bluuebunny/crossref_metadata_2025 huggingface dataset:
Robust discontinuous Galerkin-based scheme for the fully-coupled nonlinear thermo-hydro-mechanical problem
Authors: Bonetti Stefano , Botti Michele , Antonietti Paola F
Published: July 2024

We present and analyze a discontinuous Galerkin method for the numerical modeling of the nonlinear fully-coupled thermo-hydro-mechanic problem. We propose an arbitrary-order weighted symmetric interior penalty scheme that supports general polytopal grids and is robust with respect to strong heterogeneities in the model coefficients. We focus on the treatment of the nonlinear convective transport term in the energy conservation equation and we propose suitable stabilization techniques that make the scheme robust for advection-dominated regimes. The stability analysis of the problem and the convergence of the fixed-point linearization strategy are addressed theoretically under mild requirements on the problem data. A complete set of numerical simulations is presented in order to assess the convergence and robustness properties of the proposed method.
Patterns of community antibiotic use with reference to the AWaRe classification of the World Health Organization
Authors: Gagliotti Carlo , Cangini Agnese , Da Cas Roberto , Ippoliti Ilaria , Trotta Francesco , Fortinguerra Filomena
Published: July 2024

Background

Monitoring consumption through quality indicators and providing feedback is an important activity within programmes for improving antibiotic prescription. This study aims to describe the use of antibiotics for systemic use in community setting in Italy and to compare prescription patterns among regions based on quality prescription indicators to identify any inter-regional variability.

Methods

The 2021 consumption (calculated as DDDs per 1000 inhabitants per day) of antibiotics for systemic use (reimbursed or purchased privately) in community setting were considered. The WHO AWaRe system was used to classify antibiotics into Access, Watch and Reserve groups, using the 60% of prescribed antibiotics belonging to the Access group out of the total DDDs as AWaRe target. The correlation between regional consumption and percentages of DDDs in the Access group was assessed through linear regression. A further indicator ‘ratio of broad to narrow-spectrum antibacterials’ was also calculated to compare the spectrum of prescribed antibiotics.

Findings

Overall community antibiotic consumption in Italy in 2021 was 15.6 DDDs per 1000 inhabitants per day, with an increasing trend from north (13.0 DDDs) to south (19.5 DDDs) and the percentages of non-reimbursed consumption decreasing from north (33.1%) to south (21.5%). Only three regions out of 21 reached the AWaRe target (regional range 47.4%–62.9%), with a negative correlation between regional consumption and percentages of antibiotics belonging to the Access group (correlation coefficient −0.8; R2 = 0.64; P value < 0.001). The ‘ratio of broad to narrow-spectrum antibacterials’ was 8.5 at national level, with the highest value in the centre (11.0) compared to the south (9.1) and north (7.0).

Conclusion

The percentage of consumption of Access group antibiotics correlates very well with regional consumption in Italy, indicating that regions with higher antibiotics consumption also have worse prescribing patterns with a greater impact on bacterial resistance. Additional data are needed to better describe prescription patterns from an antimicrobial stewardship perspective.
Romosozumab followed by denosumab versus denosumab only: a post hoc analysis of FRAME and FRAME extension
Authors: Cosman Felicia , Oates Mary , Betah Donald , Timoshanko Jen , Wang Zhenxun , Ferrari Serge , McClung Michael R
Published: July 2024

Osteoanabolic-first treatment sequences are superior to oral bisphosphonates for fracture reduction and bone mineral density (BMD) gain. However, data comparing osteoanabolic medications, with the more potent antiresorptive, denosumab (DMAb), are limited. We analyzed FRAME and FRAME Extension data to assess BMD and fracture incidence in patients treated with romosozumab (Romo) followed by DMAb (Romo/DMAb) versus DMAb (DMAb/DMAb) for 24 months. In FRAME, women aged ≥55 years (total hip [TH] or femoral neck [FN] T-score: –2.5 to –3.5) were randomized to Romo or placebo for 12 months followed by DMAb for 12 months. In FRAME Extension, both cohorts received DMAb for another 12 months. This post hoc analysis compared BMD change and fracture incidence in patients on Romo/DMAb (months 0–24) versus DMAb/DMAb (months 12–36). Patient characteristics were balanced by propensity score weighting (PSW) and sensitivity analyses were conducted using PSW with multiple imputation (PSW-MI) and propensity score matching (PSM). Unmeasured confounding was addressed using E-values. After PSW, over 24 months, compared with DMAb/DMAb, treatment with Romo/DMAb produced significantly greater BMD increases at the lumbar spine [LS], TH, and FN (mean differences: 9.3%, 4.4%, and 4.1%, respectively; all p<0.001). At month 24, in women with a baseline T-score of –3.0, the probability of achieving a T-score > –2.5 was higher with Romo/DMAb versus DMAb/DMAb (LS: 92% versus 47%; TH: 50% versus 5%). In the Romo/DMAb versus DMAb/DMAb cohorts, new vertebral fractures were significantly reduced (0.62% versus 1.26% [odds ratio = 0.45; p=0.003]) and rates of clinical, nonvertebral, and hip fractures were lower (differences not significant). Similar BMD and fracture outcomes were observed with PSW-MI and PSM sensitivity analyses. The sequence of Romo/DMAb resulted in greater BMD gains and higher probability of achieving T-scores > –2.5, significantly reduced new vertebral fracture incidence, and numerically lowered the incidence (not significant) of clinical, nonvertebral, and hip fractures versus DMAb only through 24 months.
Longitudinal trials illustrate interactive effects between declining Bt efficacy against Helicoverpa zea (Lepidoptera: Noctuidae) and planting dates of corn
Authors: Reay-Jones Francis P F , Buntin G David , Reisig Dominic D , Bridges William C
Published: July 2024

Helicoverpa zea (Boddie) (Lepidoptera: Noctuidae) has evolved resistance to insecticidal toxins from Bacillus thuringiensis (Bt) Berliner (Bacillales: Bacillaceae) expressed in genetically engineered corn, Zea mays L. This study provides an overview of field trials from Georgia, North Carolina, and South Carolina evaluating Bt and non-Bt corn hybrids from 2009 to 2022 to show changes in susceptibility in H. zea to Bt corn. The reduction in kernel injury relative to a non-Bt hybrid averaged across planting dates generally declined over time for Cry1A.105 + Cry2Ab2 corn. In addition, there was a significant interaction with planting date used as a covariate. The reduction in kernel injury remained above 80% and did not vary with planting date from 2009 to 2014, whereas a significant decline with planting date was found in this reduction from 2015 to 2022. For Cry1Ab + Cry1F corn, the reduction in kernel injury relative to a non-Bt hybrid averaged across planting dates did not vary among years. The reduction in kernel injury significantly declined with planting date from 2012 to 2022. Kernel injury as a proxy for H. zea pressure was greater in late-planted trials in non-Bt corn hybrids. Our study showed that Bt hybrids expressing Cry1A.105 + Cry2Ab2 are now less effective in later planted trials in reducing H. zea injury; however, this was not the case during the earlier years of adoption of corn expressing these 2 toxins when resistance alleles were likely less frequent in H. zea populations. The implications for management of H. zea and for insect resistance management are discussed.
Relational hyperevent models for the coevolution of coauthoring and citation networks
Authors: Lerner Jürgen , Hâncean Marian-Gabriel , Lomi Alessandro
Published: July 2024

The development of appropriate statistical models has lagged behind the ambitions of empirical studies analysing large scientific networks—systems of publications connected by citations and authorship. Extant research typically focuses on either paper citation networks or author collaboration networks. However, these networks involve both direct relationships, as well as broader dependencies between references linked by multiple citation paths. In this work, we extend recently developed relational hyperevent models to analyse networks characterized by complex dependencies across multiple network modes. We introduce new covariates to represent theoretically relevant and empirically plausible mixed-mode network configurations. This model specification allows testing hypotheses that recognize the polyadic nature of publication data, while accounting for multiple dependencies linking authors and references of current and prior papers. We implement the model using open-source software to analyse publicly available data on a large scientific network. Our findings reveal a tendency for subsets of papers to be cocited, indicating that the impact of these papers may be partly due to endogenous network processes. More broadly, the analysis shows that models accounting for both the hyperedge structure of publication events and the interconnections between authors and references significantly enhance our understanding of the mechanisms driving scientific production and impact.
Perforated giant peptic ulcer of the stomach in a female patient with multiple sclerosis
Authors: Nikolovski Andrej , Mickovska Kristina , Argirov Ivan , Maznevska Lidija
Published: July 2024

Giant peptic ulcer of the stomach is defined with a diameter of more than 3 cm. About 2/3 of them are benign peptic ulcers and perforate in 1%–2% of all peptic ulcer stomach perforations. High rates of postoperative morbidity and mortality are reported. The treatment options include omental patch repair, jejunal serosal patch repair, duodenal exclusion, and gastric resection. Postoperative omental patch repair failure is reported and is strongly associated with the ulcer diameter. This case reports a giant peptic stomach ulcer perforation in a female patient treated successfully with omental patch repair, according to Cellan–Jones.
SRG/ART-XC Galactic Bulge deep survey. I. Maximum likelihood source detection algorithm for X-ray surveys
Authors: Semena A , Vikhlinin A , Mereminskiy I , Lutovinov A , Tkachenko A , Lapshov I , Burenin R
Published: July 2024

We describe an X-ray source detection method entirely based on the maximum likelihood analysis, in application to observations with the ART-XC telescope onboard the Spectrum Roentgen Gamma observatory. The method optimally combines the data taken at different conditions, a situation commonly found in scanning surveys or mosaic observations with a telescope with a significant off-axis PSF distortion. The method can be naturally extended to include additional information from the X-ray photon energies, detector grades, etc. The likelihood-based source detection naturally results in an optimal use of available information for the sources detection and stable and uniform definition of detection thresholds under different observing conditions (PSF, background level). This greatly simplifies the statistical calibration of the survey needed to, e.g. obtain the $\log N - \log S$ distribution of detected sources or their luminosity function. The method can be applied to the data from any imaging X-ray telescope.
Spin parity of spiral galaxies. IV. Differential reddening of globular cluster systems of nearby spiral galaxies
Authors: Iye Masanori , Yagi Masafumi
Published: July 2024

The north-west side of the disk of M 31 is known as the near side because of the differential reddening of globular clusters found from their photographic photometry. This paper reports a simple geometric model to evaluate the visibility of the effect and its application to published CCD photometry on globular cluster systems of three spiral galaxies, M 31, M 33, and NGC 253. The color difference of globular cluster systems due to differential reddening was confirmed for M 31 and NGC 253; however, the data for M 33 were insufficient. The analysis reaffirms the currently adopted interpretation that the side on the minor axis of the galactic disk, where more conspicuous dust features and interstellar reddening are visible, is the nearer side to us and provides an additional basis for using spiral galaxies with identified spiral windings, S-wise or Z-wise, to study the large-scale spin distribution of galaxies in the universe.
The BNB–GLID module regulates germline fate determination in Marchantia polymorpha
Authors: Ren Xiaolong , Zhang Xiaoxia , Qi Xiaotong , Zhang Tian , Wang Huijie , Twell David , Gong Yu , Fu Yuan , Wang Baichen , Kong Hongzhi , Xu Bo
Published: July 2024

Germline fate determination is a critical event in sexual reproduction. Unlike animals, plants specify the germline by reprogramming somatic cells at the late stages of their development. However, the genetic basis of germline fate determination and how it evolved during the land plant evolution are still poorly understood. Here, we report that the plant homeodomain finger protein GERMLINE IDENTITY DETERMINANT (GLID) is a key regulator of the germline specification in liverwort, Marchantia polymorpha. Loss of the MpGLID function causes failure of germline initiation, leading to the absence of sperm and egg cells. Remarkably, the overexpression of MpGLID in M. polymorpha induces the ectopic formation of cells with male germline cell features exclusively in male thalli. We further show that MpBONOBO (BNB), with an evolutionarily conserved function, can induce the formation of male germ cell-like cells through the activation of MpGLID by directly binding to its promoter. The Arabidopsis (Arabidopsis thaliana) MpGLID ortholog, MALE STERILITY1 (AtMS1), fails to replace the germline specification function of MpGLID in M. polymorpha, demonstrating that a derived function of MpGLID orthologs has been restricted to tapetum development in flowering plants. Collectively, our findings suggest the presence of the BNB–GLID module in complex ancestral land plants that has been retained in bryophytes, but rewired in flowering plants for male germline fate determination.
The phosphatidylethanolamine-binding proteins OsMFT1 and OsMFT2 regulate seed dormancy in rice
Authors: Shen Jun , Zhang Liang , Wang Huanyu , Guo Jiazhuo , Li Yuchen , Tan Yuanyuan , Shu Qingyao , Qian Qian , Yu Hao , Chen Ying , Song Shiyong
Published: July 2024

Seed dormancy is crucial for optimal plant life-cycle timing. However, domestication has largely diminished seed dormancy in modern cereal cultivars, leading to challenges such as preharvest sprouting (PHS) and subsequent declines in yield and quality. Therefore, it is imperative to unravel the molecular mechanisms governing seed dormancy for the development of PHS-resistant varieties. In this study, we screened a mutant of BASIC HELIX-LOOP-HELIX TRANSCRIPTION FACTOR4 (OsbHLH004) with decreased seed dormancy and revealed that OsbHLH004 directly regulates the expression of 9-CIS-EPOXYCAROTENOID DIOXYGENASE3 (OsNCED3) and GIBBERELLIN 2-OXIDASE6 (OsGA2ox6) in rice (Oryza sativa). Additionally, we determined that two phosphatidylethanolamine-binding proteins, MOTHER OF FT AND TFL1 and 2 (OsMFT1 and OsMFT2; hereafter OsMFT1/2) interact with OsbHLH004 and Ideal Plant Architecture 1 (IPA1) to regulate their binding capacities on OsNCED3 and OsGA2ox6, thereby promoting seed dormancy. Intriguingly, FT-INTERACTING PROTEIN1 (OsFTIP1) interacts with OsMFT1/2 and affects their nucleocytoplasmic translocation into the nucleus, where OsMFT1/2–OsbHLH004 and OsMFT1/2–IPA1 antagonistically modulate the expression of OsNCED3 and OsGA2ox6. Our findings reveal that OsFTIP1-mediated inhibition of nuclear translocation of OsMFT1/2 and the dynamic transcriptional modulation of OsNCED3 and OsGA2ox6 by OsMFT1/2–OsbHLH004 and OsMFT1/2–IPA1 complexes in seed dormancy in rice.
Summarized Distribution of the Reniform Nematode, Rotylenchulus reniformis, in Field Crops in the United States
Authors: Faske Travis R. , Watson Tristan , Desaeger Johan , Duffeck Maira R. , Eisenback Jonathan , Floyd Chase , Grabau Zane , Hajihassani Abolfazl , Kelly Heather , Kemerait Robert , Lawrence Kathy , Mueller John , Smith Maxwell , Wheeler Terry , Ye Weimin
Published: July 2024

The reniform nematode, Rotylenchulus reniformis Linford & Oliveira, 1940 is one of the most important yield-limiting pathogens of agronomic and vegetable crops across tropical and subtropical climates worldwide. Monitoring the distribution of nematode species across the United States can be helpful to identify areas where scouting and management are needed. Given that R. reniformis has been detected in new states and new counties on field crops since the last report nearly 35 years ago, an updated map is needed. The map created herein is an updated resource summarizing the distribution of R. reniformis on field crops (e.g., agronomic and vegetable crops) at the county level across the contiguous United States.
Calcium-activated potassium channels as amplifiers of TRPV4-mediated pulmonary edema formation in male mice
Authors: Li Mei , Roeder Juliana , Blázquez-Prieto Jorge , Schulz Sabrina , Naujox Julia , Falivene Juliana , Erfinanda Lasti , Liedtke Wolfgang , Albaiceta Guillermo M. , Kuebler Wolfgang M. , Michalick Laura
Published: July 2024

Background:

As a mechanosensitive cation channel and key regulator of vascular barrier function, endothelial transient receptor potential vanilloid-type 4 (TRPV4) contributes critically to ventilator-induced lung injury (VILI) and edema formation. Ca2+ influx via TRPV4 can activate Ca2+-activated K + (KCa) channels, categorized into small (SK1-3), intermediate (IK1), and big (BK) KCa, which may in turn amplify Ca2+ influx by increasing the electrochemical Ca2+ gradient and thus, promote lung injury. We therefore hypothesized that endothelial KCa channels may contribute to the progression of TRPV4-mediated VILI.

Methods:

Male C57Bl/6J mice were ventilated for 2 h with low or high tidal volumes in the presence or absence of the non-selective KCa antagonists apamin, charybdotoxin, or the selective IK1 antagonist TRAM34. Lung injury was similarly assessed in overventilated, endothelial-specific TRPV4-deficient mice or TRAM34-treated C57Bl/6J mice challenged with intratracheal acid installation. Changes in endothelial Ca2+ concentration ([Ca2+]i) were monitored by real-time imaging in isolated-perfused lungs in response to airway pressure elevation or in human pulmonary microvascular endothelial cells (HPMECs) in response to TRPV4 activation with or without inhibition of KCa channels. Analogously, changes in intracellular potassium concentration ([K+]i) and membrane potential (V
m) were imaged in vitro.

Results:

Endothelial TRPV4 deficiency or inhibition of KCa channels, and most prominently inhibition of IK1 by TRAM34 attenuated VILI as demonstrated by reduced lung edema, protein leak, and by quantitative lung histology. All KCa antagonists reduced the [Ca2+]i response to mechanical stimulation or direct TRPV4 activation in isolated lungs. TRAM34 and charybdotoxin, yet not apamin prevented TRPV4-induced K+ efflux and membrane hyperpolarization in HPMECs. TRAM34 also attenuated the TRPV4 agonist-induced Ca2+ influx in vitro and reduced acid-induced lung injury in vivo.

Conclusions:

KCa channels, specifically IK1, act as amplifiers of TRPV4-mediated Ca2+ influx and establish a detrimental feedback that promotes barrier failure and drives the progression of VILI.
Heparin-Induced Thrombocytopenia in Patients Suffering Cardiogenic Shock
Authors: Lüsebrink Enzo , Lanz Hugo , Binzenhöfer Leonhard , Hoffmann Sabine , Höpler Julia , Kraft Marie , Gade Nils , Gmeiner Jonas , Roden Daniel , Saleh Inas , Hagl Christian , Nickenig Georg , Massberg Steffen , Zimmer Sebastian , Jamin Raúl Nicolás , Scherer Clemens
Published: July 2024

OBJECTIVES:

Cardiogenic shock (CS) is associated with high mortality. Patients treated for CS mostly require heparin therapy, which may be associated with complications such as heparin-induced thrombocytopenia (HIT). HIT represents a serious condition associated with platelet decline and increased hypercoagulability and remains a poorly researched field in intensive care medicine. Primary purpose of this study was to: 1) determine HIT prevalence in CS, 2) assess the performance of common diagnostic tests for the workup of HIT, and 3) compare outcomes in CS patients with excluded and confirmed HIT.

DESIGN:

Retrospective dual-center study including adult patients 18 years old or older with diagnosed CS and suspected HIT from January 2010 to November 2022.

SETTING:

Cardiac ICU at the Ludwig-Maximilians University hospital in Munich and the university hospital of Bonn.

PATIENTS AND INTERVENTIONS:

In this retrospective analysis, adult patients with diagnosed CS and suspected HIT were included. Differences in baseline characteristics, mortality, neurologic and safety outcomes between patients with excluded and confirmed HIT were evaluated.

MEASUREMENTS AND MAIN RESULTS:

In cases of suspected HIT, positive screening antibodies were detected in 159 of 2808 patients (5.7%). HIT was confirmed via positive functional assay in 57 of 2808 patients, corresponding to a prevalence rate of 2.0%. The positive predictive value for anti-platelet factor 4/heparin screening antibodies was 35.8%. Total in-hospital mortality (58.8% vs. 57.9%; p > 0.999), 1-month mortality (47.1% vs. 43.9%; p = 0.781), and 12-month mortality (58.8% vs. 59.6%; p > 0.999) were similar between patients with excluded and confirmed HIT, respectively. Furthermore, no significant difference in neurologic outcome among survivors was found between groups (Cerebral Performance Category [CPC] score 1: 8.8% vs. 8.8%; p > 0.999 and CPC 2: 7.8% vs. 12.3%; p = 0.485).

CONCLUSIONS:

HIT was a rare complication in CS patients treated with unfractionated heparin and was not associated with increased mortality. Also, HIT confirmation was not associated with worse neurologic outcome in survivors. Future studies should aim at developing more precise, standardized, and cost-effective strategies to diagnose HIT and prevent complications.
Preventable Fraction in the Context of Disease Progression
Authors: Gonçalves Bronner P. , Suzuki Etsuji
Published: July 2024

The relevance of the epidemiologic concept of preventable fraction to the study of the population-level impact of preventive exposures is unequivocal. Here, we discuss how the preventable fraction can be usefully understood for the class of outcomes that relate to disease progression (e.g., clinical severity given diagnosis), and, under the principal stratification framework, derive an expression for this quantity for this type of outcome. In particular, we show that, in the context of disease progression, the preventable fraction is a function of the effect on the postdiagnosis outcome in the principal stratum in the unexposed group who would have disease regardless of exposure status. This work will facilitate an understanding of the contribution of principal effects to the impact of preventive exposures at the population level.
Prenatal Exposure to Nonpersistent Chemicals and Fetal-to-childhood Growth Trajectories
Authors: Bommarito Paige A. , Blaauwendraad Sophia M. , Stevens Danielle R. , van den Dries Michiel A. , Spaan Suzanne , Pronk Anjoeka , Tiemeier Henning , Gaillard Romy , Trasande Leonardo , Jaddoe Vincent V.W. , Ferguson Kelly K.
Published: July 2024

Introduction:

Prenatal exposure to nonpersistent chemicals, including organophosphate pesticides, phthalates, and bisphenols, is associated with altered fetal and childhood growth. Few studies have examined these associations using longitudinal growth trajectories or considering exposure to chemical mixtures.

Methods:

Among 777 participants from the Generation R Study, we used growth mixture models to identify weight and body mass index trajectories using weight and height measures collected from the prenatal period to age 13. We measured exposure biomarkers for organophosphate pesticides, phthalates, and bisphenols in maternal urine at three timepoints during pregnancy. Multinomial logistic regression was used to estimate associations between averaged exposure biomarker concentrations and growth trajectories. We used quantile g-computation to estimate joint associations with growth trajectories.

Results:

Phthalic acid (OR = 1.4; 95% CI = 1.01, 1.9) and bisphenol A (OR = 1.5; 95% CI = 1.0, 2.2) were associated with higher odds of a growth trajectory characterized by smaller prenatal and larger childhood weight relative to a referent trajectory of larger prenatal and average childhood weight. Biomarkers of organophosphate pesticides, individually and jointly, were associated with lower odds of a growth trajectory characterized by average prenatal and lower childhood weight.

Conclusions:

Exposure to phthalates and bisphenol A was positively associated with a weight trajectory characterized by lower prenatal and higher childhood weight, while exposure to organophosphate pesticides was negatively associated with a trajectory of average prenatal and lower childhood weight. This study is consistent with the hypothesis that nonpersistent chemical exposures disrupt growth trajectories from the prenatal period through childhood.
Ultrasound-guided transversalis fascia plane block or transversus abdominis plane block for recovery after caesarean section
Authors: Pinarbaşi Ahmet , Altiparmak Başak , Korkmaz Toker Melike , Pirinççi Fatih , Uğur Bakiye
Published: July 2024

BACKGROUND

Caesarean section is a widely performed surgical procedure that often results in moderate-to-severe postoperative pain. If left untreated, this pain can lead to short-term and long-term consequences. Transversalis fascia plane (TFP) block and transversus abdominis plane (TAP) block are among the regional anaesthesia techniques employed for managing pain after a caesarean section.

OBJECTIVE

We aimed to compare the impact of these two blocks on the quality of recovery in patients undergoing elective caesarean section under spinal anaesthesia.

DESIGN

A single-centre, double-blind, randomised trial.

SETTINGS

Operating room, postanaesthesia recovery unit, and ward in a tertiary hospital.

PARTICIPANTS

Ninety-three patients (ASA 2 to 3) were recruited. After exclusion, 79 patients were included in the final analysis: 40 in the TFP block group and 39 in the TAP block group.

INTERVENTIONS

After surgery, participants received either TFP block (20 ml 0.25% bupivacaine for each side) or TAP block (20 ml 0.25% bupivacaine for each side).

MAIN OUTCOME MEASURES

The primary outcome was the difference in obstetric quality of recovery 11-Turkish (ObsQoR-11T) scores between groups. Secondary outcomes included pain scores, opioid consumption and incidence of opioid-related complications.

RESULTS

The mean ObsQoR-11T score was higher in the TFP block group compared with the TAP block group (97.13 ± 6.67 points vs. 87.10 ± 9.84 points, respectively; P < 0.001). The pain scores in the TFP block group were slightly lower between postoperative 4 and 24 h. The mean total morphine consumption was 15.08 ± 2.21 mg in the TFP block group and 22.21 ± 3.04 mg in the TAP block group (P < 0.001). More patients required rescue analgesia between 4 and 8 h in the TAP block group [2.00 (5.00%) vs. 9.00 (23.08%), P = 0.02]. No significant differences were observed between groups in terms of opioid-related side effects.

CONCLUSION

TFP block used for analgesic purposes yielded a better quality recovery period than TAP block and also reduced opioid consumption.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT05999981).

VISUAL ABSTRACT

http://links.lww.com/EJA/B6.
Endothelial RUNX3 controls LSEC dysfunction and angiocrine LRG1 signaling to prevent liver fibrosis
Authors: Ojha Uttam , Kim Somi , Rhee Chang Yun , You Jihye , Choi Yoon Ha , Yoon Soo-Hyun , Park Soo Young , Lee Yu Rim , Kim Jong Kyoung , Bae Suk-Chul , Lee You Mie
Published: July 2024

Background and Aims:

Liver fibrosis represents a global health burden, given the paucity of approved antifibrotic therapies. Liver sinusoidal endothelial cells (LSECs) play a major gatekeeping role in hepatic homeostasis and liver disease pathophysiology. In early tumorigenesis, runt-related transcription factor 3 (RUNX3) functions as a sentinel; however, its function in liver fibrosis in LSECs remains unclear. This study aimed to investigate the role of RUNX3 as an important regulator of the gatekeeping functions of LSECs and explore novel angiocrine regulators of liver fibrosis.

Approach and Results:

Mice with endothelial Runx3 deficiency develop gradual and spontaneous liver fibrosis secondary to LSEC dysfunction, thereby more prone to liver injury. Mechanistic studies in human immortalized LSECs and mouse primary LSECs revealed that IL-6/JAK/STAT3 pathway activation was associated with LSEC dysfunction in the absence of RUNX3. Single-cell RNA sequencing and quantitative RT-PCR revealed that leucine-rich alpha-2-glycoprotein 1 (LRG1) was highly expressed in RUNX3-deficient and dysfunctional LSECs. In in vitro and coculture experiments, RUNX3-depleted LSECs secreted LRG1, which activated HSCs throughTGFBR1–SMAD2/3 signaling in a paracrine manner. Furthermore, circulating LRG1 levels were elevated in mouse models of liver fibrosis and in patients with fatty liver and cirrhosis.

Conclusions:

RUNX3 deficiency in the endothelium induces LSEC dysfunction, LRG1 secretion, and liver fibrosis progression. Therefore, endothelial RUNX3 is a crucial gatekeeping factor in LSECs, and profibrotic angiocrine LRG1 may be a novel target for combating liver fibrosis.
Good therapeutic connections and patient psychological safety: A qualitative survey study
Authors: Rathert Cheryl , Simmons Derick R. , Mittler Jessica N. , Enard Kimberly , Brooks Joanna Veazey
Published: July 2024

Background

Therapeutic connections (TCs) between patients and care providers are important for achieving desired patient outcomes. For patients, TC is associated with greater health self-efficacy, better health status, mental health status, and higher satisfaction with providers.

Purpose

The aim of the study was to examine patients’ descriptions of what signals to them they have a TC with their care provider.

Methodology

We conducted an online survey of patients with a recent health care visit (n = 1,766). This study analyzed the results of an open-ended question that asked how patients know they have a good TC with their care provider. Data were analyzed using framework analysis to determine the extent to which patient responses indicated TC dimensions. A thematic content analysis identified emergent themes.

Results

Of the TC dimensions, words associated with Shared Deliberation were mentioned by 60% of respondents. Other dimension mentions ranged between 14% (Shared Mind) and 2% (Bond). Thematic content analysis revealed that patient psychological safety seems to be required for many patients to feel connected.

Conclusion

A majority of patients indicated that good TCs happen when they feel seen and heard by providers. However, it appears that prior to feeling a strong TC, patients need to feel safe to be fully welcome into the encounter.

Practice Implications

Health care organizations need to give care providers the uninterrupted time and space they need to fully connect with patients. Training about how to create a psychologically safe environment for patients should be tailored for practicing providers, leaders, and students in health care fields.
Actualizing Radical Loving Leadership in Real World Health Care
Authors: Manss Ginger
Published: July 2024

With Chapman’s Radical Loving Care as a framework, this article shares practical wisdom and habits that occur daily in a busy community hospital to help all nurse leaders to develop a holistic view to shape their vision and embed radical loving care in their connections. The application of Chapman’s concepts to the mentoring of others is viewed as a form of love and helps to strengthen not only the mentee, but the entire system of nurses caring for each other. Radical loving care is seen as a far reaching, progressive and humanistic strategy to show a deep, abiding kindness and caring to other human beings in the world of health care.
Do Interventions Meet the Needs of Caregivers of Cardiac Patients?
Authors: Nissen Nina Konstantin , Guldin Mai-Britt , Nielsen Camilla Palmhøj , Ørtenblad Lisbeth
Published: July 2024

Background

Interventions targeting the needs of caregivers of cardiac patients are few, and in most cases, no effect is found on caregivers' well-being. A closer look at the existing interventions will provide a solid foundation for future efforts to develop effective interventions targeted at caregivers of cardiac patients.

Objective

The study's objective was to scrutinize and discuss interventions targeting caregivers of cardiac patients and contribute to reflections that will improve future interventions.

Methods

Systematic scoping of the literature within the field was conducted through a literature search in PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Library from January 2011 to May 2022. The development of search terms and inclusion criteria was inspired by the Patient problem/population, Intervention, Comparison/Control, and Outcome approach, and the Medical Research Council framework for developing and evaluating complex interventions served as the underlying basis for the analysis.

Results

Eleven articles were included. The interventions reported in the articles were generally not systematically developed and did not include field-specific, methodological, and theoretical reflections. Furthermore, the development process behind the studies seemed not to be transparent.

Conclusions

Lack of systematic methodology and methodological transparency in the reviewed studies hinders further testing of interventions and might explain lack of evidence for effective interventions within the field. More systematic, needs-based, and well-documented interventions targeting caregivers of various kinds of cardiac patients are needed to develop the field to the benefit of caregivers, patients, and society.
Advancing Vaccine Uptake in People With HIV: A Call for Research on Trust and Intellectual Humility in Health Care
Authors: Barr Emily A. , Celniker Jared B. , Ballantyne Nathan
Published: July 2024

This article addresses the challenge of vaccine hesitancy among people with HIV (PWH), emphasizing the need for research on the potential impact of trust and intellectual humility in health care. It underscores the complexity of vaccine acceptance in PWH and the urgency of addressing hesitancy in PWH ahead of a future HIV vaccine. The article identifies trust in health care providers as a critical factor influencing vaccine uptake and proposes that providers who demonstrate intellectual humility—openly recognizing the limits of their knowledge—might enhance patient trust. The role of nurses is spotlighted because of their social positioning in the patient experience. The article advocates for interventions tailored to PWH's unique experiences and attitudes. Such strategies are essential for improving vaccine uptake and, consequently, public health outcomes.
Nurse-led telehealth and mobile health care models for type 2 diabetes and hypertension in low-income US populations: A scoping review
Authors: Oh Kyeung Mi , Cieslowski Bethany , Beran Krista , Elnahas Nora H. , Steves Stacey Leigh , Sutter Rebecca E.
Published: July 2024

Background:

Increasing numbers of underserved people with chronic diseases and decreasing providers in rural areas have contributed to the care shortage in the United States. Nurse-led telehealth/mobile care models have potential benefits for this population. However, there is a substantial gap in the literature regarding this topic.

Purpose:

To examine the available literature on nurse-led telehealth/mobile health care models with a particular focus on care model settings, nursing roles, care components, achieved outcomes, and the identification of both facilitative factors and encountered challenges. The ultimate goal is to offer recommendations based on these findings, thereby aiding the development or refinement of evidence-based care models that meet to the unique needs of low-income populations.

Methodology:

Literature published from 2010 to 2023 was searched in six electronic databases (Cumulative Index to Nursing and Allied Health Literature, Communication and Mass Media Complete, Medline, APA PsycINFO, Social Sciences Index, and Web of Science databases).

Results:

Commonalities identified among included studies with significant improvements were the provision of home monitors and education to participants, multiple engagements, and extensive community and/or family involvement.

Conclusions:

Nurse-led telehealth/mobile health care models for chronic diseases are an emerging approach. Nurse educators must ensure that future nurses are adept in diverse telehealth modes, collaborating across disciplines. Leveraging advanced practice registered nurses and interdisciplinary teams provides holistic care.

Implications:

Our review outlined recent research findings that suggest enhanced patient outcomes through technology, communication, and community support. In addition, we offered suggestions for future research and practice, emphasizing the importance of exploring the requirements of diverse and underserved communities.
Budesonide Versus Mesalamine in Microscopic Colitis
Authors: Malik Adnan , Goyal Hemant , Adler Douglas G. , Javaid Sadia , Malik Muhammad Imran , Singh Shailendra , Nadir Abdul , Abegunde Ayokunle T.
Published: July 2024

Background:

Microscopic colitis (MC) is an inflammatory bowel disease of autoimmune origin that causes chronic watery diarrhea. Medications, including budesonide, mesalamine, loperamide, cholestyramine, and bismuth subsalicylate, are first-line therapies. Meanwhile, azathioprine, 6-mercaptopurine, and methotrexate are indicated for refractory MC.

Objective:

We aim to assess the efficacy and safety of budesonide compared with mesalamine for induction of remission in MC patients.

Methods:

We searched the Cochrane Library, Scopus, Web of Science, and PubMed for relevant clinical trials comparing either mesalamine or budesonide with a control group. We included the following outcomes: clinical remission (3 or fewer stools/day), daily stool weight, daily stool frequency, number of patients with clinical response <50% in the disease activity, and daily stool consistency. Safety end points included: any adverse event, serious adverse events, any adverse event-related discontinuation, abdominal discomfort, constipation, flatulence, nausea, dizziness, headache, bronchitis, nasopharyngitis, and depression. We conducted a meta-analysis model using the generic inverse variance method and performed a subgroup analysis based on the intervention administered.

Results:

Nineteen randomized clinical trials were included. We found that after 6 weeks of follow-up, budesonide is associated with increased clinical remission rates compared with mesalamine [RR=2.46 (2.27, 2.67), and RR=2.24 (1.95, 2.57), respectively]. However, the test of subgroup difference revealed that the difference is not significant (P=0.25). After 8 weeks of follow-up, budesonide showed significantly higher clinical remission rates than mesalamine RR=2.29 (2.14, 2.45), and RR=1.7 (1.41, 2.05), respectively (P=0.003). Regarding the daily stool weight, patients in the budesonide group showed nonsignificant less stool weight [MD=−351.62 (−534.25, −168.99)] compared with mesalamine [MD=−104.3 (−372.34, 163.74)], P=0.14. However, daily stool frequency was significantly less in the budesonide group compared with mesalamine (P<0.001). Budesonide is associated with a significantly lower incidence of adverse events compared with mesalamine (P=0.002). Analysis of other safety endpoints was not significant between both groups.

Conclusions:

Budesonide was found to be better than mesalamine in MC patients in terms of clinical remission rate, especially after 8 weeks of follow-up. Budesonide also showed less incidence of adverse events. There is an urgent need for randomized, double-blinded clinical trials to provide direct and reliable evidence.
Endoscopic Ultrasound-guided Transmural Biliary Drainage With 6 mm and 8 mm Cautery-enhanced Lumen-apposing Metal Stents
Authors: Ramai Daryl , Dawod Enad , Darwin Peter E. , Kim Raymond E. , Kim Jeong Hoon , Wang Jade , Lanka Chandana , Bakain Tarek , Mahadev SriHari , Sampath Kartik , Carr-Locke David L. , Morris John D. , Sharaiha Reem Z.
Published: July 2024

Objective:

Endoscopic retrograde cholangiopancreatography (ERCP) may be unsuccessful in patients with duodenal stenosis or malignant ampullary infiltration. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been proposed as an alternative. We aimed to assess the efficacy and safety of EUS-BD for malignant distal bile duct obstruction using the newly introduced smaller caliber 6 or 8 mm cautery-enhanced lumen-apposing metal stent.

Methods:

A multicenter retrospective study was performed on patients with unresectable malignant distal bile duct obstruction who underwent EUS-BD between 2021 and 2022 after unsuccessful ERCP.

Results:

Thirty-two patients were included [7 (53.13%) males], with a mean age of 72.2 ± 12.5 years. The technical success rate was 100%. Altered anatomy was present in 2 (6.25%). The indication for drainage was biliary obstruction from pancreatic cancer in 26 patients (84.5%), cholangiocarcinoma in 3 (9.4%), and ampullary mass in 3 (9.4%). The procedure was performed mostly in an outpatient setting (n = 19, 59.38%). The clinical success rate was 92.3% [bilirubin: 14.1 (SD: 8.9) preprocedure vs 4.9 (SD: 1.1) postprocedure; P= 0.0001]. There was one early adverse event of a perforation, which was closed endoscopically and drained percutaneously. Delayed adverse events included food impaction of the stent (n = 1), which was resolved with a repeat procedure and insertion of a double pigtail stent.

Conclusion:

This study demonstrates the feasibility of EUS-BD drainage using smaller caliber 6 or 8 mm lumen-apposing metal stent to relieve malignant distal bile duct obstruction in patients who fail conventional ERCP.
Development and Implementation of a Procedural Sedation Course for Registered Nurses
Authors: Gardner Linda , Causey Cheryl , Zito Antoinette , Novosel Lorraine M.
Published: July 2024

Procedural sedation is the administration of medication to obtund, dull, or reduce the intensity of pain or awareness associated with a therapeutic or diagnostic procedure. Because registered nurses play a key role in ensuring patient safety during procedural sedation, it is essential they have the requisite knowledge and skills to provide safe, quality care. This paper describes the development, implementation, and outcomes of a course designed for nurses providing care to patients undergoing procedural sedation.
p53 Immunohistochemistry Defines a Subset of Human Papillomavirus–Independent Penile Squamous Cell Carcinomas With Adverse Prognosis
Authors: Trias Isabel , Algaba Ferran , de Torres Inés , Saco Adela , Marimon Lorena , Peñuelas Núria , Diez-Ahijado Laia , Sisuashvili Lia , Darecka Katarzyna , Morató Alba , del Pino Marta , Ferrándiz-Pulido Carla , Ribal María José , Ajami Tarek , Corral Juan Manuel , Gaya Josep Maria , Reig Oscar , Ordi Oriol , Ribera-Cortada Inmaculada , García-Herrera Adriana , Rakislova Natalia
Published: July 2024

Penile squamous cell carcinoma (PSCC) is classified into 2 prognostically distinct types: human papillomavirus (HPV)–associated and HPV-independent. However, the impact of p53 status on prognosis remains controversial. We correlated HPV and p53 status with the prognosis of a large series of patients with PSCC. p53 was analyzed according to a recently described immunohistochemical (IHC) pattern-based framework that includes 2 normal and 4 abnormal patterns and closely correlates with TP53 mutational status. A total of 122 patients with surgically treated PSCC in 3 hospitals were included. Based on HPV in situ hybridization and p16 and p53 IHC, the tumors were classified into 3 subtypes: HPV-associated, HPV-independent/p53 normal, and HPV-independent/p53 abnormal. All patients were followed up for at least 22 months (median: 56.9 months). Thirty-six tumors (29%) were HPV-associated, 35 (29%) were HPV-independent/p53 normal, and 51 (42%) were HPV-independent/p53 abnormal. Disease-related deaths were observed in 3/36 (8%), 0/35 (0%) and 14/51 (27%) of the patients, respectively (P < 0.001). A total of 7/14 deaths in the latter group were patients with tumors showing p53 abnormal patterns not recognized in the classic p53 IHC interpretation (basal, null, and cytoplasmic). According to our multivariate analysis, HPV-independent/p53 abnormal tumors and advanced stage were associated with impaired disease-specific survival (hazard ratio = 23.4, 95% CI = 2.7-3095.3; P = 0.001 and 16.3, 95% CI = 1.8-2151.5; P = 0.008, respectively). In conclusion, compared with patients with HPV-associated and HPV-independent/p53-normal PSCC, patients with HPV-independent/p53 abnormal PSCC have worse clinical outcomes. p53 IHC results define 2 prognostic categories in HPV-independent PSCC: HPV-independent/p53-normal tumors as low-risk tumors, whereas HPV-independent/p53-abnormal tumors as aggressive neoplasms.
Occupational Exposure to Aerosolized Human Papillomavirus: Assessing and Addressing Perceptions of and Barriers to Vaccination of at-Risk Health Care Workers
Authors: Mercier Ann Marie , Allison Mary Kathryn , Greulich Jennifer , Alston Ashley , Racher Mary Luann
Published: July 2024

Objectives:

This study aimed to assess current vaccination rates among health care workers at risk for occupational human papillomavirus (HPV) exposure and explore factors that influence decisions about HPV vaccination.

Design:

Using a mixed-methods design, this study included a questionnaire and qualitative focus groups.

Setting:

The study took place at an academic medical center.

Participants:

Participants were 37 health care professionals in occupations at risk for workplace HPV exposure.

Main Outcome Measures:

The primary qualitative outcome measured was HPV vaccination status. The primary qualitative outcomes assessed were perceptions of occupational HPV exposure risk, protective measures, and HPV vaccination.

Results:

Most participants were female (86.5%, n = 32) and younger than 35 years (51.4%; n = 19) and therefore would have been eligible to receive the HPV vaccine series as a teenager or young adult. Nearly two-thirds (67.6%; n = 25) of participants had received the HPV vaccine; of those, half were vaccinated as teenagers (52%; n = 13). One-third (n = 4) of those vaccinated as adults reported vaccination due to workplace HPV exposure. Focus groups revealed themes consistent with the Health Belief Model. Most participants recognized their risk of aerosolized HPV exposure in the workplace but felt uneducated about occupational exposure risk and protective measures. Many participants recognized risk of exposure through surgical smoke but perceived that risk was stratified by medical specialty, proximity to surgical field, and personal protective equipment use. Many participants had some level of concern for head and neck lesions with exposure to aerosolized HPV. Most participants recognized the need to protect themselves against workplace HPV exposure. Those who were vaccinated felt that they were better protected against HPV exposure. Almost all participants said that they had not received formal education on workplace HPV exposure risk. Many participants voiced perceived barriers to HPV vaccination.

Conclusion:

Health care workers encounter the HPV virus in a myriad of fields and procedures. Our mixed-methods study demonstrated that at-risk health care workers feel uninformed about their risk of HPV exposure in the workplace, availability of HPV vaccination, and appropriate protective equipment recommendations.