bluuebunny/crossref_metadata_2025 huggingface dataset:
High-mass star formation in the Large Magellanic Cloud triggered by colliding H i flows
Authors: Tsuge Kisetsu , Sano Hidetoshi , Tachihara Kengo , Bekki Kenji , Tokuda Kazuki , Inoue Tsuyoshi , Mizuno Norikazu , Kawamura Akiko , Onishi Toshikazu , Fukui Yasuo
Published: May 2024

The galactic tidal interaction is a possible mechanism to trigger active star formation in galaxies. Recent analyses using H i data in the Large Magellanic Cloud (LMC) proposed that the tidally driven H i flow, the L-component, is colliding with the LMC disk, the D-component, and is triggering high-mass star formation toward the active star-forming regions R136 and N44. In order to explore the role of the collision over the entire LMC disk, we investigated the I-component, the collision-compressed gas between the L- and D-components, over the LMC disk, and found that $74\%$ of the O/WR stars are located toward the I-component, suggesting their formation in the colliding gas. We compared four star-forming regions (R136, N44, N11, and the N77–N79–N83 complex). We found a positive correlation between the number of high-mass stars and the compressed gas pressure generated by collisions, suggesting that pressure may be a key parameter in star formation.
Ex vivo cell-based assay for assessment of response to TNF inhibitors in patients with rheumatic diseases
Authors: Gertel Smadar , Rokach May , Polachek Ari , Levartovsky David , Broyde Adi , Furer Victoria , Dovrat Tali Ofir , Wollman Jonathan , Pel Sara , Neufeld Yoram , Elkayam Ori
Published: May 2024

Objective

There are five TNF inhibitors (TNFis), whose structure and signalling differ. An individual patient with a rheumatic disease may respond to one TNFi but not to another. In addition, 30–40% of patients with rheumatic diseases may respond inadequately to TNFis. The downstream signalling of the various TNFis may determine their clinical efficacy. Several reports have shown that the different TNFis exhibited differential effects on Th17 cells. We analysed the effects of the various TNFis on IL-17A expression in peripheral blood mononuclear cells (PBMCs) of patients with rheumatic diseases, in order to evaluate the possibility of predicting responses in an ex vivo setting.

Methods

PBMCs were co-cultured with the various TNFis or medium (control), and IL-17A mRNA levels were analysed by quantitative PCR. IL-17A expression levels in response to four TNFis (not including certolizumab pegol) were compared with that of the control. The IL-17A expression level as determined by the assay was correlated with the clinical response. The assay sensitivity and specificity for distinguishing responders from non-responders was calculated by receiver-operating characteristic (ROC) analysis.

Results

The results of the assay for a retrospective cohort of patients with rheumatic diseases (n = 82) correlated with their therapeutic responses to the various TNFis with 89.5% accuracy. Our results indicated that the assay predicted the responses of a prospective cohort (n = 54) to specific TNFis with 79% accuracy.

Conclusion

This functional assay could assist in predicting the odds for response to TNFi therapy, indicating whether a given patient is likely to respond to a specific TNFi.
Reckoning with Responsibility: The Mesopotamia Commission into British Military Failings during a Moment of Imperial Transformation, 1916–19
Authors: Tudor Margot , Thomas Owen D , Pennell Catriona
Published: May 2024

In August 1916, in the aftermath of significant defeats in the Middle Eastern theatre of the First World War, the British government faced a crisis of confidence in its military power. In Mesopotamia, it was under significant pressure to reckon with its perceived poor strategic decision-making and its treatment and resourcing of British troops. The Mesopotamia Commission was established to investigate and reassure the wider public that the same mistakes would not be made again. Scholarly explorations of the commission have focused on the commission’s report published in July 1917. But this neglects what came before: the construction, performance, and repercussions of the commission as it unfolded. This article undertakes a forensic archival analysis of the commission ‘in process’, revealing the political character of the commission—how it presented itself, the commissioner’s decision-making, and the intra-imperial conflicts it aggravated during the war itself—all while operating under (and benefitting from) an expert, impartial guise. This granular approach to inquiry analysis not only contributes to new understandings of British imperial politics during the First World War but also demonstrates that, as a selective process of knowledge production, the commission’s outcomes and impact went well beyond just a published report.
Testicular protective effects of hesperidin against chemical and biological toxicants
Authors: Yan Linyin , Wang Jia , Dai Decai , Zhang Yu , Li Yanqiang , Xiao Wei
Published: May 2024

Toxic agents can adversely impact the male reproductive system mainly via activating oxidative stress affecting the seminiferous epithelia, spermatogenesis, sperms, and the testis. Toxic agents lead to the excessive generation of reactive oxygen species (ROS), such as hydroxyl radicals, hydrogen peroxide, and superoxide anions. ROS exert a cytotoxic effect and oxidative damage to nucleic acids, proteins, and membrane lipids. Hesperidin is a pharmacologically active phytoflavone abundantly occurring in citrus fruits, such as oranges and lemons. It has shown various pharmacological properties such as antioxidant, anti-inflammatory, anti-carcinogenic, analgesic, antiviral, anti-coagulant, hypolipidemic, and hypoglycemic effects. Hesperidin has been found to exert protective effects against natural and chemical toxins-induced organ toxicity. Considerable evidence has implicated the testicular protective effects of hesperidin against the toxicological properties of pharmaceutical drugs as well as biological and chemical agents, and in the present review, we discussed, for the first time, the reported studies. The resultant data indicate that hesperidin can exert testicular protective effects through antioxidant properties.
The role of Nrf2 signaling pathways in nerve damage repair
Authors: Abdolmaleki Arash , Karimian Aida , Khoshnazar Seyedeh Mahdieh , Asadi Asadollah , Samarein Zahra Akhavi , Smail Shukur Wasman , Bhattacharya Deepak
Published: May 2024

The protein, Nuclear factor-E2-related factor 2 (Nrf2), is a transitory protein that acts as a transcription factor and is involved in the regulation of many cytoprotective genes linked to xenobiotic metabolism and antioxidant responses. Based on the existing clinical and experimental data, it can be inferred that neurodegenerative diseases are characterized by an excessive presence of markers of oxidative stress (OS) and a reduced presence of antioxidant defense systems in both the brain and peripheral tissues. The presence of imbalances in the homeostasis between oxidants and antioxidants has been recognized as a substantial factor in the pathogenesis of neurodegenerative disorders. The dysregulations include several cellular processes such as mitochondrial failure, protein misfolding, and neuroinflammation. These dysregulations all contribute to the disruption of proteostasis in neuronal cells, leading to their eventual mortality. A noteworthy component of Nrf2, as shown by recent research undertaken over the last decade, is to its role in the development of resistance to OS. Nrf2 plays a pivotal role in regulating systems that defend against OS. Extant research offers substantiation for the protective and defensive roles of Nrf2 in the context of neurodegenerative diseases. The purpose of this study is to provide a comprehensive analysis of the influence of Nrf2 on OS and its function in regulating antioxidant defense systems within the realm of neurodegenerative diseases. Furthermore, we evaluate the most recent academic inquiries and empirical evidence about the beneficial and potential role of certain Nrf2 activator compounds within the realm of therapeutic interventions.
Invasive electrochemical impedance spectroscopy with phase delay for experimental atherosclerosis phenotyping
Authors: Chen Michael , Neverova Natalia , Xu Shili , Suwannaphoom Krit , Lluri Gentian , Tamboline Mikayla , Duarte Sandra , Fishbein Michael C. , Luo Yuan , Packard René R. Sevag
Published: May 2024

Distinguishing quiescent from rupture‐prone atherosclerotic lesions has significant translational and clinical implications. Electrochemical impedance spectroscopy (EIS) characterizes biological tissues by assessing impedance and phase delay responses to alternating current at multiple frequencies. We evaluated invasive 6‐point stretchable EIS sensors over a spectrum of experimental atherosclerosis and compared results with intravascular ultrasound (IVUS), molecular positron emission tomography (PET) imaging, and histology. Male New Zealand White rabbits (n = 16) were placed on a high‐fat diet, with or without endothelial denudation via balloon injury of the infrarenal abdominal aorta. Rabbits underwent in vivo micro‐PET imaging of the abdominal aorta with 68Ga‐DOTATATE, 18F‐NaF, and 18F‐FDG, followed by invasive interrogation via IVUS and EIS. Background signal‐corrected values of impedance and phase delay were determined. Abdominal aortic samples were collected for histology. Analyses were performed blindly. EIS impedance was associated with markers of plaque activity including macrophage infiltration (r = .813, p = .008) and macrophage/smooth muscle cell (SMC) ratio (r = .813, p = .026). Moreover, EIS phase delay correlated with anatomic markers of plaque burden, namely intima/media ratio (r = .883, p = .004) and %stenosis (r = .901, p = .002), similar to IVUS. 68Ga‐DOTATATE correlated with intimal macrophage infiltration (r = .861, p = .003) and macrophage/SMC ratio (r = .831, p = .021), 18F‐NaF with SMC infiltration (r = −.842, p = .018), and 18F‐FDG correlated with macrophage/SMC ratio (r = .787, p = .036). EIS with phase delay integrates key atherosclerosis features that otherwise require multiple complementary invasive and non‐invasive imaging approaches to capture. These findings indicate the potential of invasive EIS to comprehensively evaluate human coronary artery disease.
Characterization of the skeletal muscle arginine methylome in health and disease reveals remodeling in amyotrophic lateral sclerosis
Authors: Wong Julian P. H. , Blazev Ronnie , Ng Yaan‐Kit , Goodman Craig A. , Montgomery Magdalene K. , Watt Kevin I. , Carl Christian S. , Watt Matthew J. , Voldstedlund Christian T. , Richter Erik A. , Crouch Peter J. , Steyn Frederik J. , Ngo Shyuan T. , Parker Benjamin L.
Published: May 2024

Arginine methylation is a protein posttranslational modification important for the development of skeletal muscle mass and function. Despite this, our understanding of the regulation of arginine methylation under settings of health and disease remains largely undefined. Here, we investigated the regulation of arginine methylation in skeletal muscles in response to exercise and hypertrophic growth, and in diseases involving metabolic dysfunction and atrophy. We report a limited regulation of arginine methylation under physiological settings that promote muscle health, such as during growth and acute exercise, nor in disease models of insulin resistance. In contrast, we saw a significant remodeling of asymmetric dimethylation in models of atrophy characterized by the loss of innervation, including in muscle biopsies from patients with myotrophic lateral sclerosis (ALS). Mass spectrometry‐based quantification of the proteome and asymmetric arginine dimethylome of skeletal muscle from individuals with ALS revealed the largest compendium of protein changes with the identification of 793 regulated proteins, and novel site‐specific changes in asymmetric dimethyl arginine (aDMA) of key sarcomeric and cytoskeletal proteins. Finally, we show that in vivo overexpression of PRMT1 and aDMA resulted in increased fatigue resistance and functional recovery in mice. Our study provides evidence for asymmetric dimethylation as a regulator of muscle pathophysiology and presents a valuable proteomics resource and rationale for numerous methylated and nonmethylated proteins, including PRMT1, to be pursued for therapeutic development in ALS.
Complexity and modification of the bull sperm glycocalyx during epididymal maturation
Authors: Sečová Petra , Hackerová Lenka , Horovská Ľubica , Michalková Katarína , Jankovičová Jana , Postlerová Pavla , Antalíková Jana
Published: May 2024

Mammalian spermatozoa have a surface covered with glycocalyx, consisting of heterogeneous glycoproteins and glycolipids. This complexity arises from diverse monosaccharides, distinct linkages, various isomeric glycans, branching levels, and saccharide sequences. The glycocalyx is synthesized by spermatozoa developing in the testis, and its subsequent alterations during their transit through the epididymis are a critical process for the sperm acquisition of fertilizing ability. In this study, we performed detailed analysis of the glycocalyx on the sperm surface of bull spermatozoa in relation to individual parts of the epididymis using a wide range (24) of lectins with specific carbohydrate binding preferences. Fluorescence analysis of intact sperm isolated from the bull epididymides was complemented by Western blot detection of protein extracts from the sperm plasma membrane fractions. Our experimental results revealed predominant sequential modification of bull sperm glycans with N‐acetyllactosamine (LacNAc), followed by subsequent sialylation and fucosylation in a highly specific manner. Additionally, variations in the lectin detection on the sperm surface may indicate the acquisition or release of glycans or glycoproteins. Our study is the first to provide a complex analysis of the bull sperm glycocalyx modification during epididymal maturation.
Effects of Hemorrhagic Shock and Rhabdomyolysis on Renal Microcirculation, Oxygenation, and Function in a Female Swine Model
Authors: Bergis Benjamin , Laemmel Elisabeth , Laitselart Philippe , Isnard Pierre , Terzi Fabiola , Seguret Manon , Hejl Carine , Huertas Alice , Decante Benoit , Vicaut Eric , Duranteau Jacques , Harrois Anatole , Libert Nicolas
Published: May 2024

Background

Hemorrhagic shock (HS) and rhabdomyolysis (RM) are two important risk factors for acute kidney injury after severe trauma; however, the effects of the combination of RM and HS on kidney function are unknown. The purpose of this study was to determine the impact of RM and HS on renal function, oxygenation, perfusion, and morphology in a pig model.

Methods

Forty-seven female pigs were divided into five groups: sham, RM, HS, HS and moderate RM (RM4/HS), and HS and severe RM (RM8/HS). Rhabdomyolysis was induced by intramuscular injection of glycerol 50% with a moderate dose (4 ml/kg for the RM4/HS group) or a high dose (8 ml/kg for the RM and RM8/HS groups). Among animals with HS, after 90 min of hemorrhage, animals were resuscitated with fluid followed by transfusion of the withdrawn blood. Animals were followed for 48 h. Macro- and microcirculatory parameters measurements were performed.

Results

RM alone induced a decrease in creatinine clearance at 48 h (19 [0 to 41] vs. 102 [56 to 116] ml/min for RM and sham, respectively; P = 0.0006) without alteration in renal perfusion and oxygenation. Hemorrhagic shock alone impaired temporarily renal microcirculation, function, and oxygenation that were restored with fluid resuscitation. The RM4/HS and RM8/HS groups induced greater impairment of renal microcirculation and function than HS alone at the end of blood spoliation that was not improved by fluid resuscitation. Mortality was increased in the RM8/HS and RM4/HS groups in the first 48 h (73% vs. 56% vs. 9% for the RM8/HS, RM4/HS, and HS groups, respectively).

Conclusions

The combination of HS and RM induced an early deleterious effect on renal microcirculation, function, and oxygenation with decreased response to resuscitation and transfusion compared with HS or RM alone.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Prediction of Readmission Following Sepsis Using Social Determinants of Health
Authors: Amrollahi Fatemeh , Kennis Brent D. , Shashikumar Supreeth Prajwal , Malhotra Atul , Taylor Stephanie Parks , Ford James , Rodriguez Arianna , Weston Julia , Maheshwary Romir , Nemati Shamim , Wardi Gabriel , Meier Angela
Published: May 2024

OBJECTIVES:

To determine the predictive value of social determinants of health (SDoH) variables on 30-day readmission following a sepsis hospitalization as compared with traditional clinical variables.

DESIGN:

Multicenter retrospective cohort study using patient-level data, including demographic, clinical, and survey data.

SETTINGS:

Thirty-five hospitals across the United States from 2017 to 2021.

PATIENTS:

Two hundred seventy-one thousand four hundred twenty-eight individuals in the AllofUs initiative, of which 8909 had an index sepsis hospitalization.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Unplanned 30-day readmission to the hospital. Multinomial logistic regression models were constructed to account for survival in determination of variables associate with 30-day readmission and are presented as adjusted odds rations (aORs). Of the 8909 sepsis patients in our cohort, 21% had an unplanned hospital readmission within 30 days. Median age (interquartile range) was 54 years (41–65 yr), 4762 (53.4%) were female, and there were self-reported 1612 (18.09%) Black, 2271 (25.49%) Hispanic, and 4642 (52.1%) White individuals. In multinomial logistic regression models accounting for survival, we identified that change to nonphysician provider type due to economic reasons (aOR, 2.55 [2.35–2.74]), delay of receiving medical care due to lack of transportation (aOR, 1.68 [1.62–1.74]), and inability to afford flow-up care (aOR, 1.59 [1.52–1.66]) were strongly and independently associated with a 30-day readmission when adjusting for survival. Patients who lived in a ZIP code with a high percentage of patients in poverty and without health insurance were also more likely to be readmitted within 30 days (aOR, 1.26 [1.22–1.29] and aOR, 1.28 [1.26–1.29], respectively). Finally, we found that having a primary care provider and health insurance were associated with low odds of an unplanned 30-day readmission.

CONCLUSIONS:

In this multicenter retrospective cohort, several SDoH variables were strongly associated with unplanned 30-day readmission. Models predicting readmission following sepsis hospitalization may benefit from the addition of SDoH factors to traditional clinical variables.
Exploring Acute Kidney Injury Following Aortic Dissection: A Comprehensive Review of Machine Learning Models for Predicting Risk, Management Strategies, Complications, and Racial and Gender Disparities
Authors: Goyal Aman , Sulaiman Samia Aziz , Pancholi Vidhi , Fatima Laveeza , Yakkali Shreyas , Doshi Apoorva , Hurjkaliani Sonia , Jain Hritvik , Khan Rozi , Sohail Amir Humza
Published: May 2024

Both types of aortic dissection (AD), Stanford type A and type B, can result in complications such as acute kidney injury (AKI) and aortic rupture. Renal complications in AD arise from compromised renal perfusion affecting the renal arteries. Understanding the intricate connection between AD and AKI is crucial for navigating the complexities of tailored treatment and formulating specific management plans. Concerning machine learning models, in patients with type A aortic dissection, factors such as decreased platelet count on admission, increased D-dimer level, longer cardiopulmonary bypass duration, elevated white blood cell levels, the need for blood transfusion, longer aortic clamp time, extended surgery duration, advanced age, and an elevated body mass index were positively associated with the development of AKI. For the risk of AKI after type B aortic dissection, elevated Nt-pro brain natriuretic peptide, prolonged activated partial thromboplastin time, elevated admission systolic blood pressure, and a higher contrast agent requirement during operative repair were found to predict the risk. Male gender was associated with a higher risk of AKI, and nonwhite race was linked to a higher risk of AKI, a greater likelihood of requiring more urgent procedures, and lower levels of insurance coverage. The treatment of AKI following AD requires a multifaceted approach. Identifying and addressing the underlying cause, such as low blood pressure, renal artery involvement, or medication-induced injury, is crucial for effective management and preventing further kidney damage. Maintaining proper fluid balance is essential for improving renal perfusion, but careful monitoring is necessary to avoid complications. The evolving landscape of research, particularly in biomarkers and AI programs, reveals a promising role in predicting the risk for and managing AKI post-AD.
Mild Allergic Reactions after Botulinum Toxin Injection: A Case Series and Literature Review
Authors: Li Yingzi , Zheng Qiaoyuan , Lin Jinhao , Su Xueshang , Zhuang Jun , Wei Qingqian , Hu Jintian
Published: May 2024

Background:

Botulinum toxin type A (BTA) is becoming more and more prevalent as an injection agent in cosmetic surgery. However, there is an increasing amount of cases reporting unexpected adverse reactions related to BTA injection. BTA can invoke many kinds of hypersensitive reactions, some of which can be delayed-type or even fatal; hence, it is of crucial importance to pay close attention to atypical and early symptoms that may indicate the presence of BTA allergy in patients.

Methods:

In this study, we reported three cases of mild and unexpected BTA-related hypersensitive reaction with a symptom of nonpruritic erythema on the chest that happened after BTA treatment of upper facial wrinkles and proposed several suggestions based on our practical experience and literature review.

Results:

Two patients’ symptoms were alleviated spontaneously, and one patient’s were alleviated after taking oral corticosteroid. According to our literature review, we believe that these incidences indicate a kind of unreported allergic reaction relevant to botulinum toxin.

Conclusions:

We suggest clinicians consider warily patients’ subsequent BTA injection schedule if any suspicious reaction occurs after treatment. We suggest that patients who experience nonpruritic erythema after botulinum toxin injection should suspend subsequent injection plans for at least 3 months to prevent more severe consequences.
Histologic Examination of Mastectomy Scars during Breast Reconstruction: A Systematic Review
Authors: Berger Ori , Talisman Ran
Published: May 2024

Background:

Breast reconstruction is a standard procedure in postmastectomy plastic surgery. The necessity of routine histological examinations for mastectomy scars during delayed reconstruction remains a topic of debate. We evaluated the need for histological examination of scars during delayed breast reconstruction.

Methods:

We conducted a systematic review using PubMed, TDnet, and Cochrane Central in August 2023. Inclusion criteria involved delayed breast reconstruction with histological scar analysis and malignancy reporting. Exclusion criteria encompassed noncancerous breast diseases, prophylactic mastectomies, articles lacking relevant information, case reports, technique descriptions, and reviews. We independently assessed articles. Differences in recurrence rates were determined using a Z-test for proportions. A linear regression model explored the relationship between reconstruction timing and pathological results. The number needed to treat was calculated based on the literature. The Wilcoxon test was used to compare mean reconstruction times and postreconstruction follow-up between groups.

Results:

Our analysis covered 11 retrospective observational studies published between 2003 and 2018, including 3754 mastectomy scars. The malignancy recurrence rate was 0.19%, consistent with previous reports, with a number needed to treat of 144.93–188.68 patients. The timing of breast reconstruction postmastectomy averaged 19.9 months, without statistically significant association between reconstruction timing and recurrence rates. Postreconstruction follow-up periods ranged from 60 to 87 months. The postreconstruction adverse outcomes ratio was 2.21%.

Conclusions:

Assessing the necessity of histological examination in breast reconstruction is complex. Based on the literature and this study, we do not recommend routine histological examination of mastectomy scars during delayed reconstruction. A selective approach based on risk factors may be beneficial, warranting further research.
Dual effects of Psoraleae Fructus on the liver: hepatoprotection or hepatoxicity?
Authors: Tang Qianhui , Yu Qinwei , Ni Bin , Jiang Zhenzhou , Zhang Luyong
Published: May 2024

Psoraleae Fructus, the dried mature fruit of the leguminous plant Psoralea corylifolia L., contains flavonoids, coumarins, monoterpene phenols, and benzofurans. It exhibits various pharmacological activities, including immune regulation, antioxidant properties, photosensitivity, and estrogen-like effects, and finds extensive use in the clinical treatment of osteoporosis, vitiligo, and psoriasis. Extensive pharmacological research has demonstrated that Psoraleae Fructus and its components improve liver function and protect hepatocytes in animal and cellular models of liver diseases. Moreover, with the increasing clinical applications of Psoraleae Fructus and its derivatives, as well as the progression in adverse drug reaction surveillance, there is an increase in clinical cases involving these preparations and the enhancement of monitoring for any adverse reactions linked to Psoraleae Fructus and its related compounds. Here, we examined the hepatoprotective effects and hepatotoxicity of the monomer components, extracts, and related preparations of Psoraleae Fructus. We aim to contribute to safety evaluation, facilitate informed clinical application, and foster advancements in Psoraleae Fructus and its derivatives.
The effectiveness of combined extrahepatic bile duct resection in radically resected cases with intrahepatic cholangiocarcinoma: a SEER-based retrospective cohort study and an external validation
Authors: Lv Tian-Run , Wang Jun-Ke , Li Fu-Yu , Hu Hai-Jie
Published: May 2024

Objective:

To evaluate the effectiveness of the combined extrahepatic bile duct resection (EHBDR) in cases with intrahepatic cholangiocarcinoma (IHCC) in terms of clinicopathological features and long-term survival.

Methods:

Radically resected cases with IHCC from 2000 to 2020 were identified from Surveillance, Epidemiology, and End Results (SEER) database. Comparative analyses were performed between resected IHCC patients who received EHBDR and those without EHBDR. Moreover, an external validation was further performed based on a single-center cohort.

Results:

A total of 1521 radically resected cases with IHCC (EHBDR: 189) were identified from the SEER database. Comparable age, sex, race, marital status, liver cirrhosis, differentiation status, and adjuvant chemotherapy were acquired between the two groups. EHBDR was associated with a higher incidence of adequate lymphadenectomy (P<0.001). The incidence of cases with T3–4 or N+ disease was significantly higher in EHBDR group (P<0.001). Adjuvant radiotherapy was more frequently performed in cases with EHBDR (P<0.001). EHBDR failed to bring any survival benefit and was associated with a worse prognosis even after matching. Similar findings have also been revealed in the external validation cohort (n=522, EHBDR: 117). EHBDR was associated with more extended resections, more aggressive tumor biological features, and worse prognosis. In the matched validation cohort, EHBDR was still associated with a higher incidence of early recurrence.

Conclusion:

EHBDR was an indicator of the advanced stage and failed to bring any survival benefit. It is the tumor stage that really determines the prognosis. More in-depth analyses focusing on different situations of EHBDR with more detailed clinical data are required.
Two cases of inflammatory myofibroblastic tumor treated with targeted drugs: A case report
Authors: Liu Mengyao , Zhu Dongyuan
Published: May 2024

Introduction:

Inflammatory myofibroblastic tumor (IMT) is a rare invasive soft tissue tumor. Many IMTs are positive for anaplastic lymphoma kinase (ALK) with ALK gene fusion; other gene mutations have also been reported, which indicates a key role for genetic testing and the development of target therapy to optimize treatment strategies.

Patient concerns:

We report 2 patients who obtained clinical benefits following targeted treatment with ensartinib.

Diagnosis:

The first patient was diagnosed as IMT, with TFG-ROS1 fusion gene mutation. The second patient was IMT harboring the ALK-STRN fusion gene mutation.

Interventions:

We performed gene testing for these 2 patients. According to the test result, both patients received ensartinib 225 mg QD as targeted therapy for a 30-day cycle.

Outcomes:

The first patient achieved partial remission and maintained a stable state for 14.7 months. The second patient was treated for 10 months and reached complete remission after 5 months and is currently still benefiting from treatment. Treatment-related side effects were mild in both patients.

Conclusion:

Our cases provided some new insights and approaches for the clinical diagnosis and treatment of IMT.
Red cell distribution width to total serum calcium ratio and in-hospital mortality risk in patients with acute ischemic stroke: A MIMIC-IV retrospective analysis
Authors: Zhang Xue-qing , Shen Jin-hua , Zhou Quan , Duan Xiang-Jie , Guo Ya-fen
Published: May 2024

We investigated the relationship among red cell distribution width (RDW), to total serum calcium (TSC) ratio (RCR), and in-hospital mortality in patients with acute ischemic stroke (AIS). This study was a retrospective analysis. The data of 2700 AIS patients was retrospectively analyzed from the Medical Information Mart for Intensive Care database (version IV). The main outcome of interest was in-hospital mortality. A Cox proportional hazards regression model was used to determine whether RCR was independently associated with in-hospital mortality. The Kaplan–Meier method was used to plot the survival curves for RCR. Subgroup analyses were performed to measure the mortality across various subgroups. The area under curve (AUC) of receiver operating characteristic curve (ROC) was calculated to ascertain the quality of RCR as a predictor of in-hospital mortality in patients with AIS. In the multivariate analysis, statistically significant differences were identified in age, ethnicity, length of ICU stay, mechanical ventilation, sequential organ failure assessment (SOFA) score, RDW, hemoglobin, RCR, whether taking anticoagulants, hyperlipidemia, and atrial fibrillation (P < .05). A threshold inflection point value of 1.83 was obtained through a two-piecewise regression model. There was a non-linear relationship between RCR and hospital mortality in patients with AIS. The hazard ratio (HR) and the 95% confidence intervals (CI) on the right and left of the inflection point were 0.93 (0.57-1.51;P = .7660) and 2.96 (1.37–6.42;P = .0060), respectively. The Kaplan–Meier curve indicated that survival rates were higher when RCR was ≤ 1.83 and lower when RDW was > 1.83 after adjustment for age, gender, BMI, ethnicity. The area under curve (AUC) of RCR was 0.715. A higher RCR was associated with an increased risk of in-hospital mortality in patients with AIS.
The role of computed tomography in acute bowel obstruction due to a supravesical hernia: a case report from Nepal
Authors: Panthi Anup , Thapaliya Ishwor , Khadka Laxman , Bhusal Madhav , Dev Santosh , Jha Sanjeeb Kumar , Neupane Anand , Sah Jayant Kumar
Published: May 2024

Introduction and importance:

Supravesical hernias are rare internal hernias but potential cause of small-bowel obstruction. The clinical features are often non-specific, preoperative diagnosis is very difficult and is often diagnosed intraoperatively. The exact pathogenesis is unclear with the major risk factors of prematurity, a positive family history, male sex, smoking habits leading to decreased collagen production, advancing age, and conditions characterized by defective collagen synthesis

Case presentation:

The authors are reporting a case of small-bowel obstruction secondary to a supravesical hernia, in a 78-year-old male presented with central abdominal pain, vomiting and obstipation. Ultrasonography of the abdomen and pelvis identified a marked dilation of the small-bowel loop with multiple loops of dilated jejunum and ileum in contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis with lead point from the terminal ileum. Exploratory laparotomy was done with the diagnosis of left posterior a left posterior superior vesical hernia with small-bowel obstruction.

Clinical discussion:

The case focuses supravesical hernia as a rare yet life-threatening etiology of small-bowel obstruction, emphasizing the importance of clinical suspicion when patients present with signs and symptoms of bowel obstruction. While diagnosis often occurs intraoperatively, the utilization of CT scans in emergency settings can provide valuable insights into the location, potential causes, and condition of the herniated bowel sac. The case highlights the pivotal role of CT scans in diagnosis and emphasizes the need for multidisciplinary cooperation among clinicians, radiologists, and surgeons.

Conclusion:

Early intervention ensures better outcomes and prevents irreversible bowel damage, underscoring the importance of a comprehensive approach to patient care.
Urgent appeal for expanded initiatives in gastric motility disorders across low and middle-income countries: illustrating the example of gastroparesis
Authors: Bharadwaj Hareesha Rishab , Dalal Priyal , Marsool Mohammed Dheyaa Marsool , Prajjwal Priyadarshi , Karkhanis Simran , Amir Omniat
Published: May 2024

This paper provides a comprehensive exploration of the current state of gastroparesis management in low and middle-income countries (LMICs), emphasising recent innovations, persistent challenges, and future prospects. Gastroparesis, a condition characterised by delayed stomach emptying, presents debilitating symptoms and is notably linked to neuropathic disorders, including diabetes mellitus. Despite an apparent higher prevalence in LMICs compared to the global average, epidemiological data remains scarce. The paper highlights pioneering research in Pakistan, Brazil, and China, showcasing a transformative shift toward comprehensive studies that delve into nuanced aspects of gastroparesis epidemiology, gender-specific patterns, and innovative therapeutic approaches such as acupuncture. However, challenges impeding clinical management and research in LMICs are identified, encompassing the absence of extensive epidemiological studies, lack of treatment guidelines, and the scarcity of specialised training programs for healthcare professionals. These challenges are intertwined with broader issues such as limited healthcare infrastructure, resource disparities, and healthcare workforce shortages. The paper proposes a multifaceted approach for addressing these challenges, involving international collaboration, capacity building, and the integration of gastroparesis management into primary healthcare services. Strategies to combat brain drain, such as collaborative agreements akin to the UK-South Africa Memorandum of Understanding, are advocated.
Changes in Inhaled Nitric Oxide Use Across ICUs After Implementation of a Standard Pathway
Authors: Radman Monique , McGuire John , Sharek Paul , Baden Harris , Koth Andy , DiGeronimo Robert , Migita Darren , Barry Dwight , Johnson James B , Rutman Lori , Vora Surabhi
Published: May 2024

OBJECTIVES:

Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. It is expensive, frequently used, and not without risk. There is limited evidence supporting a standard approach to initiation and weaning. Our objective was to optimize the use of iNO in the cardiac ICU (CICU), PICU, and neonatal ICU (NICU) by establishing a standard approach to iNO utilization.

DESIGN:

A quality improvement study using a prospective cohort design with historical controls.

SETTING:

Four hundred seven-bed free standing quaternary care academic children’s hospital.

PATIENTS:

All patients on iNO in the CICU, PICU, and NICU from January 1, 2017 to December 31, 2022.

INTERVENTIONS:

Unit-specific standard approaches to iNO initiation and weaning.

MEASUREMENTS AND MAIN RESULTS:

Sixteen thousand eighty-seven patients were admitted to the CICU, PICU, and NICU with 9343 in the pre-iNO pathway era (January 1, 2017 to June 30, 2020) and 6744 in the postpathway era (July 1, 2020 to December 31, 2022). We found a decrease in the percentage of CICU patients initiated on iNO from 17.8% to 11.8% after implementation of the iNO utilization pathway. We did not observe a change in iNO utilization between the pre- and post-iNO pathway eras in either the PICU or NICU. Based on these data, we estimate 564 total days of iNO (–24%) were saved over 24 months in association with the standard pathway in the CICU, with associated cost savings.

CONCLUSIONS:

Implementation of a standard pathway for iNO use was associated with a statistically discernible reduction in total iNO usage in the CICU, but no change in iNO use in the NICU and PICU. These differential results likely occurred because of multiple contextual factors in each care setting.
Immunogenicity of a bivalent BA.1 COVID-19 booster vaccine in people with HIV in the Netherlands
Authors: Jongkees Marlou J. , Tan Ngoc H. , Geers Daryl , de Vries Rory D. , GeurtsvanKessel Corine H. , Hensley Kathryn S. , Sablerolles Roos S.G. , Bogers Susanne , Gommers Lennert , Blakaj Blerdi , Miranda Afonso Pedro , Hansen Bettina E. , Rijnders Bart J.A. , Brinkman Kees , van der Kuy P. Hugo M. , Roukens Anna H.E. , Rokx Casper
Published: May 2024

Objective:

We evaluated the immunogenicity of a bivalent BA.1 COVID-19 booster vaccine in people with HIV (PWH).

Design:

Prospective observational cohort study.

Methods:

PWH aged ≥45 years received Wuhan-BA.1 mRNA-1273.214 and those <45 years Wuhan-BA.1 BNT162b2. Participants were propensity score-matched 1 : 2 to people without HIV (non-PWH) by age, primary vaccine platform (mRNA-based or vector-based), number of prior COVID-19 boosters and SARS-CoV-2 infections, and spike (S1)-specific antibodies on the day of booster administration. The primary endpoint was the geometric mean ratio (GMR) of ancestral S1-specific antibodies from day 0 to 28 in PWH compared to non-PWH. Secondary endpoints included humoral responses, T-cell responses and cytokine responses up to 180 days post-vaccination.

Results:

Forty PWH received mRNA-1273.214 (N = 35) or BNT162b2 (N = 5) following mRNA-based (N = 29) or vector-based (N = 11) primary vaccination. PWH were predominantly male (87% vs. 26% of non-PWH) and median 57 years [interquartile range (IQR) 53–59]. Their median CD4+T-cell count was 775 (IQR 511–965) and the plasma HIV-RNA load was <50 copies/ml in 39/40. The GMR of S1-specific antibodies by 28 days post-vaccination was comparable between PWH [4.48, 95% confidence interval (CI) 3.24–6.19] and non-PWH (4.07, 95% CI 3.42–4.83). S1-specific antibody responses were comparable between PWH and non-PWH up to 180 days, and T-cell responses up to 90 days post-vaccination. Interferon-γ, interleukin (IL)-2, and IL-4 cytokine concentrations increased 28 days post-vaccination in PWH.

Conclusion:

A bivalent BA.1 booster vaccine was immunogenic in well treated PWH, eliciting comparable humoral responses to non-PWH. However, T-cell responses waned faster after 90 days in PWH compared to non-PWH.
Improving HIV preexposure prophylaxis uptake with artificial intelligence and automation: a systematic review
Authors: Kamitani Emiko , Mizuno Yuko , Khalil George M. , Viguerie Alex , DeLuca Julia B. , Mishra Ninad
Published: May 2024

Objectives:

To identify studies promoting the use of artificial intelligence (AI) or automation with HIV preexposure prophylaxis (PrEP) care and explore ways for AI to be used in PrEP interventions.

Design:

Systematic review.

Methods:

We searched in the US Centers for Disease Control and Prevention Research Synthesis database through November 2023; PROSPERO (CRD42023458870). We included studies published in English that reported using AI or automation in PrEP interventions. Two reviewers independently reviewed the full text and extracted data by using standard forms. Risk of bias was assessed using either the revised Cochrane risk-of-bias tool for randomized trials for randomized controlled trials or an adapted Newcastle-Ottawa Quality Assessment Scale for nonrandomized studies.

Results:

Our search identified 12 intervention studies (i.e., interventions that used AI/automation to improve PrEP care). Currently available intervention studies showed AI/automation interventions were acceptable and feasible in PrEP care while improving PrEP-related outcomes (i.e., knowledge, uptake, adherence, discussion with care providers). These interventions have used AI/automation to reduce workload (e.g., directly observed therapy) and helped non-HIV specialists prescribe PrEP with AI-generated clinical decision-support. Automated tools can also be developed with limited budget and staff experience.

Conclusions:

AI and automation have high potential to improve PrEP care. Despite limitations of included studies (e.g., the small sample sizes and lack of rigorous study design), our review suggests that by using aspects of AI and automation appropriately and wisely, these technologies may accelerate PrEP use and reduce HIV infection.
Associations between epicardial, visceral, and subcutaneous adipose tissue with diastolic function in men with and without HIV
Authors: Goldberg Rachel L. , Peterson Tess E. , Haberlen Sabina A. , Witt Mallory D. , Palella Frank J. , Magnani Jared W. , Brown Todd T. , Lake Jordan E. , Lima Joao A.C. , Budoff Matt J. , Ndumele Chiadi E. , Wu Katherine C. , Post Wendy S.
Published: May 2024

Background:

People with HIV (PWH) are at greater risk for diastolic dysfunction compared with persons without HIV (PWOH). An increase in visceral adipose tissue is common among PWH and greater visceral adipose tissue is associated with diastolic dysfunction among PWOH. We investigated associations of visceral adipose tissue, subcutaneous adipose tissue, and other fat depots with subclinical diastolic dysfunction among men with and without HIV (MWH and MWOH).

Design:

Cross-sectional analysis of MWH and MWOH in the Multicenter AIDS Cohort Study (MACS).

Methods:

Participants underwent echocardiography for diastolic dysfunction assessment and CT scanning including subcutaneous, visceral, epicardial, and liver adiposity measurements. Diastolic dysfunction was defined by characterizing heart function on antiretroviral therapy0 criteria. Odds for diastolic dysfunction with each measure of adiposity were estimated using multivariable logistic regression.

Results:

Among 403 participants (median age 57, 55% white, median BMI 26 kg/m2), 25% met criteria for diastolic dysfunction and 59% MWH (82% undetectable plasma HIV RNA). Greater epicardial adipose tissue area was associated with higher odds of diastolic dysfunction [odds ratio:1.54 per SD; 95%confidence interval (CI) 1.15–2.05] when adjusted for demographics, HIV serostatus, and cardiovascular risk factors. This association did not differ by HIV serostatus and persisted when excluding MWH who were not virally suppressed. Less subcutaneous adipose tissue was associated with higher odds of diastolic dysfunction. Other adipose depots were not associated with diastolic dysfunction.

Conclusion:

Greater epicardial adipose tissue and less subcutaneous adipose tissue were associated with diastolic dysfunction, regardless of HIV serostatus and viral suppression. Greater epicardial adipose tissue and less subcutaneous adipose tissue observed among PWH may contribute to risk for heart failure with preserved ejection fraction in this population.
A Comprehensive Flap Classification
Authors: Soh Jun Yi , Pannuto Lucia , Kannan Ruben Yap
Published: May 2024

Perforator flaps have progressed massively in the last years. The improved vascular imaging techniques and the use of supermicrosurgery have shifted the practice from the traditional predefined angiosomal flaps to the endless variations of custom-made flaps. In this article, we propose a broadened classification of free-style flaps in 3 categories, the angiosomal, including all traditional perforator flaps and their variations, the extra-angiosomal, including flaps that are manufactured to include tissue from a different angiosome, such as turbocharging or supercharging a flap, and neoangiosomal flaps, which are based on the process of neoangiogenesis on autologous or allogenous tissue, such as the venous flow-through flap and integra flap. With this classification, we hope to help unify the classifications and, by doing so, facilitate the exchange of ideas, techniques and knowledge.

MeSH terms: surgical flap / classification, terminology as topic
Craniofacial Assault Against Women: A National Evaluation Defining At-risk Populations and Outcomes
Authors: Johnstone Thomas , Singh Dylan , Liu Farrah , Silverstein Max , Shah Jennifer , Darrach Halley , Staudenmayer Kristan , Sheckter Clifford , Nazerali Rahim
Published: May 2024

Introduction:

Few studies have analyzed epidemiologic factor associated with female patients presenting to the emergency department from facial fractures because of assault. Clearly understanding these factors may assist in developing effective strategies to decrease the incidence and sequelae of these injuries.

Objectives:

To determine the epidemiology of facial fractures because of assault in the female population.

Methods:

All female facial fracture visits were queried in the 2019 Nationwide Emergency Department (ED) Sample database. The likelihood of a facial fracture encounter resulting from assault was modeled using logistic regression adjusting for demographics, insurance status, geographic region, location of patient residence, and income. Secondary outcomes analyzed hospitalization costs and adverse events.

Results:

Of all facial fractures 12.4% of female encounters were due to assault were due to assault. Of assaulted females, 72.8% were between the ages of 20 and 40, and Black women experienced a disproportionate share of assault encounters (odds ratio [OR]=2.55; CI, 2.29–2.84). A large portion (46.4%) of encounters occurred in patients living in the lowest quartile of median household income, and 22.8% of patients were uninsured (OR=1.34; CI, 1.09–1.66). Assaulted patients were more likely to have fractures in nasal bone (58.1% vs. 42.5%), orbit (16.8% vs. 10.9%), zygoma (4.1% vs 3.6%), and mandible (8.7% vs. 4.8%) compared with their nonassaulted counterparts.

Conclusions:

Facial fractures were especially common in lower income, uninsured, urban, and Black populations. Examining the patterns of injury and presentation are critical to improve prevention strategies and screening tools, identifying critical patients, and develop a more efficient and effective system to treat and support female patients suffering facial fractures secondary to assault.