bluuebunny/crossref_metadata_2025 huggingface dataset:
Unexpected Increase in Invasive Group A Streptococcal Infections in Children After Respiratory Viruses Outbreak in France: A 15-Year Time-Series Analysis
Authors: Lassoued Yannis , Assad Zein , Ouldali Naim , Caseris Marion , Mariani Patricia , Birgy Andre , Bonacorsi Stephane , Bidet Philippe , Faye Albert
Published: April 2023

In a 15-year pediatric time-series analysis, we showed a rise of invasive Group A streptococcal (iGAS) infections since October 2022, mainly involving pleural empyema, simultaneously to a respiratory virus outbreak. Physicians should be aware of this increased risk of pediatric iGAS infections, especially in settings with intense respiratory viruses' circulation.
Security Design in Non-Exclusive Markets with Asymmetric Information
Authors: Asriyan Vladimir , Vanasco Victoria
Published: April 2023

We study the problem of a seller (e.g. a bank) who is privately informed about the quality of her asset and wants to exploit gains from trade with uninformed buyers (e.g. investors) by issuing securities backed by her asset cash flows. In our setting, buyers post menus of contracts to screen the seller, but the seller cannot commit to trade with only one buyer, i.e. markets are non-exclusive. We show that non-exclusive markets behave very differently from exclusive ones: (1) separating contracts are never part of equilibrium; (2) mispricing of claims faced by the seller is always greater than in exclusive markets; (3) there is always a semi-pooling equilibrium where all sellers issue the same debt contract priced at average-valuation, and sellers of low-quality assets issue remaining cash flows at low-valuation; (4) market liquidity can be higher or lower than in exclusive markets, but (5) the average quality of originated assets is always lower. Our model’s predictions are consistent with empirical evidence on the issuance and pricing of mortgage-backed securities, and we use the theory to evaluate recent reforms aimed at enhancing transparency and exclusivity in markets.
Treatment decisions in axial spondyloarthritis daily clinical practice are more than treat-to-target
Authors: Bolt Janne W , Aalbers Caroline J , Walet Laura , van Mens Leonieke J J , van Denderen Christiaan , van der Horst-Bruinsma Irene , van Baarsen Lisa G M , Landewé Robert , van de Sande Marleen G H
Published: April 2023

Objective

‘Treat-to-target principles’ are advised for axial spondyloarthritis (axSpA), although a clear target is not yet defined and targets do not always reflect inflammation. Treat-to-target use and motives for treatment choices in clinics are unknown. Therefore, we studied the presence of residual disease activity according physician’s opinion, patient’s opinion and composite indices and compared them to the subsequent treatment decisions.

Methods

This cross-sectional multicentre study included 249 patients with a clinical diagnosis of axSpA ≥6 months. Remission and low disease activity according to the BASDAI (<1.9 and <3.5, respectively) and physician’s and patient’s opinion were assessed. Questionnaires included patient-reported outcomes and patients and physicians completed questions regarding treatment decisions.

Results

A total of 115/249 (46%) patients were in remission according to the physician and 37% (n = 43) of these patients reached remission according to the BASDAI. In 51/83 (60%) of the patients with residual disease activity according to the physician and a BASDAI >3.5 the treatment was left unchanged, either because of low disease activity as rated by the physician [n = 15 (29%)] or because of a combination of low disease activity with non-inflammatory complaints or comorbidities [n = 11 (25%)]. Retrospective treat-to-target evaluations showed that treatments were most frequently intensified in patients with arthritis or inflammatory back pain and less often in patients with other (non-inflammatory) musculoskeletal comorbidities.

Conclusion

This study shows that physicians do not always strictly apply treat-to-target in case of residual disease activity in axSpA. Usually, they accept low disease activity as satisfactory.
Chronic exposure to a mixture of phthalates shifts the white and brown adipose tissue phenotypes in female mice
Authors: Graceli Jones B , da Costa Charles S , Laws Mary J , Deviney Ashley R K , Meling Daryl , Flaws Jodi A
Published: April 2023

Phthalates are endocrine-disrupting chemicals used in consumer products. Although phthalates are obesogens and affect metabolic function, it is unknown if chronic exposure for 6 months to a phthalate mixture alters adipose tissue phenotype in female mice. After vehicle or mixture exposure, white adipose tissue and brown adipose tissue (WAT and BAT) were analyzed for expression of adipogenesis, proliferation, angiogenesis, apoptosis, oxidative stress, inflammation, and collagen deposition markers. The mixture altered WAT morphology, leading to an increase in hyperplasia, blood vessel number, and expression of BAT markers (Adipoq and Fgf2) in WAT. The mixture increased the expression of the inflammatory markers, Il1β, Ccl2, and Ccl5, in WAT. The mixture also increased expression of the proapoptotic (Bax and Bcl2) and antiapoptotic (Bcl2l10) factors in WAT. The mixture increased expression of the antioxidant Gpx1 in WAT. The mixture changed BAT morphology by increasing adipocyte diameter, whitening area, and blood vessel number and decreased expression of the thermogenic markers Ucp1, Pgargc1a, and Adrb3. Furthermore, the mixture increased the expression of adipogenic markers Plin1 and Cebpa, increased mast cell number, and increased Il1β expression in BAT. The mixture also increased expression of the antioxidant markers Gpx and Nrf2 and the apoptotic marker Casp2 in BAT. Collectively, these data indicate that chronic exposure to a phthalate mixture alters WAT and BAT lipid metabolism phenotypes in female mice, leading to an apparent shift in their normal morphology. Following long-term exposure to a phthalate mixture, WAT presented BAT-like features and BAT presented WAT-like features.
Evaluation of Biological Control Agents for the Protection of Almond Pruning Wounds Against Infection by Fungal Canker Pathogens
Authors: Travadon Renaud , Lawrence Daniel P. , Li Sampson , Trouillas Florent P.
Published: April 2023

Fungal canker pathogens of almond initiate infection in trees primarily through pruning wounds. Biological control agents (BCAs) have the potential to provide long-term protection of pruning wounds by colonizing the wound surfaces and underlying tissues. Laboratory and field tests were performed to assess the efficacy of various commercial and experimental BCAs as wound protectants against almond canker pathogens. Four Trichoderma-based BCAs were evaluated using detached almond stems in the laboratory against the canker pathogens Cytospora plurivora, Eutypa lata, Neofusicoccum parvum, and Neoscytalidium dimidiatum. Results indicated that Trichoderma atroviride SC1 and T. paratroviride RTFT014 significantly reduced infections by all four pathogens. The abilities of these four BCAs to protect almond pruning wounds against E. lata and N.  parvum were further evaluated in field trials using two almond cultivars and during two consecutive years. Both T. atroviride SC1 and T. paratroviride RTFT014 protected almond pruning wounds against E. lata and N. parvum as efficiently as thiophanate-methyl, the recommended fungicide for treatment of almond pruning wounds. Comparisons of different application timings of BCA in relation to pathogen inoculation revealed a significant improvement in wound protection when inoculations were conducted 7 days versus 24 h post-BCA application for N. parvum, but not for E. lata. T. atroviride SC1 and T. paratroviride RTFT014 are promising candidates for the preventive protection of almond pruning wounds and for inclusion in integrated pest management programs and organic almond production systems.
Systemic Progestins and Progestin-Releasing Intrauterine Device Therapy for Premenopausal Patients With Endometrial Intraepithelial Neoplasia
Authors: Suzuki Yukio , Chen Ling , Hou June Y. , St. Clair Caryn M. , Khoury-Collado Fady , de Meritens Alexandre Buckley , Matsuo Koji , Melamed Alexander , Hershman Dawn L. , Wright Jason D.
Published: April 2023

OBJECTIVE:

To estimate trends in use and outcomes of progestin therapy for premenopausal patients with endometrial intraepithelial neoplasia.

METHODS:

The MarketScan Database was used to identify patients aged 18–50 years with endometrial intraepithelial neoplasia from 2008 to 2020. Primary treatment was classified as hysterectomy or progestin-based therapy. Within the progestin group, treatment was classified as systemic therapy or progestin-releasing intrauterine device (IUD). The trends in use of progestins and the pattern of progestin use were examined. A multivariable logistic regression model was fit to examine the association between baseline characteristics and the use of progestins. The cumulative incidence of hysterectomy, uterine cancer, and pregnancy since initiation of progestin therapy was analyzed.

RESULTS:

A total of 3,947 patients were identified. Hysterectomy was performed in 2,149 (54.4%); progestins were used in 1,798 (45.6%). Use of progestins increased from 44.2% in 2008 to 63.4% in 2020 (P=.002). Among the progestin users, 1,530 (85.1%) were treated with systemic progestin, and 268 (14.9%) were treated with progestin-releasing IUD. Among progestin users, use of IUD increased from 7.7% in 2008 to 35.6% in 2020 (P<.001). Hysterectomy was ultimately performed in 36.0% (95% CI 32.8–39.3%) of those who received systemic progestins compared with 22.9% (95% CI 16.5–30.0%) of those treated with progestin-releasing IUD (P<.001). Subsequent uterine cancer was documented in 10.5% (95% CI 7.6–13.8%) of those who received systemic progestins compared with 8.2% (95% CI 3.1–16.6%) of those treated with progestin-releasing IUD (P=.24). Venous thromboembolic complications occurred in 27 (1.5%) of those treated with progestins; the venous thromboembolism (VTE) rate was similar for oral progestins and progestin-releasing IUD.

CONCLUSION:

The rate of conservative treatment with progestins in premenopausal individuals with endometrial intraepithelial neoplasia has increased over time, and among progestin users, progestin-releasing IUD use is increasing. Progestin-releasing IUD use may be associated with a lower rate of hysterectomy and a similar rate of VTE compared with oral progestin therapy.
Diagnosis of Pregnancy Complications Using Blind Ultrasound Sweeps Performed by Individuals Without Prior Formal Ultrasound Training
Authors: Toscano Marika , Marini Thomas , Lennon Clare , Erlick Mariah , Silva Hannah , Crofton Kathryn , Serratelli William , Rana Neel , Dozier Ann M. , Castaneda Benjamin , Baran Timothy M. , Drennan Kathryn
Published: April 2023

OBJECTIVE:

To estimate the diagnostic accuracy of blind ultrasound sweeps performed with a low-cost, portable ultrasound system by individuals with no prior formal ultrasound training to diagnose common pregnancy complications.

METHODS:

This is a single-center, prospective cohort study conducted from October 2020 to January 2022 among people with second- and third-trimester pregnancies. Nonspecialists with no prior formal ultrasound training underwent a brief training on a simple eight-step approach to performing a limited obstetric ultrasound examination that uses blind sweeps of a portable ultrasound probe based on external body landmarks. The sweeps were interpreted by five blinded maternal–fetal medicine subspecialists. Sensitivity, specificity, and positive and negative predictive values for blinded ultrasound sweep identification of pregnancy complications (fetal malpresentation, multiple gestations, placenta previa, and abnormal amniotic fluid volume) were compared with a reference standard ultrasonogram as the primary analysis. Kappa for agreement was also assessed.

RESULTS:

Trainees performed 194 blinded ultrasound examinations on 168 unique pregnant people (248 fetuses) at a mean of 28±5.85 weeks of gestation for a total of 1,552 blinded sweep cine clips. There were 49 ultrasonograms with normal results (control group) and 145 ultrasonograms with abnormal results with known pregnancy complications. In this cohort, the sensitivity for detecting a prespecified pregnancy complication was 91.7% (95% CI 87.2–96.2%) overall, with the highest detection rate for multiple gestations (100%, 95% CI 100–100%) and noncephalic presentation (91.8%, 95% CI 86.4–97.3%). There was high negative predictive value for placenta previa (96.1%, 95% CI 93.5–98.8%) and abnormal amniotic fluid volume (89.5%, 95% CI 85.3–93.6%). There was also substantial to perfect mean agreement for these same outcomes (range 87–99.6% agreement, Cohen κ range 0.59–0.91, P<.001 for all).

CONCLUSION:

Blind ultrasound sweeps of the gravid abdomen guided by an eight-step protocol using only external anatomic landmarks and performed by previously untrained operators with a low-cost, portable, battery-powered device had excellent sensitivity and specificity for high-risk pregnancy complications such as malpresentation, placenta previa, multiple gestations, and abnormal amniotic fluid volume, similar to results of a diagnostic ultrasound examination using a trained ultrasonographer and standard-of-care ultrasound machine. This approach has the potential to improve access to obstetric ultrasonography globally.
Changing Practices in the Surgical Management of Adnexal Torsion
Authors: Ryles Hannah T. , Hong Christopher X. , Andy Uduak U. , Farrow Monique R.
Published: April 2023

OBJECTIVE:

To evaluate trends in the surgical management of adnexal torsion and to evaluate these trends with respect to the updated American College of Obstetricians and Gynecologists (ACOG) guidelines.

METHODS:

We performed a retrospective cohort study using the National Surgical Quality Improvement Program database. Women who underwent surgery for adnexal torsion between 2008 and 2020 were identified on the basis of International Classification of Diseases codes. Surgeries were grouped as either ovarian conservation or oophorectomy with the use of Current Procedural Terminology codes. Patients were also grouped into year cohorts with respect to the publication of the updated ACOG guidelines (2008–2016 compared with 2017–2020). Multivariable logistic regression, weighted by cases per year, was used to assess differences between groups.

RESULTS:

Of the 1,791 surgeries performed for adnexal torsion, 542 (30.3%) involved ovarian conservation and 1,249 (69.7%) involved oophorectomy. Older age, higher body mass index, higher American Society of Anesthesiologists classification, anemia, and diagnosis of hypertension were significantly associated with oophorectomy. There was no significant difference in the proportion of oophorectomies performed before 2017 compared with after 2017 (71.9% vs 69.1%, odds ratio [OR] 0.89, 95% CI 0.69–1.16; adjusted OR 0.94, 95% CI 0.71–1.25). A significant decrease in proportion of oophorectomies performed each year was identified over the entire study period (−1.6%/y, P=.02, 95% CI −3.0% to −0.22%); however, the rates did not differ before and after 2017 (interaction P=.16).

CONCLUSION:

There was a modest decrease in the proportion of oophorectomies for adnexal torsion performed per year over the study period. However, oophorectomy is still commonly performed for adnexal torsion, despite updated guidelines from ACOG recommending ovarian conservation.
Hyperthermic Intraperitoneal Chemotherapy and Interval Debulking Surgery in Conjunction With Elective Cesarean Delivery
Authors: Tremblay Elizabeth , Pina Annick , Avon-Després Catherine , Mercier Frédéric , Cormier Béatrice
Published: April 2023

BACKGROUND:

Ovarian cancer is rare during pregnancy. For patients beyond 20 weeks of gestation who choose to continue the pregnancy, neoadjuvant chemotherapy may be initiated, followed by interval debulking surgery. Hyperthermic intraperitoneal chemotherapy (HIPEC) may be used with interval debulking surgery for stage III epithelial ovarian cancer, but data are lacking on its administration in the peripartum period.

CASE:

We illustrate the case of a 40-year-old patient diagnosed with stage III epithelial ovarian cancer at 27 weeks of gestation who underwent neoadjuvant chemotherapy followed by cesarean delivery at term along with interval debulking surgery and HIPEC. The intervention was well tolerated and resulted in the birth of a healthy neonate. The postoperative period was unremarkable, and the patient is disease-free after 22-months of follow-up.

CONCLUSION:

We demonstrate the feasibility of peripartum HIPEC. Optimal oncologic care should not be jeopardized by the peripartum state of an otherwise healthy patient.
Levonorgestrel 52-mg Intrauterine Device Efficacy and Safety After More Than 8 Years of Use
Authors: Chen Beatrice A. , Kimble Thomas , Harris Lisa H. , Kerns Jennifer L. , Olariu Andrea I. , Creinin Mitchell D.
Published: April 2023

The levonorgestrel 52-mg intrauterine device (IUD) is approved for contraception for 8 years. We evaluated outcomes for 339 phase 3 study participants aged 16–35 years at enrollment who used the IUD for more than 8 years. At study closure, 83 and 77 participants reached 9 and 10 years, respectively. No pregnancies occurred during years 9 and 10. Expulsion occurred in one (0.3%) participant, a partial expulsion during year 10. No perforations, pelvic infections, or IUD-related serious adverse events were noted. Absence of bleeding or spotting was reported by 33 (39.8%) and 28 (36.4%) participants at years 9 and 10, respectively. The levonorgestrel 52-mg IUD demonstrates continued efficacy and safety in a small population of users during years 9 and 10 of use.

FUNDING SOURCE:

Medicines360. The Sponsor, Medicines360, designed the study and oversaw its conduct, including funding the trial and providing all study product free of charge to participants.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT00995150.
Laparoscopic Diagnosis and Treatment of an Isolated Cervical Diverticulum
Authors: Nezhat Farr , Demirel Esra , Mesbah Michael , Hill Kaitlyn
Published: April 2023

BACKGROUND:

Congenital müllerian anomalies are found in 8.0% of women with infertility and up to 5.5% of women in a general population. Cervical diverticulum is a type of cervical malformation that can be congenital or acquired, with only select cases documented in the literature. Cervical diverticulum can be asymptomatic or present with abnormal uterine bleeding, pelvic pain, or infertility. Previously described management options are largely limited to observation or exploratory laparotomy.

CASE:

A 35-year-old woman, gravida 2 para 2, presented with persistent menorrhagia, pelvic pain, and abdominal bloating and was found to have an 8-cm right adnexal mass on pelvic ultrasonography. Magnetic resonance imaging showed a hemorrhagic cervical mass communicating with the uterine cavity. The mass was resected laparoscopically, and pathology revealed fibromuscular tissue with endocervical epithelium consistent with a cervical diverticulum.

CONCLUSION:

Isolated cervical diverticula are rare but should be considered in the differential diagnosis of adnexal masses. Laparoscopic surgery is a safe, minimally invasive approach for evaluation and repair of cervical diverticula.
Role of HNF4alpha-cMyc interaction in liver regeneration and recovery after acetaminophen-induced acute liver injury
Authors: Kotulkar Manasi , Paine-Cabrera Diego , Abernathy Sarah , Robarts Dakota R. , Parkes Wendena S. , Lin-Rahardja Kristi , Numata September , Lebofsky Margitta , Jaeschke Hartmut , Apte Udayan
Published: April 2023

Background and Aims:

Overdose of acetaminophen (APAP) is the major cause of acute liver failure in the western world. We report a novel signaling interaction between hepatocyte nuclear factor 4 alpha (HNF4α) cMyc and nuclear factor erythroid 2–related factor 2 (Nrf2) during liver injury and regeneration after APAP overdose.

Approach and Results:

APAP-induced liver injury and regeneration were studied in male C57BL/6J (WT) mice, hepatocyte-specific HNF4α knockout mice (HNF4α-KO), and HNF4α-cMyc double knockout mice (DKO). C57BL/6J mice treated with 300 mg/kg maintained nuclear HNF4α expression and exhibited liver regeneration, resulting in recovery. However, treatment with 600-mg/kg APAP, where liver regeneration was inhibited and recovery was delayed, showed a rapid decline in HNF4α expression. HNF4α-KO mice developed significantly higher liver injury due to delayed glutathione recovery after APAP overdose. HNF4α-KO mice also exhibited significant induction of cMyc, and the deletion of cMyc in HNF4α-KO mice (DKO mice) reduced the APAP-induced liver injury. The DKO mice had significantly faster glutathione replenishment due to rapid induction in Gclc and Gclm genes. Coimmunoprecipitation and ChIP analyses revealed that HNF4α interacts with Nrf2 and affects its DNA binding. Furthermore, DKO mice showed significantly faster initiation of cell proliferation resulting in rapid liver regeneration and recovery.

Conclusions:

These data show that HNF4α interacts with Nrf2 and promotes glutathione replenishment aiding in recovery from APAP-induced liver injury, a process inhibited by cMyc. These studies indicate that maintaining the HNF4α function is critical for regeneration and recovery after APAP overdose.
Compounded 0.01% Atropine—What's in the Bottle?
Authors: Richdale Kathryn , Skidmore Kelsea V. , Tomiyama Erin S. , Bullimore Mark A.
Published: April 2023

Objective:

To describe the labeling, packaging practices, and characteristics of compounded 0.01% ophthalmic atropine.

Methods:

A convenience sample of parents of children who had previously been prescribed low-concentration atropine for myopia management were randomized to obtain 0.01% atropine ophthalmic solution from one of nine compounding pharmacies. The products were analyzed for various important quality attributes. The main outcomes were labeling practices, concentration of atropine and degradant product tropic acid, pH, osmolarity, viscosity, and excipients in 0.01% atropine samples obtained from nine US compounding pharmacies.

Results:

Twenty-four samples from nine pharmacies were analyzed. The median bottle size was 10 mL (range 3.5–15 mL), and eight of nine pharmacies used clear plastic bottles. Storage recommendations varied and were evenly split between refrigeration (33%), room temperature (33%), and cool, dark, dry location (33%). Beyond use dates ranged from 7 to 175 days (median, 91 days). Median pH of samples was 7.1 (range, 5.5–7.8). Median measured concentration relative to the prescribed concentration was 93.3% (70.4%–104.1%). One quarter of samples were under the 90% minimum target concentration of 0.01%.

Conclusions:

An inconsistent and wide variety of formulation and labeling practices exist for compounding 0.01% atropine prescribed to slow pediatric myopia progression.
Two cases of intraventricular hemorrhage treated by prone position drainage combined with intraventricular infusion of urokinase
Authors: Li Jiarou , Wang Hongliang
Published: April 2023

Intracerebral hemorrhage (ICH) is a common neurosurgical emergency in high mortality. In recent years, stereotactic aspiration and subsequent fibrinolysis has been considered less invasive and more effective compared with the conventional surgical removal of ICH. On this basis, we improved the treatment method and combined it with the mature prone position therapy in ICU. We present two unique cases of intraventricular hemorrhage treated by prone position, radiographic evidence proves its availability and feasibility. Prone positin can liquefy hematoma better, make its density more uniform thus easy to drain. In similar cases of intraventricular hemorrhage, we hypothesize that prone position may offer a greater result of drainage, and should be strongly recommended for treatment.
Comparative Evaluation of the ABC Score to Other Risk Stratification Scales in Managing High-risk Patients Presenting With Acute Upper Gastrointestinal Bleeding
Authors: Kherad Omar , Restellini Sophie , Almadi Majid , Martel Myriam , Barkun Alan N.
Published: April 2023

Objective:

The ABC risk score identifies patients at high risk of mortality in acute lower and upper gastrointestinal bleeding (UGIB). We aimed to externally validate the ABC score while comparing it to other prognostication scales when assessing UGIB patients at high risk of negative outcomes before endoscopy.

Methods:

UGIB patients from a national Canadian registry (REASON) were studied, with mortality prediction as a primary outcome. Secondary endpoints included prognostication of rebleeding, intensive care unit (ICU) admission, ICU and hospitalization lengths of stay (LOS), and a previously proposed composite outcome measure. Univariable and areas under the receiver operating characteristic curve analyses compared discriminatory abilities of the ABC score to the AIMS65, Glasgow Blatchford Scale (GBS), and clinical Rockall score.

Results:

The REASON registry included 2020 patients [89.4% nonvariceal; mean age (±SD): 66.3±16.4 y; 38.4% female]. Overall mortality, rebleeding, ICU admission, transfusion and composite score rates were 9.9%, 11.4%, 21.1%, 69.0%, and 67.3%, respectively. ICU and hospitalization LOS were 5.4±9.3 and 9.1±11.5 days, respectively. The ABC score displayed superior 30-day mortality prediction [0.78 (0.73; 0.83)] compared with GBS [0.69 (0.63; 0.75)] or clinical Rockall [0.64 (0.58; 0.70)] but not AIMS65 [0.73 (0.67; 0.79)]. Although most scales significantly prognosticated secondary outcomes in the univariable analysis except for ICU LOS, discriminatory abilities on areas under the receiver operating characteristic curve analyses were poor.

Conclusions:

ABC and AIMS65 display similar good prediction of mortality. Clinical usefulness in prognosticating secondary outcomes was modest for all scales, limiting their adoptions when informing early management of high-risk UGIB patients.
Acute limb ischemia due to diclofenac sodium iatrogenic intra-arterial injection: a case report
Authors: Banana Youssef , Bashir Husam , Boukabous Sara , Rezziki Abdellah , Benzirar Adnane , El Mahi Omar
Published: April 2023

Introduction:

Diclofenac sodium is a nonsteroidal anti-inflammatory, the injection of which by the intra-arterial route can lead to serious vascular complications, including limb ischemia.

Case presentation:

We report the case of accidental intra-arterial injection of diclofenac sodium in the brachial artery leading to acute limb ischemia.

Clinical discussion:

Iatrogenic intra-arterial injection is rarely reported in the literature; however, it is toxic and can lead to limb amputation. Only two cases of intra-arterial injection of diclofenac have been reported in the literature. The proposed pathophysiological mechanism is vasospasm, intravascular thrombosis, and chemical endoarteritis. The most common anatomical location in accidental intra-arterial injection is the antecubital fossa, where branches of the ulnar and brachial arteries are more superficial.

Conclusion:

The injection of medication must be as careful as possible, since the intra-arterial injection can affect the functional prognosis of the organ.
Incidental finding of Poland syndrome in a case of phimosis: a rare case report from Nepal
Authors: Niraula Zenish , Ghimire Pradip , Pokhrel Sanish , Ale Magar Sugam , Bajracharya Jasmine , Thapa Bineet
Published: April 2023

Introduction:

Poland syndrome is a rare congenital syndrome that mostly includes the absence of unilateral pectoralis major muscle and digit anomalies like symbrachydactyly. It can also present with other varied manifestations like the absence of ribs, bilateral absence of pectoralis major muscle, urogenital anomalies, dextrocardia, etc.

Case Presentation:

We herein present a case of a 6-year-old boy with Poland syndrome as an incidental finding, the second one reported from Nepal, 11 years after the first report. The syndrome was diagnosed after the patient came to the hospital for treatment of phimosis. On examination, the sternocostal head of the right pectoralis major muscle was absent with a palpable clavicular head with symbrachydactyly of the ipsilateral side.

Discussion:

Poland syndrome is mostly diagnosed clinically. Its differential diagnosis includes other chest wall anomalies, nipple anomalies, isolated thoracic lipoatrophy, and isolated hand/upper limb anomalies without pectoralis major muscle involvement. Computed tomography and MRI scans can help delineate the exact chest wall abnormality. It also helps to find other manifestations of the syndrome and for the treatment plans.

Conclusion:

Poland syndrome is a rare syndrome that has the propensity to be missed in clinical settings. Treatment, mainly sought for cosmetic reasons, includes breast augmentation procedures or myocutaneous flap coverage.
Pancreatic cancer presenting with acute pancreatitis complicated by Wernicke’s encephalopathy and a colonic fistula: a case report
Authors: Ibnawadh Abdulrahman K. , Alashgar Hamad I. , Peedikayil Musthafa , Amin Tarek
Published: April 2023

Introduction and Importance:

This account details the case of a 39-year-old male patient who presented with acute necrotizing hemorrhagic pancreatitis. The comorbid conditions of Wernicke’s encephalopathy, and a pancreatic–colonic fistula developed during his care. This case is unique in that it illustrates the effects of these complications individually and through their interaction. Given that there are no firm guidelines regarding the nature and timing of interventions for a pancreatic–colonic fistula diagnosis, this case may provide helpful information.

Case Presentation:

As previously noted, this is the case of a 39-year-old male patient with a BMI of 46 kg/m2 who presented with acute necrotizing hemorrhagic pancreatitis. Complications developed as noted above. Multiple diagnostic imaging methods were utilized but failed to detect the presence of metastatic pancreatic adenocarcinoma. After a course of antimicrobial and nutritional therapy, we attempted surgical intervention for the pancreatic–colonic fistula and pancreatic abscess debridement. Unfortunately, during that procedure, we observed extensive carcinomatosis, at which point we did a gastrojejunostomy. Subsequently, the patient’s condition did not permit chemoradiotherapy. After completion, we transferred the patient to palliative care, where he died.

Clinical Discussion:

This case was complex due to the previously recounted results of the underlying condition, pancreatic adenocarcinoma, and the complications of Wernicke’s encephalopathy and pancreatic–colonic fistula. The presence of risk factors in patients increases the need to perform appropriate diagnostic tests. Even with tests and multiple imaging modalities, these particular events remain challenging to diagnose, given the nature of the development and presentation of the disease condition. It was only after the surgical intervention that the carcinoma became evident. Early screening and imaging could improve detection rates and prevent disease progression.

Conclusion:

In this case report of acute hemorrhagic necrotizing pancreatitis and its complications, we discuss the factors making this disease process particularly difficult to diagnose, detect, and manage. Even though the complications detailed herein are rare, in this case, the significance is the need to evaluate all patients with acute pancreatitis and acute confusion for Wernicke’s encephalopathy, which is preventable. In addition, suggestive findings on computed tomography signal the need for further investigation of the colonic fistula. Finally, at this time, there are no clear guidelines for the surgical management of these complications. We hope that this case report will contribute to their development.
Direct posterior approach to posterior cruciate ligament bony avulsion fractures: a case series introducing a new surgical technique
Authors: Talebian Parham , Aref Daneshi S. , Soleimani Mohammad
Published: April 2023

Background:

Posterior cruciate ligament bony avulsion is one of the well-known knee injuries, which includes about 3–20% of knee ligament injuries. Failure to properly treat this injury causes instability in the knee. Although various surgical approaches have been introduced for this injury, there is controversy regarding selecting the suitable method under certain conditions.

Method:

In this study, as well as introducing our new surgical technique, we reported the treatment results of our patients who underwent surgery between April 2021 and June 2022. In this approach, in a short time with about 5 cm incisions, we can directly access the fracture site and directly fix the fracture with minimal tissue damage.

Result:

Results of this study showed that the operating time was about 24.2 min on average. And in the 6-month follow-up results of our patients, no complications were reported, while the results stipulate a complete recovery of knee pain, range of motion, and stability in examinations.

Conclusion:

Apparently, the direct posterior approach to posterior cruciate ligament bony avulsion fractures is a safe method with minimal complications and suitable treatment results for patients.
Spencerozyma pingqiaoensis sp. nov., a yeast species isolated from the external surface of rice leaves in China
Authors: Chai Chunyue , Zhu Lulu , Liu Jinli , Han Xuemei , Nutaratat Pumin , Khuuamwong Pannida , Hui Fengli
Published: April 2023

Four strains (NYNU 178247, NYNU 178251, DMKU-PAL160 and DMKU-PAL137) representing a novel yeast species were isolated from the external surfaces of rice and pineapple leaves collected in China and Thailand. Phylogenetic analysis based on the concatenated sequences of the internal transcribed spacer (ITS) regions and the D1/D2 domains of the large subunit rRNA gene revealed that the novel species belonged to the genus Spencerozyma. The D1/D2 sequence of the novel species differed from its closest relative, Spencerozyma acididurans SYSU-17T, by 3.2 % sequence divergence. The species also differed from Spencerozyma crocea CBS 2029T and Spencerozyma siamensis DMKU13-2T, by 3.0–6.9 % sequence divergence in the D1/D2 sequences out of 592 bp. In the ITS regions, the novel species displayed 19.8–29.2% sequence divergence from S. acididurans SYSU-17T, S. crocea CBS 2029T and S. siamensis DMKU13-2T out of 655 bp. Furthermore, the novel species could also be differentiated from the closely related species by some physiological characteristics. The species name of Spencerozyma pingqiaoensis sp. nov. (Holotype CBS 15238, Mycobank MB 844734) is proposed to accommodate these four strains.
Prediction of fast subcellular Ca2+ signals based on subcellular structures in label-free second harmonic generation microscopy measurements
Authors: Georgiev Tihomir
Published: April 2023

Ca2+ sparks were predicted based on the label-free second harmonic generation (SHG) signal of myosin filaments with pix2pix, a conditional adversarial network. Predicted Ca2+ sparks and ground truth Ca2+ sparks show similar properties. Predicted Ca2+ spark frequencies and a predominant location at the periphery of skeletal muscle fibers were in good agreement with ground truth data. High frequencies of predicted Ca2+ sparks could be observed at y-shaped structures of myosin filaments. Important image pre-processing was applied in order to enhance the signal of Ca2+ sparks used for training. Only freely available software was applied. I provide the image pre-processing algorithm and several algorithms to evaluate the quality of predicted Ca2+ sparks. This technique can be extended to other label-free microscopy techniques and other fluorescent indicators developed during the last years. It remains a difficult task to predict the exact location of Ca2+ sparks.
Restoration of the Lost Human Beta Defensin (hBD-1) in Cancer as a Strategy to Improve the Efficacy of Chemotherapy
Authors: Pandurangi Raghu S. , Sekar Thillai V. , Paulmurugan Ramasamy
Published: April 2023

Both innate and adaptive immunity are the important components of the human defense system against various diseases including cancer. Human Beta Defensin (hBD-1) is one such immunomodulatory peptide which is lost at high frequencies in malignant cancers, while high levels of expression are maintained in benign regions making it a potential biomarker for the onset and metastasis of the disease. Loss of putative function of hBD-1 as a tumor suppressor gene combined with the defects in apoptosis pathways (CD95, ASK1) make tumor cells insensitive to chemotherapy and render it ineffective.

Triple negative breast cancer (TNBC) is an aggressive form of breast cancer for which no targeted therapy works due to lack of biomarkers (ER, PR and HER2 negative). That makes chemotherapy as a first line of treatment despite high side effects. TNBC is known for avoiding immunosurveillance and desensitizing themselves to intervention by dysregulating cell death pathways (CD95 & ASK1) and developing resistance to chemotherapy A priori Activation of Apoptosis Pathways of Tumor often referred to as AAAPT is a novel targeted tumor sensitizing technology which sensitizes low responsive and resistant tumor cells to evoke a better response from the current treatments for TNBC. Here, we show that hBD-1 is shown to target tumor specific biomarker Trx, activates dual cell death pathways CD95 and ASK1 (apoptosis stimulating kinase) to sensitize TNBC cells to chemotherapy drug Doxorubicin. As far as we know, this is the first-time injection of hBD-1 in TNBC mouse model to prove the restoration of hBD-1 back to the basal level can sensitize cancer cells which resulted in significant reduction of tumor volume in TNBC mouse model‘ in vivo. Sensitizing the low or non-responsive tumor cells by AAAPT and making chemotherapy work at lower doses may lead to the significant reduction of dose related side effects and may expand the therapeutic index of the current treatments.
Differential effects of prolonged aerobic and resistance exercise on cognitive functioning in sedentary young adults
Authors: Riganello Francesco , Pearce Alexandra , Lyons Kathleen M. , Owen Adrian M. , Soddu Andrea , Stojanoski Bobby
Published: April 2023

Objectives

Inconsistencies in the literature make it difficult to outline the relationship between exercise and cognition in young adults. Our aim is to better understand the relationship between prolonged aerobic and resistance exercise and cognitive abilities in sedentary young adults, and how this relationship is mediated by changes in cardiovascular fitness.

Methods

Twenty-three volunteers were recruited and assigned to two groups to complete one hour of continuous daily workout sessions of aerobic (SPIN) and anaerobic (SCSW) exercises over a 30 day period. Each subject was provided with a Polar-10 wearable to record the heart rate (HR) activity during the workout sessions. The workout sessions were completed during five consecutive days over four consecutive weeks. Each week, HR data were collected from the last workout session. Volunteers also completed a neurocognitive test battery (Cambridge Brain Sciences, CBS) each exercise session, including an additional baseline measure before exercise regime began.

Results

We found that memory, reasoning and verbal abilities improved throughout the aerobic, but not the resistance exercise program. We found a positive correlation between heart rate index (HRI) and memory and reasoning test scores. We also found a negative correlation between reasoning ability and HRM (heart rate mean), and heart rate skewness (SKW). The results of a regression model to predict memory and reasoning abiltiies revealed that memory was best predicted by HRI and HRM, while the reasoning ability was best predicted by only HRI.

Conclusion

Regular aerobic exercises improved specific cognitive performance and it was possible to predict the performance by employing the HR parameters HRI and HRM.
NanoMOFs with Encapsulated Photosensitizer: Accumulation inChlamydia trachomatisInclusions and Antimicrobial Effects
Authors: Qi Xiaoli , Grafskaia Ekaterina , Yu Zhihao , Shen Ningfei , Fedina Elena , Masyutin Alexander , Erokhina Maria , Lepoitevin Mathilde , Lazarev Vassili , Zigangirova Nailya , Serre Christian , Durymanov Mikhail
Published: April 2023

Metal-organic framework nanoparticles (nanoMOFs) are a promising class of hybrid nanomaterials for biomedical applications. Some of them, including biodegradable porous iron carboxylates are proposed for encapsulation and delivery of antibiotics. Due to the high drug loading capacity and fast internalization kinetics nanoMOFs are more beneficial for the treatment of intracellular bacterial infections compared to free antibacterial drugs, which poorly accumulate inside the cells because of the inability to cross membrane barriers or have low intracellular retention. However, nanoparticle internalization does not ensure their accumulation in the cell compartment that shelters a pathogen. This study shows the availability of MIL-100(Fe) MOF nanoparticles to co-localize withChlamydia trachomatis, an obligate intracellular bacterium, in the infected RAW264.7 macrophages. Furthermore, nanoMOFs loaded with photosensitizer methylene blue (MB) exhibit complete photodynamic inactivation ofChlamydia trachomatisgrowth. Simultaneous infection and treatment of RAW264.7 cells with empty nanoMOFs resulted in a 3-fold decrease in bacterial load that indicates an intrinsic anti-chlamydial effect of this iron-containing nanomaterial. Thus, our findings suggest the use of iron-based nanoMOFs as a promising drug delivery platform, which contributes to antibacterial effect, for the treatment of chlamydial infections.
Increased atherosclerotic plaque and anti-oxidized low density lipoprotein in anti-Ro60 SLE autoantibody subset
Authors: Kurien Biji T. , Fesmire James , Nath Swapan K. , Scofield R. Hal
Published: April 2023

Objective

Premature atherosclerosis is associated with systemic lupus erythematosus (SLE). We previously showed an association of anti-Ro60/La/Ro52 to anti-oxidized LDL in SLE. Here, we hypothesized that atherosclerotic plaque will be associated with anti-oxidized LDL (anti-oxLDL)/anti-lipoprotein lipase (ALPL) in a specific SLE autoantibody sub-set (anti-Ro60 positive, anti-RNP positive or extractable nuclear antigen antibody negative).

Methods

We carried out a case-control study (one time-point testing) of plaque, ALPL, anti-oxLDL, anti-low density lipoprotein (ALDL) or anti-LDL in 114 SLE and 117 age/sex matched controls. Total cholesterol, LDL, HDL, triglycerides, and HDL-Trig were also measured. Students t test was used for statistical analysis

Results

Interestingly, plaque was highest in SLE subset with anti-Ro60 (23/114). Plaque and anti-oxLDL were statistically significantly elevated in the anti-Ro60 SLE subset (1.3 +/-1.66, p<0.01; 0.26 +/-0.16, p<0.002 respectively) compared to controls (0.54 +/-1.26; 0.165 +/-0.13 respectively), but not anti-LPL/anti-LDL. Plaque was significantly elevated (0.9 +/-1.71; p< 0.05) in the SLE subset without anti-ENA (63/114) compared to controls. Other antibodies in this subset were not statistically different compared to other SLE subsets or controls. Only anti-oxLDL was significantly elevated (0.29 +/-0.27; p<0.005) in SLE subset with anti-RNP (14/114) compared to controls, while none were elevated in anti-SmRNP subset (6/114). We did not find significant differences in lipids between various SLE subsets.

Conclusion

Plaque segregates in anti-Ro and ENA negative groups either with or without anti-oxLDL. It will be clinically important if cardiovascular events are augmented in SLE anti-Ro subset having elevated anti-oxidized LDL antibodies.

Key points

Plaque and anti-oxLDL significantly elevated in anti-Ro60 SLE subset

Only plaque significantly elevated in SLE subset without antibodies against extractable nuclear antigens

It will be clinically important to see if augmented cardiovascular events occur in SLE anti-Ro subset having elevated anti-oxidized LDL antibodies.
Self-supervised denoising for structured illumination microscopy enables long-term super-resolution live-cell imaging
Authors: Chen Xingye , Qiao Chang , Jiang Tao , Liu Jiahao , Meng Quan , Zeng Yunmin , Chen Haoyu , Qiao Hui , Li Dong , Wu Jiamin
Published: April 2023

Detection noise significantly degrades the quality of structured illumination microscopy (SIM) images, especially under low-light conditions. Although supervised learning based denoising methods have shown prominent advances in eliminating the noise-induced artifacts, the requirement of a large amount of high-quality training data severely limits their applications. Here we developed a pixel-realignment-based self-supervised denoising framework for SIM (PRS-SIM) that trains an SIM image denoiser with only noisy data and substantially removes the reconstruction artifacts. We demonstrated that PRS-SIM generates artifact-free images with 10-fold less fluorescence than ordinary imaging conditions while achieving comparable super-resolution capability to the ground truth (GT). Moreover, the proposed method is compatible with multiple SIM modalities such as total internal reflective fluorescence SIM (TIRF-SIM), three-dimensional SIM (3D-SIM), lattice light-sheet SIM (LLS-SIM), and non-linear SIM (NL-SIM). With PRS-SIM, we achieved long-term super-resolution live-cell imaging of various bioprocesses, revealing the clustered distribution of clathrin coated pits and detailed interaction dynamics of multiple organelles and the cytoskeleton.
Stimulus expectations do not modulate visual event-related potentials in probabilistic cueing designs
Authors: Ouden Carla den , Zhou Andong , Mepani Vinay , Kovács Gyula , Vogels Rufin , Feuerriegel Daniel
Published: April 2023

Humans and other animals can learn and exploit repeating patterns that occur within their environments. These learned patterns can be used to form expectations about future sensory events. Several influential predictive coding models have been proposed to explain how learned expectations influence the activity of stimulus-selective neurons in the visual system. These models specify reductions in neural response measures when expectations are fulfilled (termed expectation suppression) and increases following surprising sensory events. However, there is currently scant evidence for expectation suppression in the visual system when confounding factors are taken into account. Effects of surprise have been observed in blood oxygen level dependent (BOLD) signals, but not when using electrophysiological measures. To provide a strong test for expectation suppression and surprise effects we performed a predictive cueing experiment while recording electroencephalographic (EEG) data. Participants (n=48) learned cue-face associations during a training session and were then exposed to these cue-face pairs in a subsequent experiment. Using univariate analyses of face-evoked event-related potentials (ERPs) we did not observe any differences across expected (90% probability), neutral (50%) and surprising (10%) face conditions. Across these comparisons, Bayes factors consistently favoured the null hypothesis throughout the time-course of the stimulus-evoked response. When using multivariate pattern analysis we did not observe above-chance classification of expected and surprising face-evoked ERPs. By contrast, we found robust within– and across-trial stimulus repetition effects. Our findings do not support predictive coding-based accounts that specify reduced prediction error signalling when perceptual expectations are fulfilled. They instead highlight the utility of other types of predictive processing models that describe expectation-related phenomena in the visual system without recourse to prediction error signalling.

Highlights

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We performed a probabilistic cueing experiment while recording EEG.

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We tested for effects of fulfilled expectations, surprise, and image repetition.

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No expectation-related effects were observed.

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Robust within– and across-trial repetition effects were found.

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We did not find support for predictive coding models of expectation effects.