bluuebunny/crossref_metadata_2025 huggingface dataset:
Late-time accretion in neutron star mergers: Implications for short gamma-ray bursts and kilonovae
Authors: Lu Wenbin , Quataert Eliot
Published: May 2023

We study the long-term ($t\gg 10\rm \, s\!$ ) evolution of the accretion disc after a neutron star(NS)–NS or NS–black hole merger, taking into account the radioactive heating by r-process nuclei formed in the first few seconds. We find that the cumulative heating eventually exceeds the disc’s binding energy at $t\sim 10^2\mathrm{\, s}\, (\alpha /0.1)^{-1.8}(M/2.6\, \mathrm{M}_{\odot })^{1.8}$ after the merger, where α is the viscosity parameter and M is the mass of the remnant object. This causes the disc to evaporate rapidly and the jet power to shut off. We propose that this corresponds to the steep flux decline at the end of the extended emission (EE) or X-ray plateau seen in many short gamma-ray bursts (GRBs). The shallow flux evolution before the steep decline is consistent with a plausible scenario where the jet power scales linearly with the disc mass. We suggest that the jets from NS mergers have two components – a short-duration narrow one producing the prompt gamma-rays and a long-lasting wide component producing the EE. This leads to a prediction that ‘orphan EE’ (without short GRB) may be a promising electromagnetic counterpart for NS mergers observable by future wide-field X-ray surveys. The long-lived disc produces a slow ejecta component that can efficiently thermalize the β-electrons’ energy up to $t\sim 100\rm \, d$ and contributes $\sim \!10~{{\ \rm per\ cent}}$ of the kilonova’s bolometric luminosity at these late epochs. We predict that future ground-based and JWST near-IR spectroscopy of nearby ($\lesssim 100\rm \, Mpc\!$ ) NS mergers will detect narrow (Δv ∼ 0.01c) line features a few weeks after the merger.
The stellar chemical abundances of simulated massive galaxies at z = 2
Authors: Kim Jee-Ho , Belli Sirio , Weinberger Rainer
Published: May 2023

We analyse the stellar abundances of massive galaxies (log M*/M⊙ > 10.5) at redshift, z = 2, in the IllustrisTNG simulation with the goal of guiding the interpretation of current and future observations, particularly from JWST. We find that the effective size, Re, of galaxies strongly affects the abundance measurements: both [Mg/H] and [Fe/H] are anticorrelated with Re, while the relative abundance [Mg/Fe] slightly increases with Re. The α enhancement as tracked by [Mg/Fe] traces the formation time-scale of a galaxy weakly, and mostly depends on Re. Aperture effects are important: measuring the stellar abundances within 1 kpc instead of within Re can make a large difference. These results are all due to a nearly universal, steeply declining stellar abundance profile that does not scale with galaxy size – Small galaxies appear metal-rich because their stars live in the inner part of the profile where abundances are high. The slope of this profile is mostly set by the gas-phase abundance profile and not substantially modified by stellar age gradients. The gas-phase abundance profile, in turn, is determined by the strong radial dependence of the gas fraction and star-formation efficiency. We develop a simple model to describe the chemical enrichment, in which each radial bin of a galaxy is treated as an independent closed-box system. This model reproduces the gas-phase abundance profile of simulated galaxies, but not the detailed distribution of their stellar abundances, for which gas and/or metal transport are likely needed.
The rocket effect mechanism in neutron stars in supernova remnants
Authors: Agalianou V , Gourgouliatos K N
Published: May 2023

While the dipole magnetic field axis of neutron stars is usually postulated to cross the star’s centre, it may be displaced from this location, as it has been recently indicated in the millisecond pulsar J0030+0451. Under these conditions, the electromagnetic rocket effect may be activated, where the magnetic field exerts a net force, accelerating the star. This post-natal kick mechanism relies on asymmetric electromagnetic radiation from an off-centre dipole and may be relevant to the high spatial velocities of pulsars $\sim 10^{3}$  km s−1. Here, we explore its impact in young pulsars associated with supernova remnants, and we compare the observational data on characteristic quantities, such as the braking index and proper motion, with results obtained from the rocket effect. Using a Markov Chain Monte Carlo analysis, we explore the required conditions, for the initial spin periods and the distance between the magnetic axis and the star’s centre, so that the velocity kick due to the rocket effect approaches the present velocity. We find that the electromagnetic rocket effect can account for typical pulsar transverse velocities assuming an initial spin period of 3.8 $\rm {ms}$ and a dipole field whose distance from the centre of the star is approximately 7 $\rm {km}$ . We also explore the influence of the rocket effect on the braking index of a neutron star, and we find that for the sample studied this impact is minimal. Finally, we apply the rocket effect model on the pulsars J0030+0451 and J0538+2817, which are likely candidates for this mechanism.
Confident detection of doubly ionized thorium in the extreme Ap star CPD-62° 2717
Authors: Chojnowski S Drew , Hubrig Swetlana , Nidever David L , Niemczura Ewa , Labadie-Bartz Jonathan , Mathys Gautier , Hasselquist Sten
Published: May 2023

Despite the Universe containing primordial thorium (Th) of sufficient abundance to appear in stellar spectra, detection of Th has to date been tentative and based on just a few weak and blended lines. Here, we present convincing evidence not only for the first Th detection in a magnetic chemically peculiar Ap star but also for the first detection of Th iii in a stellar spectrum. CPD-62° 2717 was initially recognized as a highly magnetized Ap star due to resolved magnetically split lines captured in H-band spectra from the SDSS/APOGEE survey. The star was subsequently pinpointed as extraordinarily peculiar when careful inspection of the H-band line content revealed the presence of five lines of Th iii, none of which are detected in the other ∼1500 APOGEE-observed Ap stars. Follow-up with the VLT + UVES confirmed a similarly peculiar optical spectrum featuring dozens of Th iii lines, among other peculiarities. Unlike past claims of Th detection, and owing to high-resolution observations of the strong (∼8–12 kG) magnetic field of CPD-62° 2717, the detection of Th iii can in this case be supported by matches between the observed and theoretical magnetic splitting patterns. Comparison of CPD-62° 2717 to stars for which Th overabundances have been previously reported (e.g. Przybylski’s Star) indicates that only for CPD-62° 2717 is the Th detection certain. Along with the focus on Th iii, we use time series measurements of the magnetic field modulus to constrain the rotation period of CPD-62° 2717 to ∼4.8 yr, thus establishing it as a new example of a superslowly rotating Ap star.
Prospects for ultra-high-energy particle acceleration at relativistic shocks
Authors: Huang Zhi-Qiu , Reville Brian , Kirk John G , Giacinti Gwenael
Published: May 2023

We study the acceleration of charged particles by ultra-relativistic shocks using test-particle Monte Carlo simulations. Two field configurations are considered: (i) shocks with uniform upstream magnetic field in the plane of the shock, and (ii) shocks in which the upstream magnetic field has a cylindrical geometry. Particles are assumed to diffuse in angle due to frequent non-resonant scattering on small-scale fields. The steady-state distribution of particles’ Lorentz factors is shown to approximately satisfy dN/dγ ∝ γ−2.2 provided the particle motion is scattering dominated on at least one side of the shock. For scattering dominated transport, the acceleration rate scales as tacc ∝ t1/2, though recovers Bohm scaling tacc ∝ t if particles become magnetized on one side of the shock. For uniform field configurations, a limiting energy is reached when particles are magnetized on both sides of the shock. For the cylindrical field configuration, this limit does not apply, and particles of one sign of charge will experience a curvature drift that redirects particles upstream. For the non-resonant scattering model considered, these particles preferentially escape only when they reach the confinement limit determined by the finite system size, and the distribution approaches the escapeless limit dN/dγ ∝ γ−1. The cylindrical field configuration resembles that expected for jets launched by the Blandford & Znajek mechanism, the luminous jets of active galactic nuclei and gamma-ray bursts thus provide favourable sites for the production of ultra-high-energy cosmic rays.
Translational fidelity screens in mammalian cells reveal eIF3 and eIF4G2 as regulators of start codon selectivity
Authors: She Richard , Luo Jingchuan , Weissman Jonathan S
Published: May 2023

The translation initiation machinery and the ribosome orchestrate a highly dynamic scanning process to distinguish proper start codons from surrounding nucleotide sequences. Here, we performed genome-wide CRISPRi screens in human K562 cells to systematically identify modulators of the frequency of translation initiation at near-cognate start codons. We observed that depletion of any eIF3 core subunit promoted near-cognate start codon usage, though sensitivity thresholds of each subunit to sgRNA-mediated depletion varied considerably. Double sgRNA depletion experiments suggested that enhanced near-cognate usage in eIF3D depleted cells required canonical eIF4E cap-binding and was not driven by eIF2A or eIF2D-dependent leucine tRNA initiation. We further characterized the effects of eIF3D depletion and found that the N-terminus of eIF3D was strictly required for accurate start codon selection, whereas disruption of the cap-binding properties of eIF3D had no effect. Lastly, depletion of eIF3D activated TNFα signaling via NF-κB and the interferon gamma response. Similar transcriptional profiles were observed upon knockdown of eIF1A and eIF4G2, which also promoted near-cognate start codon usage, suggesting that enhanced near-cognate usage could potentially contribute to NF-κB activation. Our study thus provides new avenues to study the mechanisms and consequences of alternative start codon usage.
Tree Visualization By One Table (tvBOT): a web application for visualizing, modifying and annotating phylogenetic trees
Authors: Xie Jianmin , Chen Yuerong , Cai Guanjing , Cai Runlin , Hu Zhong , Wang Hui
Published: May 2023

tvBOT is a user-friendly and efficient web application for visualizing, modifying, and annotating phylogenetic trees. It is highly efficient in data preparation without requiring redundant style and syntax data. Tree annotations are powered by a data-driven engine that only requires practical data organized in uniform formats and saved as one table file. A layer manager is developed to manage annotation dataset layers, allowing the addition of a specific layer by selecting the columns of a corresponding annotation data file. Furthermore, tvBOT renders style adjustments in real-time and diversified ways. All style adjustments can be made on a highly interactive user interface and are available for mobile devices. The display engine allows the changes to be updated and rendered in real-time. In addition, tvBOT supports the combination display of 26 annotation dataset types to achieve multiple formats for tree annotations with reusable phylogenetic data. Besides several publication-ready graphics formats, JSON format can be exported to save the final drawing state and all related data, which can be shared with other users, uploaded to restore the final drawing state for re-editing or used as a style template for quickly retouching a new tree file. tvBOT is freely available at: https://www.chiplot.online/tvbot.html.
‘What does good look like’—exploring access to healthcare for the homeless population in Gateshead, England
Authors: Perkin Sadie , Visram Shelina , Lindsey Laura
Published: May 2023

Background

individuals who are homeless encounter extreme health inequalities and as a result often suffer poor health. This study aims to explore ways in which access to healthcare could be improved for individuals who are homeless in Gateshead, UK.

Methods

twelve semi-structured interviews were conducted with people working with the homeless community in a non-clinical setting. Transcripts were analysed using thematic analysis.

Results

six themes were identified under the broad category of ‘what does good look like’, in terms of improving access to healthcare. These were: facilitating GP registration; training to reduce stigma and to provide more holistic care; joined-up working in which existing services communicate rather than work in isolation; utilising the voluntary sector as support workers could actively support access to healthcare and provide advocacy; specialised roles such as specialised clinicians, mental health workers or link workers; and specialised bespoke services for the homeless community.

Conclusions

the study revealed issues locally for the homeless community accessing healthcare. Many of the proposed actions to facilitate access to healthcare involved building upon good practice and enhancing existing services. The feasibility and cost-effectiveness of interventions suggested requires further assessment.
Attacks on trusts in civil law jurisdictions
Authors: Ashdown Michael J
Published: May 2023

Modern trust litigation is distinctly international, but what happens when jurisdictions without an established law of trusts become embroiled in claims following the misapplication of trust assets? This article considers how the involvement of such non-trust jurisdictions affects claims to trace or follow equitable property rights, and in respect of dishonest assistance and knowing receipt. The latter is of particular significance in view of the 2022 decision of the Court of Appeal in Byers v Saudi National Bank—now headed for the Supreme Court—which held that actual, beneficial receipt is required to found a knowing receipt claim.
Chlorophyll fluorescence variation in two Mediterranean forest species over a 21-year drought treatment period
Authors: Silvestre-Carbonell Susana , Ogaya Romà , Fernández-Martínez Marcos , Peñuelas Josep
Published: May 2023

The Mediterranean is among the regions predicted to be most affected by climate change due to rising temperatures and increasing frequency as well as intensity of extreme weather events, such as drought. These shifts in climatic conditions might lead to changes in species community composition by enabling the increase of drought-tolerant species at the expense of less tolerant ones. This hypothesis was tested in the current study using chlorophyll fluorescence data from a 21-year precipitation exclusion experiment in a Mediterranean forest for two co-dominant Quercus ilex L. and Phillyrea latifolia L. species with contrasting low and high levels of drought tolerance, respectively. The maximum potential quantum efficiency of photosystem II (PSII) (Fv/Fm), photochemical efficiency of PSII (yield) and non-photochemical quenching (NPQ) varied seasonally. The Fv/Fm and NPQ levels were positively correlated with air temperature and standardized precipitation-evapotranspiration index (SPEI), whereas yield, which was greater under drought treatment, was negatively associated with vapor pressure deficit and SPEI. The Fv/Fm values showed similar increase in the two species over the 21-year study period regardless of treatment and in parallel to progressive warming. By contrast, yield values were higher in Q. ilex than in P. latifolia, while NPQ values were higher in P. latifolia than in Q. ilex. Notably, high yield values were also observed in the drought-treated plots. Throughout the study, plants in the drought-treated plots exhibited decreased basal area, leaf biomass and aerial cover due to high stem mortality. In addition, a continuous increase in temperature was detected in summer and autumn, which might explain the observed increase in Fv/Fm values over the study period. Higher yield and lower NPQ detected in Q. ilex could be attributed to less competition for resources in the drought-treated plots and acclimation of Q. ilex plants over the study period. Our results indicate that reduction in stem density could improve forest resilience to climate change-induced drought conditions.
LincRNA‐ROR/miR‐145/ZEB2 regulates liver fibrosis by modulating HERC5‐mediated p53 ISGylation
Authors: Shen Jie , Wang Zhu , Liu Mei , Zhu Yu‐Jie , Zheng Ling , Wang Li‐Li , Cheng Jie‐Ling , Liu Tong‐Tong , Zhang Guo‐Dong , Yang Tian‐Yu , Wang Xiao , Zhang Lei
Published: May 2023

The tumor suppressor p53 has been implicated in the pathogenesis of liver fibrosis. HERC5‐mediated posttranslational ISG modification of the p53 protein is critical for controlling its activity. Here, we demonstrated that the expression of HERC5 and ISG15 is highly elevated, whereas p53 is downregulated, in fibrotic liver tissues of mice and transforming growth factor‐β1 (TGF‐β1)‐induced LX2 cells. HERC5 siRNA clearly increased the protein expression of p53, but the mRNA expression of p53 was not obviously changed. The inhibition of lincRNA‐ROR (ROR) downregulated HERC5 expression and elevated p53 expression in TGF‐β1‐stimulated LX‐2 cells. Furthermore, the expression of p53 was almost unchanged after TGF‐β1‐stimulated LX‐2 cells were co‐transfected with a ROR‐expressing plasmid and HERC5 siRNA. We further confirmed that miR‐145 is a target gene of ROR. In addition, we also showed that ROR regulates the HERC5‐mediated ISGylation of p53 through mir‐145/ZEB2. Together, we propose that ROR/miR‐145/ZEB2 might be involved in the course of liver fibrosis by regulating ISGylation of the p53 protein.
Heart Rate Change as a Potential Digital Biomarker of Brain Death in Critically Ill Children With Acute Catastrophic Brain Injury
Authors: LaRovere Kerri L. , Luchette Matthew , Akhondi-Asl Alireza , DeSouza Bradley J. , Tasker Robert C. , Mehta Nilesh M. , Geva Alon
Published: May 2023

IMPORTANCE:

Bedside measurement of heart rate (HR) change (HRC) may provide an objective physiologic marker for when brain death (BD) may have occurred, and BD testing is indicated in children.

OBJECTIVES:

To determine whether HRC, calculated using numeric HR measurements sampled every 5 seconds, can identify patients with BD among patients with catastrophic brain injury (CBI).

DESIGN, SETTING, AND PARTICIPANTS:

Single-center, retrospective study (2008–2020) of critically ill children with acute CBI. Patients with CBI had a neurocritical care consultation, were admitted to an ICU, had acute neurologic injury on presentation or during hospitalization based on clinical and/or imaging findings, and died or survived with Glasgow Coma Scale (GCS) less than 13 at hospital discharge. Patients meeting BD criteria (BD group) were compared with those with cardiopulmonary death (CD group) or those who survived to discharge.

MAIN OUTCOMES AND MEASURES:

HRC was calculated as the interquartile range of HR divided by median HR using 5-minute windows with 50% overlap for up to 5 days before death or end of recording. HRC was compared among the BD, CD, and survivor groups.

RESULTS:

Of 96 patients with CBI (69% male, median age 4 years), 28 died (8 BD, 20 CD) and 20 survived (median GCS 9 at discharge). Within 24 hours before death, HRC was lower in BD compared with CD patients or survivors (0.01 vs 0.03 vs 0.04, p = 0.001). In BD patients, HRC decreased at least 1 day before death. HRC discriminated BD from CD patients and survivors with 90% sensitivity, 70% specificity, 44% positive predictive value, 96% negative predictive value (area under the receiver operating characteristic curve 0.88, 95% CI, 0.80–0.93).

CONCLUSIONS AND RELEVANCE:

HRC is a novel digital biomarker that, with further validation, may be useful as a classifier for BD in the overall course of patients with CBI.
Refractive outcomes after DMEK: meta-analysis
Authors: Augustin Victor A. , Son Hyeck-Soo , Yildirim Timur M. , Meis Jan , Łabuz Grzegorz , Auffarth Gerd U. , Khoramnia Ramin
Published: May 2023

In this meta-analysis and systematic literature review of refractive outcomes after Descemet membrane endothelial keratoplasty (DMEK), the extent of the refractive shift and an overview of reasons for refractive shift after DMEK are provided. The PubMed library was screened for articles containing the terms “Descemet membrane endothelial keratoplasty,” “DMEK,” “Descemet membrane endothelial keratoplasty combined with cataract surgery,” “triple-DMEK” combined with “refractive outcomes,” “refractive shift,” and “hyperopic shift.” The refractive outcomes after DMEK were analyzed and compared using a fixed and random effects model. The overall mean change of the spherical equivalent outcome when compared with the preoperative value in cases of DMEK or when compared with the preoperative target refraction in cases of DMEK combined with cataract surgery was +0.43 diopters (D) (95% CI, 0.31-0.55). When DMEK is combined with cataract surgery, a target refraction of −0.5 D is recommended to achieve emmetropia. Changes in the posterior corneal curvature are identified as the main cause of the refractive hyperopic shift.
Refractive surgery as a treatment tool for strabismus: systematic review
Authors: MacNeill Katelyn , Jindani Yasmin , Patil Nikhil , Solish Danielle , Gelkopf Maxwell J. , Sabri Kourosh
Published: May 2023

The impact refractive surgery has on preoperative horizontal strabismus is rapidly evolving, and this knowledge can provide valuable clinical context when considering refractive surgery as a treatment for strabismus. 515 studies were identified, of which 26 met the inclusion criteria. Analysis indicated that refractive surgery resulted in an overall decrease in the mean uncorrected postoperative angle of deviation caused partially or fully due to refractive error and highlighted the varied outcome of refractive surgery on nonaccommodative horizontal strabismus with limited evidence to suggest refractive surgery for this type of strabismus. Efficacy of refractive surgery in reducing concomitant horizontal strabismus depends on several factors: type of horizontal ocular deviation, patient age, and extent of refractive error. Refractive surgery can be an effective treatment for refractive accommodative horizontal strabismus in patients with stable, mild to moderate myopia or hyperopia and should be considered with careful patient selection for optimum outcome.
Interface fluid syndrome after LASIK surgery: retrospective pooled analysis and systematic review
Authors: Ravipati Advaitaa , Pradeep Tejus , Donaldson Kendall E.
Published: May 2023

Interface fluid syndrome (IFS) is a complication associated with laser in situ keratomileusis (LASIK) surgery where a fluid pocket in the corneal stroma decreases visual acuity. A systematic review of IFS cases using PRISMA guidelines was performed yielding a total of 33 patients. 2 outcomes were selected for logistic regression analysis: final corrected distance visual acuity (CDVA) and need for surgical management. Results showed 33.3% of patients required surgery, 51.5% had their IFS resolve within 1 month or sooner, and 51.5% had final CDVA 20/25 or better. Higher presenting intraocular pressure (IOP) and duration of IFS ≤1 month was associated with higher odds of final CDVA 20/25 or better (adjusted odds ratio [aOR] 1.12, P = .04; aOR 7.71, P = .02, respectively). Endothelial cell dysfunction led to 17.55 greater odds for requiring surgical compared to medical management (aOR 0.36, P = .04). Presenting IOP and duration of IFS predicted final CDVA, while prior endothelial cell dysfunction predicted need for surgery.
Reduced metabolic flexibility is a predictor of weight gain among liver transplant recipients
Authors: Bui Anh T. , Chaudhari Rahul , Bhati Chandra , Wolver Susan , Patel Samarth , Boyett Sherry , Evans Marie Claire , Kamal Hiba , Patel Vaishali , Forsgren Mikael , Sanyal Arun J. , Kirkman Danielle , Siddiqui Mohammad Shadab
Published: May 2023

Metabolic flexibility is the ability to match biofuel availability to utilization and is inversely associated with increased metabolic burden among liver transplant (LT) recipients. The present study evaluated the impact of metabolic flexibility on weight gain following LT. LT recipients were enrolled prospectively (n = 47) and followed for 6 months. Metabolic flexibility was measured using whole-room calorimetry and is expressed as a respiratory quotient (RQ). Peak RQ represents maximal carbohydrate metabolism and occurs in the post-prandial state, while trough RQ represents maximal fatty acid metabolism occurring in the fasted state. The clinical, metabolic, and laboratory characteristics of the study cohort of lost weight (n = 14) and gained weight (n = 33) were similar at baseline. Patients who lost weight were more likely to reach maximal RQ (maximal carbohydrate oxidation) early and rapidly transitioned to trough RQ (maximal fatty acid oxidation). In contrast, patients who gained weight had delayed time to peak RQ and trough RQ. In multivariate modeling, time to peak RQ (β-coefficient 0.509, p = 0.01), time from peak RQ to trough RQ (β-coefficient 0.634, p = 0.006), and interaction between time to peak RQ to trough RQ and fasting RQ (β-coefficient 0.447, p = 0.02) directly correlated with the severity of weight gain. No statistically significant relationship between peak RQ, trough RQ, and weight change was demonstrated. Inefficient transition between biofuels (carbohydrates and fatty acids) is associated with weight gain in LT recipients that is independent of clinical metabolic risk. These data offer novel insight into the physiology of obesity after LT with the potential to develop new diagnostics and therapeutics.
Carbohydrates for glycemic control: functional and microbiome aspects
Authors: Hoffmann Sarda Fabiana A. , Giuntini Eliana Bistriche
Published: May 2023

Purpose of review

Glycemia goals are used as indicators of control and progression in prediabetes and diabetes. Adopting healthy eating habits is essential. It is worth considering the quality of carbohydrates to help with dietary glycemic control. The present article aims to review recent meta-analyses published in the years 2021–2022 on the effects of dietary fiber and low glycemic index/load (LGI/LGL) foods on glycemic control and how gut microbiome modulation contributes to glycemic control.

Recent findings

Data involving more than 320 studies were reviewed. The evidence allows us to infer that LGI/LGL foods, including dietary fiber intake, are associated with reduced fasting glycemia and insulinemia, postprandial glycemic response, HOMA-IR, and glycated hemoglobin, which are more evident in soluble dietary fiber. These results can be correlated with changes in the gut microbiome. However, the mechanistic roles of microbes or metabolites implicated in these observations continue to be explored. Some controversial data highlight the need for more homogeneity between studies.

The properties of dietary fiber are reasonably well established for their glycemic homeostasis effects, including the fermentation aspects. Findings of gut microbiome correlations with glucose homeostasis can be incorporated into clinical nutrition practice. Target dietary fiber interventions on microbiome modulation can offer options to improve glucose control and contribute to personalized nutritional practices.
Vancomycin-induced bullous dermatosis: a rare case report
Authors: Sakkal Najeeb , Jazmati Aya , Alosman Majd Aldeen , Alali Kutaiba , Wereekia Mahmoud , Kadi Mohamad
Published: May 2023

Introduction:

Linear IgA bullous dermatosis (LABD) is a rare acquired skin blistering autoimmune disease. It can be diagnosed by confirming the presence of a linear band of IgA at the dermoepidermal junction on direct immunofluorescence microscopy. LABD can be characterized by vesicular lesions, diffuse blisters, or even as a mimicker of Steven–Johnson syndrome. LABD may be caused by tumours, infections, or drugs (amiodarone, furosemide, phenytoin, however, vancomycin is the potential inciting drug in most reports).

Case presentation:

The authors present here a case of a 61-year-old woman with a history of HTN. The patient had a discectomy 15 years ago, and also underwent a lumbar fusion surgery that resulted in complications with her discitis. Due to the complications from the surgery, intravenous treatment with vancomycin and meropenem was initiated. After a few days of treatment, the patient developed clear, tense, fluid-filled bullae over the upper extremities. Immunofluorescence microscopy is not available in our hospital. Therefore a diagnosis of vancomycin-induced LABD was proposed based on the clinical manifestation of the lesions and the coincidence with vancomycin administration. After 2 days of discontinuing the administration of vancomycin and applying local diprosone, the lesions started to regress and a full recovery was achieved on day 10.

Discussion and conclusion:

Even though drug-induced LABD is uncommon, its incidence has been steadily increasing in the last few years. LABD is a simple condition with a good prognosis and full recovery after the discontinuation of vancomycin
Inflammatory response-based subtyping and potential therapeutic strategies for triple-negative breast cancer
Authors: Li Ze-Qing , Zhang Wen-Juan , Jiang Yi-Zhou , Shao Zhi-Ming , Ma Ding , Wu Jiong
Published: May 2023

Objective:

Inflammatory response plays a crucial role in the development and treatment of cancer. However, the role of inflammatory response in triple-negative breast cancer (TNBC) remains unclear. Based on the heterogeneity of the inflammatory response, we classified TNBC, elucidated its subtype features, and revealed potential therapeutic strategies.

Methods:

We established inflammatory response subtyping based on the RNA sequencing data of TNBCs derived from a cohort at the Fudan University Shanghai Cancer Center (FUSCC). Next, we explored the features and potential therapeutic strategies for each subgroup by analyzing transcriptome data. Using a machine-learning method, we validated and generalized the TNBC inflammatory response subtypes in an external dataset.

Results:

A total of 360 TNBC samples and 88 normal tissues were collected from a cohort at FUSCC. Patients with TNBC were divided into four inflammatory response groups (IRGs) based on the expression of inflammatory response genes: high inflammatory response gene expression with pronounced pyroptosis phenotype and high immune cell infiltration (IRG 1), low inflammatory response gene expression and low immune cell infiltration (IRG 2), ITGB8 specific inflammatory response with a predominant proliferation phenotype (IRG 3), and low M1/M2 ratio with a marked angiogenesis phenotype (IRG 4). Relapse-free survival (RFS) was better in IRG 1 and 2 and worse in IRG 3 and 4. Owing to their poor prognosis, we mainly focused on IRG 3 and IRG 4 to investigate potential treatment strategies. ITGB8 was highly expressed in IRG 3; thus, targeting ITGB8 may be a potential therapeutic strategy for patients in IRG 3. IRG 4 had a lower M1/M2 ratio and a marked angiogenesis phenotype; therefore, therapeutic strategies, such as anti-angiogenesis or M2 to M1 repolarization of macrophages, could be recommended for these patients. Additionally, we validated and generalized the TNBC inflammatory response subtyping in an external dataset using a machine-learning method.

Conclusion:

TNBC patients with different inflammatory response subtypes have different characteristics and may need subtype-specific treatment strategies.
Unexpected FDG Uptake in the Cerebral Parenchyma in Subacute Subarachnoid Hemorrhage
Authors: Chow Tsz-Kit , Chan Ka-Wai , Chiu Ka-Lun , Chan Chun-Ho , Ma Wai-Han
Published: May 2023

Changes in cerebral glucose metabolism after subarachnoid hemorrhage have been rarely described. We present a case with subacute subarachnoid hemorrhage showing unexpected elevated FDG uptake at adjacent cerebral parenchyma on FDG PET/CT. The density of the cerebral parenchyma was normal on CT. The patient received medical management without any neurological complication.
Evaluating YouTube as a Source of Education for Patients Undergoing Surgery
Authors: Javidan Arshia , Nelms Matthew W. , Li Allen , Lee Yung , Zhou Fangwen , Kayssi Ahmed , Naji Faysal
Published: May 2023

Objective:

The objective of this systematic review is to characterize the peer-reviewed literature investigating YouTube as a source of patient education for patients undergoing surgery.

Summary Background Data:

YouTube is the largest online video sharing platform and has become a substantial source of health information that patients are likely to access before surgery, yet there has been no systematic assessment of peer-reviewed studies. A comprehensive literature search was conducted using EMBASE, MEDLINE, and Ovid HealthStar from inception through to December of 2021.

Methods:

All primary studies evaluating YouTube as a source of patient education relating to surgical procedures (general, cardiac, urology, otolaryngology, plastic, vascular) were included. Study screening and data extraction occurred in duplicate with two reviewers. Characteristics extracted included video length, view count, upload source, overall video educational quality, and quality of individual studies.

Results:

Among 6,453 citations, 56 studies were identified that examined 6,797 videos with 547 hours of content and 1.39 billion views. There were 49 studies that evaluated the educational quality of the videos. A total of 43 quality assessment tools were used, with each study using a mean of 1.90 assessment tools. Per the global rating for assessments, 34/49 studies (69%) concluded that the overall quality of educational content was poor.

Conclusions:

While the impact of non-peer-reviewed YouTube videos on patient knowledge for surgery is unclear, the large amount of online content suggests that they are in demand. The overall educational content of these videos is poor, however, and there is substantial heterogeneity in the quality assessment tools used in their evaluation. A peer-reviewed and standardized approach to online education with video content is needed to better support patients.
Remuneration and Recruitment of Study Participants for AD Cohort Studies From the General Public and From Minority Communities
Authors: Gabel Matthew , Denny Andrea , Llibre-Guerra Jorge , Morris John C. , Phillips Jennifer , Vaidyanathan Ashish
Published: May 2023

Introduction:

Offering remuneration for participation in studies of aging and Alzheimer Disease (AD) may improve recruitment, particularly among minoritized and low-income groups. But remuneration may also raise ethical problems and reduce altruistic motivations for participation.

Methods:

A nationally representative sample of Americans (N=2030) with large (N=500) Black and Hispanic oversamples was asked about willingness to participate in a longitudinal AD cohort study after random assignment of remuneration ($0, $50/visit, $100/visit). Respondents were then asked about their perceived burden, risks, and societal contribution from participation.

Results:

An offer of remuneration increased willingness to participate, with no difference between $50 and $100. The increase was similar across racial, ethnic, and income groups. Remuneration did not affect perceived risks or altruistic benefits. Compensation caused Whites and Hispanics, but not Blacks, to lower the perceived burden.

Discussion:

Modest levels of remuneration are likely to improve recruitment to AD research studies without causing collateral ethical or motivation problems. Remuneration does not differentially enhance minority recruitment.
Distal Tibial Mononeuropathy From Compression by the Posterior Tibial Artery: Clinical–Electrophysiological–Ultrasonographic Correlations
Authors: Beecher Grayson , Chompoopong Pitcha , Litchy William J. , Boon Andrea J.
Published: May 2023

The tibial nerve is bound tightly to the posterior tibial artery in the tarsal tunnel where expansion capacity is limited. Therefore, the nerve may be vulnerable to, and damaged by chronic pulsatile trauma from an atypically positioned overriding artery, labeled “punched-nerve syndrome”. In this article, we present a 49-year-old woman who presented with two months of severe burning pain in the left medial ankle and sole of the foot without antecedent trauma. Neurological examination identified dysesthetic sensation to light touch in the left medial sole of the foot, and both active and passive dorsiflexion worsened the painful paresthesia. Nerve conduction studies demonstrated a reduced left medial plantar mixed nerve action potential amplitude, 50% less than the right. High-resolution ultrasound (HRUS) showed an increased left tibial nerve cross-sectional area of 26 mm2 (normal <22.3 mm2) at the level of the ankle with side-to-side difference of 6 mm2 (normal <5.7 mm2). The distal tibial nerve and its medial plantar branch were atypically positioned immediately deep to the left posterior tibial artery and abnormally flattened with focal enlargement of the nerve on longitudinal view. Dynamic analysis demonstrated the nerve being compressed with each pulsation of the tibial artery immediately above. Active dorsiflexion of the ankle narrowed the space underneath the flexor retinaculum resulting in further compression of the nerve against the artery. In conclusion, HRUS as an adjunct to electrophysiological studies identified punched-nerve arterial compression as an etiology of tarsal tunnel syndrome.
Predictors of Hospital Readmission in Patients Undergoing Creation of an Intestinal Ostomy
Authors: Cox Jill , Isip Rachele , Reid Mary , Hulme Devin , Marra Andrew
Published: May 2023

PURPOSE:

The purpose of this study was to identify predictors of 30- and 60-day hospital readmission in patients undergoing ileostomy or colostomy creation.

DESIGN:

A retrospective, cohort study.

SAMPLE AND SETTING:

The study sample comprised 258 patients who underwent ileostomy or colostomy creation from 2018 to 2021 in a suburban teaching hospital in the northeastern United States. The mean age of participants was 62.8 (SD 15.8) years; half were female and half were male. Slightly more than half 50.3% (n = 130) and 49.2% (n =127) underwent ileostomy surgery.

METHODS:

Data were abstracted from the electronic medical record and included the following variable categories: demographic factors, ostomy- and surgical-related factors, and ostomy- and surgical-related complications. Study outcome measures were readmission within 30 and 60 days from the index hospital admission discharge date. Predictors of hospital readmission were analyzed using bivariate testing, followed by multivariate analysis.

RESULTS:

Within 30 days of the index hospitalization, 49 patients were readmitted (19%), and 17 patients were readmitted (6.6%) within 60 days. For readmissions within 30 days, anatomical location of the stoma in the ileum and transverse colon as compared to descending/sigmoid colon stomas emerged as significant predictors (odds ratio [OR] 2.2; P = .036; confidence interval [CI] 1.05-4.85; OR 4.5; P = .036; CI 1.17-18.53, respectively). Within 60 days, length of the index hospitalization from 15 to 21 days as compared to shorter lengths of hospitalization emerged as the only significant predictor at this timeframe (OR 6.62; P = .018, CI 1.37-31.84).

CONCLUSIONS:

These factors provide a basis for identifying patients at higher risk for hospital readmission following ileostomy or colostomy surgery. For patients at higher risk for readmission following ostomy surgery, heightened surveillance and management in the immediate postoperative period may be necessary to avert potential complications.
Incidence and Predictive Model of Medical Adhesive–Related Skin Injury in Cancer Patients Managed With Central Venous Access Devices
Authors: Li Jieqiong , Hao Nan , Han Juan , Zhang Mi , Li Xiaomei
Published: May 2023

PURPOSE:

The purpose of this study was to determine the prevalence of medical adhesive–related skin injury (MARSI) at the site of central venous access device (CVAD) implantation in patients with cancer, identify risk factors associated with MARSI in patients with cancer, and create a nomogram for predicting risk of MARSI.

DESIGN:

Retrospective, single-center study.

SUBJECTS AND SETTING:

The sample comprised 1172 consecutive patients who underwent CVAD implantation between February 2018 and February 2019; their mean age was 55.7 years (SD: 13.9). Data were collected at the First Affiliated Hospital of Xi'an Jiaotong University, located in Xi'an, China.

METHODS:

Demographic and pertinent clinical data were collected from patient records. Routine dressing changes were performed every 7 days for peripherally inserted central venous catheters (PICCs) or 28 days for ports except in patients with existing skin injuries. Skin injuries related to use of medical adhesives and persisting for more than for 30 minutes were classified MARSI. Data were used to develop a nomogram for predicting MARSI. The accuracy of the nomogram was verified by calculating the concordance index (C-index) and drawing a calibration curve.

RESULTS:

Among the 1172 patients, 330 (28.2%) had undergone PICC implantation, and 282 (24.1%) experienced 1 or more MARSIs representing an incidence rate of 1.7 events per 1000 CVAD days. Statistical analysis identified previous MARSI history, the need for total parenteral nutrition support, other catheter-related complications, a history of allergy, and PICC implantation as associated with a higher likelihood of developing for MARSI. Based on these factors, we established a nomogram for predicting the risk of developing MARSI in patients with cancer who underwent CVAD implantation. The C-index of the nomogram was 0.96, and the calibration curve of the nomogram showed that the predictive ability of the nomogram was strong.

CONCLUSIONS:

We evaluated patients with cancer who were undergoing CVAD and identified that previous MARSI history, patients needing total parenteral nutrition support, other catheter-related complications, allergic history, and PICC implantation (compared with ports) were associated with a higher likelihood for developing MARSI. The nomogram we developed showed a good ability for predicting the risk of developing MARSI and may assist nurses to predict MARSI in this population.
CTGF is a Modifiable Mediator of Flow-dependent Atherosclerosis under Peripheral Artery Disease Conditions
Authors: Li Feifei , Kumar Sandeep , Pokutta-Paskaleva Anastassia , Omojola Victor , Kang Dong-won , Kim Chanwoo , Raykin Julia , Hoffmann Carson , Teichmann Maiko , Ma Jing , Yanigasawa Hiromi , Leask Andrew , Timmins Lucas , Cui Xiangqin , Sutliff Roy , Gleason Rudy L. , Jo Hanjoong , Brewster Luke
Published: May 2023

Background

Peripheral arterial disease (PAD) is the 3rdleading type of atherosclerotic disease (ASD) morbidity. Arterial stiffness is intimately connected to the onset and progression of peripheral artery disease (PAD). The role of arterial stiffening on flow-mediated atherosclerotic plaque formation is not well understood. The objective of this study is to discover endothelial cell (EC) pathways under PAD conditions and test the modifiability of these pathways on ASD.

Methods

PAD conditions in mice were conferred by partial carotid ligation to induce disturbed Flow (D-flow) in pre-stiffened Fibulin-5 knockout (KO) mice that lack normal elastin function. EC pathways, including Connective tissue growth factor (CTGF/CCN) were quantified by gene analysis and histology. Atherogenic mice had PCSK9 infection + high fat diet. CTGF was inhibited in an EC-specific knockout (ECKOCTGF) and with a CTGF antibody (FG-3149). Human vascular tissue was used to validate PAD biomechanics and CTGF upregulation.

Results

Biomechanical testing demonstrated that d-flow KO arteries mimic biomechanics of PAD arteries. RNA microarray, qPCR, and immunohistochemistry identified EC plasticity in these arteries compared to WT and KO under stable flow. Under atherogenic conditions, KO arteries demonstrated vulnerable plaques not seen in WT animals. CTGF expression was increased by d-flow, in KO arteries, in aged (18 months) WT arteries, and vascular tissue under d-flow. CTGF inhibition by ECKOCTGFfavorably improved plaque characteristics in male but not female animals. FG-3149 treatment of ECWTCTGFmale animals delivered similar benefits to plaque characteristics and arterial compliance.

Conclusion

ECs in PAD arteries exist under a complex hemodynamic environment that integrates stiffness and d-flow into an atherogenic and inflammatory environment. Stiffness + d-flow stimulates precocious onset of EC plasticity and a vulnerable plaque phenotype. CTGF is a matricellular protein that can tune fibro-inflammatory pathways. CTGF is a prominent mediator of D-flow-mediated arterial remodeling and focal atherosclerotic plaque remodeling. Inhibition of CTGF improves plaque phenotype and arterial compliance. CTGF-associated pathways hold promise as therapeutic targets for PAD patients.
The clinical outcomes of acute kidney injury substages based on serum cystatin C in pediatric patients undergoing cardiac surgery
Authors: Li Yinan , Bie Dongyun , Xiong Chao , Shi Sheng , Fang Zhongrong , Lu Zhongyuan , Wang Jianhui
Published: May 2023

Background

Multiple biomarkers have been identified by previous studies to diagnose acute kidney injury (AKI). Moreover, combination of biomarkers with conventional criteria to define AKI substages so that we can identify high-risk patients and improve diagnostic accuracy were recommended. Our study aimed to explore the incidence of AKI substages defined by serum cystatin C (CysC), determine whether AKI substages were associated with worse outcomes.

Methods

We prospectively included 2519 pediatric patients (<16yrs) undergoing cardiac surgery with cardiopulmonary bypass in our cohort between March 2022 to February 2023 in Fuwai Hospital. Demographic and clinical variables we collected. To define AKI substages, Kidney Disease: Improving Global Outcomes AKI definition (based on SCr or CysC) was used. The association between AKI exposure and outcomes including length of intensive care unit stay, duration of mechanical ventilation, length of hospital stay and 30-day mortality was assessed. In addition, we determined areas under the receiver operating characteristic curve and cutoff value of CysC at different timepoints to predict AKI.

Results

507 (20.8%) patients developed SCr-AKI, with 337 (13.8%) in stage 1, 77(3.2%) in stage 2 and 93 (3.8%) in stage 3 respectively. Of the 1925 patients without SCr-AKI, 256 (14.3%) met the definition of sub-AKI. Of the 507 patients with SCr-AKI, 281 (55.4%) patients were defined as AKI substage A, while others (226, 44.6%) were defined as AKI substage B. After adjusting for BSA, neonates, STAT mortality score≥4, previous sternotomy and CPB time>120min, the postoperative LOIS, LOHS and DMV were prolonged with increasing hospitalization expense (P<0.05) in patients with SCr-AKI and/or CysC-AKI. Meanwhile, only the hospitalization expense was increased in patients with SCr-AKI(P<0.05) after the same adjustment. The AUC was 0.691, 0.720 and 0.817 respectively in ROC curves of preoperative, relative variation of or postoperative serum CysC. Delong’ test showed that postoperative serum CysC might have better diagnostic performance characteristic than preoperative or relative variation of CysC (P<0.001), with a cutoff point at 1.29 mg/dL (Specificity, 0.77; Sensitivity, 0.71)

Conclusions

Our analysis indicates defining AKI with both CysC and SCr might more significantly affecting clinical outcome associations in pediatric patients undergoing cardiac surgery. Moreover, the serum CysC cutoff of 1.29mg/dL postoperatively is a valuable threshold for AKI risk assessment to define AKI subtypes.