bluuebunny/crossref_metadata_2025 huggingface dataset:
REVEALS: an open-source multi-camera GUI for rodent behavior acquisition
Authors: Phadke Rhushikesh A , Wetzel Austin M , Fournier Luke A , Brack Alison , Sha Mingqi , Padró-Luna Nicole M , Williamson Ryan , Demas Jeff , Cruz-Martín Alberto
Published: October 2024

Deciphering the rich repertoire of mouse behavior is crucial for understanding the functions of both the healthy and diseased brain. However, the current landscape lacks effective, affordable, and accessible methods for acquiring such data, especially when employing multiple cameras simultaneously. We have developed REVEALS (Rodent Behavior Multi-Camera Laboratory Acquisition), a graphical user interface for acquiring rodent behavioral data via commonly used USB3 cameras. REVEALS allows for user-friendly control of recording from one or multiple cameras simultaneously while streamlining the data acquisition process, enabling researchers to collect and analyze large datasets efficiently. We release this software package as a stand-alone, open-source framework for researchers to use and modify according to their needs. We describe the details of the graphical user interface implementation, including the camera control software and the video recording functionality. We validate results demonstrating the graphical user interface’s stability, reliability, and accuracy for capturing rodent behavior using DeepLabCut in various behavioral tasks. REVEALS can be incorporated into existing DeepLabCut, MoSeq, or other custom pipelines to analyze complex behavior. In summary, REVEALS offers an interface for collecting behavioral data from single or multiple perspectives, which, when combined with deep learning algorithms, enables the scientific community to identify and characterize complex behavioral phenotypes.
Rearing fly larvae on various substrates: nutrient composition of larvae and frass
Authors: Klakankhai Warin , Nuntapong Nutt , Meesin Sawanya , Yongsue Tepyuda , Niyombandith Taweesak , Tainchum Krajana
Published: October 2024

Management solutions for waste in southern Thailand, such as fly larvae, are tested in a laboratory using different substrates and wastes from the Thai agricultural sector. The nutritional content of the immature stages of Musca domestica Linnaeus (Diptera: Muscidae) and Hermetia illucens (Linnaeus) (Diptera: Stratiomyidae) larvae, especially their protein and fat contents, makes them a potential animal feed. Laboratory strains of M. domestica and H. illucens were reared on selected substrates to examine how diet influenced their performance and nutritional composition. Waste from aquaculture, vegetables, and fruits in southern Thailand was examined for larval diet and showed promise as a rearing substrate for these insects. Musca domestica larvae reared on fishery waste achieved the highest larval weight and fat content, whereas H. illucens larvae reared on an aquaculture waste diet had the highest protein content. These findings imply aquaculture waste could be the best choice for large-scale fly larvae production, particularly as a protein feed additive.
Discovery of a glyphosate oxidase in nature
Authors: Ma Minghui , Ardalan Afshan , Van Dyk Adrian , Charles Trevor C , Horsman Geoff P
Published: October 2024

Glyphosate is the most used herbicide on Earth. After a half-century of use we know only two biodegradative pathways, each of which appears to degrade glyphosate incidentally. One pathway begins with oxidation of glyphosate catalysed by glycine oxidase (GO). To date, no naturally occurring GO enzymes preferentially oxidize glyphosate but nonetheless are sufficiently active to initiate its degradation. However, GO enzymes that preferentially oxidize glyphosate over glycine—i.e. glyphosate oxidases (GOXs)—may have evolved in environments facing prolonged glyphosate exposure. To test this hypothesis, we screened a metagenomic library from glyphosate-exposed agricultural soil and identified a GOX from clone 11AW19 (GO19) that prefers glyphosate over glycine by four orders of magnitude. This is the first GO isolated from a natural source exhibiting a glyphosate preference. Not only have we discovered the first GOX in nature, but we have also demonstrated the utility of functional metagenomics to find a GOX with greater catalytic efficiency and specificity than those engineered using directed evolution.
Gut Microbial Signatures in Pediatric Crohn’s Disease Vary According to Disease Activity Measures and Are Influenced by Proxies of Gastrointestinal Transit Time: An ImageKids Study
Authors: Nichols Ben , Russell Richard K , Short Bryn , Papadopoulou Rodanthi , Focht Gili , Ijaz Umer Z , Walters Thomas D , Sladek Malgorzata , Hansen Richard , Mack David R , Wine Eytan , Griffiths Anne M , Turner Dan , Gerasimidis Konstantinos
Published: October 2024

Introduction

We investigated relationships between disease activity measures and the gut microbiome in children with Crohn’s disease (CD) and how these were confounded by gastrointestinal transit time.

Methods

Microbiome was profiled (16S rRNA sequencing) in feces from 196 children with CD. Sixty participants also provided samples after 18 months. Mural inflammation (Pediatric Inflammatory Crohn’s Magnetic Resonance Enterography Index, PICMI), the simple endoscopic score for CD, and the weighted pediatric Crohn’s disease activity index (wPCDAI) were assessed. Fecal calprotectin, plasma C-reactive protein (CRP), and fecal water content (FWC), a proxy of gastrointestinal transit time, were measured too.

Results

Microbiome α diversity, clustering, and differential taxa were related to disease status, but varied remarkably by disease activity measure used. The strongest relationships between microbiome and disease activity status were observed using wPCDAI; fewer or no relationships were seen using more objective measures like PICMI. Taxa predictive of disease activity status were dependent on the disease activity measure used with negligible overlap. Active disease was associated with more pathobionts (eg, Viellonella, Enterobacterales) and fewer fiber-fermenting organisms. The effect FWC had on microbiome superseded the effect of active disease for all disease activity measures, particularly with wPCDAI. Accounting for FWC, the differences in microbial signatures explained by disease activity status were attenuated or lost.

Conclusions

In CD, microbiome signatures fluctuate depending on the measure used to assess disease severity; several of these signals might be secondary disease effects linked with changes in gut motility in active disease. PICMI appears to be less influenced when studying relationships between microbiome and mural inflammation in CD.
A new perspective on denoising based on optimal transport
Authors: García Trillos Nicolás , Sen Bodhisattva
Published: October 2024

In the standard formulation of the classical denoising problem, one is given a probabilistic model relating a latent variable $\varTheta \in \varOmega \subset{\mathbb{R}}^{m} \; (m\ge 1)$ and an observation $Z \in{\mathbb{R}}^{d}$ according to $Z \mid \varTheta \sim p(\cdot \mid \varTheta )$ and $\varTheta \sim G^{*}$, and the goal is to construct a map to recover the latent variable from the observation. The posterior mean, a natural candidate for estimating $\varTheta $ from $Z$, attains the minimum Bayes risk (under the squared error loss) but at the expense of over-shrinking the $Z$, and in general may fail to capture the geometric features of the prior distribution $G^{*}$ (e.g. low dimensionality, discreteness, sparsity). To rectify these drawbacks, in this paper we take a new perspective on this denoising problem that is inspired by optimal transport (OT) theory and use it to study a different, OT-based, denoiser at the population level setting. We rigorously prove that, under general assumptions on the model, this OT-based denoiser is mathematically well-defined and unique, and is closely connected to the solution to a Monge OT problem. We then prove that, under appropriate identifiability assumptions on the model, the OT-based denoiser can be recovered solely from information of the marginal distribution of $Z$ and the posterior mean of the model, after solving a linear relaxation problem over a suitable space of couplings that is reminiscent of standard multimarginal OT problems. In particular, due to Tweedie’s formula, when the likelihood model $\{ p(\cdot \mid \theta ) \}_{\theta \in \varOmega }$ is an exponential family of distributions, the OT-based denoiser can be recovered solely from the marginal distribution of $Z$. In general, our family of OT-like relaxations is of interest in its own right and for the denoising problem suggests alternative numerical methods inspired by the rich literature on computational OT.
Open and closed structures of L-arginine oxidase by cryo-electron microscopy and X-ray crystallography
Authors: Yamaguchi Hiroki , Takahashi Kazutoshi , Numoto Nobutaka , Suzuki Hiroshi , Tatsumi Moemi , Kamegawa Akiko , Nishikawa Kouki , Asano Yasuhisa , Mizukoshi Toshimi , Miyano Hiroshi , Fujiyoshi Yoshinori , Sugiki Masayuki
Published: October 2024

L-arginine oxidase (AROD, EC 1.4.3.25) is an oxidoreductase that catalyses the deamination of L-arginine, with flavin adenine dinucleotide (FAD) as a cofactor. Recently identified AROD from Pseudomonas sp. TPU 7192 (PT-AROD) demonstrates high selectivity for L-arginine. This enzyme is useful for accurate assays of L-arginine in biological samples. The structural characteristics of the FAD-dependent AROD, however, remain unknown. Here, we report the structure of PT-AROD at a resolution of 2.3 Å by cryo-electron microscopy. PT-AROD adopts an octameric structure with D4 symmetry, which is consistent with its molecular weight in solution, estimated by mass photometry. Comparative analysis of this structure with that determined using X-ray crystallography reveals open and closed forms of the lid-like loop at the entrance to the substrate pocket. Furthermore, mutation of Glu493, located at the substrate binding site, diminishes substrate selectivity, suggesting that this residue contributes significantly to the high selectivity of PT-AROD.
Don’t touch me! Mating not always preceded by courtship behavior in predatory coccinellids
Authors: Zeni Valeria , Ricciardi Renato , Valicenti Marta , Nieri Rachele , Mazzoni Valerio , Canale Angelo , Desneux Nicolas , Lucchi Andrea , Benelli Giovanni
Published: October 2024

Knowledge of the ecology and behavior of biological control agents is essential for their effective use in biocontrol and Integrated Pest Management (IPM) programs. There is a lack of information regarding the courtship and mating traits that are crucial for successful mating in biocontrol population of coccinellids. To expand our current understanding in this area, 2 coccinellid species commonly used for the biocontrol of soft-bodied insects, Cryptolaemus montrouzieri (Mulsant) and Propylea quatuordecimpunctata (Linnaeus) (Coleoptera: Coccinellidae), were studied. A quantitative analysis was performed to compare their courtship and mating displays. Key behavioral traits of the precopulatory, copulatory, and postcopulatory phases were investigated. The courtship and mating sequences of C. montrouzieri and P. quatuordecimpunctata were similar to each other. During the mating phase, the key displays were the opening of the elytrae and wings followed by body shaking in C. montrouzieri and leg tapping followed by body shaking in P. quatuordecimpunctata. The mating success of both species was not correlated with any courtship display, such as antennal tapping. Only in C. montrouzieri mounting attempt showed a higher frequency from the backside without affecting male mating success. This research adds baseline knowledge about the courtship and mating behavior of the biocontrol population of coccinellids, contributing to the identification of potentially useful benchmarks (e.g., body shaking, leg tapping) for monitoring prolonged mass-rearing processes, thus reducing mating failures.
Publicity of proceedings before the Unified Patent Court
Authors: Schröder Vilhelm
Published: October 2024

On 1 June 2023, the Unified Patent Court (UPC) opened its doors. One of the most discussed and debated topics during the first year of operation of the UPC has been the publicity of the proceedings. This article discusses (i) access requests by the public, and (ii) restricting access within the proceedings. The court has now handed down several decisions on access requests by the public. Different approaches were adopted by the Munich section of the central division and the Nordic-Baltic regional division. The order by the latter division was appealed and we now have guidelines from the Court of Appeal on how the rules should be interpreted. The UPC has also given several orders related to the protection of trade secrets and confidential information within the proceedings. The questions the court has had to deal with are far from easy. They require careful balancing of several interests, such as publicity and confidentiality as well as the right to a fair trial. The Hague local division held that access to certain documents could be restricted only to legal representatives (‘attorneys’ eyes only’), where the relevant party had waived its right to review the documents. Generally, however, the UPC has in its orders allowed at least one natural person from each party to review all documents, which follows the wording of the Rules of Procedure. The Court of Appeal is yet to rule on these questions.
The peripheral neuroimmune system
Authors: Song Keaton , Kim Brian S
Published: October 2024

Historically, the nervous and immune systems were studied as separate entities. The nervous system relays signals between the body and the brain by processing sensory inputs and executing motor outputs, whereas the immune system provides protection against injury and infection through inflammation. However, recent developments have demonstrated that these systems mount tightly integrated responses. In particular, the peripheral nervous system acts in concert with the immune system to control reflexes that maintain and restore homeostasis. Notwithstanding their homeostatic mechanisms, dysregulation of these neuroimmune interactions may underlie various pathological conditions. Understanding how these two distinct systems communicate is an emerging field of peripheral neuroimmunology that promises to reveal new insights into tissue physiology and identify novel targets to treat disease.
Influence of artificial intelligence on modern book design
Authors: Liu Qi , Wu Zijing
Published: October 2024

The study addresses the necessity to investigate the influence of artificial intelligence (AI) on book design in a variety of socio-cultural contexts. The objective is to conduct a cross-cultural analysis of contemporary AI applications in book design in the USA, Finland, and China. The research employs a cross-cultural, systemic, and structural approach, utilizing theoretical methods such as analysis, synthesis, and comparison. The study identifies the current design trends, which include space aestheticization, communication, and AI integration. The study examines the relationship between AI and book design, with a particular focus on the role of the creator’s subjectivity and the potential for enhanced creative output. The necessity of a comparative approach to the analysis of AI-driven book design is underscored. The particulars of AI utilization in American book design are examined, emphasizing the infusion of cultural value, communication of environmental concerns, and the creation of heritage-based works. In contrast, the Finnish design approach prioritizes human resources and pragmatic solutions in book product design. In contrast, the Chinese approach addresses key socio-cultural issues through AI in book design. The study’s practical value lies in applying these local design characteristics to interpret cultural codes through AI.
scTML: a pan-cancer single-cell landscape of multiple mutation types
Authors: Li Haochen , Ma Tianxing , Zhao Zetong , Chen Yixin , Xi Xi , Zhao Xiaofei , Zhou Xiaoxiang , Gao Yibo , Wei Lei , Zhang Xuegong
Published: October 2024

Investigating mutations, including single nucleotide variations (SNVs), gene fusions, alternative splicing and copy number variations (CNVs), is fundamental to cancer study. Recent computational methods and biological research have demonstrated the reliability and biological significance of detecting mutations from single-cell transcriptomic data. However, there is a lack of a single-cell-level database containing comprehensive mutation information in all types of cancer. Establishing a single-cell mutation landscape from the huge emerging single-cell transcriptomic data can provide a critical resource for elucidating the mechanisms of tumorigenesis and evolution. Here, we developed scTML (http://sctml.xglab.tech/), the first database offering a pan-cancer single-cell landscape of multiple mutation types. It includes SNVs, insertions/deletions, gene fusions, alternative splicing and CNVs, along with gene expression, cell states and other phenotype information. The data are from 74 datasets with 2 582 633 cells, including 35 full-length (Smart-seq2) transcriptomic single-cell datasets (all publicly available data with raw sequencing files), 23 datasets from 10X technology and 16 spatial transcriptomic datasets. scTML enables users to interactively explore multiple mutation landscapes across tumors or cell types, analyze single-cell-level mutation-phenotype associations and detect cell subclusters of interest. scTML is an important resource that will significantly advance deciphering intra-tumor and inter-tumor heterogeneity, and how mutations shape cell phenotypes.
The MaNAP1-MaMADS1 transcription factor module mediates ethylene-regulated peel softening and ripening in banana
Authors: Li Hua , Chen Zhuo , Zhu Wenjun , Ni Xueting , Wang Junru , Fu Lufeng , Chen Jialin , Li Tianpu , Tang Lingxian , Yang Yingjie , Zhang Fukun , Wang Jiashui , Zhou Biyan , Chen Faxing , Lü Peitao
Published: October 2024

The banana (Musa spp.) peel undergoes rapid softening during ripening, leading to finger drop and a shortened shelf life. The regulatory mechanism behind this process remains to be elucidated. In this study, we confirmed the role of peel softening in banana finger drop and uncovered the underlying transcriptional regulatory network. Cell wall-related (CWR) genes were substantially upregulated in both the peel and finger drop zone during ethylene-induced ripening. Transcriptome analysis and genome-wide profiling of chromatin accessibility and transcription factor (TF) binding revealed that two key regulators of fruit ripening, Musa acuminata NAC-like, Activated by apetala3/Pistillata1 (MaNAP1) and MaMADS1, regulate CWR genes by directly binding to their promoters or by targeting other ripening-related TFs to form a hierarchical regulatory network. Notably, MaNAP1 and MaMADS1 were directly targeted by ETHYLENE INSENSITIVE3 (MaEIN3), and MaNAP1 and MaMADS1 associated with tissue-specific histone modifications, enabling them to integrate MaEIN3-mediated ethylene signaling and undergo epigenetic regulation. Overexpression of MaNAP1, MaMADS1, or other identified regulatory TFs upregulated CWR genes and promoted peel softening. Our findings unveil a MaNAP1–MaMADS1-centered regulatory cascade governing banana peel softening and finger drop, offering potential targets for enhancing banana texture and shelf life.
Discovery of Neutron-Rich Silicon Isotopes 45,46Si
Authors: Yoshimoto Masahiro , Suzuki Hiroshi , Fukuda Naoki , Takeda Hiroyuki , Shimizu Yohei , Yanagisawa Yoshiyuki , Sato Hiromi , Kusaka Kensuke , Ohtake Masao , Yoshida Koichi , Michimasa Shin’ichiro
Published: October 2024

New isotopes $^{45,46}$Si, which extend beyond the most neutron-rich Si isotopes confirmed thus far, have been discovered at the RI Beam Factory at the RIKEN Nishina Center. The isotopes were produced by the in-flight fragmentation reactions of $^{70}$Zn at 345 MeV/nucleon on a Be target. All the projectile fragments were analyzed and identified using the large-acceptance two-stage separator BigRIPS. Consequently, six $^{45}$Si events and one $^{46}$Si event were confirmed. The neutron-bound nature of odd-N$^{45}$Si may have a significant impact on the nuclear stability of neutron-rich proton $sd$-shell nuclei at approximately $N=40$.
Effectiveness of an Exercise and Educational-Based Prehabilitation Program in Patients With Breast Cancer Receiving Neoadjuvant Chemotherapy (PREOptimize) on Functional Outcomes: A Randomized Controlled Trial
Authors: Casanovas-Álvarez Anabel , Estanyol Blanca , Ciendones Magda , Padròs Josep , Cuartero Jordi , Barnadas Agustí , García-Valdecasas Bárbara , González-Colom Rubèn , Sebio-García Raquel , Masià Jaume
Published: October 2024

Objective

The study objective was to determine the effectiveness of a prehabilitation program to decrease postoperative musculoskeletal impairments in patients who have breast cancer and are receiving neoadjuvant therapy (NAT).

Methods

Patients who had breast cancer and were receiving NAT before surgery were invited to participate in this randomized controlled trial. Patients randomized to the intervention group participated in a group-based prehabilitation program consisting of Nordic walking, resistance training, and therapeutic education from month 4 of NAT until before surgery. Patients in the control group received usual care (no prehabilitation). The main outcome was arm function measured with the short version of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire 1 month after surgery. Other measures included pain, range of motion, functional capacity, cancer-related fatigue, handgrip strength, physical activity, and arm circumferences.

Results

A total of 64 patients were randomized during the study period, and 61 completed all assessments. A significant difference in the main outcome (a short version of the DASH questionnaire) was found before surgery as patients in the control group experienced worsening in arm function (mean difference = −9.84, 95% CI = −17.7 to −2). In addition, they also showed increased symptom frequency/severity according to the combined scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) (mean difference = +6.7 points, 95% CI = 0.1 to 13.4) compared to the intervention group. Prehabilitation also improved functional capacity (mean difference = 67.6 m, 95% CI = 37.4 to 97.7) and physical activity levels and decreased cancer-related fatigue (mean difference = −1.3, 95% CI = −2.4 to −0.29) compared to the control group but had no effect on other secondary outcomes. After surgery, patients receiving prehabilitation also exhibited greater functional capacity at both 1 and 3 months. No other difference was observed.

Conclusion

A prehabilitation program was able to maintain arm function and increase functional capacity while decreasing fatigue in patients with breast cancer receiving NAT.

Impact

Prehabilitation programs should be offered to patients with breast cancer to maintain functionality and enhance physical performance before surgery.

Lay Summary

An exercise program combined with therapeutic education in patients with breast cancer who receive NAT before surgery can improve functional capacity and prevent declines of arm mobility and function.
How can we make ‘research quality’ a theoretical concept?
Authors: Gläser Jochen
Published: October 2024

Studies on research quality criteria and their application have largely not defined the concept of ‘research quality’. This reluctance to define and theoretically position the concept of research quality consigns empirical research to remain descriptive and makes methodological decisions more difficult. This paper aims to propose a theoretical approach to research quality by presenting a definition, grounding it in social theory, illustrating its applicability and exploring its methodological consequences for empirically investigating notions of research quality held by members of scientific communities.
Association of neuroimaging measures with facial emotional processing in healthy adults: a task fMRI study
Authors: Huang Gantian , Qiu Chen , Liao Meng , Gong Qiyong , Liu Longqian , Jiang Ping
Published: October 2024

Investigating the neural processing of emotion-related neural circuits underlying emotional facial processing may help in understanding mental disorders. We used two subscales of the Toronto Alexithymia Scale (TAS) to assess the emotional cognitive of 25 healthy participants. A higher score indicates greater difficulty in emotional perception. In addition, participants completed a n-back task during functional magnetic resonance imaging. Psychophysiological interaction analysis was used to explore the functional connectivity (FC) of neural circuits. Next, we used elastic-net regression analysis for feature selection and conducted correlation analysis between the neuroimaging measures and questionnaire scores. Following a 3-fold cross-validation, five neuroimaging measures emerged as significant features. Results of correlation analysis demonstrated that participants with higher TAS scores exhibited increased FC between the amygdala and occipital face area during facial stimulus processing, but decreased connectivity during emotional processing. These findings suggested that individuals with poor emotional recognition exhibited increased connectivity among face-related brain regions during facial processing. However, during emotional processing, decreasing neural synchronization among neural circuits involved in emotional processing affects facial expression processing. These findings suggest potential neural marker related to subjective emotional perception, which may contribute to the diagnosis and treatment of emotional dysregulation in individuals with psychiatric conditions.
Clinician-Reported Negative Symptom Scales: A Systematic Review of Measurement Properties
Authors: Weigel Lucia , Wehr Sophia , Galderisi Silvana , Mucci Armida , Davis John M , Leucht Stefan
Published: October 2024

Background

Negative symptoms of schizophrenia are correlated with reduction of normal function and lower quality of life. They were newly defined by the NIMH-MATRICS Consensus in 2005, dividing the rating tools to assess them into first-generation scales, developed before the Consensus, and second-generation scales, based on the recently introduced definitions.

Methods

The COnsensus-based Standards for the selection of health Measurement Instrument (COSMIN) guidelines for systematic reviews were used to evaluate the quality of psychometric data of the first-generation scales that cover the 5 negative symptom domains of the NIMHS Consensus: the Scale for the Assessment of Negative Symptoms (SANS), the High Royds Evaluation of Negativity Scale (HEN), and the Negative Symptom Assessment-16 (NSA-16).

Results

The search strategy resulted in the inclusion of a total of 13 articles, 7 for the SANS, 4 for the NSA-16, and 2 for the HEN. For the SANS and the NSA-16, the overall results of the scales’ measurement properties are mostly insufficient or indeterminate. The quality of evidence for the HEN is poor, due to a small number of validation studies/included patients.

Conclusions

After applying the COSMIN guidelines, we do not recommend the usage of these first-generation scales to rate negative symptoms. At the minimum they require further validation.
Impact of age on antimicrobial prescriptions in hospitalized children at three academic centres in South Africa: a point prevalence survey
Authors: Pillay Ashendri , Chetty Terusha , Moore David P , Waggie Zainab , Nakwa Firdose L , van Kwawegen Alison , Thomas Reenu , Karsas Maria , Cloete Jeané , Balakrishna Yusentha , Reddy Tarylee , Archary Moherndran , Goga Ameena , Jeena Prakash
Published: October 2024

Antimicrobial resistance is a global threat in children, and the emergence of multi-drug-resistant organisms is of concern. This secondary analysis of an antimicrobial point prevalence survey (PPS) in children evaluates the impact of age on antimicrobial use. The mean antimicrobial prescriptions were assessed in neonates, infants, young children (1–5 years), school-going children (6–12 years), and adolescents (13–15 years) from a cross-sectional PPS at three academic hospitals between September 2021 and January 2022. Primary and secondary diagnoses, antibiotic type (World Health Organization AWaRe and Anatomical Therapeutic Chemical classifications), and the incidence of healthcare-associated infections (HAI) were evaluated per age category. Multiple regression models were used to analyse age-related risk factors for HAI. The number of antimicrobials per child (1.7–1.9 per patient) was higher in neonates and infants compared to children 6–12 years old (1.4 per patient). Watch antibiotics, especially carbapenems, were commonly prescribed in neonates (32.5%) and infants (42.2%). Reserve antimicrobial use was notable in neonates (4.7%) and infants (4.1%). The incidence risk ratio (IRR) of HAI was higher in neonates and infants (IRR 2.13; 95% CI 1.23–3.70, IRR 2.20; 95% CI 1.40–3.45, respectively) compared to 6- to 12-year-olds. On multivariate analysis of participants according to age, being HIV infected, length of stay >6 days, high McCabe severity score, having surgery and receipt of blood transfusion were associated with an increased risk of HAI (P < .001 for all) while on univariate analysis only, being premature and/or underweight was associated with an increased risk of HAI in infants (P < .001 for both). Infants with risk factors for HAI significantly influenced antimicrobial prescribing, underscoring the necessity for tailored antimicrobial stewardship and enhanced surveillance. The increased use of Watch antibiotics, particularly carbapenems, in infants warrants closer scrutiny. Further research is required to identify inappropriate antimicrobial use in high-risk hospitalized young children.
Unionization of Graduate Medical Education Trainees: Perspectives From Designated Institutional Officials
Authors: Co John Patrick T. , Katznelson Laurence , Guralnick Susan , Berns Jeffrey S.
Published: October 2024

Labor unions represent an increasing number of graduate medical education (GME) trainees in the United States. Most GME and other leaders at academic medical centers lack familiarity with resident/fellow unions, including what to expect, what decisions need to be made, and the processes involved in a unionization effort. It is important for designated institutional officials (DIOs), GME program directors, teaching faculty, and other institutional leaders to understand the drivers of resident/fellow unionization, the union organizing campaign and election process, and what follows a vote to unionize, including collective bargaining. Careful consideration of the role of educational and other institutional leaders during the unionization process is important to prevent any loss of trust between residents/fellows and those they view as their advocates. In this Commentary, the authors describe these considerations from their perspective as DIOs and GME leaders.
The role of human factors engineering in patient safety
Authors: Fermin Lilibeth , Lobaugh Lauren , Parr K. Gage , Currie Morgan
Published: October 2024

Purpose of review

To explore the collaboration between human factors (HFs) experts and clinicians in order to improve perioperative patient safety

Recent findings

Recent recommendations to integrate human factors into anesthesia in the United Kingdom emphasizes the value of applying disciplines outside of medicine to optimize the patient experience.

Human factors engineering is underutilized worldwide. Patient safety would benefit from collaboration with HF experts to design resilient systems. Healthcare organizations must consider HF to develop and implement user-centered solutions to improve safety for patients and professionals.
Best perioperative practices in the management of obstructive sleep apnea patients undergoing ambulatory surgery
Authors: Pappu Ameya , Singh Mandeep
Published: October 2024

Purpose of review

This review is timely due to the increasing prevalence of obstructive sleep apnea (OSA) among patients undergoing ambulatory surgery, necessitating updated perioperative management strategies to improve outcomes and reduce complications.

Recent findings

Recent studies emphasize the importance of risk stratification using tools like STOP-Bang, highlighting the association between high-risk OSA and increased perioperative complications. Intraoperative management strategies, including the preference for regional anesthesia and careful monitoring of neuromuscular blockade, have been shown to mitigate risks. Postoperative protocols, particularly continuous monitoring, are crucial in preventing opioid-induced respiratory depression.

Effective management of OSA in ambulatory surgery requires a multidisciplinary approach, encompassing preoperative screening, tailored intraoperative techniques, and vigilant postoperative monitoring. Implementing guidelines and protocols can significantly enhance patient safety and outcomes.
Association Between Variables and Transitions Among No Opioid Use, Opioid Use, and Subsequent Dropout Among Participants on Methadone Treatment: A Retrospective Study Utilizing a Multistate Model
Authors: Li Boyu , Wang Chijie , Tang Xijia , Chen Zouxiang , Li Zhiyao , Zhou Wensu , Chen Wen , Ling Li
Published: October 2024

Background

Although previous studies have reported the variables that influence opioid use or dropout among participants receiving methadone treatment, limited attention has been given to the variables related to transitions among no opioid use, opioid use, and dropout.

Methods

This retrospective study utilized data collected from June 2010 to June 2022 at 11 methadone treatment clinics in Guangdong Province, China. Two transient states (no opioid use and opioid use) and 1 absorbing state (dropout) were defined based on monthly urine morphine test results and daily methadone intake records. We used a multistate model to explore the variables associated with transitions among no opioid use, opioid use, and dropout among participants.

Results

Among 3136 participants, with an average treatment duration of 497 days, 1646 (52.49%) underwent at least 1 period of opioid use, resulting in 3283 transitions from no opioid use to opioid use. The transitions between no opioid use and opioid use were significantly associated with variables such as age, gender, employment status, marital status, living situation, travel time to the clinic, human immunodeficiency virus and hepatitis C virus infection statuses, average methadone dosage, and attendance rates. The variables influencing participants’ dropout varied depending on their opioid use behaviors. Additionally, the probability of a specified opioid use state remaining unchanged or transitioning to a different state at a defined time point would change over time.

Conclusions

The opioid use behaviors of participants are dynamic. Methadone providers should offer targeted interventions based on participants’ opioid use behaviors to effectively decrease rates of opioid use and improve retention.
Consolidation of the Anteromedial Aspect of the Tibia Is Inferior to the Other Areas in the Reconstruction of Critical-Sized Bone Defect of the Tibial Shaft Using the Induced Membrane Technique: An Analysis of 111 Serial Computed Tomography of 37 Patients
Authors: Son Whee Sung , Lim Eic Ju , Kim Beom-Soo , Choi Wonseok , Cho Jae-Woo , Oh Jong-Keon
Published: October 2024

OBJECTIVES:

To compare the consolidation quality between the anteromedial aspect of regenerated bone (AMRB) and the other areas of regenerated bone (TORB) following the induced membrane technique (IMT) for managing critical-sized tibial shaft bone defects, and determine the factors affecting consolidation quality in the AMRB.

METHODS:

Design:

Retrospective comparative study.

Setting:

Academic Level I trauma center.

Patients Selection Criteria:

Included were patients who underwent IMT with only an intramedullary nail for tibial shaft segmental defects and serial computed tomography immediately, 6 months, and 1 year postoperatively.

Outcome Measures and Comparisons:

Comparison were made of regenerative bone volume, density, and corticalization between AMRB and TORB.

RESULTS:

This study enrolled 37 patients with a mean age of 47.7 years (range 20−79). Twenty-eight (75.7%) patients were men. Postoperatively, the AMRB exhibited significantly more negative volumetric change than TORB at 0–1 year (−20.01% ± 25.59% vs. −13.32% ± 22.48%, P = 0.028), less positive density change 0–6 months (+197.84 ± 107.95 vs. +290.14 ± 131.74 Hounsfield unit (HU), P < 0.001) and 0–1 year (+377.51 ± 150.71 HU vs. +455.48 ± 135.04 HU, P < 0.001), and lower corticalization rate in 1 year (49.77% ± 29.42% vs. 82.27 ± 19.73%, P < 0.001). Significant factors included fracture-related infection (FRI) (P = 0.047 and P = 0.048 at 0–6 months and 0–1 year, respectively) and longer defect length (P = 0.032 and P = 0.020) for the negative volumetric AMRB changes; older age (P = 0.004 and P = 0.016) for the AMRB negative density changes; higher percentage of mixed recombinant human bone morphogenetic protein-2 in graft material (P = 0.013 in 0–6 months) for the AMRB positive density change; FRI (P = 0.024) for the inferior corticalization rate of the AMRB; FRI (P = 0.026 in 0–1 year), longer defect length (P = 0.017 in 0–6 months), and higher mixed demineralized bone matrix percentage (P = 0.010 in 0–1 year) for the difference in density change between the AMRB and TORB; higher mixed demineralized bone matrix percentage (P = 0.023) for the difference between the AMRB and TORB in corticalization rates.

CONCLUSIONS:

The tibial shaft's anteromedial aspects demonstrated significantly inferior consolidation after IMT, especially in terms of volume at 6 months, density at 6 months and 1 year, and corticalization at 1 year postoperatively.

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Plasma exchange and intravenous immunoglobulin prolonged the survival of a porcine kidney xenograft in a sensitized, deceased human recipient
Authors: Ma Shuaijun , Qi Ruochen , Han Shichao , Li Zhengxuan , Zhang Xiaoyan , Wang Guohui , Liu Kepu , Xu Tong , Zhang Yang , Han Donghui , Zhang Jingliang , Wei Di , Fan Xiaozheng , Pan Dengke , Jia Yanyan , Li Jing , Wang Zhe , Zhang Xuan , Yang Zhaoxu , Tao Kaishan , Yang Xiaojian , Dou Kefeng , Qin Weijun
Published: October 2024

Background:

The primary limitation to kidney transplantation is organ shortage. Recent progress in gene editing and immunosuppressive regimens has made xenotransplantation with porcine organs a possibility. However, evidence in pig-to-human xenotransplantation remains scarce, and antibody-mediated rejection (AMR) is a major obstacle to clinical applications of xenotransplantation.

Methods:

We conducted a kidney xenotransplantation in a deceased human recipient using a porcine kidney with five gene edits (5GE) on March 25th, 2024 at Xijing Hospital, China. Clinical-grade immunosuppressive regimens were employed, and the observation period lasted 22 days. We collected and analyzed the xenograft function, ultrasound findings, sequential protocol biopsies, and immune surveillance of the recipient during the observation.

Results:

The combination of 5GE in the porcine kidney and clinical-grade immunosuppressive regimens prevented hyperacute rejection. The xenograft kidney underwent delayed graft function in the first week, but urine output increased later and the single xenograft kidney maintained electrolyte and pH homeostasis from postoperative day (POD) 12 to 19. We observed AMR at 24 h post-transplantation, due to the presence of pre-existing anti-porcine antibodies and cytotoxicity before transplantation; this AMR persisted throughout the observation period. Plasma exchange and intravenous immunoglobulin treatment mitigated the AMR. We observed activation of latent porcine cytomegalovirus toward the end of the study, which might have contributed to coagulation disorder in the recipient.

Conclusions:

5GE and clinical-grade immunosuppressive regimens were sufficient to prevent hyperacute rejection during pig-to-human kidney xenotransplantation. Pre-existing anti-porcine antibodies predisposed the xenograft to AMR. Plasma exchange and intravenous immunoglobulin were safe and effective in the treatment of AMR after kidney xenotransplantation.
Hydroxypropyl methylcellulose remove dense water droplets during fluid-air exchange on the posterior surface of intraocular lenses with posterior capsule loss
Authors: Ma Chao , Li Haoyu , Li Xinmin , Li Long
Published: October 2024

Purpose:

The research investigates the efficacy of hydroxypropyl methylcellulose (HPMC) treatment in facilitating the development of compact water droplets on the rear surface of synthetic lenses with capsule imperfections during the process of fluid-air exchange.

Method:

This study examined four patients with intraocular lens (IOL) implants and posterior capsule defects who experienced the formation of dense water droplets on the posterior surface following fluid-air exchange. When this occurrence obstructs fundus visualization during surgery, it is recommended to suspend the surgical procedure. Upon removal of the non-contact fundoscope and inspection of the IOL, the presence of dense water droplets becomes evident. Subsequently, the removal of bubbles can be achieved by employing a blunt needle filled with HPMC, which is subsequently administered to the area posterior to the intraocular lens. Subsequently, the HPMC should be uniformly distributed on IOL back surface using the blunt needle.

Results:

During the surgical procedure, it was noted that all patients attained a clear fundus field of vision after the administration of HPMC and insertion of the IOL, facilitating the successful execution of subsequent surgical procedures.

Conclusion:

HPMC serves as a suitable viscoelastic agent for the elimination of dense water droplets adhered to the surface of intraocular lenses following application, consequently maintaining a clear visual field of the fundus. This surgical intervention is characterized by its efficacy and safety.
ALTERATION OF TREATMENT CHOICES AND THE VISUAL PROGNOSIS FOR DIABETIC MACULAR EDEMA IN THE ERA OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR DRUGS
Authors: Shimura Masahiko , Hirano Takao , Tsuiki Eiko , Takamura Yoshihiro , Morizane Yuki , Akiyama Kunihiko , Yamamoto Kaori , Hikichi TAIICHI , Koto Takashi , Kinoshita Takamasa , Kusuhara Sentaro , Yoshida Shigeo , Sakamoto Shin-ichi , Kimura Kazuhiro , Sugimoto Masahiko , Kida Teruyo , Mitamura Yoshinori , Takatsuna Yoko , Washio Noriaki , Osaka Rie , Ueda Tetsuki , Minamoto Akira , Kogo Jiro , Okamoto Fumiki , Enaida Hiroshi , Sakanishi Yoshihito , Nagaoka Taiji , Gomi Fumi , Sasaki Mariko , Terasaki Hiroto , Iwase TAKESHI , Tatsumi Tomoaki , Nishi Kosuke , Shinoda Kei , Ueda Shunichiro , Ueda-Consolvo Tomoko , Nakashizuka Hiroyuki , Murata Toshinori , Kitano Shigehiko , Sakamoto Taiji ,   on behalf of the J-CREST STREAT-DME 2 Study Group
Published: October 2024

Purpose:

To assess the real-world outcome of best-corrected visual acuity after 2-year intervention for treatment-naive diabetic macular edema since the approval of anti-vascular endothelial growth factor therapy.

Methods:

A total of 1,780 treatment-naive eyes with diabetic macular edema for which intervention was initiated between 2015 and 2019, and which were followed for 2 years, were extracted from the longitudinal medical records of 37 retinal disease institutions in Japan. Interventions included anti-VEGF therapy, topical corticosteroid therapy, macular photocoagulation, and vitrectomy. The baseline and final best-corrected visual acuity, and the number and timing of interventions were recorded. Eyes were classified according to the year in which intervention was initiated.

Results:

Over a 2-year period, best-corrected visual acuity improved annually, finally reaching seven letters. The proportion of eyes in which good vision was maintained (best-corrected visual acuity >20/40) increased to 73.3% in the latest period. The administration of anti-VEGF therapy remained stable, accounting for approximately 90% of eyes. Notably, the proportion of eyes receiving anti-VEGF drugs as first-line treatment increased dramatically to approximately 80%.

Conclusion:

Anti-VEGF therapy has become the first-line treatment since the approval of anti-VEGF drugs for diabetic macular edema. These findings reflect the evolution of diabetic macular edema treatment and highlight the superiority of anti-VEGF therapy and its increased uptake over time.
NR2E3-Associated Retinopathy Presenting with Bilateral Choroidal Neovascularization
Authors: Sun Christopher , Tan Tien-En , Bylstra Yasmin , Chiam Nathalie P.Y. , Mathur Ranjana S. , Chan Choi Mun , Chen Li Yu , Poh Joey S.Z. , Tang Rachael W.C. , Gemmy Cheung Chui Ming , Fenner Beau J.
Published: October 2024

Purpose:

We describe an atypical presentation of an 11-year-old female with enhanced S-cone syndrome (ESCS).

Methods:

Case report. The patient underwent a thorough ophthalmic examination and investigations such as colour fundus photography, optical coherence tomography, fundus autofluorescence, fluorescein and indocyanine angiography, an electroretinogram and genetic testing. After determining the presence of secondary choroidal neovascularization, we treated her with intravitreal Ranibizumab injections. We present her progress and a brief literature review about ESCS.

Results:

An 11-year-old hyperopic female with no known family history of retinal disease or nyctalopia presented with bilateral reduced visual acuity (20/100 OD, 20/200 OS). Examination disclosed bilateral macular choroid neovascularization (CNV) with retinochoroidal anastomosis on the left eye, bilateral nummular deposits at the superior macular arcades. All three of her siblings, aged 7-14, were asymptomatic but were also hyperopic and had intraretinal schisis and focal loss or attenuation of the ellipsoid zone on optical coherence tomography (OCT). Electrophysiology showed a reduced scotopic response and a dramatically enhanced response to full field blue light stimuli meant to elicit a response primarily from S-cones. Genetic testing confirmed the presence of biallelic NR2E3 variants. Treatment with monthly intravitreal anti-VEGF resulted in improved visual acuity of 20/30 on the right eye, while the left eye had a persistent nodular scar and visual acuity remained at 20/200.

Conclusion:

We describe a case of bilateral CNV in a young patient with enhanced S-cone syndrome, discuss differentials and treatment approaches. This case highlights the risk of CNV in ESCS and the importance of family screening and follow-up in affected relatives.