bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma MERTK Is a Promising Biomarker for the Diagnosis and Prognosis of Hepatitis B Virus–Related Acute-on-Chronic Liver Failure
Authors: Lu Yingyan , Xin Jiaojiao , Liang Xi , Luo Jinjin , Li Peng , Zhou Xingping , Yang Hui , Li Jun , Wang Yifan
Published: February 2024

Background

Hepatitis B virus–related acute-on-chronic liver failure (HBV-ACLF) has a high short-term mortality. This study aimed to determine the diagnostic and prognostic role of MER tyrosine kinase (MERTK) in patients with HBV-ACLF.

Methods

Transcriptomics analysis evaluated MERTK expression and function during disease progression. The diagnostic and prognostic significance of MERTK for patients with HBV-ACLF were verified by enzyme-linked immunosorbent assay, area under the receiver operating characteristic curve (AUROC) analysis, and immunohistochemistry (IHC) of liver tissues.

Results

MERTK mRNA was highly expressed in patients with HBV-ACLF compared to those with liver cirrhosis (LC), chronic hepatitis B (CHB), and normal controls (NC). Elevated MERTK mRNA predicted poor prognosis for HBV-ACLF at 28 and 90 days (AUROC = 0.814 and 0.731, respectively). Functional analysis showed MERTK was significantly associated with toll-like receptor and inflammatory signaling and several key biological processes. External validation with 285 plasma subjects confirmed the high diagnostic accuracy of plasma MERTK for HBV-ACLF (AUROC = 0.859) and potential prognostic value for 28- and 90-day mortality rates (AUROC = 0.673 and 0.644, respectively). Risk stratification analysis indicated higher mortality risk for patients with plasma MERTK level above the cutoff value. Moreover, IHC staining showed increasing MERTK expression from NC, CHB, and LC to HBV-ACLF.

Conclusions

MERTK shows promise as a candidate biomarker for early diagnosis and prognosis of HBV-ACLF.
Ontological Crisis and the Compartmentalization of Insecurities
Authors: Tsintsadze-Maass Eteri
Published: February 2024

This article explores state responses to a major ontological crisis, which produces insecurities requiring contradictory foreign policy responses. I propose that leaders in such dire situations may respond by compartmentalizing insecurities, articulating distinct narratives relevant to different insecurities. Such a split might seem inconsistent for leaders within the same government, but it can enable them to navigate a precarious crisis by exploiting the state’s internal complexity to address the contrasting insecurities that a crisis generates. I explore this approach by analyzing Georgia’s response to Russia’s full-scale invasion of Ukraine in February 2022, which created a major ontological crisis in Georgia. Its two most prominent leaders (the president and the prime minister) reacted by consistently voicing contradictory positions about the country’s foreign policy. This divergent messaging becomes comprehensible when we see them as responses to different concerns: one responding to deep ontological insecurities over Georgia’s relationship with other states, its place in the international system, and the coherence of its dominant autobiographical narrative; the other responding to the threat of war and related existential concerns at the individual and collective levels. Problematizing the state as a unitary actor, this article demonstrates how unpacking its constitutive agents can help us better understand how leaders navigate complex ontological crises.
Entomopathogenic pseudomonads can share an insect host with entomopathogenic nematodes and their mutualistic bacteria
Authors: Zwyssig Maria , Spescha Anna , Patt Tabea , Belosevic Adrian , Machado Ricardo A R , Regaiolo Alice , Keel Christoph , Maurhofer Monika
Published: February 2024

A promising strategy to overcome limitations in biological control of insect pests is the combined application of entomopathogenic pseudomonads (EPPs) and nematodes (EPNs) associated with mutualistic bacteria (NABs). Yet, little is known about interspecies interactions such as competition, coexistence, or even cooperation between these entomopathogens when they infect the same insect host. We investigated the dynamics of bacteria–bacteria interactions between the EPP Pseudomonas protegens CHA0 and the NAB Xenorhabdus bovienii SM5 isolated from the EPN Steinernema feltiae RS5. Bacterial populations were assessed over time in experimental systems of increasing complexity. In vitro, SM5 was outcompeted when CHA0 reached a certain cell density, resulting in the collapse of the SM5 population. In contrast, both bacteria were able to coexist upon haemolymph-injection into Galleria mellonella larvae, as found for three further EPP-NAB combinations. Finally, both bacteria were administered by natural infection routes i.e. orally for CHA0 and nematode-vectored for SM5 resulting in the addition of RS5 to the system. This did not alter bacterial coexistence nor did the presence of the EPP affect nematode reproductive success or progeny virulence. CHA0 benefited from RS5, probably by exploiting access routes formed by the nematodes penetrating the larval gut epithelium. Our results indicate that EPPs are able to share an insect host with EPNs and their mutualistic bacteria without major negative effects on the reproduction of any of the three entomopathogens or the fitness of the nematodes. This suggests that their combination is a promising strategy for biological insect pest control.
Keeping Up and Staying Fresh: Reflections on Studying Emerging Topics in Consumer Research
Authors: Stephen Andrew T
Published: February 2024

This article reflects on the study of consumer-related emerging topics in the Journal of Consumer Research (JCR) and looks ahead to consider what the next generation of emergent issues might be that capture consumer researchers’ attention and interest. Drawing on conversations with eminent scholars who have made major contributions to JCR by introducing emerging topics to our literature, the author (i) provides a commentary of past approaches to researching novel emerging topics, (ii) suggests some domains from which new emerging topics for consumer research can be sourced, such as new digital technologies (e.g., artificial intelligence) and major societal challenges (e.g., climate change, sustainability, and health), and (iii) offers guidance on how to approach research on important emerging topics.
A population-based validation of the IGCCCG Update Consortium for survival in metastatic non-seminoma testis cancer
Authors: Incesu Reha-Baris , Morra Simone , Scheipner Lukas , Barletta Francesco , Baudo Andrea , Garcia Cristina Cano , Tappero Stefano , Piccinelli Mattia Luca , Tian Zhe , Saad Fred , Shariat Shahrokh F , de Cobelli Ottavio , Terrone Carlo , Chun Felix K H , Carmignani Luca , Briganti Alberto , Ahyai Sascha , Longo Nicola , Tilki Derya , Graefen Markus , Karakiewicz Pierre I
Published: February 2024

Background

In 2021, the International Germ Cell Cancer Collaborative Group (IGCCCG) Update Consortium reported improved overall survival (OS) rates in a modern cohort of metastatic non-seminoma testis cancer patients within each of the IGCCCG prognosis groups (96% in good vs. 89% in intermediate vs. 67% in poor), compared to the previous IGCCCG publication (92% in good vs. 80% in intermediate vs. 48% in poor). We hypothesized that a similar survival improvement may apply to a contemporary North-American population-based cohort of non-seminoma testis cancer patients.

Patients and Methods

The Surveillance, Epidemiology, and End Results (SEER) database (2010–2018) was used. Kaplan–Meier plots and multivariable Cox regression models tested the effect of IGCCCG prognosis groups on overall mortality (OM).

Results

Of 1672 surgically treated metastatic non-seminoma patients, 778 (47%) exhibited good vs. 251 (15%) intermediate vs. 643 (38%) poor prognosis. In the overall cohort, five-year OS rate was 94% for good prognosis vs. 87% for intermediate prognosis vs. 65% for poor prognosis. In multivariable Cox regression models predicting OM, intermediate (Hazard ratio [HR] 2.4, 95% confidence interval [CI] 1.4–3.9, P < 0.001) and poor prognosis group (HR 6.6, 95% CI 1.0–1.0, P < 0.001) were independent predictors of higher OM, relative to good prognosis group.

Conclusions

The survival improvement reported by the IGCCCG Update Consortium is also operational in non-seminoma testis cancer patients within the most contemporary SEER database. This observation indicates that the survival improvement is not only applicable to centres of excellence, but also applies to other institutions at large.
Anlotinib and anti-PD-1 mAbs perfected CIK cell therapy for lung adenocarcinoma in preclinical trials
Authors: Lv Yingge , Zhao Hua , Liu Shaochuan , Meng Yuan , Yu Wenwen , Liu Ting , Sun Qian , Shen Meng , Ren Xiubao , Liu Liang
Published: February 2024

Murine cytokine-induced killer (CIK) cells are heterologous cells that kill various allogeneic and isogenic tumors and have functional and phenotypic characteristics of natural killer cells and T lymphocytes. However, the effect of CIK cells alone on solid tumor therapy is only limited. To enhance the therapeutic effect, it is vital to discover a mix of several therapy approaches. Immune cell function is inhibited by abnormal tumor vessels and the tumor microenvironment, which block lymphocyte entry into tumor tissue. To increase the effectiveness of CIK cells’ antitumor activity, antivascular therapy and CIK cell therapy can be combined. Furthermore, anlotinib is a tiny drug with multitarget tyrosine kinase inhibitors that can block cell migration, delay angiogenesis, and decrease blood vessel density. Compared with other antiangiogenesis drugs, anlotinib stands out due to the wider target of action and lower effective dose. In this work, anlotinib and murine CIK cells were coupled to boost CD3+ T cell infiltration, CD3+CD4+ T cell infiltration, and expression of granzyme B and interferon γ from CD3+CD8+ T cells, which increased the antitumor activity. Through the generation of cytotoxic cytokines by T lymphocytes, the therapeutic group using anti-PD-1 monoclonal antibodies in conjunction with anlotinib and CIK cells was more successful than the group receiving dual therapy. The preclinical study contributes to exploring the therapeutic alternatives for patients with lung adenocarcinoma, thus prolonging their lives.
Highlights of Veterinary Entomology, 2022
Authors: Hubbard Caleb B
Published: February 2024

The field of veterinary entomology is dominated by research concerning insects and arthropods that negatively impact the health of domestic animals. A curated selection of peer-reviewed research which was highlighted at the 2022 Joint Meeting between the Entomological Society of America, the Entomological Society of Canada, and the Entomological Society of British Columbia, which prioritized exploring entomology through the lens of art, science, and culture are summarized. Articles are categorized into (i) biting and non-biting flies, (ii) ectoparasites, and (iii) review articles, with the overall goal of showcasing innovative methodologies, addressing overlooked questions in veterinary entomology, and highlighting comprehensive reviews. While not exhaustive, the selected studies represent a myriad of arthropods, methodologies, and perspectives, to inspire future scientists with diverse research avenues and emphasize the continual evolution and importance of entomological studies in today’s world.
Ecological interactions of Triatoma sanguisuga (Hemiptera: Reduviidae) and risk for human infection with Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) in Illinois and Louisiana
Authors: Dumonteil Eric , Tu Weihong , Jiménez F Agustín , Herrera Claudia
Published: February 2024

Triatoma sanguisuga (Leconte) is one of the most widely distributed kissing bugs in the United States, associated with an extensive zoonotic circulation of Trypanosoma cruzi, the agent of Chagas disease, in a large part of the country. However, the actual risk for human infection in the United States is poorly understood. Here, we further assessed the ecology of T. sanguisuga bugs collected in residents’ houses in Illinois and Louisiana, using a metagenomic approach to identify their blood-feeding sources, T. cruzi parasites and gut microbiota. Blood meal analysis revealed feeding on domestic animals (dogs, cats, pigs, goats, and turkeys), synanthropic species (raccoons, opossums, and squirrels), as well as the more sylvatic white-tail deer. Human blood was identified in 11/14 (78%) of bugs, highlighting a frequent vector–human contact. The infection rate with T. cruzi was 53% (8/15), and most infected bugs (6/8) had fed on humans. A total of 41 bacterial families were identified, with significant differences in microbiota alpha and beta diversity between bugs from Louisiana and Illinois. However, predicted metabolic functions remained highly conserved, suggesting important constraints to fulfill their role in bug biology. These results confirmed a significant risk for vector-borne transmission of T. cruzi to humans in Louisiana and Illinois, which warrants more active screening for human infections. Also, while there is broad plasticity in the bacterial composition of T. sanguisuga microbiota, there are strong constraints to preserve metabolic profile and function, making it a good target for novel vector control strategies.
The stellar ‘Snake’ – II. The mass function
Authors: Yang Xiang-Ming , Bird Sarah A , Li Jiadong , Tian Hai-Jun , Qiu Dan , Li Jia-Peng , Li Cheng-Yuan , Liu Gao-Chao , Zhang Peng , Zhang Ju-Yong , Chen Zhi-Ping
Published: February 2024

We present a comprehensive investigation on the mass function (MF) of a snake-like stellar structure in the solar neighbourhood, building on our previous discovery. To ensure the reliability of the data, we reselect the member stars of the Stellar ‘Snake’ in the latest Gaia Data Release 3 using the same approach as the initial series of articles. We also precisely measure the physical parameters of the clusters within the Stellar Snake. In light of the high completeness of the member stars in the cluster regions, we develop a simulated model colour–magnitude diagram-based inference method to derive the mass function, binary fraction, and mass-ratio distribution of the clusters in the Stellar Snake. Notably, despite their similar ages and metallicity, we discover systematic variations in the MFs along the elongation direction of the Snake in the mass range of 0.5 to 2.0 M⊙. The ‘head’ of the Snake conforms to a canonical initial mass function with a power-law slope of α ∼ −2.3. Extending towards the ‘tail’, the MF becomes more top-light, indicating a deficiency of massive stars within these clusters. This result provides evidence for the delayed formation of massive stars in the clusters. Such clues give support to the hypothesis that the Stellar Snake constitutes as a hierarchically primordial structure.
Attila and the Huns
Authors: Barnes Cameron
Published: February 2024

The Huns appear in the Volga-Don steppes in the late fourth century ce, bringing with them Inner Asian traditions of war and statecraft. After subduing the Alans, the Huns overwhelmed the Goths, sending waves of refugees toward the Roman frontier on the Danube. Roman mismanagement of the resulting crisis led to the Gothic victory at Adrianople (378), the first sign of the disasters to overtake the Mediterranean world in the years to come. The shock occasioned by the Huns’ two dramatic raids across the Caucasus in the 390s lasted until the Arab Conquest. In the fifth century, the rising Hunnic proto-state on the Danube became a growing threat to the Eastern Empire, while the Western Empire gradually slipped into military dependence upon the nomads, particularly during the years of the patrician Aetius’s dominance. In Attila’s reign, Hunnic power stretched from the Rhine to the Dnieper. The Huns ravaged the Roman Balkans in 441–442 and 446–447, invaded Gaul in 451, and raided northern Italy the next year. Their assaults entailed widespread devastation and ended urban life over much of the Balkans. When Attila died suddenly in 453, his empire collapsed. Although the Huns eventually faded from history, our sources continued to refer to Hunnic raids for decades. The Huns’ legacy in terms of military history is complex. The danger they posed led to profound innovations in Roman tactics, equipment, and military engineering. Hunnic mounted archery began a process that ended centuries of infantry dominance in the Mediterranean world.
Survey to assess the feasibility of establishing an international network for evidence synthesis in occupational safety and health
Authors: McElvenny D M , Verbeek J , Gagliardi D , Tikka C , Hoving J L
Published: February 2024

Background

Evidence synthesis in the field of occupational safety and health (OSH) has been continuously growing over the last two decades. With over 100 systematic reviews now published, the Cochrane Work Review group has played an important role in this development and the Cochrane Thematic Group ‘Work & Health & Social Security’ was established recently to combine evidence from both the OSH and insurance medicine fields. Worldwide, many organizations produce and synthesize evidence in OSH that can complement and support each other. We believe that a global network including Cochrane and others can collaborate on methods development and in the production, synthesis, use and dissemination of different types of evidence even more effectively.

Aims

To determine if establishing a global network for evidence synthesis in OSH is feasible.

Methods

We conducted a survey of international and national institutions between November 2022 and January 2023 using LimeSurvey. Participants included representatives of affiliated and sustaining members of the International Commission on Occupational Health, national institutes for OSH, academia and other international organizations.

Results

From 151 invitations, we received responses from 57 representatives of 54 organizations. Representatives reported that their organization will contribute financially on an annual basis (n = 1) or provide in-kind support (n = 10), and will probably be able to provide financial or in-kind support (n = 25).

Conclusions

The feasibility criterion was met and an international network is being established.
SUBA-Itraconazole for Primary Antifungal Prophylaxis After Allogeneic Hematopoietic Cell Transplantation
Authors: Lindsay Julian , Othman Jad , Kong Yvonne , Yip Annie , Van Hal Sebastiaan , Larsen Stephen , Bryant Christian , Gibson John , Kerridge Ian , Fay Keith , Stevenson William , Arthur Chris , Chen Sharon C A , Kong David C M , Greenwood Matthew , Pergam Steven A , Liu Catherine , Slavin Monica A
Published: February 2024

Background

Itraconazole (ITZ) is an effective agent when used as primary invasive fungal disease (IFD) prophylaxis, but is limited by drug tolerability and variability in serum concentrations. A new formulation, SUBA-itraconazole (for “super bioavailability”; S-ITZ), addresses the limitations of conventional ITZ formulations.

Methods

We conducted a retrospective cohort study at 2 Australian centers to evaluate the safety, tolerability, and effectiveness of S-ITZ as primary antifungal prophylaxis in hematopoietic cell transplant (HCT) recipients without grade II–IV acute graft-vs-host disease, from day 1 until approximately day 100 (cohort A) or day 1 until neutrophil engraftment (cohort B). A total of 204 patients and 1410 trough plasma ITZ concentrations were assessed.

Results

The incidence of breakthrough proven/probable IFD at day 180 was 1.0% (95% confidence interval [CI], .2%–3.2%), with 1.6% in cohort A and 0% in cohort B, and overall fungal-free survival of proven/probable IFD was 82.9% (95% CI, 76.8%–87.4%). Preengraftment early permanent S-ITZ discontinuation was 3.4% overall, with no significant difference between cohorts. No patients required cessation due to gastrointestinal intolerance attributed to S-ITZ. The geometric mean trough plasma ITZ concentration was 1130ng/mL (interquartile range, 566–1801ng/mL; coefficient of variation, 56.57%) and the median time to achieve therapeutic levels was 10 days.

Conclusions

S-ITZ is a safe and well-tolerated oral formulation and is a novel alternative for primary IFD prophylaxis after HCT.
Eosinophilic Liver Abscess: A Case of Locally Acquired Fasciola hepatica in Alberta, Canada
Authors: King Teagan , Cabada Miguel M , Kowalewska-Grochowska Kinga , Vaughan Stephen D
Published: February 2024

Fasciola hepatica is a trematode causing acute and chronic infection. A 33-year-old Canadian woman with eosinophilic liver abscesses and no relevant travel was diagnosed with F hepatica infection. F hepatica is reported in livestock in Alberta. This is the first case of locally acquired fascioliasis in Canada in >100 years.
Directed droplet motion along thin fibers
Authors: Khattak Hamza K , Shanzeela Aileen , Raphael Elie , Dalnoki-Veress Kari
Published: February 2024

When microscopic droplets are placed between fibers held at a fixed angle, the droplets spontaneously move toward the apex of the fibers. The speed of the droplet motion increases both with the angle between the fibers and the distance the droplet spans across the fibers. The speed of these droplets can be described by a simple scaling relationship. Bending these fibers into a sawtooth geometry results in a droplet ratchet where cyclic motion in a fiber results in extended linear motion of the droplet, and can even be used to induce droplet mergers.
Oxytocin differentially modulates the early neural responses to faces and non-social stimuli
Authors: Moses Eleanor , Nelson Nicole , Taubert Jessica , Pegna Alan J
Published: February 2024

Oxytocin (OT) alters social cognition partly through effects on the processing and appraisal of faces. It is debated whether the hormone also impacts the processing of other, non-social, visual stimuli. To this end, we conducted a randomized, counter-balanced, double-blind, placebo (PL)-controlled within-subjects’ electro-encephalography (EEG) study with cismale participants (to control for gender dimorphic hormonal effects; n = 37). Participants received intranasal OT (24IU) and completed a one-back task viewing emotional (fearful/ happy) and neutral faces, and threat (snakes/spiders) and non-threat (mushrooms/flowers) non-social stimuli. OT differentially impacted event-related potentials (ERP)s to faces and non-social stimuli. For faces regardless of emotion, OT evoked greater occipital N1 and anterior P1 amplitudes at ∼155 ms than after PL, and lead to sustained differences over anterior, bilateral parietal and occipital sites from 205 ms onwards. For all non-social stimuli, OT evoked greater right parietal N1 amplitudes, and later only impacted threat stimuli over right parietal and occipital sites. None of these OT-induced modulations was related to individual anxiety levels. This pattern of results indicates that OT differentially modulates the processing of faces and non-social stimuli, and that the hormone’s effect on visual processing and cognition does not occur as a function of non-clinical levels of anxiety.
High HIV diversity, recombination, and superinfection revealed in a large outbreak among persons who inject drugs in Kentucky and Ohio, USA
Authors: Switzer William M , Shankar Anupama , Jia Hongwei , Knyazev Sergey , Ambrosio Frank , Kelly Reagan , Zheng HaoQiang , Campbell Ellsworth M , Cintron Roxana , Pan Yi , Saduvala Neeraja , Panneer Nivedha , Richman Rhiannon , Singh Manny B , Thoroughman Douglas A , Blau Erin F , Khalil George M , Lyss Sheryl , Heneine Walid
Published: February 2024

We investigated transmission dynamics of a large human immunodeficiency virus (HIV) outbreak among persons who inject drugs (PWID) in KY and OH during 2017–20 by using detailed phylogenetic, network, recombination, and cluster dating analyses. Using polymerase (pol) sequences from 193 people associated with the investigation, we document high HIV-1 diversity, including Subtype B (44.6 per cent); numerous circulating recombinant forms (CRFs) including CRF02_AG (2.5 per cent) and CRF02_AG-like (21.8 per cent); and many unique recombinant forms composed of CRFs with major subtypes and sub-subtypes [CRF02_AG/B (24.3 per cent), B/CRF02_AG/B (0.5 per cent), and A6/D/B (6.4 per cent)]. Cluster analysis of sequences using a 1.5 per cent genetic distance identified thirteen clusters, including a seventy-five-member cluster composed of CRF02_AG-like and CRF02_AG/B, an eighteen-member CRF02_AG/B cluster, Subtype B clusters of sizes ranging from two to twenty-three, and a nine-member A6/D and A6/D/B cluster. Recombination and phylogenetic analyses identified CRF02_AG/B variants with ten unique breakpoints likely originating from Subtype B and CRF02_AG-like viruses in the largest clusters. The addition of contact tracing results from OH to the genetic networks identified linkage between persons with Subtype B, CRF02_AG, and CRF02_AG/B sequences in the clusters supporting de novo recombinant generation. Superinfection prevalence was 13.3 per cent (8/60) in persons with multiple specimens and included infection with B and CRF02_AG; B and CRF02_AG/B; or B and A6/D/B. In addition to the presence of multiple, distinct molecular clusters associated with this outbreak, cluster dating inferred transmission associated with the largest molecular cluster occurred as early as 2006, with high transmission rates during 2017–8 in certain other molecular clusters. This outbreak among PWID in KY and OH was likely driven by rapid transmission of multiple HIV-1 variants including de novo viral recombinants from circulating viruses within the community. Our findings documenting the high HIV-1 transmission rate and clustering through partner services and molecular clusters emphasize the importance of leveraging multiple different data sources and analyses, including those from disease intervention specialist investigations, to better understand outbreak dynamics and interrupt HIV spread.
Regional anesthesia is associated with prolonged operative time and unplanned inpatient admission in distal radius fractures
Authors: Horn Ryan W. , Johnson Charles A. , Newton William N. , Brewbaker Carey L. , Daley Dane N.
Published: February 2024

Background:

Regional anesthesia is commonly used as an alternative to general anesthesia in the surgical treatment of distal radius fractures. The purpose of this study is to evaluate the effect general versus regional anesthesia has on post-operative outcomes and perioperative time in the open treatment of distal radius fractures.

Methods:

The National Surgical Quality Improvement Program database was queried to identify adult who underwent open reduction and internal fixation of distal radius fractures between 2005 and 2018. Patients were classified as receiving either general anesthesia or regional anesthesia. Mean perioperative times and length of stay were compared between groups. Univariate analysis and multivariate logistic regression were used to assess the risk of prolonged operative time and of 30-day post-operative complications, based on anesthesia type.

Results:

A total of 13,059 patients were identified, with 11,761 (90.1%) receiving GA and 1,298 (9.9%) receiving RA. RA was associated with a significantly longer duration of anesthesia (124.5 vs. 115.7 min) and total operative time (77.0 vs. 72.6 min) but shorter wake-up times (11.8 vs. 13.0 min). Using multivariate analysis, RA was independently associated with an increased risk of prolonged operative time (OR 1.448; CI 1.234-1.699; P<0.001) and unplanned inpatient admission (OR 1.225, CI 1.019-1.545, P=0.033). The risk of all other acute postoperative complications was similar between groups.

Conclusion:

Regional anesthesia is independently associated with prolonged operative time and unplanned inpatient admission but not with acute postoperative complications in the open treatment of distal radius fractures.

Level of Evidence:

III
Barriers and Facilitators to End-of-Life Care Delivery in ICUs: A Qualitative Study
Authors: Janczewski Lauren M. , Chandrasekaran Adithya , Abahuje Egide , Ko Bona , Slocum John D. , Tesorero Kaithlyn , Nguyen My L. T. , Yang Sohae , Strong Erin A. , Bhakta Kunjan , Huml Jeffrey P. , Kruser Jacqueline M. , Johnson Julie K. , Stey Anne M.
Published: February 2024

Objectives:

To understand frontline ICU clinician’s perceptions of end-of-life care delivery in the ICU.

Design:

Qualitative observational cross-sectional study.

Setting:

Seven ICUs across three hospitals in an integrated academic health system.

SUBJECTS:

ICU clinicians (physicians [critical care, palliative care], advanced practice providers, nurses, social workers, chaplains).

Interventions:

None.

Measurements and Main Results:

In total, 27 semi-structured interviews were conducted, recorded, and transcribed. The research team reviewed all transcripts inductively to develop a codebook. Thematic analysis was conducted through coding, category formulation, and sorting for data reduction to identify central themes. Deductive reasoning facilitated data category formulation and thematic structuring anchored on the Systems Engineering Initiative for Patient Safety model identified that work systems (people, environment, tools, tasks) lead to processes and outcomes. Four themes were barriers or facilitators to end-of-life care. First, work system barriers delayed end-of-life care communication among clinicians as well as between clinicians and families. For example, over-reliance on palliative care people in handling end-of-life discussions prevented timely end-of-life care discussions with families. Second, clinician-level variability existed in end-of-life communication tasks. For example, end-of-life care discussions varied greatly in process and outcomes depending on the clinician leading the conversation. Third, clinician-family-patient priorities or treatment goals were misaligned. Conversely, regular discussion and joint decisions facilitated higher familial confidence in end-of-life care delivery process. These detailed discussions between care teams aligned priorities and led to fewer situations where patients/families received conflicting information. Fourth, clinician moral distress occurred from providing nonbeneficial care. Interviewees reported standardized end-of-life care discussion process incorporated by the people in the work system including patient, family, and clinicians were foundational to delivering end-of-life care that reduced both patient and family suffering, as well as clinician moral distress.

Conclusions:

Standardized work system communication tasks may improve end-of life discussion processes between clinicians and families.
Identification of Subtypes in Triple-negative Breast Cancer Based on Shared Genes Between Immunity and Cancer Stemness
Authors: Lv Xianmei , Lan Gaochen , Guo Qiusheng
Published: February 2024

The correlation between triple-negative breast cancer (TNBC) and genes related to immunity and cancer stemness, particularly shared genes, remains unclear. This study aimed to investigate the correlation of immunity and cancer stemness with the molecular subtyping and survival rates in TNBC using bioinformatics approaches. Differential gene analysis was conducted to identify TNBC-associated differentially expressed genes (DEGs). Cancer stem cell (CSC)-related genes were obtained using weighted gene coexpression network analysis. Immune-related gene sets were retrieved from the literature. Venn analysis was performed to identify the shared DEGs between immunity and cancer stemness in TNBC. Cluster analysis and survival analysis based on the expression of these genes were conducted to identify TNBC subtypes with significant survival differences. A total of 5259 TNBC-associated DEGs, 2214 CSC-related genes, 1793 immune-related genes, and 44 shared DEGs between immunity and cancer stemness were obtained. Among them, 3 shared DEGs were closely associated with TNBC survival rates (P<0.05). Cluster and survival analyses revealed that among 3 subtypes, cluster2 exhibited the best survival rate, and cluster3 showed the worst survival rate (P<0.05). Dendritic cells were highly infiltrated in cluster2, while plasma cells and resting mast cells were highly infiltrated in cluster3 (P<0.05). Genes shared by immunity and cancer stemness were capable of classifying TNBC samples. TNBC patients of different subtypes exhibited significant differences in immune profiles, genetic mutations, and drug sensitivity. These findings could provide new insights into the pathogenesis of TNBC, the immune microenvironment, and the selection of therapeutic targets for drug treatment.
Using the Plan-Do-Study-Act Evaluation Framework to Improve the Recruitment of Women Experiencing Homelessness
Authors: Galvin Annalynn M. , Walters Scott T. , Lewis Melissa A. , Thompson Erika L.
Published: February 2024

Background and Objectives:

Strategic recruitment is necessary to reach recruiting goals when conducting research with vulnerable and transient populations, such as postpartum women experiencing homelessness. The current study evaluated the recruitment process for a qualitative study using the Plan-Do-Study-Act (PDSA) method.

Methods:

In a study conducting semistructured interviews about reproductive interconception care barriers and facilitators for local women who were recently pregnant and homeless in 2022, PDSA cycles were used to improve community organizations' assistance with identifying participants, facilitate screening and interviewing processes, and ensure participants were safeguarded.

Results:

Iterative PDSA cycles were conducted across a 20-week period. Ultimately, 12 women were interviewed, with increasing participant location and organizational assistance over time. Following 4 key lessons were identified: provide in-person and remote options for conducting data collection; include fair compensation that balances time versus study coercion; weigh feasibility versus importance of sample size with eligibility criteria; and support partnerships with organization connections.

Conclusions:

The PDSA method served as a parsimonious framework for evaluation. The lessons learned will help facilitate future recruitment efforts for this difficult-to-recruit and vulnerable population.
Lower Perceived Neighborhood Collective Efficacy Indirectly Influences the Association Between Perceived Maternal Exposure to Community Violence and Household Food Insecurity
Authors: Daundasekara Sajeevika S. , Marshall Allison N. , Schuler Brittany R. , Testa Alexander , Hernandez Daphne C.
Published: February 2024

Background and Objectives:

Individuals of color and of low socioeconomic status are at greater risk of experiencing community violence and food insecurity, which are both influenced by neighborhood conditions. We evaluated neighborhood collective efficacy as a linkage between community violence exposure and household food insecurity.

Methods:

Mothers from the Future of Families and Child Wellbeing Study who completed phone surveys when the child was 3 (time 1, T1) and 5 years old (time 2, T2) were included (n = 2068). A covariate-adjusted structural equation model estimated direct and indirect effects of community violence exposure on household food insecurity. A covariate-adjusted multiple mediator model estimated the indirect effects of the 2 neighborhood collective efficacy subscales (informal social control; social cohesion and trust).

Results:

At T1, 40% of mothers reported community violence exposure; 15% experienced food insecurity at T2. Mean neighborhood collective efficacy (range 1-5) at T1 was 2.44 (SD = 0.94). Neighborhood collective efficacy indirectly influenced the association between community violence exposure and food insecurity (indirect effect = 0.022, 95% CI = 0.007 to 0.040). Only social cohesion and trust contributed independent variance to the indirect effect model (indirect effect = 0.028, 95% CI = 0.001 to 0.056).

Conclusions:

Community-based efforts to reduce household food insecurity should emphasize building social cohesion and trust in communities experiencing violence.
Measurement Matters: MRI Analysis of Differing Anatomic Measurement Techniques for Velar Length and the Velopharyngeal Needs Ratio
Authors: Mason Kazlin N. , Hanson Bailey , Black Jonathan S.
Published: February 2024

Background:

Advances in imaging tools provide opportunities to enhance how velopharyngeal (VP) variables are quantified to facilitate surgical decisions. The purpose of this study was to use magnetic resonance imaging (MRI) to determine if quantitative differences were present between measures of linear and curvilinear velar length, and subsequently, the VP needs ratio.

Methods:

Data were prospectively collected from patients presenting with repaired cleft palate and/or congenital palatal insufficiency with or without VPI at a single center tertiary children’s hospital. Quantitative measures of the velopharynx using a novel nonsedated MRI protocol were obtained. Paired samples t tests were conducted to assess if differences were present between the VP needs ratio and measurements of linear and curvilinear velar length at rest and during sustained phonation. Intraclass correlation coefficients were calculated to assess intra/inter-rater reliability.

Results:

Significant differences were present between measurements of linear and curvilinear velar length at rest (P ≤ 0.001) and during sustained phonation (P ≤ 0.001). Significant differences were also present in the VP needs ratio (P ≤ 0.001). Curvilinear velar length at rest and during sustained phonation was longer than that of linear velar length at rest and during sustained phonation. No significant differences were observed between measures of effective velar length (P = 0.393).

Conclusions:

Measurement differences influence the VP needs ratio. This may have implications for comparisons to previously reported normative reference values and for those who are anatomically at risk for VPI. MRI provides an enhanced imaging modality to assess normative benchmarks and the anatomic variables used to define VP anatomy for clinical decision-making.
Predictors of blood pressure response to continuous positive airway pressure treatment in patients with sleep apnea
Authors: Seidel Maximilian , Kiziler Muhammed F. , Matiakis Marios , Bertram Sebastian , Wang Simon , Seibert Felix S. , Babel Nina , Westhoff Timm H.
Published: February 2024

Background:

Sleep apnea is associated with hypertension. Metaanalyses indicate that treatment of sleep apnea by continuous positive airway pressure (CPAP) reduces blood pressure (BP) by a mean of 3 mmHg. To date, predictors of BP response to CPAP remain incompletely understood. We hypothesized that the magnitude of CPAP-induced BP reduction depends on baseline apnea–hypopnea index (AHI) and the extent of daytime sleepiness

Methods:

We performed a retrospective study on the association of BP response to CPAP with polysomnographic readings, intensity of sleepiness (measured by Epworth Sleepiness Scale, ESS), and epidemiologic parameters in 2461 patients with obstructive sleep apnea. BP response was defined as the difference between office BP at polysomonography examinations before and after initiation of CPAP.

Results:

Five hundred and fifty-five patients fulfilled all inclusion and exclusion criteria and were included in the analysis. Median monthly CPAP usage was 143.7 h (85.4–204.1 h). BP was significantly higher at baseline than at follow-up (129.9 ± 15.5 vs. 128.3 ± 15.2, P = 0.021) resulting in mean reduction of BP of −1.5 ± 19.2 mmHg. patients with a higher than median baseline AHI (median 21) showed a more pronounced reduction of BP than those with lower AHI (AHI ≥21: 130.5 ± 15.3 vs. 128.6 ± 14.6, P = 0.06; AHI <21: 129.5 ± 15.8 vs. 127.9 ± 15.8, P = 0.18). CPAP therapy led to a significant reduction in sleepiness (8.3 ± 4.8 vs. 6.6 ± 4.5, P < 0.0001). Those subjects with higher than median sleepiness score (ESS ≥8), however, did not show a significant difference in BP response compared with those with a lower sleepiness score. Receiver-operating characteristic (ROC) curve analyses investigating the accuracy of AHI and ESS to predict a BP reduction at least 5 mmHg revealed an AUC of 0.51 and 0.52, respectively.

Conclusion:

The study confirms that CPAP therapy for sleep apnea has a mild BP lowering effect. Although this effect is slightly higher in patients with above-average AHI, neither AHI nor ESS can be used to define threshold values predicting a BP decrease at least 5 mmHg.
Oculoplastic Management of an Eyelid Zipper Injury
Authors: Tso Hanna L. , Mudie Lucy I. , Ferguson Mark , Yen Michael T. , Williams Katherine J.
Published: February 2024

We present a case of a zipper injury to an upper eyelid in a pediatric patient. The zipper was successfully removed in the operating room by using a double-action bone cutter to cut the median footplate of the zipper and release the entrapped tissue. Zipper injuries are well-described in urology literature, however, limited case reports exist in ophthalmology literature. We review several methods for zipper removal and present special considerations for eyelid injuries.
Evaluation of Recurrence Rates of Pseudomonas Pneumonia in Mechanically Ventilated ICU Patients Receiving ≤7 Versus >7 Days of Antibiotic Therapy
Authors: Bollinger Christopher , Carroll Zachary , Collazo Valeria Laboy , Murray Brian
Published: February 2024

Background

Pseudomonas aeruginosa (PA) is commonly implicated in ventilator-associated pneumonia (VAP). Consensus guidelines for VAP recommend a 7-day course of appropriate antibiotics. However, recent studies have shown higher recurrence rates of PA pneumonia with shorter courses of antibiotics. This study was designed to compare PA pneumonia recurrence rates in patients who received appropriate antibiotics for ≤7 days vs >7 days.

Methods

A retrospective, single-center, observational cohort study of adults diagnosed with PA-VAP between January 2017 and May 2022 was conducted. Patients were divided into a >7-day cohort or a ≤7-day cohort based on duration of appropriate antibiotics. The primary outcome was the recurrence rate of PA pneumonia.

Results

A total of 106 patients were included, 59 in the >7-day cohort and 47 in the ≤7-day cohort. The median (interquartile range) duration of appropriate antipseudomonal therapy was 12 days (8–18 days) in the >7-day cohort and 7 days (6–7 days) in the ≤7-day cohort. Pseudomonas aeruginosa recurrence was observed in 15 (25.4%) patients in the >7-day cohort and 20 (42.6%) patients in the ≤7-day cohort (P = 0.059). Over 33% of patients in the >7-day cohort had persistently positive PA cultures after at least 7 days of appropriate antibiotic therapy.

Conclusion

Extending duration of antipseudomonal antibiotics beyond 7 days did not significantly reduce the recurrence of PA pneumonia. However, the lower rate of recurrence in the >7-day group and high rate of persistent positive cultures may be clinically significant, suggesting a role for extended treatment. Further prospective studies are needed to determine the optimal duration of therapy for PA-VAP.
Alcohol Dependence, Treatment Seeking, and Treatment Preferences Among Elderly
Authors: Jirwe Maria , Andreasson Sven , Wallhed Finn Sara
Published: February 2024

Introduction

In Sweden, alcohol consumption has increased among people aged 65 years and older. Among older adults, 2.7% of men and 1.6% of women fulfill criteria for alcohol dependence. The large majority do not seek treatment. Little is known about treatment seeking among older adults with alcohol dependence.

Aim

The aim of this study was to describe elderly's views on alcohol dependence, treatment seeking, and treatment preferences. Possible gender differences will also be explored.

Methods

Between December 2017 and March 2018, two focus group interviews and 10 individual interviews were conducted, using semistructured interviews. In total, 13 elderly participated. Data were analyzed using the framework approach.

Results

Two themes and five subthemes were identified: (a) “regret and feelings of shame when losing control” consisting of two subthemes, namely, (1) loss of control over your alcohol consumption and (2) regret and feelings of shame, and (b) “taking back control over your life” consisting of three subthemes, namely, (1) becoming aware that you have problematic alcohol use, (2) to seek help for alcohol dependence, and (3) views on treatment options and treatment settings.

Conclusions

Increased alcohol use was attributed to a decrease in responsibility and belonging. Alcohol dependence was associated with shame and stigma, which was especially strong for women. Preferred treatments were tailored for the individual, rather than to general factors such as age or gender. Moreover, important components of treatment were to be met with respect, continuity, and controlled drinking as a treatment goal. Future research should focus on interventions to reduce stigma and the development of patient-centered treatments.
A Strengths and Needs Assessment of Campus Sexual Assault Response
Authors: Miyamoto Sheridan , Bittner Cynthia , Delwiche Jennifer , Ganguli Aishwarya
Published: February 2024

Background

Sexual violence and sexual assault (SA) disproportionately affect the young adult population aged 18–24 years, half of which are enrolled in higher education. Campuses are tasked with providing a safe space for students and enacting an appropriate response to campus SA (CSA).

Aims

As part of a grant-funded program to strengthen SA nurse examiner (SANE) services to those who experience SA on college campuses, we conducted a campus needs assessment and a campus website review for key messaging and analyzed the responses to identify strengths and gaps in campus resources related to CSA. These findings were the basis of individualized Campus Community Summary reports shared with participants from each campus.

Methods

Guided qualitative interviews with interdisciplinary stakeholders across seven campus communities and campus website reviews were used to identify campus resource strengths, gaps, and recommendations for improvement.

Results

Common strengths included awareness of campus programs and community services, leadership support for CSA activities, and community CSA response. Identified opportunities for improvement included strengthening interdisciplinary collaboration, solving transportation issues to obtain care, mental healthcare and advocacy services, awareness and resource messaging, and fighting stigma and bias. Campus websites reviews indicated gaps in key information about SANE care and how to access SANE services.

Conclusions

Numerous gaps and opportunities to strengthen campus SA awareness and coordination and access to a timely response to SA were identified. Addressing these gaps is essential to ensure quality care and services for individuals who experience SA on college campuses.