urner Martin , Munshi Laveena , Rochwerg Bram , Needham Dale M. , Hodgson Carol L. , Brodie Daniel , Fowler Robert A. , Slutsky Arthur S. , Scales Damon C. , Herridge Margaret S. , Tanuseputro Peter , Fan Eddy
Published: February 2025

Objectives:

To evaluate 1-year outcomes (mortality, and recurrent hospital and ICU readmission) in adult survivors of COVID-19 critical illness compared with survivors of critical illness from non-COVID-19 pneumonia.

Design:

Population-based retrospective observational cohort study.

Setting:

Province of Ontario, Canada.

Patients:

Six thousand ninety-eight consecutive adult patients (≥ 18 yr old) from 102 centers, admitted to ICU with COVID-19 (from January 1, 2020, to March 31, 2022), and surviving to hospital discharge.

Interventions:

None.

Measurements and Main Results:

The primary outcome was 1-year mortality. We also evaluated the number of emergency department (ED) visits, hospital readmissions, and ICU readmissions over this same time period. We compared patients using overlap propensity score-weighted, cause-specific proportional hazard models. Mean age was 59.6 years and 38.5% were female. Of these patients, 1610 (26.4%) and 375 (6.1%) were readmitted to hospital and ICU, respectively, and 917 (15.0%) died within 1 year. Compared with survivors of critical illness from non-COVID-19 pneumonia (n = 2568), those who survived COVID-19 critical illness had a lower risk of ED visit (hazard ratio [HR], 0.65 [95% CI, 0.60–0.71]), hospital readmission (HR, 0.56 [95% CI, 0.51–0.62]), ICU readmission (HR, 0.44 [95% CI, 0.37–0.53]), and mortality (HR, 0.67 [95% CI, 0.58–0.78]) within 1 year.

Conclusions:

Risk of ED visit, hospital readmission, ICU readmission, and mortality within 1 year of discharge among survivors of COVID-19 critical illness was lower than survivors of critical illness from non-COVID-19 pneumonia.
The History of Angina and Its Remedies: COURAGE, ORBITA, and a Path Forward
Authors: Dasaro Christopher , Mandrola John , Murthy Venkatesh , Prasad Vinay
Published: February 2025

The recent publication of the second Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina trial has renewed debate surrounding the indications and benefits of percutaneous coronary intervention (PCI) in stable angina. The second Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina results show that PCI improves anginal symptoms in the absence of antianginal medications. Taken together with the first Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina and Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial results, proponents argue that in contrast to current guidance, PCI and aggressive medical therapy are both equally acceptable initial antianginal strategies and subject to patient preference. Drawing on the history of randomized studies of interventional management for stable angina, we detail our reservations with this interpretation. More broadly, we highlight the merits of elegantly designed sham-controlled trials in answering lingering clinical questions. Finally, we offer select frameworks for more conclusive trials designed to answer the looming question that cardiologists face: does the landscape of randomized evidence support a medication-first, PCI-first, or shared decision-making treatment paradigm in stable angina?
The hypotension prediction index versus mean arterial pressure in predicting intraoperative hypotension
Authors: Rellum Santino R. , Noteboom Sijm H. , van der Ster Björn J.P. , Schuurmans Jaap , Kho Eline , Vlaar Alexander P.J. , Schenk Jimmy , Veelo Denise P.
Published: February 2025

BACKGROUND

The hypotension prediction index (HPI) predicts hypotension, with randomised trials showing a significant reduction in hypotension-related metrics. However, the reliability of previous validation studies is debated, and it's unclear if mean arterial pressure (MAP) can be used interchangeably with HPI.

OBJECTIVES

This study compared the effectiveness of HPI versus MAP thresholds in predicting intraoperative hypotension, focusing on three clinically relevant metrics: time from alert to event, positive predictive value (PPV), and proportion of missed hypotensive events.

DESIGN

Prospective observational study conducted between 2018 and 2020.

SETTING

Single-centre, academic hospital in the Netherlands.

PARTICIPANTS

Adults scheduled for elective non-cardiac surgery lasting over two hours. Of the 105 eligible patients, 91 had sufficient data for analysis.

MAIN OUTCOME MEASURES

The primary outcome was the time-to-hypotensive event intervals predicted by HPI popup alerts (≥85 for ≥40 s) and MAP-alerts (70–75 mmHg). Secondary analyses examined differences between these predictors regarding the PPV and missed event rates, as well as the difference in these metrics between instant HPI-85 alerts and the six MAP-alerts.

RESULTS

The largest time-to-event difference was seen between HPI-85 popup and MAP-70 alerts, with a gain of 0.58 (95% confidence interval (CI), 0.57 to 0.58) min, favouring HPI. Higher MAP thresholds reduced this time difference, but worsened PPV values, with 20.5 (95% CI, 20.3 to 20.6)% at MAP-75 compared to 55.6 (95% CI, 55.4 to 55.8)% for HPI-85 popups. Missed event proportions were similar: between one to three percent. Instant HPI-85 and MAP-72 alerts showed comparable performance, but both had suboptimal PPV values around 30%. However, adding a 40-s time-dependence to MAP's alert definition levelled the differences across the three evaluated metrics, aligning more closely with HPI-85 popup alerts.

CONCLUSIONS

Using HPI-85 popup alerts does not provide additional prediction time over MAP-alerts in the 70 to 75 mmHg range, but they may be preferred due to higher PPV values. Instant HPI-85 and MAP-alerts perform similarly, with MAP-72 being closest, though these alerts more frequently occur regardless of subsequent hypotension with the potential to introduce unnecessary treatment. Adding a 40-s time-dependence to MAP-alerts to match the HPI popup characteristic eliminates distinctions between prediction time and missed events, while maintaining the higher PPV. However, whether 40sec-MAP-alerts are clinically equivalent remains to be determined in prospective clinical trials.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT03795831) on 10 January 2019. https://clinicaltrials.gov/study/NCT03795831
Impact of self-expandable metal stent deployment site on stent dysfunction during EUS-guided hepaticogastrostomy
Authors: Ogura Takeshi , Ueno Saori , Okuda Atsushi , Nishioka Nobu , Sakamoto Jun , Yamada Masanori , Yamamura Masahiro , Uba Yuki , Tomita Mitsuki , Hattori Nobuhiro , Nakamura Junichi , Bessho Kimi , Nishikawa Hiroki
Published: February 2025

Background and Objectives

Hyperplasia at the distal side of an EUS–guided hepaticogastrostomy (HGS) stent is one of the most frequent causes of stent dysfunction. However, risk factors for hyperplasia during EUS-HGS remain unclear. The aim of the present study was to determine the most appropriate stent site during EUS-HGS to obtain prolonged stent patency.

Method

This study included 100 consecutive patients who underwent successful EUS-HGS using a partially covered, self-expandable, metal stent (PCSEMS) between January 2017 and September 2022. The patients were divided into 2 groups according to the distal site of the PCSEMS at the intrahepatic bile duct, the peripheral side group and the central side group.

Results

There were 30 patients in the peripheral side group and 70 in the central side group. The diameter of the intrahepatic bile duct at the PCSEMS deployment site was significantly greater in the central side group (mean 7.90 mm) than in the peripheral side group (mean 4.25 mm; P < 0.05). Stent patency was significantly longer in the central side group than in the peripheral side group (median, 60 days vs. 144 days, P = 0.011), although overall survival was not significantly different. Hyperplasia was significantly more frequent in the peripheral side group. On multivariate analysis, the site of the PCSEMS (peripheral) was the only risk factor for stent dysfunction.

Conclusions

In conclusion, the distal site of the PCSEMS deployed at the hepatic hilar site from the confluence between B2 and B3 might play a role in obtaining longer stent patency.
Relationship between night eating syndrome, eating disorders, and menopausal symptoms in climacteric women: a pilot study
Authors: Ayar Pelin , Yılmaz Hacı Ömer
Published: February 2025

Objective

The aim of this study was to examine the relationship between night eating syndrome, eating disorders, and menopausal symptoms in climacteric women.

Methods

In this descriptive study, 90 climacteric women who met the inclusion criteria volunteered to participated. The data for the participants were collected via a face-to-face interview method using a sociodemographic and menopause questionnaire, the Eating Disorder Examination Questionnaire, the Night Eating Questionnaire, and the Menopause Rating Scale, and their anthropometric measurements were recorded.

Results

Among all participants, 51.1% had night eating syndrome. However, the night eating syndrome (P = 0.790) and eating disorders (P = 0.634) of the participants did not differ significantly according to the climacteric periods. Menopausal symptoms were found to be higher in perimenopausal and postmenopausal women than in premenopausal women (P = 0.001). There were significant positive correlations between eating disorders and both night eating (r = 0.253 and P < 0.05) and menopausal symptoms (r = 0.291 and P < 0.001). There was no relationship between menopausal symptoms and night eating habits (r = 0.141 and P > 0.05).

Conclusions

Eating disorders were found to be associated with night eating and menopausal symptom severity in climacteric women. There is a need for multidisciplinary studies to measure the risk of occurrence and recurrence of menopausal symptoms and the association with eating disorders experienced by women.
The Use of Stromal Vascular Fraction, Platelet-rich Plasma, and Stem Cells in the Treatment of Thumb Carpometacarpal Osteoarthritis
Authors: Pumberger Peter , Wechselberger Gottfried , Schwaiger Karl , Zimmermann Valentin
Published: February 2025

Background:

Thumb function is integral to hand movement and overall hand function. Impairment, often caused by carpometacarpal (CMC) arthritis, reduces the quality of life. Here, we explored a novel approach using a mixture of the stromal vascular fraction, adipose-derived stem cells, and platelet-rich plasma to treat symptomatic trapeziometacarpal osteoarthritis.

Methods:

Retrospective data from 30 hands of 19 patients classified as Eaton and Littler stages 1–4 were analyzed. Platelet-rich plasma and fat were collected under sterile conditions, followed by centrifugation, stem cell extraction, and injection of the mixture into the thumb CMC joint under x-ray guidance. The measurement parameters included the visual analog scale pain score, grip strength, pinch strength, and Thumb Disability Examination (TDX) score. Statistical analysis was performed using paired t tests to evaluate the outcomes across the entire group, individual stages, and early/late stages.

Results:

We examined 30 hands of 19 patients with trapeziometacarpal osteoarthritis. Pain reduction was significant at 6 and 24 months for all stages, particularly stages 2 and 3. Substantial pain reduction was also observed at the early and late stages. The TDX score decreased significantly in all groups after 6 and 24 months. Hand function notably improved with significant gains in tip-to-tip pinch strength at 24 months and palmar pinch strength at 6 and 24 months. No complications were observed.

Conclusions:

The intra-articular injection of autologous conditioned plasma/stromal vascular fraction in patients with thumb CMC arthritis, in all stages, helps to improve pain symptoms and postpone potential resection arthroplasty with minimal surgical intervention and risks.
Effects of Cardiovascular Rehabilitation on Myocardial Perfusion and Functional Exercise Capacity in Patients With Stable Coronary Artery Disease and Myocardial Ischemia
Authors: Mazzucco Guillermo , Pilón Leonardo , Torres-Castro Rodrigo , Lista-Paz Ana , López Silvana , Chichizola Nicolás , Zapata Gerardo , López Jorge , Berenguel-Senén Alejandro , Arbillaga-Etxarri Ane
Published: February 2025

Purpose:

Myocardial ischemia is prevalent in chronic heart diseases. Cardiac rehabilitation (CR) offers non-pharmacological benefits to reduce hospitalization and mortality, yet its impact on coronary vascular changes remains unclear. We assessed the effects of CR on myocardial perfusion and exercise capacity in patients with stable coronary artery disease and exercise-induced ischemia.

Methods:

We conducted a retrospective observational study in individuals with stable coronary artery disease and myocardial ischemia enrolled in a CR program. Inclusion criteria required a minimum of 3 months of supervised CR and cardiac single-photon emission computed tomography (SPECT) imaging before and after the program. Blinded analysis and interpretation of the SPECT studies was carried out by nuclear cardiologists. The primary outcome was a change in myocardial perfusion via SPECT analysis. Secondary outcomes included changes in exercise capacity, electrocardiographic changes during treadmill stress tests, and evaluation of adverse effects during training. Cinecoronariographies reports were collected for further cardiac status assessment.

Results:

Of 394 patients, 22 with myocardial ischemia were analyzed (96% males, 61.5 ± 9.5 yr). Number of CR sessions ranged from 42 to 73. Stress-induced ischemia significantly decreased (P = .019), with improvements in exercise capacity, including absolute peak oxygen uptake (mL/min, P = .027), relative oxygen uptake (mL/kg/min, P = .044), maximum metabolic equivalent of task (P = .019), and exercise duration (P < .001). No adverse events occurred.

Conclusion:

After a structured CR program of at least 3 months in patients with stable coronary artery disease and exercise-induced ischemia, there was a notable reduction in stress-induced ischemia and enhancements in exercise capacity, highlighting the safety and efficacy of CR in improving myocardial perfusion and exercise tolerance.
Impaired Endothelial Function in Individuals With Post-Acute Sequelae of COVID-19
Authors: Choi Tae Gu , Kim Jae Yeop , Seong Joon Youp , Min Ho Jeong , Jung Yong Joon , Kim Yun Wook , Cho Min Jeong , Kim Hyun Jeong , Kunutsor Setor K. , Heffernan Kevin S. , Jae Sae Young
Published: February 2025

Purpose:

We investigated the presence of impaired endothelial function in individuals with post-acute sequelae of coronavirus disease-2019 (PASC) compared to healthy individuals and explored the efficacy of combined exercise training in restoring or improving endothelial function in those with PASC.

Methods:

Study I was a cross-sectional study which compared endothelial function between individuals with PASC (n = 29, mean age 22.9 ± 3.9 year) and healthy individuals (n = 42, mean age 21.7 ± 2.0 year). Study II, an intervention design, explored if combined exercise training (n = 14) could reverse the decline in endothelial function associated with PASC compared to controls (n = 14). The combined exercise program included aerobic, resistance, and inspiratory muscle training administered for 8 weeks. We measured endothelial function using flow-mediated dilation of the brachial artery and assessed peak oxygen uptake (VO2peak), dyspnea, and fatigue before and after the intervention.

Results:

Individuals with PASC exhibited significantly lower endothelial function compared to healthy controls (4.95 ± 2.0% vs 8.00 ± 2.4%, P < .001). The exercise group showed a significant increase in endothelial function (4.73 ± 1.5% to 7.98 ± 2.4%) as opposed to the control group (5.31 ± 2.5% to 6.30 ± 2.5%) (interaction effect: P = .008), reaching levels similar to those in healthy individuals. Additionally, the exercise group demonstrated improvement in VO2peak (38.3 ± 6.4 ml/min/kg to 42.8 ± 7.3 ml/min/kg, P < .001) and a reduction in dyspnea and fatigue compared to the control group (P < .001).

Conclusions:

Having PASC is associated with impaired endothelial function, but combined exercise training effectively restores it, making it a promising lifestyle intervention for vascular function in PASC.
Cardiovascular and Risk Factor Outcomes for Ethnic Minorities From Cardiac Rehabilitation
Authors: Duggan Sarah , Gallagher Robyn , Zhang Ling , de Melo Ghisi Gabriela Lima , Candelaria Dion
Published: February 2025

Purpose:

To determine the benefits of cardiac rehabilitation (CR) among ethnic minorities for cardiovascular risk factors (systolic blood pressure [BP], exercise capacity, lipids, body fat), mortality, and morbidity, and compare outcomes to majority reference groups.

Review Methods:

We searched electronic databases (Medline, EMBASE, CINAHL, Scopus, Cochrane Library) from inception until September 2023 for studies reporting CR outcomes of ethnic minorities. Meta-analyses were conducted for data that could be pooled using random effects model. Data that were not suitable for meta-analysis were synthesized and reported narratively.

Thirteen studies with a total of 132 109 participants (10 494 from ethnic minorities [8% of total participants]) were included. Patients from ethnic minority groups made improvements in several outcomes post-CR. These outcomes were equivalent to majority groups for systolic BP (Mean Difference [MD] = −0.69: 95% CI, −1.62 to 0.24 mmHg), maximal exercise capacity (MD = −0.10: 95% CI, −0.63 to 0.44 metabolic equivalents of task), total cholesterol (MD = 0.16: 95% CI, −0.01 to 0.33 mmol/L), and low-density lipoprotein cholesterol (MD = 0.25: 95% CI, −0.04 to 0.54 mmol/L). However, ethnic minorities achieved less improvements than the majority for body mass index (MD = −0.31: 95% CI, −0.47 to −0.14 kg/m2) and waist circumference (MD = −1.50: 95% CI, −2.33 to −0.68 cm). Narrative synthesis indicated equivalent outcomes for minorities for all-cause mortality and mean cholesterol, with worse risk of hospitalization at 1 year. Patients from ethnic minorities attending CR achieve equivalent benefits to majority counterparts for multiple risk factors and potentially mortality and morbidity, therefore CR should be strongly promoted. Individual tailoring may be needed to address adiposity and exercise capacity.
New viscochopper design for intracameral viscosurgical device infiltration at the same time of chopping by the nondominant hand
Authors: Nowrouzi Ali
Published: February 2025

NOROOZI viscochopper is a new surgical instrument designed with a precise grasping handle. This viscochopper improves surgical control during intraocular maneuvers with the nondominant hand while the dominant hand maintains irrigation of the phacoemulsification handpiece in the anterior chamber during surgery. This new viscochopper prevents anterior chamber depression or collapse, particularly in challenging situations such as shallow anterior chambers, Fuchs endothelial dystrophy, posterior polar cataracts, rock-hard nucleus piece chattering, posterior capsular rupture, zonular debilities, and intraocular lens exchange. In our design, we use a precise grasping handpiece with a synchronized handle squeeze to facilitate precise grasping and easier infiltration of OVDs by the nondominant hand while chopping or performing other intraocular maneuvers.
Infection prevention and control of epidemic-prone acute respiratory infections in healthcare setting
Authors: Simniceanu Alice , Satta Giovanni
Published: February 2025

Purpose of review

The recent COVID-19 pandemic sparked discussions and highlighted significant gaps on the most appropriate infection prevention and control (IPC) measures when dealing with acute respiratory infections (ARIs). This narrative review aims to provide an overview of the existing international and national guidelines on the IPC measures to control epidemic and pandemic-prone ARIs in healthcare settings.

Recent findings

The WHO has recently produced a report proposing an updated terminology for respiratory pathogens. One of the key outcomes of this consultation was the adoption of the term ‘infectious respiratory particles’ (IRPs). According to the report, IRPs are defined as infectious particles that can be expired from an infected person through activities like breathing, talking, singing, coughing, sneezing, or even spitting. Most notably, there is no longer the clear and traditional distinction between droplet and aerosol based on the cut-off of particle size, but rather a continuum of particle sizes of IRPs.

Among other recommendations, all international guidelines place emphasis on the use of standard and transmission-based precautions when dealing with respiratory viruses. It is important to assess how the new proposed terminology for respiratory pathogens may affect the current existing IPC measures.
Targeting aldosterone to improve cardiorenal outcomes: from nonsteroidal mineralocorticoid receptor antagonists to aldosterone synthase inhibitors
Authors: Helmeczi Wryan , Hundemer Gregory L.
Published: February 2025

Purpose of review

Aldosterone dysregulation plays a major role in the pathogenesis of hypertension, cardiovascular disease, and kidney disease. Traditionally, steroidal mineralocorticoid receptor (MR) antagonists, namely spironolactone and eplerenone, have been the only available options to target aldosterone. Over recent years, a host of promising novel aldosterone-targeted pharmacologic agents have been developed thereby providing new options to mitigate aldosterone-mediated cardiovascular and kidney disease.

Recent findings

Recently, a number of nonsteroidal MR antagonists (finerenone, esaxerenone, and ocedurenone) and highly specific aldosterone synthase inhibitors (baxdrostat, lorundrostat, dexfadrostat, and vicadrostat) have been developed. The early clinical data for these novel medications looks promising regarding their efficacy in improving blood pressure control, preventing adverse cardiovascular outcomes, and slowing chronic kidney disease progression. Moreover, they appear to be generally safe and well tolerated.

In the coming years, nonsteroidal MR antagonists and aldosterone synthase inhibitors are likely to play an increasingly large role in routine medical practice to help improve cardiovascular and kidney outcomes.
Environmental factors trigger pubertal development
Authors: Malave-Ortiz Sofia , Grant Cameron , Shaw Natalie D.
Published: February 2025

Purpose of review

We provide an overview of the secular trend of earlier pubertal development, why there is a growing concern that environmental factors may be to blame, and how these factors may influence the developing reproductive axis.

Recent findings

We highlight recent work suggesting that, in addition to activating sex steroid receptors, environmental compounds may influence neuropeptide receptors and/or epigenetic regulators. We describe recent studies linking air pollution, metals, endocrine disrupting compounds (EDCs), short sleep duration, early life adversity, and stress to pubertal timing.

Pubertal timing is tightly controlled by genetic, epigenetic, and environmental factors. While animal and epidemiological studies have pointed to several potential environmental factors, additional work is necessary to identify the critical levels and developmental windows of exposure as well as the mechanistic underpinnings.
Acute Care Management of Brief Resolved Unexplained Events
Authors: DeLaroche Amy M. , Nama Nassr , Tieder Joel S.
Published: February 2025

A brief resolved unexplained event was defined in 2016 by the American Academy of Pediatrics in their clinical practice guideline. Since introduction of this term, research has characterized the epidemiology, clinical outcomes, and management of patients following a brief resolved unexplained event. Pediatric health care providers should be familiar with the current brief resolved unexplained event literature to minimize unnecessary health care utilization and guide shared decision-making discussions with caregivers.
Large Vessel Vasculitis on 18F-FDG PET/CT in a Patient With Sarcoidosis
Authors: Kulkarni Raksha , Rayamajhi Sampanna Jung , Jadav Vipashyana , Akinlusi Rahman , Ghesani Nasrin
Published: February 2025

Large vessel vasculitis is a rarely reported finding in patients with sarcoidosis. 18F-FDG PET/CT is an effective modality in detecting active sites of inflammation in sarcoidosis. We present a case of systemic sarcoidosis where 18F-FDG PET/CT incidentally detected a rare finding of sarcoid-associated large vessel vasculitis along with cardiac and pulmonary sarcoidosis.
Impact of Bowel Diary Completion and Education on Fecal Incontinence Severity
Authors: Andy Uduak U. , Carper Benjamin , Zyczynski Halina , Sripad Abhishek , Dyer Keisha Y. , Schaffer Joseph , Mazloomdoost Donna , Gantz Marie G. ,   for the NICHD Pelvic Floor Disorders Network
Published: February 2025

Objective

This study aimed to determine the effect of a run-in period on fecal incontinence (FI) symptom severity.

Study Design

This study conducted a planned secondary analysis of the run-in period to a study evaluating the effect of 12-week treatment with percutaneous tibial nerve stimulation versus sham in reducing FI severity in women. All participants completed a 4-week run-in period designed to exclude from randomization women whose symptoms reduced below the eligibility threshold after receiving education on FI and completing bowel diaries. Change in St Mark's (Vaizey) score and weekly FI episodes during the run-in period (week 1 vs week 4) was assessed.

Results

One hundred and eighty-five women completed the run-in period. The mean St Mark's (Vaizey) score was 17.8 ± 2.6 and 16.9 ± 3.5 at week 1 and week 4, respectively. There was no significant change in the St Mark's (Vaizey) score from week 1 to week 4 (mean change, −0.93 [95% CI, −1.56 to −0.31]). The average number of FI episodes per week did not change significantly between week 1 and week 4, nor did other bowel diary measures. Only 11 (6%) women became ineligible for the trial following the run-in period, all of whom had baseline St Mark's (Vaizey) scores of 18 or lower.

Conclusions

Completion of a bowel diary and receiving education on FI during the 4-week run-in period did not significantly affect symptom severity in women with FI. Only 6% of women became ineligible for participation following the run-in period, suggesting that, in a refractory population, a run-in period may have minimal effect.
An introduction to clinical prediction models using logistic regression in acute care surgery research: Methodologic considerations and common pitfalls
Authors: Garwe Tabitha , Choi Jeff
Published: February 2025

Clinical prediction models can enhance timely clinical decision-making when appropriately developed and integrated within clinical workflows. A risk prediction model is typically a regression equation that uses patient risk factor data to estimate the probability of the presence of disease (diagnostic) or its future occurrence (prognostic). Risk prediction models are widely studied in the surgical literature and commonly developed using logistic regression. For a risk prediction model to be useful, it must balance statistical performance and clinical usefulness. This article provides a brief overview of the various methodologic issues to consider when developing or validating a risk prediction model and common pitfalls.
Obesity and Work in Abdominal Surgery
Authors: Childers Christopher P , Petty Abigail M , Selzer Don J , Senkowski Christopher K
Published: February 2025

Background:

Recent analyses have shown that Modifier 22 does not reimburse surgeons for the increased work required to care for the most complex patients. New strategies are needed to identify patients that require additional work to create a financial system that ensures equitable access. Obesity has been identified as a growing and potentially reliable patient risk factor that could be used to identify cases that require additional work.

Study Design:

Using 2022 ACS NSQIP data, this study evaluated 10 common general surgery operations (appendectomy, cholecystectomy, colon/rectal operations, hernia repairs). The primary predictor was BMI category (Normal: 18.5-25, overweight: 25-29.9, class I obesity: 30-34.9, class II obesity: 35-39.9, class III obesity 40-49.9, extreme obesity >=50). Primary outcomes were operative time and composite measures of complications.

Results:

The final sample included 158,692 operations. Across the entire cohort, 22.2% were normal weight and 76.3% were overweight or obese. Overall, operative time was increased by 5.6% (95% CI 4.8-6.3%) for overweight, by 10.6% (CI 9.8-11.5%) for class I obesity, by 14.7% (CI 13.6-15.8%) for class II obesity, by 18.9% (CI 17.6-20.2%) for class III obesity, and by 26.8% (CI 14.1-29.6%) for extreme obesity compared to those with normal BMI. Obesity was associated with higher odds of any complication or serious complication, driven by wound complications, pulmonary emboli, and renal insufficiency.

Conclusion:

Obesity is a growing challenge in abdominal surgery and is associated with increase operative time and risk of complications. The consistency of the magnitude of effect makes it an ideal target for a modifier or add-on code that could identify cases requiring additional work.
Parameter selection and optimization of a computational network model of blood flow in single-ventricle patients
Authors: Taylor-LaPole Alyssa M. , Paun L. Mihaela , Lior Dan , Weigand Justin D. , Puelz Charles , Olufsen Mette S.
Published: February 2025

Hypoplastic left heart syndrome (HLHS) is a congenital heart disease responsible for 23% of infant cardiac deaths each year in the United States. HLHS patients are born with an underdeveloped left heart, requiring several surgeries to reconstruct the aorta and create a single-ventricle circuit known as the Fontan circulation. While survival into early adulthood is becoming more common, Fontan patients often have a reduced cardiac output, putting them at risk for a multitude of complications. These patients are monitored using chest and neck magnetic resonance imaging (MRI), but their scans do not capture energy loss, pressure, wave intensity or haemodynamics beyond the imaged region. This study develops a framework for predicting these missing features by combining imaging data and computational fluid dynamics (CFD) models. Predicted features from models of HLHS patients are compared with those from control patients with a double outlet right ventricle (DORV). We infer patient-specific parameters through the proposed framework. In the calibrated model, we predict pressure, flow, wave intensity (WI) and wall shear stress (WSS). Results reveal that HLHS patients have lower compliance than DORV patients, resulting in lower WSS and higher WI in the ascending aorta and increased WSS and decreased WI in the descending aorta.
Dust production through collisions between small bodies: an application to the G-ring arc
Authors: Lattari V. , Sfair R. , Siqueira P. B. , Schäfer C. M.
Published: February 2025

The G-ring arc of Saturn, confined by the 7:6 corotation eccentric resonance with Mimas, is primarily composed of micrometric particles. These particles, significantly influenced by the solar radiation pressure, are subject to rapid depletion. This study investigates a mechanism for dust replenishment in the arc, specifically analysing collisions between macroscopic bodies and the satellite Aegaeon. Utilizing N-body and smoothed particle hydrodynamics simulations, we assess the dust generation from these impacts, with a focus on the most likely collision parameters derived from the N-body simulations. Our findings indicate that, while collisions among macroscopic bodies are inefficient for dust production, impacts involving Aegaeon are substantially more effective, providing conservative lower limits for dust generation. This mechanism, in conjunction with the natural decay processes and continuous dust generation from impacts, potentially keeps the arc population over thousands of years with a possible variation in brightness.

This article is part of the theme issue ‘Major advances in planetary sciences thanks to stellar occultations’.
Insights into the early evolution of modern avian physiology from fossilized soft tissues from the Mesozoic
Authors: O’Connor Jingmai K.
Published: February 2025

Modern birds (Neornithes) are the mostly highly modified group of amniotes, bearing little resemblance to other extant sauropsids.
Archaeopteryx
, with its nearly modern wings but plesiomorphic skeleton, demonstrated more than 160 years ago that soft tissue specializations preceded skeletal modifications for flight. Soft tissues are thus of great importance for understanding the early evolution of modern avian physiology. Most commonly, traces of the integumentary system are preserved; exceptional discoveries include remnants of organs. Together, these have helped to elucidate the evolution of the lungs, ovaries, plumage and beak in early diverging birds. These fossils reveal that many important adaptations for efficient digestion, high oxygen intake, reduced body mass and improved wing structure, all of which serve to improve aerial capabilities and/or meet the energetic demands of this costly form of locomotion, evolved within the first 20–30 Myr of avian evolution. Soft tissue preservation also provides important clues for understanding the ecology of early diverging birds and may even elucidate the extinction of certain groups. However, the current fossil record of Mesozoic avian soft tissues is almost entirely limited to the Early Cretaceous and thus, discoveries from the Late Cretaceous have the potential to drastically transform our interpretation of the available data.

This article is part of the theme issue ‘The biology of the avian respiratory system’.
Evaluating the Impact of Over-the-Counter Aspirin on the Growth of Selected Intestinal Microbial Strains
Authors: Srinivasan Shivaneesri , Ratnasingam Shalini
Published: February 2025

The human intestinal microbiota varies in composition among individuals and is largely influenced by external factors such as diet, drugs and environment. While it is well-known to play a pivotal role in maintaining gut health, its interactions with non-antibiotic pharmaceuticals remain understudied. This in vitro study evaluates the effects of over-the-counter (OTC) aspirin (Cardiprin) on the growth dynamics of three commensal gut bacterial strains, Escherichia coli, Klebsiella pneumoniae and Enterococcus faecalis. Employing a dual-method approach of disk diffusion assay (DDA) and colony-forming unit (CFU) analysis, the study evaluates aspirin’s effects at physiologically relevant (300 µg/mL) and high (1000 µg/mL) concentrations. DDA demonstrated consistent inhibition zones across all strains and highlighted aspirin’s weak antibacterial potency, while CFU analyses revealed strain-specific responses. At 300 µg/mL of aspirin, E. coli and E. faecalis exhibited growth comparable to baseline while K. pneumoniae uniquely showed enhanced growth. However, at a higher concentration of 1000 µg/mL, growth of all strains were inhibited to different extents. These results underscore the need for further investigation into the therapeutic and unintended effects of oral aspirin on gut microbial growth.
Boosting Hyperalignment Performance with Age-specific Templates
Authors: Zhang Yuqi , Gobbini Maria Ida , Haxby James V. , Feilong Ma
Published: February 2025

Hyperalignment aligns individual brain activity and functional connectivity patterns to a common, high-dimensional model space, resolving idiosyncrasies in functional–anatomical correspondence and revealing shared information encoded in fine-grained spatial patterns. Given that the brain undergoes significant developmental and functional changes over the lifespan, it is likely that certain features in brain functional organization are more prominent in certain age groups than others. In this study, we examined whether age-specific functional templates, as compared to a canonical template, could enhance alignment accuracy across diverse age groups. We used the Cambridge Centre for Ageing and Neuroscience (Cam-CAN) dataset (18 to 87 yo) to build age-specific templates and tested their performance for analyzing data in young and old brains in both the Cam-CAN dataset and the Dallas Lifespan Brain Study (DLBS) dataset (20 to 90 yo). We found the congruent age-specific template outperforms the incongruent template for various analyses, including inter-subject correlation of hyperaligned connectivity profiles and predicting individualized connectomes using the template. The results are consistent across both datasets. This work enhances our understanding of age-related differences in brain function, highlights the benefits of creating age-specific templates to refine hyperalignment model performance, and may contribute to the development of age-sensitive diagnostic tools and interventions for neurological disorders.
Subgenome dominance ofALStarget site mutations impacts herbicide resistance in allohexaploidEchinochloa crus-galli
Authors: Cutti Luan , Turra Guilherme Menegol , Machado Filipi Mesquita , Sulzbach Estéfani , Angonese Paula Sinigaglia , Markus Catarine , Gaines Todd Adam , Merotto Aldo
Published: February 2025

Herbicide target site resistance in polyploid species is more complex than diploids due to potential subgenome interactions and gene dosage of mutations. The objective of this study was to identify the level of resistance and cross-resistance patterns ofALSmutations located in the different subgenomes of allohexaploidEchinochloa crus-galli.E. crus-gallipopulations were screened and dose-response curves were performed with ALS-inhibitors from different chemical groups. TheALSgenes of each subgenome (A, B, and C) were sequenced. Copy number variation, global relative expression, and the specific relative expression ofALSgene from each subgenome were performed. Out of 100 populations, 32% were resistant only to imazethapyr, and 48% were cross-resistant to all ALS-inhibitors. The mutations Ala122Thr, Ala205Asn, and Ser653Asn confer resistance only to imazethapyr, while Trp574Leu confers resistance to all four herbicides tested.ALSmutations were most frequent in subgenome A, butALSfrom subgenome C had the highest expression. The biotype SAOJER-01 had Trp574Leu mutation in subgenome C and was 22 times more resistant to imazethapyr and penoxsulam than CAMAQ-01, which had the same Trp574Leu mutation in subgenome A with no differences in herbicide metabolism rate. TheALSgenes from subgenomes A and C contribute approximately 13% and 50% respectively to the totalALStranscripts. The higher contribution of subgenome C to the totalALStranscripts pool combined with the Trp574Leu resistance mutation makes the biotype SAOJER-01 more resistant to herbicides than CAMAQ-01. This is the first study showing the effect of subgenome gene expression level on the herbicide resistance level in a polyploid weed species. In addition, while imazethapyr did not control any biotype with anALSmutation, the other ALS-inhibitor herbicides were able to control biotypes carrying Ala122Thr, Ala205Asn, and Ser653Asn, which reinforces the utility of these herbicides in weed and resistance management.
Comparative Molecular, Innate, and Adaptive Impacts of Chemically Diverse STING Agonists
Authors: Mizuno Nobuyo , Boehm Dylan , Jimenez-Perez Kevin , Abraham Jinu , Springgay Laura , Rose Ian , DeFilippis Victor R.
Published: February 2025

Pharmacologic activation of the innate immune response is being actively being pursued for numerous clinical purposes including enhancement of vaccine potency and potentiation of anti-cancer immunotherapy. Pattern recognition receptors (PRRs) represent especially useful targets for these efforts as their engagement by agonists can trigger signaling pathways that associate with phenotypes desirable for specific immune outcomes. Stimulator of interferon genes (STING) is an ER-resident PRR reactive to cyclic dinucleotides such as those synthesized endogenously in response to cytosolic dsDNA. STING activation leads to transient generation of type I interferon (IFN-I) and proinflammatory responses that augment immunologically relevant effects including antiviral responses, antigen presentation, immune cell trafficking, and immunogenic cell death. In recent years engineered cyclic dinucleotides and small molecules have been discovered that induce STING and safely confer clinically useful outcomes in animal models such as adjuvanticity of anti-microbial vaccines and tumor clearance. Unfortunately, clinical trials examining the efficacy of STING agonists have thus far failed to satisfactorily recapitulate these positive outcomes and this has prevented their translational advancement. A likely relevant yet perplexingly under investigated aspect of pharmacologic STING activation is the diversity of molecular and immune responses that associate with chemical properties of the agonist. Based on this, a comparative survey of these was undertaken using unrelated STING-activating molecules to characterize the molecular, innate, cellular, and immune outcomes they elicit. This was done to inform and direct future studies aimed at designing and selecting agonists appropriate for desired clinical goals. This revealed demonstrable differences between the agonists in potency, transcriptomes, cytokine secretion profiles, immune cell trafficking, and antigen-directed humoral and cell mediated immune responses. As such, this work illustrates that phenotypes deriving from activation of a protein target can be linked to chemical properties of the engaging agonist and thus heightened scrutiny is necessary when selecting molecules to generate specificin vivoeffects.