bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of the influence of the green economy on sustainable development: bibliometric approach
Authors: Tursunov F
Published: December 2024

Researchers from all over the world especially from industrialized countries increasingly began to write about the possibilities of the green economy in the sustainable development of countries. The most popular journals, the top authors, the top-cited papers, the top countries, and major subject areas were investigated using a bibliometric analytic approach based on Scopus databases. The analysis revealed a sharp jump of the number of relevant publications and that more than a quarter of articles are devoted to the environmental science. The implementation of the proposed ideas of the researchers is an important factor and the state and the business environment play a major role in this. The role of international investment projects and the participation of the private sector in the development of a green economy are becoming increasingly relevant.
On the issue of reducing the level of environmentally harmful emissions from the cascade of technological processes of an automation facility of energy production
Authors: Kovalev I V , Losev V V , Tynchenko Y A , Kovalev D I
Published: December 2024

The article considers the issues of reducing harmful factors that are formed during the operation of energy production facilities and have a significant impact on the environment. An overview of complex measures to reduce toxic emissions of NOx and SOx is presented, a number of technical and organizational solutions in the cascade of technological processes aimed at reducing harmful factors are considered. A solution for the use of flue gas recuperation technology, which is based on the principle of reusing flue gases that are taken from the chimney in different ratios, is considered in more detail. A basic diagram of this solution, a list of additional equipment are given, the advantages and efficiency parameters of using flue gas recuperation technology are noted, as well as the problematization of engineering and research tasks of this solution.
Clean water consumption of the coal mining operations in East Kalimantan province
Authors: Amin R , Rajagukguk S G , Wulandari F T
Published: December 2024

Water consumption of mining workers is a crucial factor in the environmental impact assessment but is often overlooked by the mining company. In addition, water consumption for mining activities is not reflected in some domestic water consumption standards such as SNI and PUPR standards. Therefore, calculating the rate of clean water demand is important to estimate water supply, organize and manage water distribution, and determine the waste water treatment plant (WWTP) capacity. The purpose of this study was to identify clean water consumption of mine workers at the contractor Lati Site of PT. Berau Coal, East Kalimantan Province per person per day. We conducted a direct measurement of water usage using the installed flow meters, and employed assumptions such as piping leakage and roster day-off to calculate clean water consumptions. Compared to the existing standards, clean water consumption at Lati Site was much greater, up to 229 litres per head per day whereas the water usage in the mining camp was 156 litres per head per day.
Effects of particle sizes and roasting temperature on the Fe-Ni enrichment of limonite ore from the Wolo mine area, Southeast Sulawesi, using corncob char as reductant
Authors: Sufriadin  , Shinta D , Purwanto  , Amalia R , Akhiruddin  , Ito A , Onggang S
Published: December 2024

The reduction roasting of a limonite ore sample from the Wolo mine area was investigated using corncob char as a reductant. The objectives of this study were to analyze the effects of particle sizes and roasting temperature on the mineralogical transformation and Fe-Ni enrichment during the roasting process. The limonite ore was prepared into three size fractions of mesh sieves (-100+150, -150+200, and -200 mesh). Limonite ore was roasted with 2g of corn cob char reductant at temperatures ranging between 800 °C and 1100 °C with a 1-hour reduction time. Limonite ore and roasted products were analyzed to determine the mineral and chemical composition using optical microscopy, X-ray diffraction (XRD), and X-ray fluorescence (XRF) methods. Results of the mineralogical analysis indicated that the sample contained chlorite, goethite, lizardite, maghemite, and quartz. Limonite ore is mainly composed of Fe2O3 (53.59%), followed by SiO2 (12.16%), MgO (2.63%), and Ni (1.52%). Results of reduced roasting of limonite ore exhibited that the ore minerals were transformed into spinel, wustite, fayalite, and some tetrataenite (FeNi). The ore with -100+150 mesh particle and heated at 1,000 °C provided the optimum enrichment of 1.74% Ni and 42.87% Fe, respectively.
Circular Economy Approach on Decarbonization by Repurposing Used Cooking Oil for Nickel Smelter – A Case Study of PT Megah Surya Pertiwi, Obi Island, North Maluku, Indonesia
Authors: Gultom TH , Hasiholan C , Iqbal M , Mulyati D
Published: December 2024

This research was instigated by the world’s endeavours to fight dependency on fossil energy sources. While coal prevails as a beneficial energy source, countries worldwide have strived to reduce coal usage in the future under the Net Zero Emission Pledge. Questions linger on how to minimize coal usage, play down its impact on the environment, and maintain economic advantages. This quantitative study focused on the repurposing of used cooking oil for alternative energy sources at PT Megah Surya Pertiwi (PT MSP), the first downstream company of Harita Nickel that processes nickel saprolite ore to Ferronickel using the Rotary Kiln Electric Furnace (RKEF) technology in Obi Island, North Maluku, Indonesia. As the company’s employment grows, wastes, including used cooking oil (UCO), accumulate. The result showed that repurposing UCO in PT MSP has lowered the consumption of coal by 2,206 tons (7.53%), diverted 2,980 tCO2e indirect GHG emission (Scope 1), and saved the total cost up to IDR 1,408,231,332.
Long-term evaluation of FABA utilization to prevent AMD generation – a review of barrel kinetic test
Authors: Pirdiansy Q , Hartanto W P , Deni M C N
Published: December 2024

The utilization of fly ash and/or bottom ash (FABA) to prevent the generation of acid mine drainage is present in several mining companies to maximize geochemical and geotechnical potentials of FABA. Geochemically, FABA has the potential as a neutralizing material due to its high acid-neutralizing capacity, therefore it can be used as a sealing material for the potentially acid-forming (PAF) overburden in coal mining activities, which has the potential to produce acid drainage. This study aims to ensure that the potential leachate runoff at PAF disposals through neutralizing and sealing is not in acidic condition. A series of kinetic geochemical tests were carried out using a 200-liter volume column, applying various compositions of non-acid forming (NAF) rocks, a mixture of FABA, and PAF to ensure the method reliability. Leachate leaking out of the column was subjected to pH and EC analysis. The test results for a period of 3 years (Jan 2021 – June 2024) showed that the NAF-PAF-FABA sealing system produced a neutral pH compared to the FABA-PAF and NAF-FABA-PAF-NAF sealing. The position of FABA under the PAF layer triggered the carbonate released by acidic water, enabling neutralization. The 9:1 ratio of FA to BA in NAF-PAF-FABA sealing system showed better results than 4:1 ratio, indicative of greater neutralizing capacity of FA than BA. Compositions with smaller amounts of PAF produced better results due to less potential acidity that must be neutralized.
Characterization of ion-adsorption clay rare earth elements (REEs) in weathered granite rock in North-Western area of Pahang state, Malaysia
Authors: Ubaidillah A S , Ismail H , Endut Z , Aminuddin M I K A
Published: December 2024

This study characterised the weathered granite profiles in a selected area in northwestern Pahang State and determined the content of ion-adsorption clay rare earth elements (REEs). The geochemical study analyzed the REE elements and major elements in the samples, while the XRD analysis identified the clay mineral known to adsorb REEs. Quantification of REE concentration by ICP-MS analysis revealed significant differences between samples, with sample C1 from upper horizon C and sample B2 from lower horizon B (ΣREE+Y: 915.98 and 454.52 ppm respectively) from moderately weathered granite. Lower REE content was observed in sample C2 (lower horizon C and sample B1 (upper horizon B). Kaolinite and halloysite in XRD analysis, provide a higher ionic adsorption of REEs. These results emphasize the potential of REEs deposit in this area and call for a follow-up study to explore the ion-adsorption clay REEs in the whole weathered granitic profiles of Pahang State.
Nickel mine planning application to support smelter demand fulfilment: a case study of gag nickel mine
Authors: Wibowo G S , Sari D V , Milwadi A
Published: December 2024

Gag Nickel is a mining project in West Papua developed by Antam, with a total resource of approximately 300 million wet metric tons. In the central block, mining activities are carried out to meet the demand target for the nickel smelter. There are two types of specifications, saprolite and limonite ores, each with specific grade requirement based on sales purchase contract. The aim of this study was to fulfill the long-term target from 2024 to 2028 through integrated mine planning to generate production scheduling plan based on agreed contract of around 6 million wet metric tons ore per year. The quantitative method was implemented to gather primary data, including the 6-meter-high bench and material classification based on specific quality of elements-compounds, and to use the secondary data such as reserve block model to create a reverse model. The challenges of this study included different ore specifications of each location of the hill, and constraints on limited stockyard location to support differentiation between two types of products. Based on the simulations performed, production and sales targets could be achieved according to predetermined product specifications, amounting to 6 million wet metric tons of saprolite and limonite with fluctuating processes during the period. From the scheduling results, the smelter supply composition ratio between saprolite and limonite was between 1.37 and 1.85. After the implementation above, Gag Nickel can conserve resources by optimizing reserves of both limonite and saprolite for optimum utilization.
Application of multiple linear regression (MLR) on copper ore separation based on grade and density
Authors: Aslam I N , Putri N A , Maulana A A , Muslim A , Ayuni R
Published: December 2024

Productivity in the mining industry has decreased significantly, partly due to declining level of minerals processed. On a global scale, the commonly researched theme in mineral processing is the comminution process which requires high energy in the production of metallic minerals. The coarse gangue separation method with two strategies, sensor-based separation and gravity separation, is the efficient solution for this issue. However, sensor-based sorting has disadvantages in terms of cost, so gravity separation is considered a more effective separation method. This research aimed to evaluate the efficiency of the gravity separation method using secondary data subjected to Multiple Linear Regression with several processing methods that included Constitution Heterogeneity (CH), R2 Optimization, Single Linear Model, and Multivariate Linear Regression Model based on particle grade and density data. The results showed that in relation to particle size, CH values was inclined to be very small due to the homogeneity of the materials when comminution ensued. In addition, the analysis shows that the Multivariate Linear Regression Model is unable to predict results based on experiments or real results, so this has an impact on the low effectiveness of separations carried out in the field.
Etiology, persistence, and risk factors of subclinical mastitis in a meat-producing sheep flock
Authors: Peckler Gretchen L , Fuenzalida Maria Jose , Aulik Nicole , Adcock Sarah J J
Published: December 2024

Subclinical mastitis, the asymptomatic inflammation of the udder often caused by bacterial infection, is an important economic and welfare concern in meat-producing flocks. We conducted a longitudinal observational study to: (1) characterize the etiology, prevalence, incidence, and persistence of intramammary infections during the first 8 wk of lactation, and (2) investigate the potential risk factors of lactation stage, parity, and the number of lambs reared. Duplicate milk samples (n = 592) were collected aseptically from each udder half of 37 clinically healthy ewes (9 Hampshire, 22 Polypay, and 6 Targhee) weekly for their first 8 wk of lactation. A sample was considered a true infection if at least 100 CFU/mL of a bacterial species were isolated. Out of a total of 560 non-contaminated duplicate udder half samples, 186 (33.2%) were infected. The prevalence of subclinical mastitis in the first week of lactation was 26.0% at the udder half level and increased over lactation to 47.1% by 8 wk. Over the course of lactation, 34 of the 37 (91.9%) ewes had an intramammary infection in at least one udder half. The most common bacteria isolated were non-aureus Staphylococci (72.1%), Staphylococcus aureus (7.5%), and Mannheimia haemolytica (5.9%). The weekly incidence rate of new infections was 18.0% ± 10.2% (mean ± SD). Infections lasted 2.1 ± 2.1 wk, with 9.0% present the full 8 wk of observation. Spontaneous cures occurred in 36.0% of infection bouts but varied from 0% to 100% depending on the pathogen. The probability of subclinical mastitis infection increased as lactation progressed for ewes rearing single or multiple lambs and for ewes in their first or second parity, but not for ewes in later parities. In conclusion, intramammary infections in this flock were prevalent across lactation, parities, and litter sizes, and varied in their duration and spontaneous cure rate. Improved knowledge of the etiological agents and risk factors involved in subclinical mastitis is important in developing effective control measures in meat-producing flocks.
Predicting gene expression from histone marks using chromatin deep learning models depends on histone mark function, regulatory distance and cellular states
Authors: Murphy Alan E , Askarova Aydan , Lenhard Boris , Skene Nathan G , Marzi Sarah J
Published: December 2024

To understand the complex relationship between histone mark activity and gene expression, recent advances have used in silico predictions based on large-scale machine learning models. However, these approaches have omitted key contributing factors like cell state, histone mark function or distal effects, which impact the relationship, limiting their findings. Moreover, downstream use of these models for new biological insight is lacking. Here, we present the most comprehensive study of this relationship to date – investigating seven histone marks in eleven cell types across a diverse range of cell states. We used convolutional and attention-based models to predict transcription from histone mark activity at promoters and distal regulatory elements. Our work shows that histone mark function, genomic distance and cellular states collectively influence a histone mark’s relationship with transcription. We found that no individual histone mark is consistently the strongest predictor of gene expression across all genomic and cellular contexts. This highlights the need to consider all three factors when determining the effect of histone mark activity on transcriptional state. Furthermore, we conducted in silico histone mark perturbation assays, uncovering functional and disease related loci and highlighting frameworks for the use of chromatin deep learning models to uncover new biological insight.
Recognition and management of treatment-resistant depression
Authors: Ma Cyrus , Strelow Brittany
Published: December 2024

Major depressive disorder (MDD) is a common psychiatric condition that causes considerable morbidity and disability. MDD is characterized by recurrent depressive episodes that can result in loss of productivity, job insecurity, social isolation, and suicidality. Primary care providers frequently provide the initial management of MDD; however, some patients do not respond to first- or second-line treatments, a condition called treatment-resistant depression (TRD). Understanding how to accurately diagnose and manage TRD is important for clinicians.
Heterogeneity in Prescription Opioid Misuse Motives by Age in Adolescents and Young Adults in the United States
Authors: Schepis Ty S. , Ford Jason A. , Veliz Philip T. , West Brady T. , McCabe Sean Esteban
Published: December 2024

Objective

Adolescent (12–17 years) and young adult (18–25 years) prescription opioid misuse (POM) is linked to poor health outcomes. We investigated how POM motives vary across these ages and the potential links between motives and other substance use, mental health, and sociodemographic characteristics to help guide screening and prevention.

Methods

Pooled 2015–2019 US National Survey on Drug Use and Health data were used, with 137,858 participants. Cross-tabulations estimated prevalence of individual motives and motive category by age. Mutually exclusive motive categories were no past-year POM, pain relief only, pain/sleep/relax (ie, some combination of only these motives), and any non–self-treatment motives (eg, get high, experiment). Logistic regression models evaluated links between motive category and sociodemographic, mental health, and substance use (eg, alcohol, cannabis, nicotine, other prescription misuse) outcomes by age group, versus reference groups of no past-year POM or pain relief only.

Results

Pain relief was the most common POM motive (estimated at >50% at all ages), but POM for non–self-treatment motives was the most common category after 14 years. POM for non–self-treatment motives had the highest adjusted odds ratios (aORs) of all substance use and mental health characteristics (eg, past-year substance use disorder aORs of 6.11 in adolescents [95% confidence interval (CI), 4.23–8.85] and 4.81 [95% CI, 4.01–5.77] in young adults, versus the pain relief only reference).

Conclusions

POM for any non–self-treatment motives is linked to the highest prevalence of other substance use and mental health concerns, whereas POM for pain relief also signals a need for substance use and mental health screening.
Community-level Socioeconomic Status is a Poor Predictor of Outcomes Following Lumbar and Cervical Spine Surgery
Authors: Lambrechts Mark J. , Issa Tariq Z. , Lee Yunsoo , McCurdy Michael A. , Siegel Nicholas , Toci Gregory R. , Sherman Matthew , Baker Sydney , Becsey Alexander , Christianson Alexander , Nanavati Ruchir , Canseco Jose A. , Hilibrand Alan S. , Vaccaro Alexander R. , Schroeder Gregory D. , Kepler Christopher K.
Published: December 2024

Study Design:

Retrospective Cohort study.

Objective:

Our objective was to compare 3 socioeconomic status (SES) indexes and evaluate associations with outcomes after anterior cervical discectomy and fusion (ACDF) or lumbar fusion.

Background Data:

Socioeconomic disparities affect patients’ baseline health and clinical outcomes following spine surgery. It is still unclear whether community-level indexes are accurate surrogates for patients’ socioeconomic status (SES) and whether they are predictive of postoperative outcomes.

Methods:

Adult patients undergoing ACDF (N=1189) or lumbar fusion (N=1136) from 2014 to 2020 at an urban tertiary medical center were retrospectively identified. Patient characteristics, patient-reported outcomes (PROMs), and surgical outcomes (90-day readmissions, complications, and nonhome discharge) were collected from the electronic medical record. SES was extracted from 3 indexes (Area Deprivation Index, Social Vulnerability Index, and Distressed Communities Index). Patients were classified into SES quartiles for bivariate and multivariate regression analysis. We utilized Youden’s index to construct receiver operating characteristic curves for all surgical outcomes using indexes as continuous variables.

Results:

Preoperatively, lumbar fusion patients in the poorest ADI community exhibited the greatest ODI (P=0.001) and in the poorest DCI and SVI communities exhibited worse VAS back (P<0.001 and 0.002, respectively). Preoperatively, ACDF patients in the lowest DCI community had significantly worse MCS-12, VAS neck, and NDI, and in the poorest ADI community had worse MCS-12 and NDI. There were no differences in the magnitude of improvement for any PROM. All indexes performed poorly at predicting surgical outcomes (AUC: 0.467-0.636, all P>0.05).

Conclusions:

Community-wide SES indexes are not accurate proxies for individual SES. While patients from poorer communities present with worse symptoms, community-level SES is not associated with overall outcomes following spine fusion. Patient-specific factors should be employed when attempting to stratify patients based on SES given the inherent limitations present with these indexes.

Level of Evidence:

Level III.
Association of leukocyte telomere length with the risk of digestive diseases: A large-scale cohort study
Authors: Yang Hongqun , Chen Lanlan , Liu Yahui
Published: December 2024

Background:

Leukocyte telomere length (LTL) shortening, a biomarker of telomere attrition, has been linked to multiple diseases. However, the relationship between LTL and digestive diseases remains uncertain. This study aimed to investigate the association between LTL and the risk of digestive diseases.

Methods:

A cohort analysis of over 500,000 participants from the UK Biobank (UKB) between 2006 and 2021 was conducted to estimate the associations of LTL with more than 90 common digestive diseases. LTL was quantified using multiplex quantitative polymerase chain reaction, and cases of each disease were determined according to inpatient and primary care data. Multivariable Cox proportional hazards regression analysis was used to evaluate the associations of LTL with the risk of digestive diseases. Furthermore, such associations were also evaluated after stratification by sex and ethnicity.

Results:

After a mean follow-up time of 11.8 years, over 20 International Classification of Diseases, 10th Revision (ICD-10) codes were showed to be associated with telomere attrition. LTL shortening is associated with an increased risk of several digestive diseases, including gastroesophageal reflux disease (K21: hazard ratio [HR] = 1.30, 95% confidence interval [95% CI]: 1.19–1.42), esophageal ulcer (K221: HR = 1.81, 95% CI: 1.22–2.71), Barrett’s esophagus (K227: HR = 1.58, 95% CI: 1.14–2.17), gastritis (K29: HR = 1.39, 95% CI: 1.26–1.52), duodenal ulcer (K26: HR = 1.55, 95% CI: 1.14–2.12), functional dyspepsia (K30X: HR = 1.36, 95% CI: 1.06–1.69), non-alcoholic fatty liver disease (NAFLD) (K760: HR = 1.39, 95% CI: 1.09–1.78), liver cirrhosis (K74: HR = 4.73, 95% CI: 3.27–6.85), cholangitis (K830: HR = 2.55, 95% CI: 1.30–5.00), and hernia (K43: HR = 1.50, 95% CI: 1.17–1.94; K44: HR = 1.29, 95% CI: 1.17–1.42). The risk of rectal polyps (K621: HR = 0.77, 95% CI: 0.63–0.92) decreased per unit shortening of LTL.

Conclusions:

This study suggests that LTL shortening is associated with an increased risk of most digestive diseases except for rectal polyps. These findings may provide some clues for understanding the pathogenesis of digestive diseases.
Surgery as Process: Do Little Things Matter?
Authors: Gonnering Russell S.
Published: December 2024

Using the techniques of cognitive task analysis and process mining may allow an increased understanding of both the action and decision components of a surgical procedure. Prior research has demonstrated that these are not intuitive and seemingly small, insignificant elements may have a large impact on success. This increased understanding may allow a more effective transfer of skills by facilitating the transfer of explicit knowledge into tacit knowledge.
Intraoperative measurement of intraocular pressure using a handheld rebound tonometer with sterilized probes: simple method for intraoperative tonometry
Authors: Handzel Daniel M. , Ben Abdallah Chiraz , Sekundo Walter , Ladewig Markus S.
Published: December 2024

This article describes the utilization of a commercially available device for intraoperative measurement of intraocular pressure (IOP). The presented technique will enable a better understanding of intraoperative dynamics using a commercially available device. 261 phakic eyes were included. Measurements were conducted using the iCare 200. The probes were autoclaved at 134°C for 5 minutes. A successful measurement was achieved in 100% of cases. In 2 cases (0.67%), the initially used probe had to be replaced to conduct a successful measurement. The use of sterilized probes in rebound tonometry is a safe and valid method for intraoperative IOP measurement. This enables, for the first time to the authors' knowledge, precise measurements according to modern standards using commercially available devices. This method will support further investigations into surgical techniques and materials, as well as surgical education.
High Risk of HPV Related Preneoplastic and Neoplastic Vulvar Lesions in Women Living With HIV
Authors: Agarossi Alberto , Savasi Valeria , Frangipane Chiara , Parisi Francesca , Agarossi Andrea , Dominoni Mattia , Gardella Barbara
Published: December 2024

Objective

We aimed to investigate the epidemiology of human papilloma virus (HPV)-related preneoplastic and neoplastic vulvar lesions in a large cohort of women living with HIV (WLWH).

Materials and Methods

We retrospectively selected 1,796 WLWH who had a gynecological examination, cervical cytology, high-risk (HR-) HPV test, vulvoscopy, and colposcopy with targeted biopsies when necessary between 1987 and 2020 at 2 Italian institutions. Univariable and multivariable regression analyses were carried out to test the association of the anamnestic and clinical data with the development of precancerous and cancerous lesions.

Results

At baseline, 348 (19.4%) of 1,796 WLWH had genital warts, 30 (1.7%) had vulvar high-grade intraepithelial neoplasia (VHSIL), and 2 (0.1%) had squamous cell carcinoma of the vulva. Among 895 WLWH who had more than 1 year of follow-up, we found 40 (4.5%) new cases of VHSIL and 7 (0.8%) cases of vulvar cancer. The cumulative incidence of VHSIL and vulvar cancer was respectively 0.56 and 0.10 per 100 person-years. Risk factors independently associated with the development of vulvar HSIL and cancer included history of injection drug use (p < .01), genital warts at baseline (p < .001), HR-HPV test positivity at diagnosis (p < .001), and severe immunodepression (CD4 cell count <200 cells/mL) at diagnosis (p < .01).

Conclusions

WLWH are at high risk of vulvar high-grade intraepithelial neoplasia and cancer, especially those with severe immunodepression. A careful inspection of vulva, perineum and anus, possibly with the aid of colposcopy, should become part of the surveillance protocol of HIV-infected women.
Liver cirrhosis complicated with pulmonary Nocardia infection: A case report and literature review
Authors: Xiao Yan , Wang Hongwei , Tian Tingting , Zheng Juanjuan , Liu Mengyang , Wang Qing , Li Jing
Published: December 2024

Rationale:

Nocardia is a conditionally pathogenic bacterium found in the natural environment and is an aerobic bacterium, which causes severe pneumonia relatively rarely. The diagnosis of primary Nocardia infection is always made late due to the nonspecific clinical presentation of patients with Nocardia infection and the time required for Nocardia culture. Due to its rarity and nonspecific clinical presentation, patient survival is often compromised due to misdiagnosis.

Patient concerns:

A 53-year-old woman with autoimmune cirrhosis was treated with glucocorticoids. Three and a half months later the patient developed fever, nausea, cough and sputum, treated with empirical antibiotics, and the patient occurred type I respiratory failure.

Diagnoses:

Nocardia was identified by sputum culture micromorphology and Meriere matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF).

Interventions:

The patient was treated with trimethoprim-sulfamethoxazole (TMZ), and the patient’s oxygen saturation recovered significantly.

Outcomes:

The patient’s overall recovery was slow due to decreased albumin (ALB) and increased procalcitonin (PCT) caused by the patient’s cirrhosis. Due to economic reasons, the family gave up, asked to be discharged.

Lessons:

In our report, patients with underlying disease are immunocompromised and at increased risk of infection with conditionally pathogenic bacteria. Nocardia has no specific presentation and is often overlooked clinically. Treatment of these patients should not be limited to common bacteria or viruses, but should consider rare opportunistic pathogens, and we need to be vigilant for Nocardia infections and timely use of sulfonamide antibiotics to reduce mortality.
Resolution of acute motor axonal neuropathy in a patient after treatment with efgartigimod: A case report
Authors: Zhou Jinli , Yu Weifei , Ding Siqi , Shi Chanhong , Liang Hui
Published: December 2024

Background:

Guillain-Barré syndrome (GBS) is an acute autoimmune neuropathy characterized by progressive muscle weakness, often caused by immunoglobulin G (IgG) autoantibodies. There are several subtypes of GBS, of which acute motor axonal neuropathy (AMAN) is one of the most severe subtypes associated with axonal damage. It is well known that the current clinical standard of treatment is intravenous immunoglobulin (IVIg) and plasma exchange (PLEX), but some patients often show limited response or experience persistent disability. Efgartigimod, an Fc fragment of human IgG antibody, provides a way to target and reduce pathogenic IgG antibodies as a natural ligand Fc receptor (FcRn). The purpose of this study was to observe the therapeutic effect of efgartigimod on axonal GBS, which is expected to be a potential therapeutic method for GBS and AMAN.

Methods:

We present a case of a 58-year-old man diagnosed with AMAN, presenting with ascending symmetrical limb weakness, flaccid paralysis, and multiple cranial nerve palsies. Electromyography confirmed the axonal subtype of GBS. Despite receiving IVIg and PLEX, the patient showed suboptimal recovery. Subsequently, he was treated with efgartigimod at a dose of 10 mg/kg weekly for 4 weeks, demonstrating significant improvement in both clinical symptoms and electromyographic findings, with good tolerability.

Result:

This case highlights the potential efficacy and safety of a 4-dose efgart-igimod regimen in AMAN, particularly for patients with inadequate response to conventional therapies. By targeting FcRn and promoting IgG degradation, efgartigimod offers a novel mechanism to modulate the aberrant immune response underlying AMAN.

Conclusion:

Efgartigimod at a dose of 10 mg/kg weekly for 4 weeks demonstrated promising results in this case of AMAN. While further research is warranted, our findings suggest that efgartigimod may represent a valuable addition to the therapeutic armamentarium for AMAN and potentially other autoimmune neurological conditions. Well-designed clinical trials are crucial to confirm these findings and establish optimal treatment protocols for efgartigimod in AMAN.
Predicting prognosis prior to the combination of atezolizumab and bevacizumab on unresectable HCC: Analysis and comparison of tumor heterogeneity at CT and Gd-EOB-DTPA hepatobiliary MR imaging
Authors: Kwon Heejin , Kang Eunju , Kim Sanghyun , Baeck Yanghyun , Bark Ilcheol , Cho Jinhan
Published: December 2024

Since 2007, the combination of atezolizumab and bevacizumab, comprising an immune checkpoint inhibitor and a molecularly targeted agent, has become the first-line treatment for advanced hepatocellular carcinoma (HCC). Predicting prognosis prior to systemic chemotherapy remains a critical concern. This study included 84 advanced HCC patients who underwent enhanced computed tomography (CT) and Gd-EOB-DTPA magnetic resonance imaging (MRI) before the systemic therapy were included. In CT, the 2 radiologists measured mean CT Hounsfield unit (CTHU) value by drawing region of interest at the largest diameter of the tumor on arterial phage. The HU values were categorized into 5 groups: ≤ 0, 0 < HU ≤ 50, 50 < HU ≤ 100, 100 < HU ≤ 150, and HU > 150. The percentage of the entire tumor in each category was calculated. On MRI, hepatobiliary phase imaging features and relative enhancement ratio (RER) were also evaluated by 2 radiologists. Prognostic factors associated with progression-free survival were identified using statistical analysis. RER on HBP MRI correlated with prognosis in systemic chemotherapy. Conversely, other image features on HBP MRI and CT histogram provided consistent treatment effect.
Evaluation of the clinical efficacy of microwave ablation for benign thyroid nodules based on contrast-enhanced ultrasound
Authors: Zhang Yun , Feng Jun , Fu Gang
Published: December 2024

This study evaluates the clinical efficacy of microwave ablation in patients with benign thyroid nodules based on contrast-enhanced ultrasound. A total of 92 patients with benign thyroid nodules admitted to our hospital from January 2020 to December 2022 were selected as research subjects and divided into control group and observation group according to different treatment methods, with 46 cases in each group. All patients received microwave ablation. Imaging examination and monitoring were performed before and after microwave ablation. The control group underwent routine ultrasound examination, and the observation group underwent contrast-enhanced ultrasound examination. It was determined whether or not to terminate ablation therapy according to the imaging examination results. Results of enhanced MRI were used as the gold standard to evaluate the clinical efficacy, thyroid nodule volume, thyroid nodule volume reduction rate, nodule recurrence, and complication rate of the 2 groups. Using the results of enhanced MRI as the gold standard, the total ablation rate of observation group was 96.55%, which was significantly higher than that of control group 85.96%, and the nodule survival rate of 3.45% was significantly lower than that of control group 14.04% (P < .05). After 1 month, 3 months, 6 months, and 12 months, the thyroid nodule volume of both groups was significantly reduced, and the thyroid nodule volume of observation group was significantly smaller than that of control group (P < .05). After 1 month, 3 months, 6 months, and 12 months, the reduction rate of thyroid nodule volume in 2 groups was significantly increased, and the reduction rate of thyroid nodule volume in observation group was significantly higher than that in control group (P < .05). After treatment, the recurrence rate of nodule in observation group was 4.35%, which was significantly lower than that in control group, 15.22% (P < .05). After treatment, the complication rate of observation group was 8.70%, which was significantly lower than that of control group 26.09% (P < .05). Contrast-enhanced ultrasound can effectively monitor the treatment range of benign thyroid nodules by microwave ablation, improve clinical efficacy, reduce the recurrence rate of nodules, and has high effectiveness and safety.
Evaluating the efficacy of full-scale and tabletop exercises in enhancing paramedic preparedness for external disasters: A quasi-experimental study
Authors: Alakrawi Ghadeer A. , Al-Wathinani Ahmed M. , Gómez-Salgado Juan , Alobaid Abdullah M. , Abahussian Mohammed , Alhazmi Riyadh , Mobrad Abdulmajeed , Jebreel Albaraa , Althunayyan Saqar , Goniewicz Krzysztof
Published: December 2024

Background:

The increasing frequency and severity of disasters worldwide needs effective disaster management training to enhance the preparedness and response capabilities of emergency responders. This study compares the outcomes of tabletop exercises (TTEs) and full-scale exercises (FSEs) in training senior paramedic students at Prince Sultan bin Abdul Aziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia.

Methods:

A nonequivalent two-group quasi-experimental design was used. Forty-five senior paramedic students who had completed a disaster management course were randomly assigned to either TTE or FSE groups. Both groups participated in a simulated multi-vehicle accident scenario. Data were collected using an adapted CLUT Scale survey, which measured learning, trust, and usefulness immediately after the exercises. The Mann–Whitney U test was applied to compare outcomes between the 2 groups.

Results:

Both TTE and FSE resulted in high levels of perceived learning, trust, and usefulness among participants, indicating a positive impact on disaster preparedness. While the TTE group scored slightly higher on average across all variables, these differences were not statistically significant, suggesting that both exercise types are similarly effective. The findings underscore the cost-effectiveness of TTEs and their potential to foster collaborative learning environments

Conclusions:

Both TTE and FSE are effective in enhancing disaster preparedness among senior paramedic students. Given their adaptability and cost-effectiveness, TTEs may be particularly valuable for resource-constrained training settings. Further research with larger, more diverse samples and pre-/post-intervention assessments is recommended to validate these findings and improve disaster management training programs.
Lipoma arborescens in a 22-year-old male: A case report
Authors: Li Mingyang , Ding Ling , Nie Qilong , Jiang Zeping
Published: December 2024

Rationale:

Lipoma arborescens (LA) is a rare, benign proliferative disorder of the synovial lining that typically affects middle-aged individuals, predominantly in the knee joint. However, its occurrence in younger patients is unusual and may pose unique diagnostic and therapeutic challenges. This case report aims to highlight the clinical, imaging, and therapeutic aspects of LA in a young adult, thereby expanding the understanding of its presentation in this age group.

Patient concerns:

A 22-year-old male presented with acute swelling and pain in the right knee following a minor sprain. Although the symptoms persisted and worsened over several days, the patient was particularly concerned about his prognosis and the possibility of recurrence. Given the rarity of LA, he expressed anxiety about being diagnosed with such an uncommon condition at his age and feared the potential impact on his future mobility. He was also apprehensive about the risks of surgery and questioned why he, at such a young age, was affected by this rare condition.

Diagnoses:

Initial clinical assessment was inconclusive, leading to further investigations. Magnetic resonance imaging findings suggested a meniscal tear and the presence of LA, characterized by fat globules and joint effusion, which was confirmed during arthroscopic surgery.

Interventions:

The patient underwent arthroscopic surgery involving trimming of the medial meniscus and debridement of the synovium. Surgical findings included extensive synovial proliferation and intra-articular fat globules, which were histologically confirmed as LA.

Outcomes:

Postoperative recovery was successful, with significant improvement in joint function and alleviation of symptoms. Follow-up magnetic resonance imaging confirmed the absence of abnormal synovial proliferation.

Lessons:

This case report underscores the diagnostic and therapeutic challenges associated with LA in a young patient, highlighting the importance of considering LA in differential diagnoses of acute knee swelling, especially when initial evaluations are inconclusive. Through a combination of imaging, arthroscopic intervention, and histopathological confirmation, this case illustrates an effective approach for accurately diagnosing and managing LA. By documenting this atypical presentation in a young adult, this report contributes to the limited literature on LA in younger populations, aiming to enhance clinical awareness and guide future cases involving similar joint lesions.
A rare case report of infective endocarditis caused by Enterococcus gallinarum following renal laser lithotripsy
Authors: Wang Ruoxin , Lv Meng , Fu Liang , Zhao Jinlong , Ni Yinkai , Li Tianyu , Chen Zonghui , Li Feng
Published: December 2024

Rationale:

Enterococcus gallinarum is a part of the normal fecal microbiota in the general population and animals, and is rarely isolated in clinical specimens. Due to the increasing use of immunosuppressants, invasive treatments, and overuse of antibiotics, infections caused by enterococci are gradually increasing.

Patient concerns:

A 48-year-old man was admitted to our hospital due to a persistent fever for 1 month after renal laser lithotripsy.

Diagnoses:

The cardiac ultrasound showed a mass on the mitral valve leaflet of the left atrium. The metagenomic next-generation sequencing test results of blood and vegetation were positive, reporting a large number of characteristic reads of E. gallinarum. The patient was diagnosed with infective endocarditis.

Interventions:

Mechanical mitral valve replacement was performed, and daptomycin was administered during the perioperative period.

Outcomes:

After 4 weeks of antibiotic treatment, the patient’s inflammatory indexes were normal, and no abnormalities such as fever were found. Blood culture and metagenomic next-generation sequencing test results were negative. The patient was then discharged from the hospital.

Lessons:

This case emphasizes the possibility of E. gallinarum developing severe invasive infections after kidney surgery. Clinical doctors should strengthen their understanding of this type of bacteria, understand their sensitive characteristics and treatment principles.
Effects of factors influencing cesarean section rates between 2008 and 2018 in Taiwan: A population-based cross-sectional study
Authors: Tsui Wing Lam , Deng Guang-Hong , Hsieh Tsung-Cheng , Ding Dah-Ching
Published: December 2024

Many factors can affect delivery mode decisions. Therefore, this study aimed to explore the effects of maternal age, physician’s sex, region, income, and hospital type on cesarean section (C/S) delivery rates between 2008 and 2018 in Taiwan. In this population-based cross-sectional study, data were extracted from the Taiwan National Health Insurance Research Database (2 million individuals). The logistic regression method was used to analyze the aforementioned risk factors, and data are expressed as odds ratios (ORs) and 95% confidence intervals. In total, 9826 and 9714 deliveries in 2008 and 2018, respectively, were included in the analysis. The C/S ratio increased from 16.5% (n = 1607) in 2008 to 19.7% (n = 1916) in 2018. A higher C/S risk for women aged >34 years (ORs: 2.835 and 2.225 in 2008 and 2018, respectively) than for those aged ≤34 years was noted in both years. Female physicians had a lower risk of performing C/S than male physicians in 2008 (OR: .762, 95% confidence interval: .625–.928), but this was not apparent in 2018. Higher income levels (>new Taiwan dollar 45,081) and central Taiwan were associated with a lower C/S risk in both years. Private, not-for-profit hospitals had a lower C/S risk in 2008, which was not apparent in 2018. In conclusion, this study revealed a significant increase in C/S rates over the past decade, which was influenced by multiple factors. Maternal age, physician’s sex, income status, location, and type of hospital may influence C/S rates. Analyzing these relationships can inform the development of strategies aimed at reducing future C/S rates, and targeted interventions may reduce the C/S rates.
Causality between gut microbiota, immune cells, and breast cancer: Mendelian randomization analysis
Authors: Lv Rui , Wang Danyan , Wang Tengyue , Li Rongqun , Zhuang Aiwen
Published: December 2024

The association between gut microbiota (GM) and breast cancer (BC) has been studied. Nevertheless, the causal relationship between them and the potential mediating factors have not been clearly defined. Therefore, in this study, Mendelian randomization analysis (MR) was employed to explore the causal relationship between 473 GM and BC, as well as the mediating effect of potential immune cells. In this investigation, we availed ourselves of the publicly accessible summary statistics from the genome-wide association study to undertake two-sample and reverse Mendelian randomization analyses on GM and BC, with the intention of clarifying the causal association between GM and BC. Subsequently, through the application of the two-step Mendelian randomization analysis, it was revealed that the relationship between GM and BC was mediated by immune cells. The stability of the research outcomes was verified via sensitivity analysis. Mendelian randomization analysis elucidated the protective impacts of 8 genera on BC (such as Phylum Actinobacteriota, Species Bacteroides A plebeius A, Species Bifidobacterium adolescentis, Species CAG-841 sp002479075, Family Fibrobacteraceae, Order Fibrobacterales, Class Fibrobacteria, and Species Phascolarctobacterium sp003150755). Additionally, there are 23 immune cell traits related to BC. Our research findings showed that the species Megamonas funiformis was associated with an increased risk of BC, and 11.20% of this effect was mediated by CD38 on IgD+ CD24‐. Likewise, HLA DR on CD33br HLA DR+ CD14‐ mediated the causal relationship between Species Prevotellamassilia and BC, having a mediating ratio of 7.89%. This study clarifies a potential causal relationship between GM, immune cells, and BC and provides genetic evidence for this causal connection. It offers research directions for the subsequent prevention and treatment of BC through the interaction between GM and immune cells, and provides a reference for future mechanistic and clinical studies in this field.
No causal association between serum vitamin D levels and bronchiectasis: A Mendelian randomization analysis
Authors: Pan Weicong , Huang Zhanqiang , Deng Haiyan , Huang He , Yu Ke
Published: December 2024

Observational studies have reported an association between Vitamin D deficiency and an increased risk of bronchiectasis. This study aims to investigate the causal relationship between Vitamin D levels and bronchiectasis using a 2-sample Mendelian randomization (MR) analysis. Data from 2 genome-wide association studies (GWAS) based on European ancestry were analyzed: serum vitamin D levels (sample size = 441,291 [UK Biobank]) and bronchiectasis (sample size = 187,830 [cases = 1107, controls = 186,723; FinnGen]). Inverse-variance weighted (IVW) analysis was primarily used to assess the causal effect of 25(OH)D levels on bronchiectasis, supplemented by Mendelian randomization Egger regression (MR-Egger), weighted median, simple mode, and weighted mode analyses. Additionally, MR-Egger intercept test and MR-Pleiotropy Residual Sum and Outlier methods were implemented to determine pleiotropy, and Cochran’s Q test was conducted for heterogeneity testing. Leave-one-out analysis and Bayesian weighted Mendelian randomization was also used to assess the robustness of the results. The MR analysis suggested no significant causal effects of serum 25(OH)D levels on bronchiectasis using the IVW method (odds ratio = 1.550; 95% confidence interval [CI]: 0.908–2.315; P = .120). These results were consistent across MR-Egger regression, weighted median, simple mode, and weighted mode analyses. No significant heterogeneity, pleiotropy, or bias was detected in instrumental variables. Additionally, no evidence supported the causal effects of bronchiectasis on serum vitamin D levels (β = −0.002, 95% CI: −0.007 to 0.003; P = .463). Our study found no significant causal association between serum 25(OH)D levels and bronchiectasis, in either direction. A larger sample-sized randomized controlled trial (RCT) is needed to further investigate this potential causal relationship.