bluuebunny/crossref_metadata_2025 huggingface dataset:
Special Operations Success
Authors: Kiras James D.
Published: February 2025

James D. Kiras establishes a new benchmark in military theory in this deeply analytic and innovative work. In it, he answers several pressing questions: how successful have American special operations been over the past quarter-century? Are special forces fated to cycles of expansion and misuse? Will special forces invariably exceed the authorities granted to them because of who they are and what they do? Is a general theory of special operations feasible given the range of activities and conditions that fall under the category? The book is based on two decades of practical experiences, teaching, and consulting experience within different special operations communities. Its analysis and conclusions are designed to inform practitioners, policy makers, educators, and the general public. It develops a framework, in the form of a theory comprising capabilities and control, for comprehensively evaluating special operations success. It contains more than twenty figures, maps, and illustrations to aid in the process. The book is divided into three parts. Part I lays the foundation for a general theory of special operations by looking at previous waves of scholarship, as well as historical special operations precedents stretching back into ancient history. Part II explores the two component parts of theory, capabilities and control, and expands our understanding of the former as well as the civil-military conceptualizations of the latter. Each become the basis for a triad that, when merged and animated by elements of strategy, form a dynamic theory and framework to evaluate special operations success. Part III uses various aspects of the theory, depending on available information, to assess the success of special operations over a twenty-year period in the United Kingdom, South Africa, and the United States.
Strategies Used by Developed Countries Away from the Negotiating Table
Authors: Das Abhijit
Published: February 2025

Using specific episodes in multilateral trade negotiations at GATT and WTO spanning four decades, this chapter examines some of the strategies and tactics deployed by the developed countries away from the negotiating table. These include forum shifting, suitable framing of issues, influencing negotiations through research, using policy instruments to browbeat developing countries, dangling the carrot and threatening with the stick, Quislings to influence negotiating positions of developing countries, using decoys to peep and pry and crafting a better alternative to a negotiated agreement (BATNA). While many of these strategies are relevant after negotiations have formally commenced, a few of them assume salience even prior to the start of negotiations. Some of these strategies may be extremely sensitive and controversial, as these clearly encroach on the sovereignty of nations. This chapter throws light on some of the strategies which have remained in the shadows behind a cloak of secrecy. It concludes by briefly discussing why most developing countries may not be in a position to deploy these strategies.
Davids Join Hands to Take on Goliath in the Battle on Agriculture
Authors: Das Abhijit
Published: February 2025

Agriculture has remained one of the most contested issues in the multilateral trade negotiations at the GATT and the WTO. High stakes were involved for both developed and developing countries on the negotiations on the Agreement on Agriculture during the Doha Round of WTO negotiations. Retaining the right to subsidize their agriculture and agri-business but seeking to prise open the markets of developing countries was the main objective of the USA-EU combine. On the other hand, many developing countries sought to convince the developed countries to cut their agriculture subsidies, while seeking to protect their own farmers from subsidised imports from other countries.

With the USA and the EU joining hands on this issue to protect their interests during the Doha Round of negotiations, developing countries were yet again at the risk of being compelled to agree to trade rules that were against their interest. This chapter describes the crisis that confronted developing countries in WTO agriculture negotiations and how it resulted in the creation of G-20, a coalition of developing countries. It provides a fascinating account of how this coalition, led by Brazil and India, overcame the power asymmetry and turned the tables on the USA-EU combine. This chapter brings out the negotiating strategies deployed by the G-20 coalition and draws valuable lessons for creating and nurturing an effective coalition at the negotiating table.
Conclusion
Authors: Myers Matt
Published: February 2025

The conclusion outlines how the left had more options available to it than supposed during the 1970s. Economic constraints were very powerful but alone cannot explain why the major workers’ parties disempowered their core supporters when they still had the capacity to resist. The longer-term development of Fordism provided the conditions for a short-term crisis where radically different outcomes were believed possible. It describes how the European left ceased to play the same role after the 1970s. It establishes how the protracted and uneven decline of the left which followed these years was about more than the re-emergence of longstanding internal political and organisational divisions. The book concludes by emphasising that historical analogies should remind us that all crises are preludes to new forms of politics, and even progress.
Reimbursement for services provided by clinical pharmacists in primary care: Description of changes over time in an academic primary care network in Ohio following the recognition of pharmacists as providers
Authors: Coffey Cory P , Barnes Kelli D , Tayal Neeraj H , Jonas Daniel E , Beatty Stuart J
Published: February 2025

Purpose

In January 2021, Ohio pharmacists were recognized by Medicaid as providers, became eligible to obtain Medicaid provider identification numbers, and were able to begin billing for services using evaluation and management codes. The objectives of this study were to compare outcomes before (2020) and after (2021 and 2022) pharmacist provider status was implemented in a network of primary care clinics: (1) the percent change in pharmacist-provided services that were billed and reimbursed, 2) the percent change in pharmacist-provided services that were billed as “incident-to” versus with the pharmacist as provider, and (3) the percent change in reimbursement per encounter as a result of pharmacist-provided services.

Methods

A retrospective review of all encounters and administrative claims (all payors) provided by pharmacists (7.9 full-time equivalents) within 7 primary care clinics affiliated with a large academic medical center was conducted. The data were compared year-to-year using descriptive statistics to determine the magnitude of change.

Results

A total of 14,416 encounters were included in the study (1,863 in 2020, 4,963 in 2021, and 7,590 in 2022). In 2020, 37.8% (705/1,863) of pharmacist encounters were billed for reimbursement. In 2021, this percentage increased to 39.1% (1,939/4,963) encounters, with a further increase in 2022 to 49.1% (3,725/7,590). Differences in the percentage of pharmacist encounters billed as incident-to versus pharmacist as provider were also evident, with 37.8% (705/1,863) of pharmacist encounters billed incident-to in 2020, as compared to 36.8% (2,796/7,590) in 2022. In this same time period, mean reimbursement for pharmacist-as-provider encounters increased by 189.5% (from $10.45 to $30.25) per encounter, and the number of pharmacist-as-provider encounters increased year over year (from 0% [0/1863] in 2020 to 1.1% [54/4,963] in 2021 and 12.3% [929/7,590] in 2022; P < 0.001).

Conclusion

This study found an increase in the billing and reimbursement attributable to clinical pharmacists in primary care settings in Ohio after their recognition as providers.
Interleukin-37 attenuates aortic valve lesions by inhibiting N6-methyladenosine-mediated interleukin-1 receptor-associated kinase M degradation
Authors: Xian Gaopeng , Huang Rong , Hu Dongtu , Xu Minhui , Chen Yangchao , Ren Hao , Xu Dingli , Zeng Qingchun
Published: February 2025

Aims

Calcific aortic valve disease (CAVD) has become an increasingly important global medical problem without effective pharmacological intervention. Accumulating evidence indicates that aortic valve calcification is driven by inflammation. Interleukin-1 receptor-associated kinase M (IRAK-M) is a well-known negative regulator of inflammation, but its role in CAVD remains unclear.

Methods and results

Here, we stimulated aortic valve interstitial cells (AVICs) with low-dose lipopolysaccharide (LPS) to mimic the inflammatory response in aortic valve calcification and observed the expression pattern of IRAK-M. Furthermore, we generated IRAK-M−/− mice to explore the effect of IRAK-M deficiency on the aortic valve in vivo. Additionally, overexpression and knockdown experiments were performed to verify the role of IRAK-M in AVICs. Methylated RNA immunoprecipitation-quantitative polymerase chain reaction was used to detect the N6-methyladenosine (m6A) level of IRAK-M, and recombinant interleukin (IL)-37-treated AVICs were used to determine the regulatory relationship between IL-37 and IRAK-M. We found that IRAK-M expression was upregulated in the early stages of inflammation as part of a negative feedback mechanism to modulate the immune response. However, persistent inflammation increased overall m6A levels, ultimately leading to reduced IRAK-M expression. In vivo, IRAK-M−/− mice exhibited a propensity for aortic valve thickening and calcification. Overexpression and knockdown experiments showed that IRAK-M inhibited inflammation and osteogenic responses in AVICs. In addition, IL-37 restored IRAK-M expression by inhibiting m6A-mediated IRAK-M degradation to suppress inflammation and aortic valve calcification.

Conclusion

Our findings confirm that inflammation and epigenetic modifications synergistically regulate IRAK-M expression. Moreover, IRAK-M represents a potential target for mitigating aortic valve calcification. Meanwhile, IL-37 exhibited inhibitory effects on CAVD development both in vivo and in vitro, giving us hope that CAVD can be treated with drugs rather than surgery.
Cardiac Magnetic Resonance Feature-Tracking in Olympic Athletes: a myocardial deformation analysis
Authors: Monosilio Sara , Prosperi Silvia , Filomena Domenico , Lemme Erika , Di Gioia Giuseppe , Mango Ruggiero , Netti Lucrezia , Tonti Giovanni , Pedrizzetti Gianni , Gualdi Gianfranco , Squeo Maria Rosaria , Pelliccia Antonio , Maestrini Viviana
Published: February 2025

Background

Athlete’s heart induces extreme cardiovascular remodelling, generating challenges for the differential diagnosis with early stages of cardiomyopathies. Advanced cardiac function analysis could be helpful, but data on healthy athletes and the impact of sports disciplines are lacking.

Aim

To describe myocardial deformation by cardiac magnetic resonance (CMR) in a cohort of Olympic athletes and to evaluate possible differences based on sports disciplines and sex.

Methods

A group of Olympic athletes with normal cardiovascular evaluation and a group of sedentary controls matched for age and sex underwent CMR without contrast administration. Cine-images were post-processed for volumes and function evaluation and to assess bi-ventricular myocardial deformation parameters, as left ventricular global longitudinal and circumferential strain (LV-GLS and -GCS) and right ventricular GLS, by a dedicated feature-tracking (FT) software. Athletes were divided according to ESC sports classification and sex.

Results

Three hundred Olympic athletes (13% skill, 20% power, 25% mixed, 42% endurance, 58% male) and 42 untrained controls were enrolled. No significant differences were found between LV-GLS, -GCS, and RV-GLS when comparing different sports categories, except for a slightly lower LV-GLS in the endurance group compared to the skill one (p=0.045). Athletes showed slightly lower biventricular ejection fraction (p<0.001) and LV-GCS (p<0.001) than sedentary controls, while only endurance athletes showed significant differences in LV- and RV-GLS versus the sedentary group (p=0.002 and p=0.001). Female athletes showed higher bi-ventricular GLS than males (p<0.001 for LV- and RV-GLS).

Conclusions

Our results provided for the first time CMR-FT strain values in a large cohort of Olympic athletes free of cardiovascular abnormalities, according to type of sports. Endurance athletes showed the lowest LV-GLS values being significantly different versus skill and sedentary controls. No other significant differences in myocardial deformation parameters between sports categories were found, but only based on sex.
A Mendelian randomization study investigating the role of sleep traits and their joint effects on the incidence of atrial fibrillation
Authors: Arora Nikhil , Brumpton Ben Michael , Åsvold Bjørn Olav , Loennechen Jan Pål , Malmo Vegard , Bhatta Laxmi , Skarpsno Eivind Schjelderup , Richmond Rebecca Claire , Strand Linn Beate
Published: February 2025

Background and Aims

Sleep disturbances can induce alterations in functional and electrical properties of the heart, thereby increasing susceptibility to atrial fibrillation (AF). We aimed to test the causal role of different sleep traits and their joint effects on the risk of AF.

Methods

We used an observational cohort study design along with one-sample and factorial Mendelian randomization (MR) approaches to test for individual and joint associations of sleep traits (i.e., insomnia symptoms, sleep duration and chronotype) on the risk of AF using UK Biobank and the second survey of the Trøndelag Health Study (HUNT2).

Results

One-sample MR analysis showed that genetic predisposition to insomnia symptoms (hazard ratio (HR) 1.14; 95% confidence interval (CI) 1.07, 1.21) and short (≤6 h vs. 7-8 h) sleep duration (HR 1.14; 95% CI 1.04, 1.26) increased the risk of AF in UK Biobank. However these findings (HR 0.95; 95% CI 0.81, 1.11 for insomnia symptoms and HR 1.41; 95% CI 0.57, 3.46 for short sleep duration) were not consistent in HUNT2. Factorial MR analysis showed participants with genetic predisposition to both insomnia symptoms and short sleep duration (HR 1.08; 95% CI 1.03, 1.12) had the highest risk of AF, although there was no evidence of interaction (relative excess risk due to interaction (RERI 0.03; 95% CI -0.03, 0.09). However, this finding (HR 0.96; 95% CI 0.89, 1.04) was not consistent in HUNT2. Participants with genetic predisposition to both a morning chronotype and insomnia symptoms (HR 1.08; 95% CI 1.04, 1.13) and a morning chronotype and short sleep (HR 1.06; 95% CI 1.02, 1.10) had the highest risk of AF in UK Biobank, although there was no evidence of interaction (RERI -0.01; 95% CI -0.07, 0.04 and RERI 0.06; 95% CI -0.01, 0.12, respectively).

Conclusions

Our study indicates that insomnia symptoms and short sleep duration are causal risk factors for AF. However, having two sleep traits in combination does not increase risk beyond the additive risk of each individual trait. This reinforces clinical and public health efforts to effectively manage insomnia symptoms and short sleep, in order to mitigate the risk of AF and improve overall cardiovascular health.
Pervasive mitochondrial tRNA gene loss in the clade B of haplosclerid sponges (Porifera, Demospongiae)
Authors: Lavrov Dennis V , Turner Thomas L , Vicente Jan
Published: February 2025

Mitochondrial tRNA gene loss and cytosolic tRNA import are two common phenomena in mitochondrial biology, but their importance is often under-appreciated in animals. This is because the mitochondrial DNA (mtDNA) of most bilaterally symmetrical animals (Bilateria) encodes a complete set of tRNAs required for mitochondrial translation. By contrast, the mtDNA of non-bilaterian animals (phyla Cnidaria, Ctenophora, Porifera, and Placozoa) often contains a reduced set of tRNA genes, necessitating tRNA import from the cytosol.

Interestingly, in many non-bilaterian lineages, tRNA gene content appears to be set early in evolution and remains conserved thereafter. Here, we report that Clade B of Haplosclerid Sponges (CBHS) represents an exception to this pattern, displaying considerable variation in tRNA gene content even among relatively closely related species. We determined mt-genome sequences for eight CBHS species and analyzed them in conjunction with six previously available sequences.

Additionally, we sequenced mt-genomes for two species of haplosclerid sponges outside the CBHS and used eight previously available sequences as outgroups. We found that tRNA gene content varied widely within CBHS, ranging from three in an undescribed Haliclona species (Haliclona sp. TLT785) to 25 in Xestospongia muta and X. testudinaria. Furthermore, we found that all CBHS species outside the genus Xestospongia lacked the atp9 gene, with some also lacking atp8.

Analysis of nuclear sequences from Niphates digitalis revealed that both atp8 and atp9 had transferred to the nuclear genome, while the absence of mt-tRNA genes indicated their genuine loss. We argue that CBHS can serve as a valuable system for studying mt-tRNA gene loss, mitochondrial import of cytosolic tRNAs, and the impact of these processes on mitochondrial evolution.
Ethylene antagonizes ABA and inhibits stomatal closure and chilling tolerance in rice
Authors: Huang Shuying , Wang Huanhuan , Liu Shiyan , Lu Shan , Hua Jian , Zou Baohong
Published: February 2025

Chilling stress restricts the geographical distribution of rice and severely impacts its growth and development, ultimately reducing both yield and quality. The plant hormone ethylene is involved in plant stress responses; however, its role in rice chilling tolerance has not been thoroughly explored. This study reveals that ethylene negatively regulates chilling tolerance in rice by antagonizing the chilling tolerance-promoting effects of abscisic acid (ABA). Treatment with ethylene or its biosynthetic precursor, 1-aminocyclopropane-1-carboxylic acid (ACC), results in a reduced survival rate after chilling and delayed stomatal closure in response to chilling. There are two ethylene signaling-related Raf-like protein kinases, OsCTR1 and OsCTR2, which have overlapping functions in ethylene signaling; their loss-of-function mutants exhibit constitutive ethylene responses. The ctr1 ctr2 double mutant displays lower survival rates and slower stomatal closure under chilling stress compared to the wild type. In contrast, ABA treatment significantly enhances the survival rate of the wild type under chilling stress and promotes stomatal closure in response to chilling. Furthermore, ethylene inhibits the effects of ABA on chilling tolerance and stomatal closure. The ctr1 ctr2 double mutant fails to respond to external ABA treatment regarding stomatal closure and increased survival rate under chilling stress. In conclusion, our findings suggest that ethylene negatively regulates chilling tolerance in rice by inhibiting ABA-induced stomatal closure through the action of OsCTR1 and OsCTR2.
Double the Trouble: Successful Cannulation and Air Transportation of Two Obese Trauma Patients Requiring Extracorporeal Membrane Oxygenation
Authors: Stoffel Steven T , Juhasz Sarah A , Wood Matthew E , Danciu Theodor , Wiggins Amanda R , O’Neil Erika R , Manninen Erik S
Published: February 2025

Acute Respiratory Distress Syndrome (ARDS) is a known and severe complication of thoracic trauma. Many patients, despite appropriate ventilator and medical support, continue to worsen requiring additional cardiopulmonary support with extracorporeal membrane oxygenation (ECMO). Additionally, obesity adds a layer of complexity in the management of trauma ARDS on ECMO. We describe the first U.S. Military air transportation mission via Critical Care Air Transport (CCAT) involving the cannulation and transportation of 2 obese trauma patients requiring ECMO support. We reviewed a cohort of 2 obese patients with ARDS secondary to trauma cannulated for venovenous ECMO and simultaneously transferred via Critical Care Air Transport to a DoD ECMO Center. We describe the logistics involved in the transport and management of obese trauma patients on ECMO. Both patients were safely cannulated and transported without complications, and survived their ECMO run and hospital stay. This is the first air transport of 2 obese ECMO patients simultaneously in U.S. Military history. This transport highlights the safety of cannulation and transportation of obese trauma patients, in addition to the flexibility and logistics needed to successfully complete an ECMO military transport.
Host-Calibrated Time Tree Caps the Age of Giant Viruses
Authors: Tee Hwee Sze , Ku Chuan
Published: February 2025

Viruses are widespread parasites with important impacts on public health, economy, and ecosystems. However, little is known about their origins, ages, and early evolutionary relationships with hosts. Here, we infer the maximum divergence times for eukaryotic giant DNA viruses (phylum Nucleocytoviricota) with dating analyses calibrated by host taxon ages of virus lineages with specific host ranges. The last common ancestor of Nucleocytoviricota existed after 1,000 million years ago, suggesting a much later origin than that of the eukaryotes. The early evolution of Nucleocytoviricota either coincided with or postdated a substantial increase in the oxygen levels on the Earth's surface during the Neoproterozoic Era. The lineage diversification of giant viruses was frequently associated with host shifts, including two major transitions from amoebozoan hosts to animal hosts that eventually led to the emergence of iridoviruses and African swine fever viruses within the last 450 million years. These results outline the evolutionary timescale of a major virus group and are pivotal for further understanding the virus–host interactions and their potential ecological roles in the Earth's history.
The homeotic gene PhDEF regulates production of volatiles in petunia flowers by activating EOBI and EOBII
Authors: Bednarczyk Dominika , Skaliter Oded , Kerzner Shane , Masci Tania , Shklarman Elena , Shor Ekaterina , Vainstein Alexander
Published: February 2025

In petunia (Petunia × hybrida), MADS-box homeotic genes dictate floral organ identity. For instance, DEFICIENS (PhDEF), GLOBOSA1, and GLOBOSA2 (PhGLO1/2) are responsible for petal and stamen identity. However, whether homeotic genes, particularly PhDEF, have a function at the later stages of flower development remains elusive. In petunia flowers, scent production initiates at anthesis, when the flower is ready for pollination, and is triggered by activation of EMISSION OF BENZENOIDS I (EOBI) and EOBII, MYB transcriptional regulators of scent-related genes. Here, we revealed the role of PhDEF in mature flowers, showing that it activates scent production. PhDEF suppression using a transient viral system in petunia flowers led to a significant reduction in volatile emission and pool levels, and in the transcript levels of scent-related transcriptional regulators and enzymes. Promoter activity assays demonstrated that PhDEF activates EOBI, EOBII, and the phenylpropanoid biosynthesis genes L-PHENYLALANINE AMMONIA LYASE and PHENYLACETALDEHYDE SYNTHASE. Our findings underscore the importance of PhDEF in petunia flower development from initiation to maturation and in coordinating petal specification and the establishment of showy pollination-related traits.
Relative Susceptibility of Tomato and Pepper Crops to Root-Knot Nematodes in Georgia, Fall 2023
Authors: Afroz Tania , Poudel Nabin , Torres Luis , Chowdhury Intiaz Amin
Published: February 2025

Southern root-knot nematodes (Meloidogyne incognita) are sedentary endoparasites that reduce crop yield. These pests are problematic in U.S. vegetable production where sandy soils and plasticulture favor nematode reproduction. In Georgia multiple crops are grown under the same plastic mulch over multiple seasons and tomato (Solanum lycopersicum) or pepper (Capsicum annuum) are selected as the first crop. We evaluated the susceptibility of pepper cultivar ‘Regulator’ and tomato cultivar ‘STM2255’ to root-knot nematodes, with and without 1,3-dichloropropene. Results showed lower nematode populations and galling severity in ‘Regulator’ compared to ‘STM2255,’ demonstrating that selecting the less-susceptible pepper cultivar can reduce nematode population further.
Safety and Efficacy of Neuroprotective Agents as Adjunctive Therapies for Reperfusion in the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Zhang Zihui , Wang Xinyan , Zhang Kangda , Wu Youxuan , Liang Fa , Wang Anxin , Han Ruquan
Published: February 2025

There is still no clear evidence of the efficacy of the application of neuroprotective agents (NPAs) for acute ischemic stroke (AIS) patients receiving reperfusion therapies. This meta-analysis aimed to determine the effects of NPAs versus placebo on functional and safety outcomes as an adjunctive treatment to intravenous thrombolysis (IVT) or endovascular therapy (EVT) in AIS patients. The primary outcome was neurological functional independence, as evaluated by the proportion of patients whose modified Rankin Scale scores were 0 to 2 at 90 days after treatment. Thirteen randomized controlled trials with a total of 3736 patients were included. The application of NPAs was associated with greater odds of functional independence (odds ratio [OR]: 1.28; 95% CI: 1.12 to 1.46; P < 0.001; I
2 = 0.0%) within 90 days. However, subgroup analysis of reperfusion therapy type (IVT, EVT, or both) revealed that only the EVT subgroup showed a significant association between NPAs or placebo and functional independence at 90 days (EVT group, OR: 1.43; 95% CI: 1.05 to 1.94; P = 0.022; I
2 = 0.0%; IVT group, OR: 1.51; 95% CI: 0.93 to 2.46; P = 0.099; I
2 = 39.8%; IVT plus EVT group, OR: 1.17; 95% CI: 0.94 to 1.45; P = 0.157; I
2 = 16.0%). This meta-analysis revealed that NPAs could increase the possibility of AIS patients undergoing reperfusion therapies achieving functional independence within 90 days of onset; however, with the limited number of studies on each drug, further evidence is still needed to demonstrate the efficacy of each individual agent as an adjunctive therapy for different means of reperfusion.
Diagnosis and Management of Carpal Tunnel Syndrome During Pregnancy
Authors: Milano Molly E. , Pennington Margaret V. , Ilyas Asif M.
Published: February 2025

Carpal tunnel syndrome (CTS) represents a constellation of symptoms that can occur as a result of compression of the median nerve as it traverses through a constrained space at the level of the wrist. It is the most common compressive mononeuropathy in the human body. Patients frequently present with similar history and physical examination findings, most commonly consisting of numbness of the hand that is worse at nighttime. Although CTS is one of the more common conditions seen by hand, orthopedic, or plastic surgeons, patients often first report symptoms to their primary or obstetric care clinician. In this review, we describe the pathophysiology of CTS in pregnant patients, summarize the best methods for diagnosing this condition, and review the recommended treatment options. This review provides a practical strategy that can be used by both primary care and obstetric care clinicians in diagnosing and treating pregnant patients with CTS.
Issues in Using Four Languages in a Culturally Tailored Technology-Based Intervention Study
Authors: Im Eun-Ok , Kim Dongmi , Quan Jianing , Chee Wonshik
Published: February 2025

To provide culturally competent care for racial/ethnic minorities, it is important to provide information and coaching/support in the languages that users can understand. However, issues in using multiple languages, especially in culturally tailored technology-based intervention research among racial/ethnic minority cancer survivors, have rarely been discussed. The purpose of this article is to discuss the issues in using four different languages among Asian American breast cancer survivors with depressive symptoms in a culturally tailored technology-based intervention study for cancer pain management and make suggestions for future technology-based intervention research using multiple languages. Research diaries written by the research team members, the recordings of biweekly research team meetings, and postings on Microsoft Teams were analyzed using content analysis. The issues included: (1) difficulties in recruiting eligible translators for multiple languages; (2) differences in selecting words by translators’ traits; (3) difficulties in ensuring conceptual equivalence in measurements; (4) necessary contextual translation based on cultural understanding; (5) avoiding words with stigma; and (6) required multiple repeated steps. These methodological and conceptual issues need to be considered in future culturally tailored technology-based intervention research among racial/ethnic minorities, especially Asian American breast cancer survivors.
Executive Summary of the American Radium Society Appropriate Use Criteria for Management of Squamous Cell Carcinoma of the Cervical Esophagus
Authors:   Expert Panel Management of Cervical Esophageal Cancer, Williams Vonetta M. , Hallemeier Christopher L. , Jethwa Krishan R. , Selfridge J. Eva , Shah Pari , Anker Christopher J. , Abood Gerard , Akselrod Dmitriy , Berlin Jordan , Kim Ed , Kennedy Timothy , Lee Percy , Sharma Navesh , William Small , Tchelebi Leila , Russo Suzanne
Published: February 2025

Objectives:

Cervical esophageal cancer (CEC) is an uncommon malignancy accounting for <5% of all esophageal carcinomas. Treatment of CEC varies and is adapted from established regimens used for squamous cell carcinoma (SCC) or the lower esophageal and head and neck. The present systematic review and guidelines are intended to assist treatment decision making for patients with CEC based on the available evidence.

Methods:

Using the Population, Intervention, Comparator, Outcome, Timing, and Study Design (PICOTS) framework, the evidence regarding treatment outcomes was assessed using Cochrane and PRISMA 2020 methodology. Eligible studies included prospective Phase II to III trials and retrospective analyses published between January 1, 2013 and February 23, 2024 in the Ovid Medline database. These references were assessed through the American Radium Society (ARS) Appropriate Use Criteria (AUC) methodology. A systematic review PRISMA 2020 checklist confirmed the completion of essential elements. RAND-UCLA consensus methodology was used by the expert panel to rate the appropriateness of the treatment options.

Results:

ARS AUC recommendations include (1) larynx preservation using endoscopic resection (EMR or ESD) alone for the typical case with pT1a cN0 cM0 CEC, (2) definitive CRT for the typical case with cT1bN0M0 in patients who cannot undergo endoscopic resection, (3) larynx-preserving using definitive CRT (with or without induction chemotherapy) for the typical case with nonmetastatic locally advanced CEC (advanced T-stage tumors or involved lymph nodes), with surgery reserved for those patients with incomplete response or locoregional recurrence.

Conclusions:

This ARS AUC summary provides guidelines for the management of SCC of the cervical esophagus provides based on available evidence. Topics that warrant further investigation include optimization of (1) patient selection; (2) multimodality therapies including chemotherapy, immunotherapy, and targeted agents; (3) radiation dose, schedule, and treatment volume; and (4) supportive care for patients with CEC. Ongoing trials continue to improve outcomes for patients with CEC.
BRCA1-Associated Protein-1 Inactivated Melanoma Arising in a Pre-existing Nevus With ALK Fusion and Low Tumor Mutational Burden
Authors: Shaker Nada , Phelps Robert , Niedt George , Sangueza Omar , Krishnan Ramakrishnan , Patel Ankush , Torres-Cabala Carlos , Aung Phyu P. , Prieto Victor , Dumur Catherine I. , Pradhan Dinesh
Published: February 2025

Breast cancer1-associated protein 1 (BAP-1)-inactivated melanocytic tumors are a group of familial or sporadic lesions with distinctive histology and molecular features. Inherited germline inactivating mutations in BAP1 have been associated with the development of multiple epithelioid melanocytic neoplasms resembling Spitz nevi and increased susceptibility for developing several malignancies, including uveal melanoma, cutaneous melanoma, renal cell carcinoma, mesothelioma, and other tumors. Cutaneous melanoma with loss of BAP1 expression is rare. We present a unique case of BAP1-inactivated melanoma with anaplastic lymphoma kinase (ALK) fusion arising in a pre-existing BAP1-inactivated nevus in a 47-year-old female patient who presented with a dome-shaped red papule on the superior crus of the right antihelix. Histology revealed intradermal melanocytic proliferation with biphenotypic morphology. There was a proliferation of atypical melanocytes showing epithelioid features in the background of nevus. Mitotic figures were identified in the cytologically atypical component of the lesion. Mart-1/Ki67 dual stain demonstrated a higher proliferation index in the larger epithelioid atypical cells, supporting the diagnosis of melanoma. Nuclear BAP-1 expression was lost in the larger atypical cells and associated nevoid cells. Preferentially expressed antigen in melanoma stain demonstrated focal positive staining in 20%–30% of the melanocytes. Immunostaining for B-Raf proto-oncogene, serine/threonine kinase V600E was diffusely positive and ALK demonstrated patchy immunoreactivity in the melanocytic proliferation. Interphase fluorescence in situ hybridization studies showed gains at chromosome 6p25 (Ras responsive element binding protein 1) in the tumor cells. The comprehensive next-generation sequencing revealed B-Raf proto-oncogene, serine/threonine kinase
V600E mutation, TP53 mutation, ALK fusion, BAP1 loss (copy number variation = 0.0, potentially germline), and loss of MAP2K7,
Von Hippel-Lindau tumor suppressor
, FGFR3, CDKN2A, 19q, and telomerase reverse transcriptase. The tumor was microsatellite stable with a low tumor mutational burden (5.76 mutations/Mb). The tumor was completely excised with negative margins. The patient is doing well at 17 months follow-up with no signs of recurrence.
Unraveling the complexity in diagnosis and management of multisystem inflammatory syndrome in children with kawasaki disease mimicry: a case report
Authors: Ansari Abdus Samad , Chaurasia Dhiraj , Kafle Sagar
Published: February 2025

Introduction and importance:

COVID-19 can lead to a severe complication in children known as Multisystem Inflammatory Syndrome (MIS-C), often mimicking Kawasaki Disease (KD). This study addresses the diagnostic challenges and management of MIS-C.

Case presentation:

A 6-year-old female presented with fever, vomiting and rash. Clinical examination revealed cervical lymphadenopathy, periungual desquamation, lip fissures and abdominal tenderness. Echocardiography showed RCA dilatation. These findings suggested multisystem involvement and fulfilled the criteria of typical KD. The treatment was started accordingly with IVIG and empirical antibiotics. However, the confirmation of presence of SARS CoV 2 antibody led to substantial shift of diagnosis to MIS-C. Despite initial treatment, fever persisted, thus, Intravenous steroid was started which led to significant clinical improvement, rendering her almost asymptomatic in 2 weeks.

Clinical discussion:

Distinguishing MIS-C from KD is critical. Diagnostic criteria, epidemiology, and lab markers play a vital role. The case underscores the importance of recognizing subtle differences for accurate diagnosis and effective management.

Conclusion:

MIS-C, resembling KD, poses diagnostic complexities. This case emphasizes the need for clinicians to consider MIS-C in children with persistent fever and multisystem involvement post-COVID-19 exposure. Timely diagnosis and intervention are paramount for favorable outcomes in this emerging pediatric condition, urging increased awareness and reporting among healthcare professionals.
Exercise-based cardiac rehabilitation for heart failure: effects on echocardiographic parameters and functional capacity: a randomized clinical trial
Authors: Mahmoodi Zahra , Salari Arsalan , Ahmadnia Zahra , Roushan Zahra Atrkar , Gholipour Mahboobeh , Sedighinejad Abbas
Published: February 2025

Background:

Multiple comorbidities and physiological changes play a role in a range of heart failure (HF) conditions and influence the most effective approach to exercise-based rehabilitation.This research aimed to examine and compare the outcomes of concurrent exercise training, focusing on echocardiographic parameters and functional capacity of patients with heart failure with reduced ejection fraction (HFrEF).

Materials and Methods:

In this randomized control trial, a total of 76 patients (average age: 68.2 ± 4.8 years) with HFrEF were randomly allocated into two groups: intervention group (IG, N = 38) and control group (CG, N = 38) that IG performed an eight weeks concurrent exercise training (3 aerobic and 2 resistance exercise sessions/ week) and daily breathing exercises.

Echocardiographic parameters (left ventricular ejection fraction, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, and functional capacity (6-minute walking test) were assessed before and the end of the study.

Results:

The comparison of CG and IG showed that 6MWT (204.2 ± 28.72 vs.273 ± 38.37) and EF (28.28 ± 4.39 vs.37.23 ± 6.54) had increased, and LVEDD (53.89 ± 4.73 vs. 46.71 ± 5.35), LVESD (45.55 ± 4.8 vs. 39 ± 5.26) had decreased after 8 weeks, respectively (p < 0/05).

Conclusion:

In summary, this study provides compelling evidence that exercise-based cardiac rehabilitation can lead to meaningful improvements in echocardiographic parameters and functional capacity among older adults with heart failure, advocating for its broader implementation in clinical settings.
Unusual presentation of bezoars and foreign body insertion in the breast as a self-harm behavior: a case report
Authors: Rehman Ibad Ur , Farooqui Fareeha , Aqeel Raheela , Qaiser Aabia , Waseem Sania , Amir M. Ayhan , Okon Inibehe Ime , Satti Rida Altaf , Shah Syed Qamber Ali , Iqbal Khadija
Published: February 2025

Introduction and importance:

Although they are uncommon, self-inflicted foreign bodies in the breast pose special care difficulties. Since underlying psychological issues are frequently linked to these instances, early detection and a multidisciplinary approach are necessary to improve results.

Case presentation:

Over the course of four to five months, a 28-year-old mother developed recurring breast abscesses and draining sinuses. An ultrasound showed a cord-like structure with fluid accumulation in the right breast, and CT imaging identified the foreign matter as a broken safety pin. Saline irrigation and surgical excision were carried out. Bipolar disorder was diagnosed during a meeting with a psychiatrist. Other foreign objects, such as two hair tufts and a broken needle, were found during follow-up and extracted under local anesthetic. Because the patient did not take their psychiatric medication as prescribed, they were lost to follow-up.

Clinical discussion:

Patients with unexplained breast complaints or recurrent abscesses should be evaluated for self-inflicted foreign bodies. This instance emphasizes the value of a multidisciplinary strategy that addresses the psychological as well as the physical aspects of self-harm by combining psychiatric treatment with surgical intervention.

Conclusion:

Physicians need to be on the lookout for self-inflicted foreign bodies, especially in patients who have inconsistent medical histories or mental health conditions. Improving patient outcomes requires early discovery and thorough treatment, which includes psychological support.
Validation of an Artificial Intelligence-Powered Virtual Assistant for Emergency Triage in Neurology
Authors: Alessandro Lucas , Crema Santiago , Castiglione Juan I. , Dossi Daiana , Eberbach Federico , Kohler Alejandro , Laffue Alfredo , Marone Abril , Nagel Vanesa , Pastor Rueda José M. , Varela Francisco , Fernandez Slezak Diego , Rodríguez Murúa Sofía , Debasa Carlos , Claudio Pensa , Farez Mauricio F.
Published: February 2025

Objectives:

Neurological emergencies pose significant challenges in medical care in resource-limited countries. Artificial intelligence (AI), particularly health chatbots, offers a promising solution. Rigorous validation is required to ensure safety and accuracy. Our objective is to evaluate the diagnostic safety and effectiveness of an AI-powered virtual assistant (VA) designed for the triage of neurological pathologies.

Methods:

The performance of an AI-powered VA for emergency neurological triage was tested. Ten patients over 18 years old with urgent neurological pathologies were selected. In the first stage, 9 neurologists assessed the safety of the VA using their clinical records. In the second stage, the assistant’s accuracy when used by patients was evaluated. Finally, VA performance was compared with ChatGPT 3.5 and 4.

Results:

In stage 1, neurologists agreed with the VA in 98.5% of the cases for syndromic diagnosis, and in all cases, the definitive diagnosis was among the top 5 differentials. In stage 2, neurologists agreed with all diagnostic parameters and recommendations suggested by the assistant to patients. The average use time was 5.5 minutes (average of 16.5 questions). VA showed superiority over both versions of ChatGPT in all evaluated diagnostic and safety aspects (P<0.0001). In 57.8% of the evaluations, neurologists rated the VA as “excellent” (suggesting adequate utility).

Conclusions:

In this study, the VA showcased promising diagnostic accuracy and user satisfaction, bolstering confidence in further development. These outcomes encourage proceeding to a comprehensive phase 1/2 trial with 100 patients to thoroughly assess its “real-time” application in emergency neurological triage.
Pediatric Golf Cart Injuries and Morbidity: A Single-Center Trauma Experience
Authors: Boggs Kaitlyn , Wortham Andrew , Gregoski Mathew J , Pruitt Christopher M. , McDuffie Lucas A.
Published: February 2025

Objective:

The primary aim of this study was to characterize pediatric golf cart injuries at our center including demographic, clinic, and outcome data. The secondary outcomes explored were associations between patient and driver age and mechanism of injury with hospital admission, length of stay, and surgical interventions.

Methods:

We conducted a retrospective analysis of golf cart injuries at a pediatric American College of Surgeons Level I trauma center (2013-2023). Demographic information, mechanism of injury, location in the cart, driver age, injury locations and types, and other clinical factors were assessed. Possible differences in hospital admission, length of stay, and surgical intervention were assessed.

Results:

There were 156 patients who sustained golf cart injuries, with 39% requiring trauma activation upon initial presentation. The majority of patients were 13 years old or younger (75.6%), injured from a fall from the cart (55.8%), and admitted to the hospital (51.9%). Over half of the patients had more than one injury type, most commonly affected areas were head, neck, or face (61.5%) and extremities (66.7%). There was a disproportionate number of privately insured patients who presented with golf cart-related injuries compared with the general emergency department population (64.1 vs. 18.5%, 45.6% difference, 95% CI: 37.8%-52.7%, P<0.0001). Over half (63%) of patients with a documented driver age were in golf carts driven by a minor, with a median driver age of 13 years old. Patients in accidents where the drivers were minors were more likely to be admitted to the hospital (P<0.001).

Conclusions:

Golf carts are a considerable source of injury for our pediatric population, with some accidents leading to serious morbidity. There is a need for consistent safety regulation of golf carts and increased public knowledge of the hazards they pose to children.
The prevalence of chronic pain and its impact on activities of daily living disability and depressive symptoms according to multiple definitions in a Japanese population: the Hisayama study
Authors: Shibata Mao , Hosoi Masako , Anno Kozo , Hirabayashi Naoki , Morisaki Yukiko , Saito Takafumi , Sudo Nobuyuki , Ninomiya Toshiharu
Published: February 2025

Objectives:

This study aimed to compare the prevalence of chronic pain using various definitions from previous studies and to determine the optimal definition for detecting chronic pain associated with physical and emotional dysfunction in a general Japanese population.

Methods:

A total of 2700 community-dwelling Japanese residents aged ≥40 years were assessed for chronic pain and its components of duration, frequency, and intensity. The activities of daily living (ADL) disability and depressive symptoms of participants were also evaluated using the modified Lankin Scale and Patient Health Questionnaire-9. The odds ratios and the population attributable fractions (PAFs) for ADL disability and depressive symptoms were estimated using a logistic regression model.

Results:

The prevalence of chronic pain varied greatly by definition, ranging from 13% for pain defined as pain duration ≥3 months, pain frequency ≥ twice a week, and pain intensity of ≥50 mm by a visual analogue scale (VAS) to 48% for a simple definition of pain duration ≥3 months. The PAFs for ADL disability and depressive symptoms were relatively high at 33% in participants with pain duration of ≥6 months and 30% in those with pain frequency of ≥twice a week, while the VAS ≥50 mm group had a low PAF of 12%.

Conclusion:

For screening people with chronic pain and ADL disability or depressive symptoms, the criteria of pain duration and pain frequency yielded essentially identical results, while the criterion of pain intensity risked overlooking individuals with chronic pain and these associated symptoms.
Cemento-osseous Dysplasia Mimicking Periapical Cyst After the Orthodontic Treatment of the Mandible
Authors: Ko Da-Eun , Yoon Jung-Hoon , Kim A-Young , Song Hyun-Min , Lee Soo-Bin , Park Woo-Ju , Oh Min Seok , Yeom Han-Gyeol
Published: February 2025

Cemento-osseous dysplasia (COD) is a non-neoplastic condition, characterized by the replacement of normal cancellous bone with fibrous tissues containing woven bone and cementum in the tooth-bearing areas. This report presents the case of a 21-year-old male who developed COD following orthodontic treatment. A panoramic radiograph showed a periapical radiolucent lesion in the right mandibular canine area. Cone beam computed tomography revealed a mixed radiolucent and radiopaque lesion. Histologically, the lesion exhibited cementum-like calcifications and woven bone scattered within the hemorrhagic fibrous tissue. Ultimately, the lesion was diagnosed as cemento-osseous dysplasia, focal type. This case highlights the importance of careful monitoring of orthodontic forces to minimize risks and prevent unexpected complications during orthodontic treatment.