bluuebunny/crossref_metadata_2025 huggingface dataset:
Genotoxicity by rapeseed methyl ester and hydrogenated vegetable oil combustion exhaust products in lung epithelial (A549) cells
Authors: Rothmann Monika Hezareh , Møller Peter , Essig Yona J , Gren Louise , Malmborg Vilhelm B , Tunér Martin , Pagels Joakim , Krais Annette M , Roursgaard Martin
Published: May 2023

Biofuel is an attractive substitute for petrodiesel because of its lower environmental footprint. For instance, the polycyclic aromatic hydrocarbons (PAH) emission per fuel energy content is lower for rapeseed methyl ester (RME) than for petrodiesel. This study assesses genotoxicity by extractable organic matter (EOM) of exhaust particles from the combustion of petrodiesel, RME, and hydrogenated vegetable oil (HVO) in lung epithelial (A549) cells. Genotoxicity was assessed as DNA strand breaks by the alkaline comet assay. EOM from the combustion of petrodiesel and RME generated the same level of DNA strand breaks based on the equal concentration of total PAH (i.e. net increases of 0.13 [95% confidence interval (CI): 0.002, 0.25, and 0.12 [95% CI: 0.01, 0.24] lesions per million base pairs, respectively). In comparison, the positive control (etoposide) generated a much higher level of DNA strand breaks (i.e. 0.84, 95% CI: 0.72, 0.97) lesions per million base pairs. Relatively low concentrations of EOM from RME and HVO combustion particles (<116 ng/ml total PAH) did not cause DNA strand breaks in A549 cells, whereas benzo[a]pyrene and PAH-rich EOM from petrodiesel combusted using low oxygen inlet concentration were genotoxic. The genotoxicity was attributed to high molecular weight PAH isomers with 5–6 rings. In summary, the results show that EOM from the combustion of petrodiesel and RME generate the same level of DNA strand breaks on an equal total PAH basis. However, the genotoxic hazard of engine exhaust from on-road vehicles is lower for RME than petrodiesel because of lower PAH emission per fuel energy content.
Integration of dietary nutrition and TRIB3 action into diabetes mellitus
Authors: Lu Guangping , Li Jiahao , Gao Ting , Liu Qingbo , Chen Ou , Zhang Xiaohui , Xiao Mengjie , Guo Yuanfang , Wang Jie , Tang Yufeng , Gu Junlian
Published: May 2023

Despite intensive studies for decades, the common mechanistic correlations among the underlying pathology of diabetes mellitus (DM), its complications, and effective clinical treatments remain poorly characterized. High-quality diets and nutrition therapy have played an indispensable role in the management of DM. More importantly, tribbles homolog 3 (TRIB3), a nutrient-sensing and glucose-responsive regulator, might be an important stress-regulatory switch, linking glucose homeostasis and insulin resistance. Therefore, this review aimed to introduce the latest research progress on the crosstalk between dietary nutrition intervention and TRIB3 in the development and treatment of DM. This study also summarized the possible mechanisms involved in the signaling pathways of TRIB3 action in DM, in order to gain an in-depth understanding of dietary nutrition intervention and TRIB3 in the pathogenesis of DM at the organism level.
Three-Dimensional Morphological Analysis Revealed the Cell Patterning Bases for the Sexual Dimorphism Development in the Liverwort Marchantia polymorpha
Authors: Cui Yihui , Hisanaga Tetsuya , Kajiwara Tomoaki , Yamaoka Shohei , Kohchi Takayuki , Goh Tatsuaki , Nakajima Keiji
Published: May 2023

In land plants, sexual dimorphism can develop in both diploid sporophytes and haploid gametophytes. While developmental processes of sexual dimorphism have been extensively studied in the sporophytic reproductive organs of model flowering plants such as stamens and carpels of Arabidopsis thaliana, those occurring in gametophyte generation are less well characterized due to the lack of amenable model systems. In this study, we performed three-dimensional morphological analyses of gametophytic sexual branch differentiation in the liverwort Marchantia polymorpha, using high-depth confocal imaging and a computational cell segmentation technique. Our analysis revealed that the specification of germline precursors initiates in a very early stage of sexual branch development, where incipient branch primordia are barely recognizable in the apical notch region. Moreover, spatial distribution patterns of germline precursors differ between males and females from the initial stage of primordium development in a manner dependent on the master sexual differentiation regulator MpFGMYB. At later stages, distribution patterns of germline precursors predict the sex-specific gametangia arrangement and receptacle morphologies seen in mature sexual branches. Taken together, our data suggest a tightly coupled progression of germline segregation and sexual dimorphism development in M. polymorpha.
A Critique of Yablo’s If-thenism
Authors: Armour-Garb Bradley , Kroon Frederick
Published: May 2023

Using ideas proposed in Aboutness and developed in ‘If-thenism’, Stephen Yablo has tried to improve on classical if-thenism in mathematics, a view initially put forward by Bertrand Russell in his Principles of Mathematics. Yablo’s stated goal is to provide a reading of a sentence like ‘The number of planets is eight’ with a sort of content on which it fails to imply ‘Numbers exist’. After presenting Yablo’s framework, our paper raises a problem with his view that has gone virtually unnoticed in the literature. If we are right, then Yablo’s version of if-thenism cannot succeed.
Peronophythora litchii RXLR effector P. litchii avirulence homolog 202 destabilizes a host ethylene biosynthesis enzyme
Authors: Li Peng , Li Wen , Zhou Xiaofan , Situ Junjian , Xie Lizhu , Xi Pinggen , Yang Bo , Kong Guanghui , Jiang Zide
Published: May 2023

Oomycete pathogens can secrete hundreds of effectors into plant cells to interfere with the plant immune system during infection. Here, we identified a Arg-X-Leu-Arg (RXLR) effector protein from the most destructive pathogen of litchi (Litchi chinensis Sonn.), Peronophythora litchii, and named it P. litchii avirulence homolog 202 (PlAvh202). PlAvh202 could suppress cell death triggered by infestin 1 or avirulence protein 3a/resistance protein 3a in Nicotiana benthamiana and was essential for P. litchii virulence. In addition, PlAvh202 suppressed plant immune responses and promoted the susceptibility of N. benthamiana to Phytophthora capsici. Further research revealed that PlAvh202 could suppress ethylene (ET) production by targeting and destabilizing plant S-adenosyl-L-methionine synthetase (SAMS), a key enzyme in the ET biosynthesis pathway, in a 26S proteasome-dependent manner without affecting its expression. Transient expression of LcSAMS3 induced ET production and enhanced plant resistance, whereas inhibition of ET biosynthesis promoted P. litchii infection, supporting that litchi SAMS (LcSAMS) and ET positively regulate litchi immunity toward P. litchii. Overall, these findings highlight that SAMS can be targeted by the oomycete RXLR effector to manipulate ET-mediated plant immunity.
A Fiscal Theory of Persistent Inflation
Authors: Bianchi Francesco , Faccini Renato , Melosi Leonardo
Published: May 2023

We develop a new class of general-equilibrium models with partially unfunded debt to propose a fiscal theory of persistent inflation. In response to business cycle shocks, the monetary authority controls inflation and the fiscal authority stabilizes debt. However, the central bank accommodates unfunded fiscal shocks, causing persistent movements in inflation, output, and real interest rates. In an estimated quantitative model, fiscal inflation accounts for the bulk of inflation dynamics. In the aftermath of the pandemic, unfunded fiscal shocks sustain the recovery but also cause a persistent increase in inflation. The model is able to predict the inflationary effects of the American Rescue Plan Act fiscal stimulus out of sample and with real-time data.
Prognostic and predictive markers of systemic sclerosis-associated interstitial lung disease in a clinical trial and long-term observational cohort
Authors: Ghuman Abeer , Khanna Dinesh , Lin Celia J F , Furst Daniel E , Raghu Ganesh , Martinez Fernando J , Zucchetto Mauro , Huang Suiyuan , Jennings Angus , Nihtyanova Svetlana I , Denton Christopher P
Published: May 2023

Objectives

To explore prognostic and predictive markers of SSc-associated interstitial lung disease (SSc-ILD) outcomes in a phase 3 trial (focuSSced) and prognostic markers in a real-world cohort (SMART).

Methods

The focuSSced SSc-ILD subgroup included 68 of 106 placebo-treated and 68 of 104 tocilizumab-treated patients. The SMART cohort included 505 patients with SSc-ILD. Linear mixed-effect models were used to identify factors associated with change in forced vital capacity (FVC). Kaplan–Meier estimation and Cox regression were used for time-to-event analyses.

Results

In placebo-treated focuSSced patients, sex was a significant prognostic factor for FVC decline; males had increased risk for absolute decline ≥10% in percent-predicted FVC (ppFVC) and 0.22% faster weekly FVC decline than females (P = 0.0001). FVC was 9.8% lower in patients with CRP >6 mg/ml vs those with CRP ≤6 mg/ml (P = 0.0059). Tocilizumab reduced the risk for ≥10% decline in ppFVC in patients who were male, had earlier disease (<2 years duration), had IL-6 levels <10 pg/ml, or had anti-topoisomerase antibodies (ATA). In the SMART cohort, prognostic factors for ppFVC <70% were male sex, ATA, and low baseline FVC. Males had 3.3% lower FVC 1 year after disease onset (P < 0.001) and 0.6% faster yearly decline (P = 0.03) than females.

Conclusion

Prognostic markers in SSc-ILD were similar between focuSSced and SMART. Male sex and inflammatory markers were associated with lower FVC but IL-6 ≥10 pg/ml was not predictive of response to tocilizumab.

Trial Registration

ClinicalTrials.gov: NCT02453256.
Citizen monitoring of ambient dose rate: the SAFECAST project
Authors: Kuča Petr , Helebrant Jan , Bossew Peter
Published: May 2023

Citizen Science (CS) is research performed by citizens who are not professional scientists in general. SAFECAST was founded in Japan after the Fukushima accident 2011, motivated by distrust in the perceived biassed information by authorities about radiation situation. Measurements of ambient dose rate (ADR) performed by citizens were intended to verify and complement official data using bGeigieNano designed for purpose, recording ADR, GPS coordinates and date/time allowing projection on digital maps. The project expanded internationally, by mid-2022 containing ⁓180 million measurements. CS generates large amount of data as valuable source for science; it has educational value and serves communication between citizens and professionals. Problems consist in quality assurance (QA): citizens who are no trained metrologists are usually little familiar with notions of representativeness, measurement protocols and uncertainty that are the central QA topics. We discuss variability of response of instruments of the same kind under same ambient conditions and isotropy of response under field conditions.
Assessment of absorbed power density in multilayer planar model of human tissue
Authors: Poljak Dragan , Šušnjara Anna , Kraljević Lucija
Published: May 2023

The paper deals with the determination of the absorbed power density (Sab) in a planar multilayer model of a tissue exposed to the radiation of a dipole antenna, based on the analytical/numerical approach. A derivation of Sab from the differential form of Poynting theorem is presented. The two-layer and three-layer tissue models are used. Illustrative analytical/numerical results for electric and magnetic fields and Sab induced at the tissue surface for various antenna lengths, operating frequencies and antenna-interface distances are presented in the paper. Exposure scenarios of interest pertain to frequencies above 6GHz pertaining to 5G mobile systems.
Twenty years of inspection interventions in Slovenia
Authors: Janžekovič Helena
Published: May 2023

After the Dijon Conference in 1998, Slovenia upgraded emergency response systems giving attention to orphan sources. It followed the European Union legislation, e.g. Council Directive 2013/59/EURATOM, and international experiences. The upgrading includes, among others, 24h on duty Slovenian Nuclear Safety Administration (SNSA) service, reporting of incidents and accidents and installation of radiation monitors. The SNSA established already in 2002, the SNSA Database of Interventions with records of all events requiring prompt inspector actions, i.e. interventions. Today, the SNSA Database contains records on about 300 cases. Despite the fact that each intervention is unique, several types of interventions might be identified, e.g. interventions related to handling sources or radioactive waste, transport and false alarms. About 20% of interventions are related to NORM, whereas about 30% are false alarms. The SNSA Database is a tool used to implement a graded approach as well as an optimization of radiation protection in SNSA response to interventions.
Optimisation of gamma spectrometry measurements in atmosphere during nuclear emergencies
Authors: Magnoni Mauro , Bertino Stefano , Bellina Luca
Published: May 2023

During emergencies following a major nuclear accident a prompt and accurate characterisation of the radioactive cloud is one of the main task of any radioactivity monitoring system. This task is usually performed by means of γ-spectrometry High Purity Germanium (HPGe) measurements on atmospheric particulate samples gathered by means of high-volume pumps. The key parameters describing the performances of a monitoring system are the Minimum Detectable Activities (MDAs) of the most relevant radionuclides. These parameters depend on a number of factors related to the efficiency of the available germanium detector, the volume of air filtered by the sampling devices and the γ-decay scheme of each radionuclides as well. Besides the MDAs, another very important characteristic of a monitoring system, especially during an evolving emergency, is its capability of giving reliable results at a given and constant pace. It is therefore important to define the time resolution of the monitoring system, i.e. the minimum time needed to produce the data, namely the activity concentrations of the radionuclides in the atmosphere. The optimization of the measurements procedures are discussed in this work: in particular it is demonstrated that, being t the time resolution of the monitoring system, the lowest MDAs can be achieved with a sampling time given by (2/3)·t and a counting time of (1/3)·t. Finally, the MDAs achievable for a standard monitoring system based on a 30% HPGe detector are calculated for all the most important fission products.
Radiofrequency personal exposimetry during outdoor entertainment of young adults: a case study
Authors: Vecsei Zsuzsanna , Szilágyi Zsófia , Thuróczy György
Published: May 2023

Radiofrequency (RF) exposure has grown substantially over time in the public area. Personal dosimetry measurements are intended to estimate how human RF exposure relates to exposure limits that do not pose a health risk. For our case study, an outdoor festival was chosen to assess realistic RF exposure of young adults during their entertainment. Band-selective RF exposure—sorted along 2G–4G uplinks and downlinks, 5G and Wi-Fi bands—was evaluated. Electric field strength data subsets were classified on the basis of activities as well as crowd density. 2G contributed the most to the overall RF exposure. Highest RF exposure was associated with attendance in a concert. In moderately crowded situations, RF exposure was higher than in the most crowded ones. However, the total measured electric field values were higher than in other outdoor environment, but still far below the national and international directives of regulatory RF-EMF exposure limits.
Respiratory protection strategies for the public in emergency response
Authors: Shin Seung Hun , Lee Hyeonmin , Kim Hee Reyoung
Published: May 2023

A strategy was established to minimize the stochastic effects of internal and external exposure to radioactive substances by wearing respiratory protection equipment (RPE) during an emergency evacuation. During the evacuation of residents in the event of a nuclear power plant accident, the stochastic effects of internal exposure caused by the inhalation of radioactive aerosol and external exposure due to accumulated radioactive particles in the filter medium of a mask must be minimized. The radioactivity concentration along an evacuation route considers atmospheric dispersion and the resuspension of particles deposited on surfaces. The effective dose due to internal exposure is evaluated using inhalation dose coefficients for each particle diameter. When the face seal leakage and filter medium penetration ratio for each particle diameter of the RPE (N95) is taken into consideration, the internal dose is reduced by 97.2%. Furthermore, the accumulated radioactivity in the filter medium decreases by 91.4% when the respirator is replaced every 48 h.
Preliminary study on individual radiation dose received by medical staff for dose constraint determination
Authors: Milecz-Mitykó Richárd , Bérczi Viktor , Czibor Sándor , Bánsághi Zoltán , Taba Gabriella , Kári Béla , Györke Tamás
Published: May 2023

The staff of the Radiation Protection Service of a European clinical center measured the radiation dose by type-tested thermoluminescent dosemeter systems to which the medical staff was exposed, to assess the effectiveness of current procedures and equipment for optimalisation prompted by the requirements EU Basic Safety Standard 2013. There were three participating sites, the Site 1 was an external hospital, whereas Sites 2 and 3 are part of the same clinical center, who provided data regarding their personnel, from technologists, nurses and medical doctors. In this preliminary study, only a low number of cases were available and used to establish a new, more realistic yearly dose constraint, namely 6 (from two) mSv for whole-body effective dose, 15 (from two) mSv for eye lens dose and 300 (from 50) mSv for extremity dose. Furthermore, the state of safety culture and protection equipment was assessed. Collection of the sufficient amount of data for statistical evaluation is ongoing.
On the Social Existence of Mental Health Categories: The Case of Sex Addiction
Authors: Brossard Baptiste , Roy Melissa , Brown Julia , Hemmings Benjamin , Larocque Emmanuelle
Published: May 2023

Mental health categories can circulate in societies regardless of whether they are recognized by medical professionals. This article asks why some labels are adopted en masse to commonly characterize some forms of distress, while other labels remain confined to specialist spheres. Contrasting with many examples of medicalization, “sex addiction” offers a heuristic case study because it was only after its exclusion from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994 that it became widely used to pathologize sexual excess in Western cultures. To understand how this and other categories acquire such popularity, it is necessary to account more explicitly for the multiple social appropriations of these categories within various non-medical fields and examine how they circulate between these fields. Drawing on two years of qualitative data collection from North American and Australian social institutions of non-medical therapy, law, the media, and religion, this article proposes a theoretical and methodological framework for studying the “social existence” of mental health categories such as sex addiction.
Vulnerable settlors—capacity and undue influence
Authors: Stanley Clare
Published: May 2023

There is a dearth of authority addressing what the test for capacity is where a settlor is exercising powers reserved to them under a trust instrument, and even less guidance as to the application of the law of undue influence to the exercise of such powers. The Grand Court of the Cayman Islands has recently grappled with both of these issues.
The Fungal Pathogen Gnomoniopsis castaneae Induces Damaging Cankers in Multiple Domestic Fagaceae Species
Authors: Dobry Emily P. , Rutter Michael A. , Campbell Michael
Published: May 2023

Gnomoniopsis castaneae is internationally recognized as a destructive pathogen of chestnut species. Primarily associated with nut rot, it has also been associated with branch and stem cankers of chestnut and as an endophyte of multiple additional hardwood species. The present study evaluated implications of the recently reported United States presence of the pathogen for domestic Fagaceae species. Stem inoculation assays of Castanea dentata, C. mollissima, C. dentata × C. mollissima, and Quercus rubra (red oak) seedlings were utilized to examine the cankering ability of a regional isolate of the pathogen. The pathogen induced damaging cankers in all assessed species and significant stem girdling in all chestnut species. No previous study has associated the pathogen with damaging infection in Quercus species, and its presence in the United States has the potential to compound ongoing chestnut recovery programs and oak regeneration problems within forest systems.
An Immunologic and Biomechanical Comparison of Polyether Ether Ketone-Zeolite and Polyether Ether Ketone Interbody Fusion Devices
Authors: Cheng Boyle C. , Swink Isaac , McClain Edward J. , Vyas Praveer S. , Muzzonigro Thomas , Carbone Jake , Zaidi Ali , Long Jason D. , Altman Daniel T. , Yu Alexander K.
Published: May 2023

Study Design.

A laboratory study comparing polyether ether ketone (PEEK)-zeolite and PEEK spinal implants in an ovine model.

Objective.

This study challenges a conventional spinal implant material, PEEK, to PEEK-zeolite using a nonplated cervical ovine model.

Summary of Background Data.

Although widely used for spinal implants due to its material properties, PEEK is hydrophobic, resulting in poor osseointegration, and elicits a mild nonspecific foreign body response. Zeolites are negatively charged aluminosilicate materials that are hypothesized to reduce this pro-inflammatory response when used as a compounding material with PEEK.

Materials and Methods.

Fourteen skeletally mature sheep were, each, implanted with one PEEK-zeolite interbody device and one PEEK interbody device. Both devices were packed with autograft and allograft material and randomly assigned to one of 2 cervical disc levels. The study involved 2 survival time points (12 and 26 weeks) and biomechanical, radiographic, and immunologic endpoints. One sheep expired from complications not related to the device or procedure. A biomechanical evaluation was based on measures of segmental flexibility, using 6 degrees of freedom pneumatic spine tester. Radiographic evaluation was performed using microcomputed tomography scans in a blinded manner by 3 physicians. Levels of the pro-inflammatory cytokines, interleukin (IL)-1β, IL-6, and tumor necrosis factor-alpha at the implant, were quantified using immunohistochemistry.

Results.

PEEK-zeolite and PEEK exhibited an equivalent range of motion in flexion extension, lateral bending, and axial torsion. A motion was significantly reduced for implanted devices at both time points as compared with native segments. Radiographic assessments of fusion and bone formation were similar for both devices. PEEK-zeolite exhibited lower levels of IL-1β (P = 0.0003) and IL-6 (P = 0.03).

Conclusion.

PEEK-zeolite interbody fusion devices provide initial fixation substantially equivalent to PEEK implants but exhibit a reduced pro-inflammatory response. PEEK-zeolite devices may reduce the chronic inflammation and fibrosis previously observed with PEEK devices.
Implementation of a Private Payer Bundled Payment Model While Maintaining High-Value Lumbar Spinal Fusion
Authors: Issa Tariq Z. , Lee Yunsoo , Lambrechts Mark J. , D’Antonio Nicholas D. , Toci Gregory R. , Mazmudar Aditya , Kalra Andrew , Sherman Matthew , Canseco Jose A. , Hilibrand Alan S. , Vaccaro Alexander R. , Schroeder Gregory D. , Kepler Christopher K.
Published: May 2023

Study Design:

Retrospective single-institution cohort

Objective:

To evaluate the implementation of a commercial bundled payment model in patients undergoing lumbar spinal fusion.

Summary of Background Data:

BPCI-A caused significant losses for many physician practices, prompting private payers to establish their own bundled payment models. The feasibility of these private bundles has yet to be evaluated in spine fusion.

Methods:

Patients undergoing lumbar fusion from October to December 2018 in BPCI-A before our institution’s departure were included for BPCI-A analysis. Private bundle data was collected from 2018 to 2020. Analysis of the transition was conducted among Medicare-aged beneficiaries. Private bundles were grouped by calendar year (Y1, Y2, Y3). Stepwise multivariate linear regression was performed to measure independent predictors of net deficit.

Results:

The net surplus was the lowest in Y1 ($2,395, P=0.03) but did not differ between our final year in BPCI-A and subsequent years in private bundles (all, P>0.05). AIR and SNF patient discharges decreased significantly in all private bundle years compared with BPCI. Readmissions fell from 10.7% (N=37) in BPCI-A to 4.4% (N=6) in Y2 and 4.5% (N=3) Y3 of private bundles (P<0.001). Being in Y2 or Y3 was independently associated with a net surplus in comparison to the Y1 (β: $11,728, P=0.001; β: $11,643, P=0.002). Postoperatively, length of stay in days (β: $-2,982, P<0.001), any readmission (β: -$18,825, P=0.001), and discharge to AIR (β: $-61,256, P<0.001) or SNF (β: $-10,497, P=0.058) were all associated with a net deficit.

Conclusions:

Nongovernmental bundled payment models can be successfully implemented in lumbar spinal fusion patients. Constant price adjustment is necessary so bundled payments remain financially beneficial to both parties and systems overcome early losses. Private insurers who have more competition than the government may be more willing to provide mutually beneficial situations where cost is reduced for payers and health systems.

Level of Evidence.

3
Noninvasive Monitoring of Arterial Pressure: Finger or Lower Leg As Alternatives to the Upper Arm: A Prospective Study in Three ICUs
Authors: Lakhal Karim , Dauvergne Jérôme E. , Kamel Toufik , Messet-Charriere Hélène , Jacquier Sophie , Robert-Edan Vincent , Nay Mai-Anh , Rozec Bertrand , Ehrmann Stephan , Muller Grégoire , Boulain Thierry
Published: May 2023

OBJECTIVES:

When the upper arm is inaccessible for measurements of arterial pressure (AP), the best alternative site is unknown. We performed a between-site comparison of the agreement between invasive and noninvasive readings of AP taken at the lower leg, the finger, and the upper arm. The risk associated with measurement errors and the trending ability were also assessed.

DESIGN:

Prospective observational study.

SETTING:

Three ICUs.

PATIENTS:

Patients having an arterial catheter and an arm circumference less than 42 cm.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Three triplicates of AP measurements were collected via an arterial catheter (reference AP), a finger cuff system (ClearSight; Edward Lifesciences, Irvine, CA), and an oscillometric cuff (at the lower leg then the upper arm). Trending ability was assessed through an additional set of measurements after a cardiovascular intervention. The default bed backrest angle was respected. Failure to measure and display AP occurred in 19 patients (13%) at the finger, never at other sites. In 130 patients analyzed, the agreement between noninvasive and invasive readings was worse at the lower leg than that observed at the upper arm or the finger (for mean AP, bias ± sd of 6.0 ± 15.8 vs 3.6 ± 7.1 and 0.1 ± 7.4 mm Hg, respectively; p < 0.05), yielding a higher frequency of error-associated clinical risk (no risk for 64% vs 84% and 86% of measurements, respectively, p < 0.0001). According to the International Organization for Standardization (ISO) 81060-2:2018 standard, mean AP measurements were reliable at the upper arm and the finger, not the lower leg. In 33 patients reassessed after a cardiovascular intervention, both the concordance rate for change in mean AP and the ability to detect a therapy-induced significant change were good and similar at the three sites.

CONCLUSIONS:

As compared with lower leg measurements of AP, finger measurements were, when possible, a preferable alternative to upper arm ones.
Treatment of Urinary Tract Infections in Hospitalized Adults
Authors: Maldonado Cody R. , Grubbs Riley , Spilman Sarah K. , Jansen Jeffrey W.
Published: May 2023

Background

The purpose of the study was to evaluate whether ceftriaxone therapy would result in less clinical failure than levofloxacin therapy in hospitalized adults treated for urinary tract infections (UTIs).

Methods

This was a single-center, retrospective cohort study of hospitalized adult patients with UTI as admitting diagnosis from 2012 to 2017. Patients were included in the study if they received ≥48 continuous hours of levofloxacin or ceftriaxone. The primary end point was clinical failure, defined as a composite of attributable mortality, in vitro resistance, or change of antimicrobial class. All variables from bivariate analysis with significance P < 0.20 were included in a multivariate regression model completed in the backward stepwise method to determine predictors of clinical failure.

Results

Of the 325 patients who met study inclusion criteria, 187 (57%) received ceftriaxone and 138 (43%) received levofloxacin. Clinical failure occurred in 11% of patients treated with ceftriaxone and 22% of patients treated with levofloxacin (P < 0.01). Ceftriaxone therapy was associated with reduced odds of clinical failure when controlling for chronic kidney disease, history of UTIs, cirrhosis, and fever at therapy initiation.

Conclusions

Patients treated with ceftriaxone experienced significantly less clinical failure than patients treated with levofloxacin despite low baseline resistance rates.
Enhanced vs conventional monofocal intraocular lens clinical results in patients with cataract: randomized clinical trial
Authors: Donoso Rodrigo , Torres Andrés , Klagges Jorge , Mercado Yuri , Gonzalez Tomás , Astudillo Macarena , Norambuena Héctor , Medina Emilio
Published: May 2023

Purpose:

To compare clinical outcomes between an enhanced and a conventional monofocal intraocular lens (IOL) after cataract surgery.

Setting:

Ophthalmology Unit, Hospital del Salvador, University of Chile (tertiary care hospital).

Design:

Double-masked, prospective randomized controlled trial.

Methods:

66 healthy adults with corneal astigmatism less than 1.50 diopters and axial length between 21 and 27 mm were randomly allocated (1:1) for bilateral phacoemulsification with either an enhanced monofocal IOL (ICB00) or a conventional aspheric monofocal IOL (ZCB00) implant. The refractive target was emmetropia in both eyes. Visual acuities, defocus curves, Catquest-9SF, and quality of vision (QoV) were measured 3 months postoperatively.

Results:

Binocular uncorrected intermediate visual acuity was improved in patients implanted with the enhanced monofocal lens (0.37 ± 0.12) compared with the conventional monofocal (0.45 ± 0.10) (P < .01). There were no significant differences in corrected distance visual acuity (CDVA), Catquest-9SF, or QoV scores.

Conclusions:

The enhanced monofocal IOL provided 1 additional line of intermediate visual acuity after cataract surgery. There was no significant change in either CDVA or QoV.
Comparing Short-Term Knee-Related Quality of Life and Associated Clinical Outcomes Between Youth With and Without a Sport-Related Knee Injury
Authors: Le Christina Y. , Pajkic Andrea , Losciale Justin M. , Filbay Stephanie R. , Emery Carolyn A. , Manns Patricia J. , Whittaker Jackie L.
Published: May 2023

Objective:

To compare short-term changes in knee-related quality of life (QOL) and associated clinical outcomes between youth with and without a sport-related knee injury.

Design:

Prospective cohort study.

Setting:

Sport medicine and physiotherapy clinics.

Participants:

Youth (11-19 years old) who sustained an intra-articular, sport-related knee injury in the past 4 months and uninjured youth of similar age, sex, and sport.

Independent Variable:

Injury history.

Main Outcome Measures:

Knee-related QOL (Knee injury and Osteoarthritis Outcome Score, KOOS), knee extensor and flexor strength (dynamometry), physical activity (accelerometer), fat mass index (FMI; bioelectrical impedance), and kinesiophobia (Tampa Scale for Kinesiophobia, TSK) were measured at baseline (within 4 months of injury) and at 6-month follow-up. Wilcoxon rank sum tests assessed between-group differences for all outcomes. Regression models assessed the association between injury history and outcome change (baseline to 6-month follow-up), considering sex. The influence of injury type, baseline values, and physiotherapy attendance was explored.

Results:

Participants' (93 injured youth, 73 uninjured control subjects) median age was 16 (range 11-20) years and 66% were female. Despite greater improvements in KOOS QOL scores (20; 95% confidence interval, 15-25), injured participants demonstrated deficits at 6-month follow-up (z = 9.3, P < 0.01) compared with control subjects, regardless of sex. Similar findings were observed for knee extensor and flexor strength and TSK scores but not for physical activity or FMI. Lower baseline values were associated with greater outcome changes in injured youth.

Conclusions:

Youth have worse knee-related QOL, muscle strength, and kinesiophobia early after a sport-related knee injury than control subjects. Despite improvements, deficits persist 6 months later.
Brief Report: Use and Side Effects of Sodium–Glucose Transporter 2 Inhibitors Among US People With HIV With Clinical Indications
Authors: Sise Meghan E. , Katz-Agranov Nurit , Strohbehn Ian A. , Harden Destiny , Moreno Daiana , Durbin Claudia , Toribio Mabel , Neilan Tomas G. , Zanni Markella V.
Published: May 2023

Background:

Sodium–glucose transporter 2 (SGLT2) inhibitors have been approved for treatment of diabetes mellitus (DM), chronic kidney disease, and heart failure, but little is known about prescription levels and safety profiles among people with HIV (PWH).

Methods:

We leveraged data from the US Mass General Brigham electronic healthcare database to determine the use/uptake of SGLT2 inhibitors among PWH with type II diabetes (DM2) (with or without chronic kidney disease, proteinuria, or heart failure) and to assess rates of adverse events among PWH with DM2 taking SGLT2 inhibitors.

Results:

Among eligible PWH with DM2 receiving care at US Mass General Brigham (N = 907), SGLT2 inhibitors were prescribed to 8.8%. SGLT2 inhibitors were prescribed to a fraction of eligible PWH with DM2 and a concomitant diagnosis of chronic kidney disease (3.8%), proteinuria (13.2%), or heart failure (8.2%). PWH with DM2 on SGLT2 inhibitors experienced side effects (urinary tract infection, diabetic ketoacidosis, and acute kidney injury) at rates comparable with PWH with DM2 prescribed glucagon-like peptide-1 agonists. Rates of mycotic genitourinary infections were higher among those prescribed SGLT2 inhibitors (5% vs. 1%, P = 0.17), but no cases of necrotizing fasciitis ensued.

Conclusions:

Additional studies are needed to characterize population-specific salutary and adverse effects of SGLT2 inhibitors among PWH and potentially augment prescription rates when guideline indicated.
A Systematic Review and Meta-Analysis Comparing the Clinical Outcomes of Profunda Artery Perforator Versus Gracilis Thigh Flap as a Second Choice for Autologous Breast Reconstruction
Authors: Borrelli Mimi R. , Spake Carole S.L. , Rao Vinay , Sinha Vikram , Crozier Joseph W. , Basta Marten N. , Lee Gordon K. , Kwan Daniel K. , Nazerali Rahim
Published: May 2023

Purpose

Autologous breast reconstruction remains a versatile option to produce a natural appearing breast after mastectomy. The deep inferior epigastric perforator remains the most commonly used flap choice, but when this donor site is unsuitable or unavailable, the transverse upper gracilis (TUG) or profunda artery perforator (PAP) flaps are popular secondary alternatives. We conduct a meta-analysis to better understand patient outcomes and adverse events in secondary flap selection in breast reconstruction.

Methods

A systematic search was conducted on MEDLINE and Embase for all articles published on TUG and/or PAP flaps for oncological breast reconstruction in postmastectomy patients. A proportional meta-analysis was conducted to statistically compare outcomes between PAP and TUG flaps.

Results

The TUG and PAP flaps were noted to have similar reported rates of success and incidences of hematoma, flap loss, and flap healing (P > 0.05). The TUG flap was noted to have significantly more vascular complications (venous thrombosis, venous congestion, and arterial thrombosis) than the PAP flap (5.0% vs 0.6%, P < 0.01) and significantly greater rates of unplanned reoperations in the acute postoperative period (4.4% vs 1.8%, P = 0.04). Infection, seroma, fat necrosis, donor healing complications, and rates of additional procedures all exhibited high degree of heterogeneity precluding mathematical synthesis of outcomes across studies.

Conclusions

Compared with TUG flaps, PAP flaps have fewer vascular complications and fewer unplanned reoperations in the acute postoperative period. There is need for greater homogeneity in reported outcomes between studies to enable for synthesis of other variables important in determining flap success.
Factors Influencing Postoperative Recovery Time of Patients With Gastric Cancer
Authors: Shao Jun , Xie Jiang , Sun Peng , Zhang Yunpeng , Chen Daqing , Chen Ying , Xu Ming
Published: May 2023

Background:

To explore the factors associated with prolonged enhanced recovery after surgery (ERAS) time in gastric cancer patients who underwent gastrectomy.

Methods:

This was a retrospective of patients with gastric cancer who received ERAS at our hospital between 01/2014 and 01/2022. The outcome was prolonged ERAS time. Factors associated with prolonged ERAS time of patients undergoing gastric cancer surgery were analyzed by logistic regression.

Results:

Among 663 patients, 182 (27.6%) patients had a prolonged ERAS time. The postoperative time to the first flatus time was 2.8 ± 1.2 days. There were 41 (6.2%) patients with intestinal obstruction, 25 (3.8%) with abdominal infection, and four (0.5%) with anastomotic leakage. The multivariable analysis showed that age >80 years (OR = 1.57, 95% CI: 1.31–4.40, P = 0.048), laparoscopic surgery (OR = 0.45, 95% CI: 0.21–0.95, P = 0.035), intraoperative jejunostomy (OR = 334.60, 95% CI: 2.81–39,831.90, P = 0.017), postoperative time to the first flatus time (OR = 3.79, 95% CI: 1.23–11.68, P = 0.021), total gastrectomy (OR = 0.08, 95% CI: 0.01–0.94, P = 0.044), and patient compliance with ERAS (OR = 0.01, 95% CI: 0–0.09, P < 0.001) were independently associated with prolonged ERAS time.

Conclusions:

Age >80 years, laparoscopic surgery, intraoperative jejunostomy, postoperative time to the first flatus time, total gastrectomy, and patient compliance with ERAS might be factors associated with prolonged ERAS time in gastric cancer patients.
Delay and Disparity in Observed vs Predicted Incidence Rate of Screenable Cancer During the COVID-19 Pandemic
Authors: Romatoski Kelsey S , Chung Sophie H , Kenzik Kelly , Rasic Gordana , Ng Sing Chau , Tseng Jennifer F , Sachs Teviah E
Published: May 2023

BACKGROUND:

The COVID-19 pandemic resulted in disruption of healthcare services, including cancer screenings, yet data on this are limited. We sought to compare observed and expected cancer incidence rates for screenable cancers, quantifying potential missed diagnoses.

STUDY DESIGN:

Lung, female breast, and colorectal cancer patients from 2010 to 2020 in the National Cancer Database were standardized to calculate annual incidence rates per 100,000. A linear regression model of 2010 through 2019 incidence rates (pre-COVID) was used to calculate predicted 2020 incidence compared with observed incidence in 2020 (COVID) with subanalyses for age, sex, race, ethnicity, and geographic region.

RESULTS:

In total, 1,707,395 lung, 2,200,505 breast, and 1,066,138 colorectal cancer patients were analyzed. After standardizing, the observed 2020 incidence was 66.888, 152.059, and 36.522 per 100,000 compared with the predicted 2020 incidence of 81.650, 178.124, and 44.837 per 100,000, resulting in an observed incidence decrease of –18.1%, –14.6%, and –18.6% for lung, breast, and colorectal cancer, respectively. The difference was amplified on subanalysis for lung (female, 65 or more years old, non-White, Hispanic, Northeastern and Western region), breast (65 or more years old, non-Black, Hispanic, Northeastern and Western region), and colorectal (male, less than 65 years old, non-White, Hispanic, and Western region) cancer patients.

CONCLUSIONS:

The reported incidence of screenable cancers significantly decreased during the COVID-19 pandemic (2020), suggesting that many patients currently harbor undiagnosed cancers. In addition to the human toll, this will further burden the healthcare system and increase future healthcare costs. It is imperative that providers empower patients to schedule cancer screenings to flatten this pending oncologic wave.
Prevalence and epidemiological characteristics of methicillin-resistant Staphylococcus aureus isolated from cattle as a part of the One Health approach
Authors: Venugopal Nimita , Tewari Rituparna , Ganaie Feroze A. , Mitra Susweta , Shome Rajeswari , Shome Bibek R.
Published: May 2023

In India, limited studies are available on the epidemiological aspects of methicillin-resistant Staphylococcus aureus (MRSA) infections in both animal and human settings. Herein, we investigated the prevalence, antimicrobial resistance profile, and molecular characteristics of MRSA isolates collected from cattle. Out of 66 mecA positive staphylococcus, species-specific multiplex PCR detected 24% (n=16) of isolates as MRSA. Maximum antibiotic resistance was seen against cloxacillin (94%, n=15) and least for enrofloxacin and cephalothin (each 13%, n=2). Overall, 13% (n=2) of MRSA isolates were multidrug-resistant. Molecular characterization by SCCmec typing identified 88% (n=14) of MRSA isolates as type V. Twelve isolates (75%) belonged to novel spa-type t17242, of which 67% (n=8) belonged to agr type I. MLST analysis revealed ST 1687 (50%, n=8) as the most predominant sequence type.  Circulation of different MRSA clones among the cattle populace offers a risk of transmission to humans through direct contact, food chain, or environmental contamination. Thus, continuous monitoring of MRSA strains is imperative for early diagnosis and for establishing effective treatment strategies to restrain the disease burden caused by MRSA infections.
Georgenia halotolerans sp. nov., a halotolerant actinobacterium isolated from Taklamakan desert soil
Authors: Liu Shao-Wei , Luo Ke-Ke , Li Fei-Na , Zhang Ben-Yin , Zhang De-Jun , Sun Cheng-Hang
Published: May 2023

A Gram-stain-positive, aerobic, non-motile, non-spore-forming and rod-shaped actinobacterium, designated strain 10Sc9-8T, was isolated from Taklamakan desert soil sampled in the Xinjiang Uygur Autonomous Region, China. Strain 10Sc9-8T grew at 8‒37 °C (optimum, 28‒30 °C), pH 6.0‒10.0 (optimum, pH 7.0–8.0) and in the presence of 0‒15 % (w/v) NaCl (optimum, 0–3 %). Phylogenetic analysis based on 16S rRNA gene sequence suggested that strain 10Sc9-8T was affiliated with members of the genus

Georgenia

and showed the highest 16S rRNA gene sequence similarity to

Georgenia yuyongxinii

Z443T (97.4 %). Phylogenomic analysis based on the whole genome sequences indicated that strain 10Sc9-8T should be assigned into the genus

Georgenia

. The average nucleotide identity and digital DNA–DNA hybridization values calculated from the whole genome sequences indicated that strain 10Sc9-8T was clearly separated from other closely related species of the genus

Georgenia

with values below the thresholds for species delineation. Chemotaxonomic analyses showed that the cell-wall peptidoglycan was in a variant of A4α type with an interpeptide bridge comprising l-Lys–l-Ala–Gly–l-Asp. The predominant menaquinone was MK-8(H4). The polar lipids comprised diphosphatidylglycerol, phosphatidylglycerol, phosphatidylinositol, phosphatidylinositol mannoside, several unidentified phospholipids, glycolipids and one unidentified lipid. The major fatty acids were anteiso-C15 : 0, anteiso-C15 : 1 A and C16 : 0. The genomic DNA G+C content was 72.7 mol%. On the basis of phenotypic, phylogenetic and phylogenomic data, strain 10Sc9-8T represents a novel species of the genus

Georgenia

, for which the name Georgenia halotolerans sp. nov. is proposed. The type strain is 10Sc9-8T (=JCM 33946T=CPCC 206219T).
Clarity and precision in legal language: Linguistic-discursive analysis of Organic Law 3/2021 on the regulation of euthanasia in Spain
Authors: Hernando-Garreta A. , Centeno C. , Olza I
Published: May 2023

Spain has recently regulated the practice of euthanasia through the Organic Law 3/2021. The social relevance of this law clear, as it directly affects fundamental rights enshrined in the Spanish Constitution. The aim of this article is to examine the clarity and precision of the discourse with which the legislator refers to the context of end-of-life care. A linguistic-discursive analysis of the Organic Law 3/2021 is carried out using a mixed methodological approach. The data are categorized and quantified in order to detect potential designative and interpretative problems. We find argumentative inconsistencies in the preamble (n=2) and abundant problematic lexical-semantic choices (n=151) such as vagueness, ambiguity, euphemisms, improper epistemic expressions, evaluative adjectives, verbs of appreciation. Although a legal text must be sufficiently abstract given its generalizable nature, the euthanasia law presents a series of phenomena that affect its interpretation and are potentially negative for its procedural concreteness and effective execution.
Robust estimation of dynamic cerebrovascular reactivity using breath-holding fMRI: application in diabetes and hypertension
Authors: Nanayakkara Nuwan D. , Meusel Liesel-Ann , Anderson Nicole D. , Chen J. Jean
Published: May 2023

Breath-holding (BH) tasks during functional magnetic resonance imaging (fMRI) acquisitions are gaining popularity for non-invasive mapping of carbon-dioxide (CO2) driven cerebrovascular reactivity (CVR), which is a valuable clinical marker of vascular function. However, compliance to BH tasks is often unclear, and the ability to record end-tidal CO2often limited, rendering the optimal analysis of BH fMRI data a challenge. In this work, we demonstrate an adaptive data-driven approach for estimating CVR from BH fMRI data that minimizes errors due to subject non-compliance and regional CVR time delay variability. Building on previous work, we propose a frequency-domain-based approach for CVR estimation without the need for end-tidal CO2(PETCO2) recordings. CVR amplitude is estimated in units of %ΔBOLD directly from the data-driven BH frequency. Serious deviations from the designed task paradigm were suppressed and thus did not bias the estimated CVR values. We demonstrate our method in detecting regional CVR amplitude and time-lag differences in a group of 56 individuals, consisting of healthy (CTL), hypertensive (HT) and diabetic-hypertensive (DM+HT) groups of similar ages and sex ratios. The CVR amplitude was lowest in HT+DM, and HT had a lower CVR amplitude than CTL regionally but the voxelwise comparison did not yield statistical significance. Notably, we demonstrate that the voxelwise CVR time delay estimated in Fourier domain is a more sensitive marker of vascular dysfunction than CVR amplitude. While HT+DM seems to confer longer CVR delays, HT seems to confer shorter delays than CTL. These are the first MRI-based observations of CVR time delay differences between diabetic-hypertensive patients and healthy controls. These results demonstrate the feasibility of extracting CVR amplitude and CVR time delay using BH challenges without PETCO2recordings, and the unique clinical value of CVR time-delay information.