bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth and production of superior rice varieties in freshwater swampland at the Alabio Polder, Hulu Sungai Utara
Authors: Maharani Puspita Harum , Noor Aidi , Yasin Muhammad , Ningsih Rina Dirgahayu , Yuliani Nurmili
Published: September 2023

The freshwater swampland is one alternative as a source of food production in Indonesia because it is quite fertile and vast about 25.20 million ha. Several limitations of this area includes unpredictable water regime, floods in the rainy season, and drought in the dry season. The objective of this study is to evaluate new high yielding varieties and planting system in the freshwater swampland. The experiments were carried out in the freshwater swampland of the Alabio polder area, Teluk Cati Village, Hulu Sungai Utara Regency covering an area of 5 ha, in the dry season in 2013 and 2014. In 2013 there were two kinds of treatment: planting system (2:1 and 4:1) and varieties (Ciherang, Inpari-1, Inpari-17, and Inpari-19). In 2014, the treatment were varities (Ciherang, Inpari-1, Inpari-17 and Inpari-30) and planted by jajar legowo planting 4:1. The treatments were implemented by randomized block design with 10 replication. This study indicates that high-yielding varieties can increase rice productivity and farmer income. Rice productivity in the two growing seasons ranges from 4.46 to 7.12 t ha−1 dry grain. The study concluded that at freshwater swampland, jajar legowo (2:1 and 4:1) was not significantly different. The new superior varieties of rice like Inpari-1, Inpari-17 dan Inpari-30 can increase the productivity and income of farmers at Teluk Cati Village. In 2013 n 2014, the yield of inpari varieties (1, 17, 19, 30) were higher than ciherang, average yield 5,91 t/ha. Rice farming on freshwater swampland is profitable (RC−1 3.09 and 2.78) and feasible (BC−1 2.09 and 1.78).
Between Democratic Modernization and Authoritarian Punitiveness in Brazil: Mass Incarceration, Political Rationalities and the Dynamics of Subnational Variation
Authors: Fonseca David S
Published: September 2023

Since the return to democracy in the 1980s, the Federal government in Brazil promoted the democratic modernization of the criminal justice apparatus. However, the arrival of a post-neoliberal government to the federal administration at the beginning of the century took place simultaneously with the emergence of mass incarceration. Rather than readily blaming their penal policies for this development, the present work addresses aspects of subnational variation and different political rationalities for comprehending this increase in the prison population. The coexistence of neoliberal and post-neoliberal rationalities of governance around the country between 2007 and 2018 corresponded to significantly diverse trends in incarceration at the state level, in which neoliberal governments played a more prominent role. Besides, authoritarian punitiveness has acted as an obstacle to the modernization of crime and punishment practices and institutions throughout this period. The resurgence of authoritarianism as an autonomous political rationality in the 2018 elections reconfigured policies and attitudes in the field, mostly by reversing past modernizing efforts.
Should teachers use Platonic or Aristotelian dialogues for the moral education of young people?
Authors: Sanderse Wouter
Published: September 2023

Is a neo-Platonic theory of moral education better than a neo-Aristotelian one, because the former offers a dialogue method that teachers can use in universities to induce epiphanies in students, in order to jump-start the moral development of those with a rather vicious character? In this paper, this claim, put forward by Jonas and Nakazawa in their book A Platonic Theory of Moral Education, is evaluated. Admittedly, the Nicomachean Ethics, which came to us in the form of a collection of edited lecture notes, gives the impression that Aristotle was not interested in dialogue. But by looking at the dialogical form of the Ethics and by consulting some of his ideas on logic, I show that Aristotle’s oeuvre does include valuable ideas about how teachers may conduct dialogues with their students. These dialogues may not yield epiphanies and will not convert vicious adults, but they are suitable for reaching most students and can appeal to their emotions and practical wisdom. While Jonas and Nakazawa argue that Plato and Aristotle only agree on the centrality of habituation, imitation, and role-modelling in their accounts of moral education, I conclude that dialogue should be added to that list.
Platonic character education
Authors: Mintz Avi I
Published: September 2023

In A Platonic Theory of Moral Education, Mark Jonas and Yoshiaki Nakazawa have argued that Plato outlines a theory of virtue education. Alkis Kotsonis has similarly argued that Plato articulated a theory of intellectual character education. I think that Jonas, Nakazawa, and Kotsonis have opened a productive line of enquiry on this matter, and I expand on their work in this paper by identifying connections between Plato’s work and the contemporary discourse on character education, which features four domains of virtues: moral, intellectual, civic, and performance virtues. Plato’s treatment of virtue, I argue, not only can be mapped onto the contemporary treatment of character education but it also further demonstrates that cultivating virtue—the project of character education—was a paramount concern for Plato.
Isolation and Identification of the Causal Agent of Top Rot and the Genetic Architecture of Resistance in Maize
Authors: Liu Huanhuan , Zhao Chunyue , Wang Yan , Ye Shiyu , He Yonghui , Hu Qinying , Yin Zhitong
Published: September 2023

In maize (Zea mays), the disease known as “top rot” causes necrosis of the upper plant, disrupts tassel formation and pollen dispersal, and decreases yield. However, the causal agent, mode of pathogen infestation, and genetic architecture of resistance in maize remain to be explored. Here, to identify the causal agent, we isolated 41 fungal strains from maize plants infected with top rot. We classified these strains into six groups based on their morphological and molecular characteristics. Four species of Fusarium (F. fujikuroi, F. equiseti, F. proliferatum, and F. verticillioides) were able to cause top rot, with F. fujikuroi and F. equiseti being the main causal agents. Microscopic observations of a F. fujikuroi strain labeled with enhanced green fluorescent protein revealed that this pathogen first colonizes the stomata of leaves and then spreads through intercellular spaces, creating an expanding lesion. To dissect the genetic basis of maize resistance to top rot, we performed quantitative trait locus (QTL) mapping using a recombinant inbred line population constructed from the resistant parent LDC-1 and the susceptible parent YS501. Under natural conditions in Yangzhou and Hainan, we detected three and five QTLs, respectively, with qRtr7-1, located on chromosome 7, detected in both environments. Using inoculated seedlings, we detected three QTLs for resistance on chromosomes 1, 5, and 8. These results improve our understanding of maize top rot and provide a theoretical basis for its control.
Diversity of Lasiodiplodia Species Associated with Canker and Dieback in Fruit Trees in the Henan and Shandong Provinces of China
Authors: Wang Yanfen , Song Xinzheng , Xie Shunpei , Geng Yuehua , Xu Chao , Yin Xinming , Zang Rui , Guo Lihua , Zhang Meng , Guo Yashuang
Published: September 2023

Lasiodiplodia is a widely distributed genus that is associated with a variety of diseases in many plant species, especially fruit trees. In this study, a disease survey of fruit trees growing in 12 orchards located in the Henan and Shandong provinces of China was conducted between 2020 and 2022. The symptoms observed included stem canker, branch dieback, and gummosis. Phylogenetic analyses of internal transcribed spacer, tub2, tef1, and rpb2 sequence data combined with morphological characteristics revealed that the 19 isolates collected during the survey belonged to five documented Lasiodiplodia species, namely, Lasiodiplodia citricola, L. chiangraiensis, L. huangyanensis, L. pseudotheobromae, and L. theobromae, and two previously undescribed species, L. xinyangensis and L. ziziphi. In addition, the survey identified three novel host–pathogen interactions: L. chiangraiensis on loquat, L. citricola on apple, and L. huangyanensis on grapevine. Furthermore, the detailed phylogenic analysis indicated that four previously described Lasiodiplodia species were genetically very closely related that they would be better classified as synonyms rather than distinct species, so L. paraphysoides and L. nanpingensis should be considered synonyms of L. citricola, L. fujianensis should be a synonym of L. iraniensis, and L. henanica should be a synonym of L. huangyanensis. Pathogenicity tests confirmed that representative isolates of the two novel species and three new host–pathogen interactions identified in the current study were pathogenic to their original hosts, thereby fulfilling Koch’s postulates. Similarly, all of the isolates were found to be pathogenic on four alternative hosts, although a high degree of variation in virulence was observed.
Progranulin deficiency exacerbates cardiac remodeling after myocardial infarction
Authors: Sasaki Takahiro , Kuse Yoshiki , Nakamura Shinsuke , Shimazawa Masamitsu , Hara Hideaki
Published: September 2023

Myocardial infarction (MI) is a lethal disease that causes irreversible cardiomyocyte death and subsequent cardiovascular remodeling. We have previously shown that the administration of recombinant progranulin (PGRN) protects against myocardial ischemia and reperfusion injury. However, the post‐MI role of PGRN remains unclear. In the present study, we investigated the effects of PGRN deficiency on cardiac remodeling after MI. Wild‐type and PGRN‐knockout mice were subjected to MI by ligation of the left coronary artery for histological, electrophysiological, and protein expression analysis. Cardiac macrophage subpopulations were analyzed by flow cytometry. Bone marrow‐derived macrophages (BMDMs) were acquired and treated with LPS + IFN‐γ and IL‐4 to evaluate mRNA levels and phagocytic ability. PGRN expression was gradually increased in the whole heart at 1, 3, and 7 days after MI. Macrophages abundantly expressed PGRN at the border areas at 3 days post‐MI. PGRN‐knockout mice showed higher mortality, increased LV fibrosis, and severe arrhythmia following MI. PGRN deficiency increased the levels of CD206 and MerTK expression and macrophage infiltration in the infarcted myocardium, which was attributed to a larger subpopulation of cardiac CCR2+ Ly6Clow CD11b+ macrophages. PGRN‐deficient BMDMs exhibited higher TGF‐β, IL‐4R, and lower IL‐1β, IL‐10 and increased acute phagocytosis following stimulation of LPS and IFN‐γ. PGRN deficiency reduced survival and increased cardiac fibrosis following MI with the induction of abnormal subpopulation of cardiac macrophages early after MI, thereby providing insight into the relationship between properly initiating cardiac repair and macrophage polarization after MI.
Outcomes of Emergency Department Patients With Opioid Use Disorder Utilizing a Virtual Addiction Bridge Clinic: A Case Series
Authors: Wills Brandon K. , Ringwood Katy J. , Davis Theresa T. , Provost Rosellen , Bachireddy Chethan , Wang Jennifer , Keyser-Marcus Lori , Moeller F. Gerard
Published: September 2023

Objectives

Within the last decade, there has been a dramatic increase in the rate of emergency department (ED) visits and death from opioid overdose. Those who present to the ED are at high risk for subsequent morbidity and mortality. Despite effective treatment, many patients do not get rapidly connected to outpatient care. The aim of this investigation was to describe outpatient treatment engagement after ED discharge among patients with opioid use disorder (OUD) enrolled in a virtual Addiction Bridge Clinic (ABC).

Methods

This was a retrospective case series describing an ED-initiated referral for rapid telehealth follow-up among patients with OUD. The primary outcome was addiction treatment engagement among those who completed the initial virtual ABC visit (engaged in ABC) vs. those who did not complete an ABC visit (Not engaged in ABC) at 1 week, 1 month, and 3 and 6 months timepoint intervals after the initial ED presentation.

Results

Of the N = 201 patients referred to the ABC between March and December 2021, a majority were Black (71%) and male (77%). Of the 201 referrals, 85 (42%) completed an initial ABC telehealth visit. Subsequent treatment engagement was 26% at 1 week, 26% at 1 month, 22% at 3 months, and 18% at 6 months after the index ED visit.

Conclusions

A telehealth-enabled virtual addiction bridge clinic is one potential approach to reduce barriers to rapid treatment access. Strategies are needed to improve subsequent addiction treatment engagement after a virtual addiction bridge clinic visit.
Fracture Patterns and Mortality in Osteopetrosis: A 7-year Retrospective Analysis from Türkiye’s National Registry
Authors: Bingöl Olgun , Yaşar Niyazi Erdem , Özdemir Güzelali , Bekmez Şenol , Söylemez Mehmet Salih , Dumlupinar Ebru , Ayvali Mustafa Okan , Ata Naim , Ülgü M. Mahir , Birinci Şuayip , Bingöl İzzet
Published: September 2023

Background:

The aim of this study is to determine the demographic data, fracture treatment methods, and medical treatments of patients diagnosed with osteopetrosis in the national registry.

Methods:

Patients with International Classification of Diseases (ICD)-10 code Q78.2 for osteopetrosis between January 1, 2016 and April 11, 2023 were retrospectively reviewed. Data on sex, age at time of diagnosis, fracture history, mortality, and use of medications were evaluated for all patients. In addition, open reduction and internal fixation, closed reduction and internal fixation, closed reduction and casting, and conservative treatment methods were noted. The number of patients requiring deformity surgery was determined. The incidence and prevalence of osteopetrosis were also calculated in this cross-sectional study.

Results:

A total of 476 patients diagnosed with osteopetrosis were identified. The mean age at time of diagnosis of these patients was 5.79 ± 5.43 years. A total of 101 patients died. As the age at diagnosis decreased, the mortality rate of the patients increased with statistical significance (P<0.001). A total of 192 fractures were seen in 121 osteopetrosis patients in this study. Femur fractures were most common among these patients with osteopetrosis. A history of fracture was statistically significantly less common in patients using a combination of vitamin D + calcium compared with patients not using such medication (P<0.001). In this 7-year cross-sectional study, the incidence was found to be 1 in 416,000 and the prevalence was 0.00199% in the population under 18 years of age.

Conclusion:

Younger age at diagnosis is associated with higher mortality in patients with osteopetrosis. In addition, the combination of vitamin D and calcium were associated with lower fracture incidence.

Level of Evidence:

Prognostic Level II.
The Pressure Is on: Dorsal Versus Volar Univalves for Long-arm Casts
Authors: Udall Dallyn , Zimmerman Remy , Bastrom Tracey , Schlechter John
Published: September 2023

Background:

Fiberglass casts are routinely used to treat fractures of the upper extremity. When posttraumatic edema is anticipated, the cast is often valved to hopefully prevent potential complications, especially compartment syndrome. Due to volar forearm compartments being most involved with upper extremity compartment syndrome, volar skin surface pressures (SSP) are paramount. Despite past literature showing that a univalved cast will retain a 3-point mold better than a bivalved cast, there is a paucity of information analyzing the effects of univalving on the volar SSP. We hypothesized that a volar univalve technique would have a greater decrease in the volar skin surface pressures compared to a dorsal univalve in long-arm casts.

Methods:

A 100-mL saline bag attached to an arterial line pressure transducer was placed between a long-arm cast and the skin along the volar forearm of a single adult volunteer. Fourteen casts were applied by a single certified orthopaedic technologist with 30 years of experience and assigned randomly to receive either a volar or dorsal univalve. We calculated the change in volar forearm SSP on each cast in 4 stages: isolated univalve, with a 3-mm cast spacer, with a 6-mm spacer, and with bivalve. Statistical analysis of the data was performed using a Mann-Whitney U test.

Results:

When comparing volar versus dorsal univalve, volar SSP significantly dropped by a mean of 32.00 versus 20.43 mm Hg (P value=0.001) in stage I, 45.14 versus 38.00 mm Hg in stage II (P value=0.026), and 56.53 versus 49 mm Hg in stage III (P value=0.001). There was no significant difference between the 2 groups after a bivalve was performed at stage IV (P value=0.318).

Conclusion:

Our findings support that a volar univalve with a 6-mm spacer will provide the greatest reduction of skin surface pressure while theoretically maintaining the cast’s structural integrity and biomechanical properties when compared to a bivalved cast.

Level of Evidence:

Level II, prospective comparative study.
Tracheoesophageal Fistula Closure in a Pediatric Patient Using a Supraclavicular Artery Island Flap
Authors: Seebauer Caroline T. , Völkl Melanie , Kunkel Jürgen , Künzel Julian , Kühnel Thomas , Hofmann Hans-Stefan , Bohr Christopher
Published: September 2023

Acquired tracheoesophageal fistulas can lead to large defects with fatal complications. Surgical management is challenging but necessary to prevent respiratory infections and poor weight gain. Therefore, a reliable and pliable flap like the pedicled supraclavicular artery island flap with its wide arc of rotation and robust vascularization is needed for reconstruction. We highlight the surgical technique and postoperative measures in managing a tracheoesophageal fistula due to button battery ingestion in a 9-month-old boy with the supraclavicular artery island flap. In summary, the supraclavicular artery island flap is a safe and successful tool for closure of large acquired tracheoesophageal fistulas in pediatric patients.
Carotid intima–media thickness and incident hypertension: the Brazilian Longitudinal Study of Adult Health
Authors: Dutra Robertson T. , Bensenor Isabela M. , Goulart Alessandra C. , Pereira Alexandre C. , Lotufo Paulo A. , Santos Itamar S.
Published: September 2023

Background:

High blood pressure (BP) increases carotid intima–media thickness (CIMT). On the other hand, it is not clear whether the vascular abnormalities reflected in high CIMT may predict incident hypertension. The present study aims to investigate the association between CIMT and incident hypertension after 4 years of follow-up in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multiethnic sample of middle-aged adults from six Brazilian cities.

Methods:

We analyzed data from 6682 ELSA-Brasil participants (aged 35–74) without hypertension and with complete CIMT data at baseline. After 4 years of follow-up, we describe hypertension incidence, stratifying the sample according to age, sex, and race-specific CIMT quartiles. We also built crude and adjusted Poisson regression models to analyze the association between mean and maximal CIMT values and incident hypertension.

Results:

We found incident hypertension in 987 (14.8%) participants. According to mean CIMT quartile groups, hypertension incidence varied from 10.2% (first quartile group) to 22.4% (fourth quartile group;Pfor trend <0.001). In fully adjusted models, 0.1 mm increments in mean CIMT values were associated with a 16% [relative risk (RR):1.16; 95% confidence interval (95% CI) 1.10–1.21;P < 0.001] higher risk of incident hypertension, respectively. Results were similar when maximal CIMT values were considered instead of mean CIMT values.

Conclusion:

CIMT values at baseline strongly predicted incident hypertension after 4 years of follow-up in this large multiethnic cohort. This highlights the relationship between CIMT and BP and may provide important insights into the significance of this ultrasound measurement.
Anxiety and depression in patients with uveitis: a comprehensive review of observational studies
Authors: Choo Charlene H. , Gonzales John , Shantha Jessica G.
Published: September 2023

Purpose of the review

The purpose of this review is to provide a comprehensive summary of observational studies evaluating anxiety and depression in patients with uveitis.

Recent findings

A higher prevalence of depression was reported in patients with uveitis compared to healthy controls in most observational studies. Symptoms of anxiety were often, but not always, significantly worse in patients with uveitis compared to controls. Most studies found that patients with uveitis had reduced vision-related quality of life that was associated with anxiety and depression symptoms.

Patients with uveitis have a higher risk of experiencing symptoms of depression and could benefit from screening and treatment. Preliminary screening for vision-related quality of life could also help determine if the patient requires assistance in mental health or other aspects of daily living.
Neuro-ophthalmic manifestations of autoimmune disorders: diagnostic pearls & pitfalls
Authors: Poonja Sabrina , Costello Fiona
Published: September 2023

Purpose of review

The purpose of this review is to highlight a clinical-anatomical approach to localizing neuro-ophthalmic manifestations of associated autoimmune disorders.

Recent findings

Our understanding of autoimmune conditions has changed considerably over recent years, particularly with the emergence of novel autoantibodies. Cardinal neuro-ophthalmic signs and symptoms of antibody-mediated autoimmune disorders have been well characterized; knowledge thereof may be the first step towards an accurate diagnosis.

A thorough history, further refined by a comprehensive examination are cornerstones to disease localization in clinical medicine. Taken together, these essential steps both guide investigations and facilitate early recognition of autoimmune disorders. From a neuro-ophthalmic perspective, it is important to understand heralding signs and symptoms of autoimmune syndromes, avoid cognitive errors, and remain mindful of common diagnostic pitfalls to optimize care.

Video abstract

http://links.lww.com/COOP/A61
Preoperative planning of compact zone trajectory is necessary in treating osteoporotic vertebral compression fracture with endplate involvement: A prospective randomized controlled study
Authors: Hung Pei-I , Chou Po-Hsin , Yao Yu-Cheng , Chen Kuan-Jung , Lin Hsi-Hsien , Wang Shih-Tien , Chang Ming-Chau , Liu Chien-Lin
Published: September 2023

Background:

This prospective randomized controlled study compares the clinical and radiological outcomes between reduction methods with or without compact trabecular bone during percutaneous kyphoplasty in osteoporotic vertebral fractures.

Methods:

The cohort of 100 patients who underwent percutaneous kyphoplasty was randomly divided into group A (guide pin and balloon introduced directly into fracture site) and group B (guide pin and balloon inserted away fracture site). The surgery duration, clinical and radiological outcomes postoperatively and at follow-up, and complications of cement leakage and adjacent fracture were recorded. Patients were followed up for an average of 20.18 months. The clinical outcomes were assessed using the Oswestry Disability Index and visual analog scale.

Results:

The two groups had similar patient demographics, surgery times, and volume of cement injected. The method using elevation of the collapsed endplate indirectly had no significant influence on radiological outcomes but significantly decreased the occurrence of intradiscal cement leakage and improved 1- and 12-month postoperative functional outcomes.

Conclusion:

Elevating and reinforcing the collapsed endplate rather than just filling the defect during percutaneous kyphoplasty is safe and effective. This technique decreased pain and improved function with lower rates of further collapse of the osteoporotic vertebrae compared to defect-filling alone.
“I had become fed up”: A qualitative study of Black nurse practitioners' experiences fighting against health inequity, racism, and burnout
Authors: Brooks Carthon J. Margo , Aponte Ravenne , Mason Aleigha , Nikpour Jacqueline
Published: September 2023

Background:

Increasing diversity in the nurse practitioner (NP) workforce is key to improving outcomes among patients who experience health inequities. However, few studies to date have examined the specific mechanisms by which NPs from diverse backgrounds address inequities in care delivery.

Purpose:

To explore Black NPs' efforts in addressing inequities, and the facilitators and barriers they face in doing so.

Methodology:

We conducted focus groups and interviews of Black NPs (N = 16) in the greater Philadelphia area in early 2022, just following the height of the COVID-19 pandemic and the social unrest of the early 2020s. Data were analyzed using thematic analysis.

Results:

Emergent themes included: Strategies Utilized to Address Health Inequities; Burnout & the Minority Tax; Risks & Rewards of Taking a Stance; and Uneven Promises of Organizational Engagement. Nurse practitioners prioritized patient-centered, culturally congruent care, taking additional time to explore community resources and learn about patients' lives to facilitate care planning. Participants advocated to administrators for resources to address inequities while simultaneously navigating organizational dynamics, microaggressions, and racism. Finally, NPs identified organizational-level barriers, leading to emotional exhaustion and several participants' intent to leave their roles.

Conclusions:

Black NPs use a myriad of strategies to improve equity, yet frequently face substantial barriers and emotional exhaustion in doing so with little change to the inequities in care.

Implications:

The NP workforce has a critical role to play in reducing health inequities. The strategies outlined by Black NPs in this study offer a roadmap for all clinicians and health care organizations to prioritize equity in care delivery.
Understanding Sexual and Gender Minority Populations and Organ-Based Screening Recommendations for Human Papillomavirus–Related Cancers
Authors: Jodry Dominique , Obedin-Maliver Juno , Flowers Lisa , Jay Naomi , Floyd Serina , Teoh Deanna , Conageski Christine , Downs Levi , Khan Michelle J.
Published: September 2023

Objectives

Sexual gender minority (SGM) populations are at risk for human papillomavirus (HPV)–related cancers of the anogenital tract and oropharynx and often face barriers to health care. The goals of this document are to clarify language to provide inclusive care for SGM populations and to provide recommendations for screening and prevention of HPV-related cancers in SGM populations.

Materials and Methods

An expert committee convened by the American Society for Colposcopy and Cervical Pathology performed a narrative review of the literature through February 2023. A comprehensive MEDLINE database search was performed for relevant studies. The literature review was divided into categories by organ/topic and by SGM population. Given the variability in available data for several of the categories, recommendations were made based on national guidelines where appropriate or expert opinion where there were less data to support risk-based guidelines.

Results

Definitions and terminology relevant to SGM populations are presented. The authors advocate the adoption of sexual orientation gender identity data collection and an organ-based screening approach, which is possible with knowledge of patient anatomy, sexual behaviors, and clinical history. This includes screening for cervical cancer per national recommendations, as well as screening for anal, vulvar, vaginal, penile, and oral cancers based on risk factors and shared clinical decision making. The authors recommend consideration of HPV vaccination in all SGM individuals up to age 45 years old who are at risk.

Conclusions

An organ-based screening approach is part of a global strategy to create an inclusive care environment and mitigate barriers to screening and prevention of HPV-mediated cancers in SGM populations.
Future Directions for Research on Anal Precancerous Lesion Treatment
Authors: Albuquerque Andreia
Published: September 2023

The benefit of treating anal precancerous lesions to reduce anal cancer progression was recently shown in people living with HIV. This will certainly impact the future development of recommendations on anal cancer prevention by including anal precancerous lesions screening and treatment for people living with HIV. However, by bringing this topic to the spotlight, it has also uncovered data that are still missing in this field and that need to be addressed by research.

This article will discuss the many unanswered questions about treatment of anal precancerous lesions and future directions for research.
“Check Your Vulva”—A Patient Education and Virtual Vulva Care Pilot Project
Authors: Selk Amanda , Elangainesan Praniya , Tannenbaum Evan , Wong Karen
Published: September 2023

Objective

The aim of the study is to identify whether vulvar self-examination learned from a web site could lead to a self-identification of vulvar lesions and the feasibility of virtual vulvar care with patient submitted photos.

Materials and Methods

The study used a prospective cohort design in a tertiary academic hospital over a 1-year period. Eligible participants who self-identified a vulvar lesion/skin changes were invited to send vulvar photos through a secure patient portal and schedule a phone consult to discuss diagnosis/management. Clinical data, photo interpretability, and patient satisfaction measures were collected. Self-referral patients versus vulva clinic waitlist patients were analyzed separately.

Results

Few people were interested in submitting vulvar photos online. Twenty-eight participants directly contacted the study, 8 consented, and 6 sent in vulvar photos. Forty four of 476 on the waitlist consented but only 24 of 44 sent in photos (5% of waitlist patients). The median time for a virtual assessment was 7 days for study participants while it was 18 months for the in-person usual care pathway. Most patient submitted photos were assessable. However, 60% participants needed help from another person to take the photos. More than 90% of patients required an in-person visit for their vulvar condition/concerns. While most patients were happy with the virtual process, 58% rated their satisfaction with the ease of taking photos of the genital region as “fair” or “poor.”

Conclusions

Virtual care with photos/phone calls might be feasible, although most patients are unlikely to participate. Because of patient discomfort, unease with taking photos, and patient privacy concerns, vulvar care should continue to be in-person for most new consults.
Pain management for liver transplant recipients
Authors: Kaur Simrat , Henthorn Patrick , Hendrickse Adrian
Published: September 2023

Purpose of review

Liver transplant recipients pose several pain management challenges. Altered hepatic drug metabolism and clearance in end-stage liver disease patients complicates the use of certain medications, while existing coagulopathy and thrombocytopenia can limit the use of regional anesthetic techniques. Largely due to a high prevalence of substance use disorders, these patients have increased vulnerability to opioid misuse in the perioperative period, which can make acute postoperative pain difficult to control and potentiates prolonged and painful recovery, increasing the risk of developing chronic postsurgical pain. We present current evidence-based literature that reviews optimal pain management strategies for this challenging patient demographic.

Recent findings

Multiple studies have shown that thoracic epidurals provide superior pain control in open hepatic resections. Recent data suggests thoracic epidurals may be safely considered in select liver transplant recipients with normal preoperative coagulation status; however, this evidence is limited, and further studies are needed. When the risks of coagulopathy prohibit epidural placement, truncal blocks such as transversus abdominis plane blocks or quadratus lumborum blocks and abdominal wound catheters can serve as alternative regional modalities. Specialized teams should manage pain using a multimodal approach.

Thoracic epidural analgesia may be an option for liver transplant recipients with normal coagulation profiles prior to surgery; however, additional studies are warranted. Other regional techniques are also available. Emphasis should be placed on optimizing multimodal pain medication management. Nonpharmacological interventions should also be considered.
Research on texture images and radiomics in urology: a review of urological MR imaging applications
Authors: Valeri Antoine , Nguyen Truong An
Published: September 2023

Purpose of review

Tumor volume and heterogenicity are associated with diagnosis and prognosis of urological cancers, and assessed by conventional imaging. Quantitative imaging, Radiomics, using advanced mathematical analysis may contain information imperceptible to the human eye, and may identify imaging-based biomarkers, a new field of research for individualized medicine. This review summarizes the recent literature on radiomics in kidney and prostate cancers and the future perspectives.

Recent findings

Radiomics studies have been developed and showed promising results in diagnosis, in characterization, prognosis, treatment planning and recurrence prediction in kidney tumors and prostate cancer, but its use in guiding clinical decision-making remains limited at present due to several limitations including lack of external validations in most studies, lack of prospective studies and technical standardization.

Future challenges, besides developing prospective and validated studies, include automated segmentation using artificial intelligence deep learning networks and hybrid radiomics integrating clinical data, combining imaging modalities and genomic features. It is anticipated that these improvements may allow identify these noninvasive, imaging-based biomarkers, to enhance precise diagnosis, improve decision-making and guide tailored treatment.
Utilizing a Tailored Approach to Standardized Screening of Health-Related Social Needs
Authors: Wright Qaashuntae C. , Wiencek Clareen A. , Williams Ishan C.
Published: September 2023

Background:

Despite the increased awareness of social determinants of health (SDoH), integrating social needs screening into health care practice has not consistently occurred.

Local Problem:

No social needs screening using recommended standardized questions was available at an outpatient hemodialysis clinic.

Methods:

Plan-Do-Study-Act cycles, based on the Model for Improvement, were used to implement the Core 5 SDoH screening tool, a staff referral process, and an evaluation of the implementation process.

Intervention:

A standardized social needs screening tool and a staff referral process were implemented. An evaluation of the implementation process also occurred.

Results:

Of 73 patients screened, 21 reported 32 unmet social needs; all received referrals to community resources. Nurses demonstrated high acceptance and usability of the tool and the referral process.

Conclusions:

Implementing a standardized screening and referral process customized to clinical workflow enhanced the identification of social needs in patients undergoing hemodialysis.
Assessing Neglect in Pediatric Environmental Deaths
Authors: Mahar Tara J. , Keyes Kelly , Ely Susan F. , Dennison Emily H. , Gill James R.
Published: September 2023

There are 4 common types of environmental pediatric deaths that may involve various degrees of neglect: hyperthermia, ingestion, drownings, and unsafe infant sleep practices. Because the circumstances surrounding each are disparate, there is no set of standards by which these factors may be weighed and interpreted. Given the same facts, the manner of death certification may differ depending upon training/experience and/or local practice.

To assess certification variations, 147 board-certified forensic pathologists were surveyed for the choice of manner in scenarios with different degrees of negligence intent. In addition to evaluating certification consistency, the survey examined whether certain factors affected the choice. The results demonstrated strong consistency in certain scenarios and widely disparate certifications in others.

Medical examiner/coroner certifications are administrative decisions for vital statistical purposes. The manner of death reflects an evidence-based conclusion, but because it is ultimately an opinion, determinations may vary. Based on the survey, some certification criteria were identified (ie, intent, child age, and knowingly placing a child in an environment with a reasonable risk of harm). Using these criteria may improve consistency, but it is unreasonable to expect 100% concordance. Understanding the certificate's role helps to place the manner in the proper legal and public health contexts.
What is the clinical significance of ‘heteroresistance’ in nonfermenting Gram-negative strains?
Authors: Tiseo Giusy , Galfo Valentina , Falcone Marco
Published: September 2023

Purpose of review

The aim of this study was to discuss the potential clinical significance of heteroresistance in nonfermenting Gram-negative bacilli (GNB).

Recent findings

Recently, heteroresistance has been considered potentially responsible for clinical failure in Acinetobacter baumannii infections. This raised a scientific debate, still open, about the potential clinical significance of heteroresistance in nonfermenting GNB.

We reviewed the literature of last 20 years and found a limited number of studies evaluating the relationship between heteroresistance and clinical outcome in nonfermenting GNB. Unlike Gram-positive bacteria, heteroresistance is reported in a significant proportion of nonfermenting GNB with some studies describing it in all tested strains and for several antibiotics (including tigecycline, carbapenems, levofloxacin, cefiderocol, colistin). One important issue is the need for validated detection method since the population analysis profile test, that is considered the gold standard, requires high costs and time. Studies evaluating the correlation between heteroresistance and clinical outcome are contrasting and have several limitations. Although in-vitro detection of heteroresistance in nonfermenting GNB has not been associated with in-vivo treatment failure, its presence may suggest to prefer combination regimens instead monotherapy when treating infections by nonfermenters. Further studies are needed to clarify the clinical significance of heteroresistance.
Risk factors for severity in seasonal respiratory viral infections and how they guide management in hematopoietic cell transplant recipients
Authors: Matsui Toshihiro , Ogimi Chikara
Published: September 2023

Purpose of review

Seasonal respiratory virus infections (RVIs) often progress to severe diseases in hematopoietic cell transplant (HCT) recipients. This review summarizes the current evidence on risk factors for the severity of RVIs in this high-risk population and provides clinical management.

Recent findings

The likelihood of the respiratory viral disease progression depends on the immune status of the host and the type of virus. Conventional host factors, such as the immunodeficiency scoring index and the severe immunodeficiency criteria, have been utilized to estimate the risk of progression to severe disease, including mortality. Recent reports have suggested nonconventional risk factors, such as hyperglycemia, hypoalbuminemia, prior use of antibiotics with broad anaerobic activity, posttransplant cyclophosphamide, and pulmonary impairment after RVIs. Identifying novel and modifiable risk factors is important with the advances of novel therapeutic and preventive interventions for RVIs.

Validation of recently identified risk factors for severe RVIs in HCT recipients is required. The development of innovative interventions along with appropriate risk stratification is critical to improve outcomes in this vulnerable population.
Aneurysmal growth in type-B aortic dissection: assessing the impact of patient-specific inlet conditions on key haemodynamic indices
Authors: Stokes C. , Ahmed D. , Lind N. , Haupt F. , Becker D. , Hamilton J. , Muthurangu V. , von Tengg-Kobligk H. , Papadakis G. , Balabani S. , Díaz-Zuccarini V.
Published: September 2023

Type-B aortic dissection is a cardiovascular disease in which a tear develops in the intimal layer of the descending aorta, allowing pressurized blood to delaminate the layers of the vessel wall. In medically managed patients, long-term aneurysmal dilatation of the false lumen (FL) is considered virtually inevitable and is associated with poorer disease outcomes. While the pathophysiological mechanisms driving FL dilatation are not yet understood, haemodynamic factors are believed to play a key role. Computational fluid dynamics (CFD) and 4D-flow MRI (4DMR) analyses have revealed correlations between flow helicity, oscillatory wall shear stress and aneurysmal dilatation of the FL. In this study, we compare CFD simulations using a patient-specific, three-dimensional, three-component inlet velocity profile (4D IVP) extracted from 4DMR data against simulations with flow rate-matched uniform and axial velocity profiles that remain widely used in the absence of 4DMR. We also evaluate the influence of measurement errors in 4DMR data by scaling the 4D IVP to the degree of imaging error detected in prior studies. We observe that oscillatory shear and helicity are highly sensitive to inlet velocity distribution and flow volume throughout the FL and conclude that the choice of IVP may greatly affect the future clinical value of simulations.
Perivascular pumping of cerebrospinal fluid in the brain with a valve mechanism
Authors: Gan Yiming , Holstein-Rønsbo Stephanie , Nedergaard Maiken , Boster Kimberly A. S. , Thomas John H. , Kelley Douglas H.
Published: September 2023

The flow of cerebrospinal fluid (CSF) along perivascular spaces (PVSs) is an important part of the brain’s system for clearing metabolic waste. Experiments reveal that arterial motions from cardiac pulsations and functional hyperaemiadrive CSF in the same direction as the blood flow, but the mechanism producing this directionality is unclear. Astrocyte endfeet bound the PVSs of penetrating arteries, separating them from brain extracellular space (ECS) and potentially regulating flow between the two compartments. Here, we present two models, one based on the full equations of fluid dynamics and the other using lumped parameters, in which the astrocyte endfeet function as valves, regulating flow between the PVS and the ECS. In both models, cardiac pulsations drive a net CSF flow consistent with prior experimental observations. Functional hyperaemia, acting with cardiac pulsation, increases the net flow. We also find, in agreement with experiments, a reduced net flow during wakefulness, due to the known decrease in ECS permeability compared to the sleep state. We present
in vivo
imaging of penetrating arteries in mice, which we use to measure accurately the amplitude of their constrictions and dilations during both cardiac pulsation and functional hyperaemia, an important input for the models. Our models can be used to explore the effects of changes in other input parameters, such as those caused by ageing or disease, as better measurements of these parameters become available.
The effect of fibre cell remodelling on the power and optical quality of the lens
Authors: Rodriguez J. , Tan Q. , Šikić H. , Taber L. A. , Bassnett S.
Published: September 2023

Vertebrate eye lenses are uniquely adapted to form a refractive index gradient (GRIN) for improved acuity, and to grow slowly in size despite constant cell proliferation. The mechanisms behind these adaptations remain poorly understood. We hypothesize that cell compaction contributes to both. To test this notion, we examined the relationship between lens size and shape, refractive characteristics and the cross-sectional areas of constituent fibre cells in mice of different ages. We developed a block-face imaging method to visualize cellular cross sections and found that the cross-sectional areas of fibre cells rose and then decreased over time, with the most significant reduction occurring in denucleating cells in the adult lens cortex, followed by cells in the embryonic nucleus. These findings help reconcile differences between the predictions of lens growth models and empirical data. Biomechanical simulations suggested that compressive forces generated from continuous deposition of fibre cells could contribute to cellular compaction. However, optical measurements revealed that the GRIN did not mirror the pattern of cellular compaction, implying that compaction alone cannot account for GRIN formation and that additional mechanisms are likely to be involved.
Methanol on the rocks: green rust transformation promotes the oxidation of methane
Authors: Farr Orion , Gaudu Nil , Danger Gregoire , Russell Michael J. , Ferry Daniel , Nitschke Wolfgang , Duval Simon
Published: September 2023

Shared coordination geometries between metal ions within reactive minerals and enzymatic metal cofactors hints at mechanistic and possibly evolutionary homology between particular abiotic chemical mineralogies and biological metabolism. The octahedral coordination of reactive Fe
2+/3+
minerals such as green rusts, endemic to anoxic sediments and the early Earth's oceans, mirrors the di-iron reaction centre of soluble methane monooxygenase (sMMO), responsible for methane oxidation in methanotrophy. We show that methane oxidation occurs in tandem with the oxidation of green rust to lepidocrocite and magnetite, mimicking radical-mediated methane oxidation found in sMMO to yield not only methanol but also halogenated hydrocarbons in the presence of seawater. This naturally occurring geochemical pathway for CH
4
oxidation elucidates a previously unidentified carbon cycling mechanism in modern and ancient environments and reveals clues into mineral-mediated reactions in the synthesis of organic compounds necessary for the emergence of life.
Multispecies interactions shape the transition to multicellularity
Authors: Kalambokidis Maria , Travisano Michael
Published: September 2023

The origin of multicellularity transformed the adaptive landscape on Earth, opening diverse avenues for further innovation. The transition to multicellular life is understood as the evolution of cooperative groups which form a new level of individuality. Despite the potential for community-level interactions, most studies have not addressed the competitive context of this transition, such as competition between species. Here, we explore how interspecific competition shapes the emergence of multicellularity in an experimental system with two yeast species,
Saccharomyces cerevisiae
and
Kluyveromyces lactis
, where multicellularity evolves in response to selection for faster settling ability. We find that the multispecies context slows the rate of the transition to multicellularity, and the transition to multicellularity significantly impacts community composition. Multicellular
K. lactis
emerges first and sweeps through populations in monocultures faster than in cocultures with
S. cerevisiae
. Following the transition, the between-species competitive dynamics shift, likely in part to intraspecific cooperation in
K. lactis
. Hence, we document an eco-evolutionary feedback across the transition to multicellularity, underscoring how ecological context is critical for understanding the causes and consequences of innovation. By including two species, we demonstrate that cooperation and competition across several biological scales shapes the origin and persistence of multicellularity.