bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-CO2-inducible bestrophins outside the pyrenoid sustain high photosynthetic efficacy in diatoms
Authors: Nigishi Minori , Shimakawa Ginga , Yamagishi Kansei , Amano Ryosuke , Ito Shun , Tsuji Yoshinori , Nagasato Chikako , Matsuda Yusuke
Published: March 2024

Anion transporters sustain a variety of physiological states in cells. Bestrophins (BSTs) belong to a Cl− and/or HCO3− transporter family conserved in bacteria, animals, algae, and plants. Recently, putative BSTs were found in the green alga Chlamydomonas reinhardtii, where they are upregulated under low CO2 (LC) conditions and play an essential role in the CO2-concentrating mechanism (CCM). The putative BST orthologs are also conserved in diatoms, secondary endosymbiotic algae harboring red-type plastids, but their physiological functions are unknown. Here, we characterized the subcellular localization and expression profile of BSTs in the marine diatoms Phaeodactylum tricornutum (PtBST1 to 4) and Thalassiosira pseudonana (TpBST1 and 2). PtBST1, PtBST2, and PtBST4 were localized at the stroma thylakoid membrane outside of the pyrenoid, and PtBST3 was localized in the pyrenoid. Contrarily, TpBST1 and TpBST2 were both localized in the pyrenoid. These BST proteins accumulated in cells grown in LC but not in 1% CO2 (high CO2 [HC]). To assess the physiological functions, we generated knockout mutants for the PtBST1 gene by genome editing. The lack of PtBST1 decreased photosynthetic affinity for dissolved inorganic carbon to the level comparable with the HC-grown wild type. Furthermore, non-photochemical quenching in LC-grown cells was 1.5 to 2.0 times higher in the mutants than in the wild type. These data suggest that HCO3− transport at the stroma thylakoid membranes by PtBST1 is a critical part of the CO2-evolving machinery of the pyrenoid in the fully induced CCM and that PtBST1 may modulate photoprotection under CO2-limited environments in P. tricornutum.
Dialogues Across Time: Perspectives on Historical and Contemporary Democratization
Authors: Golden Miriam A
Published: March 2024

This review article leverages Isabela Mares’ Protecting the Ballot: How First-Wave Democracies Ended Electoral Corruption as a jumping off point to consider how to construct a dialogue between scholars of contemporary electoral malfeasance and historical political economists. It makes two main points. First, because both scholars of history and of the contemporary world are usually engaged in mixed-method case study research, both grapple with issues of case generalizability and external validity. This produces a naturally shared research agenda, although one that has largely gone unrecognized. Generalizability would be improved if both groups mapped their cases onto larger distributions of the phenomenon of interest. Second, the very substantial differences between party systems of first-wave and recent democratizers suggest that political elites will support reforms aimed at improving election integrity differently across the two periods. Contemporary electoral competition is unlikely to naturally give rise to the emergence of programmatic politics, instead locking parties into clientelism and various types of election malfeasance. I discuss what might be required for politicians today to support reforms aimed at curbing election malfeasance, and when the shift to programmatic politics becomes in the political interests of elected officials.
A comparison of two obesity-related hypoventilation disorders: Impact on sleep, quality of life and neurocognitive outcomes and the effects of positive airway pressure therapy
Authors: Zheng Yizhong , Yee Brendon J , Wong Keith , Grunstein Ronald R , Piper Amanda J
Published: March 2024

Study Objectives

Symptom impact and neurocognitive function have not been previously compared between patients with obesity-associated hypoventilation disorders (obesity hypoventilation syndrome [OHS]) and hypoventilation in the setting of obesity and obstructive airways disease (OHAD). The aim of this study is to compare baseline sleep-related symptoms, health-related quality of life, and neurocognitive function between OHS and OHAD and the impact of PAP therapy on these outcomes.

Methods

Epworth Sleepiness Scale (ESS), Pittsburgh Sleepiness Quality Index (PSQI), SF36, and various neurocognitive tests, in addition to anthropometric, polysomnography, lung function, and blood gas data from participants with OHS and participants with OHAD, were included in the analysis. These data were originally collected in their respective randomized clinical trials, comparing the efficacy of different PAP modes (bilevel PAP vs. CPAP) in resolving hypercapnia. Between groups (OHS vs OHAD), pre- and post-treatment (with 3 months of positive airway pressure) comparisons were made using linear mixed modeling.

Results

45 OHS participants (mean age 51 years old, 33% female, BMI 52 kg/m2, FER 0.81, PaCO2 54 mmHg, AHI 87/h) and 32 OHAD participants (mean age 61years old, 31% female, BMI 43kg/m2, FER 0.60, PaCO2 54 mmHg, AHI 59/h) were included in the analysis. Both OHS and OHAD had similar baseline ESS (14(5.6) vs. 12(5.4)), Global PSQI (10(3.2) vs. 11(4.8)), SF36 and neurocognitive test performances (other than OHAD had lower digit symbol substitution test performance). Treatment with PAP therapy resulted in similar ESS, Global PSQI, and SF36 improvements in both groups. Neurocognitive performance did not significantly improve after PAP therapy in either group.

Conclusions

The symptom impact between two separate hypoventilation disorders (OHS and OHAD), in terms of sleepiness, sleep quality, quality of life, and cognitive function, were similar. OHS and OHAD had similar treatment responses in these parameters after 3 months of PAP therapy.

Nocturnal ventilatory support in OHS.
Dynamics of ‘Candidatus Liberibacter asiaticus’ Growth, Concentrations of Reactive Oxygen Species, and Ion Leakage in Huanglongbing-Positive Sweet Orange
Authors: Pandey Sheo Shankar , Li Jinyun , Oswalt Chris , Wang Nian
Published: March 2024

Citrus Huanglongbing (HLB) caused by ‘ Candidatus Liberibacter asiaticus’ (CLas) is the most devastating citrus disease worldwide. CLas induces systemic and chronic reactive oxygen species (ROS) production, which has been suggested to be a primary cause of cell death in phloem tissues and subsequent HLB symptoms. Mitigating oxidative stress caused by CLas using horticultural approaches has been suggested as a useful strategy to reduce HLB damages. To provide information regarding the application timing to mitigate ROS, we investigated monthly dynamics of CLas concentration, CLas-triggered ROS, and phloem cell death in the bark tissues of asymptomatic and symptomatic branches of HLB-positive Hamlin and Valencia sweet orange trees in the field. Healthy branches in the screenhouse were used as controls. CLas concentration exhibited significant variations over the course of the year, with two distinct peaks observed in Florida citrus groves—late spring/early summer and late fall. Within both Hamlin and Valencia asymptomatic tissues, CLas concentration demonstrated a negative correlation with the deviation between the monthly average mean temperature and the optimal temperature for CLas colonization in plants (25.7°C). However, such a correlation was not evident in symptomatic tissues of Hamlin or Valencia sweet oranges. ROS levels were consistently higher in symptomatic or asymptomatic branches than in healthy branches in most months. ROS concentrations were higher in symptomatic branches than in asymptomatic branches in most months. CLas triggered significant increases in ion leakage in most months for asymptomatic and symptomatic branches compared with healthy controls. In asymptomatic branches of Hamlin, a positive correlation was observed between CLas concentration and ROS concentrations, CLas concentration and ion leakage levels, as well as ROS and ion leakage. Intriguingly, such a relationship was not observed in Valencia asymptomatic branches or in the symptomatic branches of Hamlin and Valencia. This study sheds light on the pathogenicity of CLas by providing useful information on the temporal dynamics of ROS production, phloem cell death, and CLas growth, as well as provides useful information in determining the timing for application of antioxidants and antimicrobial agents to control HLB.
The Use and Impact of Antibiotics in Plant Agriculture: A Review
Authors: Batuman Ozgur , Britt-Ugartemendia Kellee , Kunwar Sanju , Yilmaz Salih , Fessler Lauren , Redondo Ana , Chumachenko Kseniya , Chakravarty Shourish , Wade Tara
Published: March 2024

Growers have depended on the specificity and efficacy of streptomycin and oxytetracycline as a part of their plant disease arsenal since the middle of the 20th century. With climate change intensifying plant bacterial epidemics, the established success of these antibiotics remains threatened. Our strong reliance on certain antibiotics for devastating diseases eventually gave way to resistance development. Although antibiotics in plant agriculture equal to less than 0.5% of overall antibiotic use in the United States, it is still imperative for humans to continue to monitor usage, environmental residues, and resistance in bacterial populations. This review provides an overview of the history and use, resistance and mitigation, regulation, environmental impact, and economics of antibiotics in plant agriculture. Bacterial issues, such as the ongoing Huanglongbing (citrus greening) epidemic in Florida citrus production, may need antibiotics for adequate control. Therefore, preserving the efficacy of our current antibiotics by utilizing more targeted application methods, such as trunk injection, should be a major focus.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Factors Affecting Postoperative Courses After Removal of Transphyseal Screws Inserted for Correction of Genu Valgum
Authors: Shim Jong Sup , Ko Kyung Rae , Lim Kyung Sup , Na Sangwoon
Published: March 2024

Background:

The aim of this study was to investigate factors determining the final outcomes of hemipercutaneous epiphysiodesis using transphyseal screw (PETS) for the genu valgum, especially focusing on postoperative courses after screw removal.

Methods:

Fifty-five patients with idiopathic genu valgum treated with hemi-PETS were included. The mechanical lateral distal femoral angle (mLDFA) and medial proximal tibial angle (MPTA) were measured to calculate the degree of correction and rebound. Regarding factors related to surgical techniques, the number of screw threads beyond the physis, the moment arm of the screw, and screw insertion angles were measured.

Results:

In 54 femoral segments (randomly selected in bilateral cases), hemi-PETS was performed with a growth remaining of 2.0±0.6 years. The screw was removed after 6.5±2.1 months, and the degree of correction was 5.0±1.5 degrees. The mean rebound angle was -0.4±2.4 (the negative value means further correction after screw removal). A late time of surgery and an extreme peripheral position of a screw were associated with the growth inhibition. In 50 tibial segments (also randomly selected in bilateral cases), a screw was inserted with a growth remaining of 2.0±0.6 years and removed after 6.3±1.9 months. The degree of correction was 2.9±1.7 degrees during the interval, and the rebound angle was 0.8±1.7 degrees. An earlier time of surgery and a greater correction angle before screw removal were associated with the rebound phenomenon.

Conclusions:

Growth inhibition of >1.6 degrees was observed in about one-fourth of femoral segments. An extreme peripheral position of a screw should be avoided when performing hemi-PETS at the distal femur. We also recommend not performing hemi-PETS at distal femur with too short a period of growth remaining.

Level of Evidence:

Level III—retrospective comparative series.
The Canal Bone Ratio
Authors: Wang Yunsheng , Tong Tong , Zhang Jiali , Miao Dechao , Wang Feng , Wang Linfeng
Published: March 2024

Study Design.

Retrospective diagnostic study.

Objectives.

To evaluate the utility of quantitative assessment of bone density using proximal femoral morphological parameters based on full-spine x-rays.

Summary of Background Data.

CT and MRI are commonly utilized methods for opportunistic assessment of bone density. However, there is currently a lack of means to quantitatively assess bone density in adult spinal deformity (ASD) patients through radiographs.

Methods.

Data collection involved medical records of ASD patients treated at our hospital. Patients were categorized into osteoporotic and nonosteoporotic groups based on dual-energy x-ray absorptiometry T-scores. Demographic information, radiographic parameters (canal bone ratio, canal bone ratio (CBR); cortical bone thickness, cortical bone thickness (CBT)), Hounsfield units, and vertebral body quality (VBQ) scores were compared. Pearson correlation analysis was conducted to assess the correlation between CBR, CBT, and T-scores. Multiple linear regression analysis identified independent predictors of bone density T-scores. Receiver operating characteristic curves and area under the curve calculations were performed to investigate the predictive performance for osteoporosis.

Results.

A total of 102 patients were included, with the osteoporotic group showing larger CBR and smaller CBT compared with the nonosteoporotic group. Proximal femoral morphological parameters exhibited the strongest correlation with total hip T-scores. Advanced age (β=−0.028, 95% CI=−0.054 to −0.002, P=0.032), low BMI (β=0.07, 95% CI=0.014–0.126, P=0.015), and high CBR (β=−7.772, 95% CI=−10.519 to −5.025, P<0.001) were identified as independent predictors of low bone density. Receiver operating characteristic analysis demonstrated that CBR had a similar osteoporosis screening capability as Hounsfield units, followed by CBT and VBQ scores.

Conclusions.

The utilization of CBR from full-spine x-rays is a simple and effective osteoporosis screening indicator for ASD patients, facilitating bone density assessments by spine surgeons for all attending patients.
Advancements in Diagnosis and Multimodal Treatment Strategies for Retroperitoneal Tumors
Authors: Zhao Shuai , Sun Longhe , Zhou Jiajie , Li Ruiqi , Sun Qiannan , Wang Wei , Wang Daorong
Published: March 2024

Retroperitoneal tumors (RPTs) encompass both benign and malignant entities, constituting ~0.1% to 0.2% of all malignant tumors, of which 70% to 80% manifest malignancy. Predominantly, retroperitoneal sarcomas (RPS) represent the most prevalent subtype among RPT. With over 70 histologic forms identified, liposarcomas and leiomyosarcomas emerge as the primary constituents of RPS. Accurate diagnosis of RPTs necessitates preoperative core-needle biopsy and comprehensive imaging assessment. The current staging protocol for RPS relies on the eighth edition of the American Joint Committee on Cancer/TNM classification. Surgical excision remains the established gold standard for treating RPS. Therapeutic approaches vary according to the underlying pathophysiology. Although chemotherapy and radiotherapy exhibit efficacy in managing metastatic and recurrent unresectable RPS, their role in primary RPS remains unresolved, necessitating further clinical trials for validation. Concurrently, ongoing research explores the potential of targeted therapies and immunotherapy. This literature review aims to provide a comprehensive overview of existing research, delineating diagnostic pathways and optimal therapeutic strategies for RPT.
A review of the Moses effect and its applications in endourology
Authors: Piñero Adrià , Narváez Alonso , Placer José , Miret Enric , Trilla Enrique , Morote Juan
Published: March 2024

The holmium:yttrium aluminum garnet laser, the gold standard for lithotripsy, is widely used in various endourological fields. Their physical characteristics contribute to the Moses effect. This narrative review aimed to analyze the current knowledge of the Moses effect and its applications in endourology. The Moses effect involves the rapid formation of a vapor bubble that allows the remaining energy to reach the target with less attenuation. Lumenis® developed pulse modulation technology, the MOSES™ technology, that harnesses the Moses effect to optimize holmium energy. Preclinical studies concluded that the new technology improves stone retropulsion, allowing for reduced lithotripsy duration. However, the heterogeneity of clinical studies and the lack of randomized controlled trials do not allow definitive conclusions. The MOSES™ technology has also been applied in holmium laser enucleation of the prostate, reducing enucleation and hemostasis times, leading to improved enucleation efficiency. However, minimal changes occurred in hemoglobin or hematocrit levels and no significant differences were noted in complications or functional outcomes. Further research is needed to fully evaluate the benefits and limitations of MOSES™ technology in clinical practice.
Outer retinal microcavitations in Retinitis Pigmentosa: a novel OCT finding common in RP1-related retinopathy.
Authors: Dimopoulos Ioannis S. , Huryn Laryssa A. , Hufnagel Robert B. , Ullah Ehsan , Agather Aime R. , Blain Delphine , Brooks Brian P. , Cukras Catherine A. , Zein Wadih M.
Published: March 2024

PURPOSE.

To describe a novel optical coherence tomography (OCT) finding of outer retina microcavitations in RP1-related retinopathy and other retinal degenerations.

METHODS.

Medical charts and OCT images of 28 patients with either autosomal dominant (adRP) or recessive (arRP) RP1-related retinopathy were reviewed. Outer retina microcavitations were defined as hypo-reflective OCT structures of at least 30μm in diameter between the ellipsoid zone (EZ) and retinal pigment epithelium. Comparison was made based on the following metrics: (i) functional measures including best-corrected visual acuity (BCVA) and color discrimination errors on D-15 test; and (ii) structural measures, including central subfield (CSF), average macular thickness (AMT), and preserved transfoveal EZ width. Mann-Whitney tests were used for comparisons with significance set at P<0.05. The specificity of microcavitations for RP1-related retinopathy was estimated against 26 patients with non-RP1 RP.

RESULTS.

Among 15 included patients, microcavitations were found in at least one eye of all arR patients and 7/12 (58%) of adR patients. Patients with adR and microcavitations were older at the time of examination (51 vs. 43 years of age; p=0.04) and their eyes demonstrated worse BCVA (0.09 vs. 0 logMAR; p=0.008), reduced CSF (256 vs. 293μm; p=0.01), AMT (241 vs. 270μm; p=0.02) and shorter transfoveal EZ widths (1.67 vs. 4.98mm; p<0.0001). The finding of microcavitations showed a specificity of 0.92 for RP1-related retinopathy.

CONCLUSION.

A novel OCT finding of outer retina microcavitations was commonly observed in patients with RP1-related retinopathy. Eyes with outer retinal OCT microcavitations had worse visual function and more affected central retinal structure.
Incidence and risk factors of breast cancer-related lymphedema in Korea: a nationwide retrospective cohort study
Authors: Ahn Ha Rim , Jeong Hyeong Eun , Jeong Choyun , Kang Sang Yull , Jung Sung Hoo , Youn Hyun Jo , Kim Jong Seung
Published: March 2024

Background:

Breast cancer-related lymphedema (BCRL) is a secondary lymphedema that occurs after breast cancer related treatments. BCRL develops from damage or dysfunction of the normally functioning lymphatic system due to surgery, radiation therapy, and rarely due to cancer recurrence. This nationwide, retrospective study was aimed at investigating the incidence and risk factors of BCRL using the database of the Korean National Health Insurance Service (NHIS).

Methods:

Patients with newly diagnosed breast cancer who underwent breast surgery from 1 January 2017 to 31 December 2020, were recruited. The incidence was compared by four groups according to the operation type of breast cancer [breast conserving surgery (BCS) with sentinel lymph node biopsy (S), BCS with axillary lymph node dissection (A), total mastectomy (TM) with S, modified radical mastectomy (MRM)]. The incidence rates of lymphedema were calculated by the number of incident events by the total follow-up period. Cox proportional hazard regression was used to calculate the risk of incidence of lymphedema based on a patients’ characteristics, breast cancer treatment, and comorbidities.

Results:

The final cohort of operation subjects that satisfied the inclusion criteria was 34 676. BCRL occurred in 4242 patients (12.2%), and the median follow-up period was 695.4 days. The BCRL was diagnosed in the BCS with S (8.0%), BCS with A (23.5%), TM with S (10.7%), and MRM (28.5%) with an incidence of 40.8, 132.2, 55.8, and 171.8 per 1000 person-years, respectively. Young age, obesity, chemotherapy, radiotherapy, residence in metropolitan areas, and hyperlipidemia were identified as risk factors.

Conclusion:

In Korea, the incidence of BCRL was found to be 12.2%, with the highest risk observed among patients who underwent MRM. Therefore, surgical oncologists should meticulously assess the appropriate surgical approach and consider providing education to patients with risk factors for BCRL, aiming to ensure effective prevention strategies.
A New Methodology for Evaluation of Large Vestibular Aqueduct in CT and MRI Images
Authors: Ivanauskaite Jurgita , Ivanauskaite Justina , Matin-Mann Farnaz , Giesemann Anja Maria , Lenarz Thomas , Lesinski-Schiedat Anke
Published: March 2024

Hypothesis

Development of a new method for large vestibular aqueduct (LVA)/large endolymphatic sac anomaly (LESA) assessment using magnetic resonance imaging (MRI) and computed tomography (CT)/cone beam CT (CBCT) images. The secondary objective was to compare both modalities.

Background

The gold standard for LVA diagnosis is the analysis of CT images using Valvassori and Clemis or Cincinnati criteria. The previous studies showed inconclusive results regarding the correlation between audiological and radiological data.

Methods

Retrospective analysis of radiological images from 173 patients (315 ears), who were diagnosed with LVA/LESA based on CT/CBCT and/or MRI images of the temporal bone. The images obtained using both techniques were used to measure the following dimensions of vestibular aqueduct (VA)/endolymphatic duct (ED)/intraosseous endolymphatic sac (ES): width of the opening, length, and width at external aperture. In MRI images, the maximal contact diameters of the extraosseous or intraosseous ES and dura mater were measured as well.

Results

LVA has been reported to be bilateral in 82% (142 patients) and unilateral in 18% (31 patients) of cases. Comparison of MRI and CT/CBCT measurements showed a moderate correlation (0.64) in external aperture, a moderate correlation (0.57) in the width of the VA opening, and a weak correlation (0.34) in length measurements (p < 0.05).

Conclusion

We developed a new method to identify the heterogeneous pathology of LVA/LESA using reconstruction along the VA/ED/intraosseous ES axis, three measurements on two planes, and focus on the maximal contact diameter between the extraosseous or intraosseous ES and dura mater.
High antibiotic resistance rates in Helicobacter pylori strains in Turkey over 20 years: implications for gastric disease treatment
Authors: Sarıkaya Burak , Çetinkaya Riza Aytaç , Özyiğitoğlu Derya , Işık Sinem Akkaya , Kaplan Mustafa , Kırkık Duygu , Görenek Levent
Published: March 2024

Objective

Helicobacter pylori (Hp) eradication therapy is crucial for preventing the development of gastritis, peptic ulcers, and gastric cancer. An increase in resistance against antibiotics used in the eradication of Hp is remarkable. This meta-analysis aims to examine the resistance rates of Hp strains isolated in Turkey over the last 20 years against clarithromycin (CLR), metronidazole (MTZ), levofloxacin (LVX), tetracycline (TET), and amoxicillin (AMX) antibiotics.

Basic methods

Literature search was carried out in electronic databases, by searching articles published in Turkish and English with the keywords ‘helicobacter pylori’ or ‘Hp’ and ‘antibiotic resistance’ and ‘Turkey’. That meta-analysis was carried out using random-effect model. First, the 20-year period data between 2002 and 2021 in Turkey were planned to be analyzed. As a second stage, the period between 2002 and 2011 was classified as Group 1, and the period between 2012 and 2021 as Group 2 for analysis, with the objective of revealing the 10-year temporal variation in antibiotic resistance rates.

Main results

In gastric biopsy specimens, 34 data from 29 studies were included in the analysis. Between 2002–2021, CLR resistance rate was 30.9% (95% CI: 25.9–36.2) in 2615 Hp strains. Specifically, in Group 1, the CLR resistance rate was 31% in 1912 strains, and in Group 2, it was 30.7% in 703 strains. The MTZ resistance rate was found to be 31.9% (95% CI: 19.8–45.4) in 789 strains, with rates of 21.5% in Group 1 and 46.6% in Group 2. The overall LVX resistance rate was 25.6%, with rates of 26.9% in Group 1 and 24.8% in Group 2. The 20-year TET resistance rate was 0.8%, with 1.50% in Group 1 and 0.2% in Group 2. The overall AMX resistance rate was 2.9%, 3.8% between 2002–2011, and 1.4% between 2012–2021.

Principal conclusion

Hp strains in Turkey exhibit high resistance rates due to frequent use of CLR, MTZ, and LVX antibiotics. However, a significant decrease has been observed in TET and AMX resistance to Hp in the last 10 years. Considering the CLR resistance rate surpasses 20%, we suggest reconsidering the use of conventional triple drug therapy as a first-line treatment. Instead, we recommend bismuth-containing quadruple therapy or sequential therapies (without bismuth) for first-line treatment, given the lower rates of TET and AMX resistance. Regimens containing a combination of AMX, CLR, and MTZ should be given priority in second-line therapy. Finally, in centers offering culture and antibiogram opportunities, regulating the Hp eradication treatment based on the antibiogram results is obviously more appropriate.
The frequency and clinical significance of antibodies to soluble liver antigen/liver pancreas in autoimmune hepatitis: a prospective single-center study
Authors: Yüksekyayla Osman , Kina Nabi , Ulaba Arjen , Emin Ergün Mehmet , Batibay Ersin , Şimşek Cem , Yildiz Zeyrek Fadile , Wahlin Staffan , Efe Cumali
Published: March 2024

Background and aims

Soluble liver antigen/liver pancreas antibodies (anti-SLA/LP) are specific markers for autoimmune hepatitis (AIH) that have been associated with a distinct clinical phenotype and a more aggressive form of AIH. We prospectively evaluated the frequency and clinical significance of anti-SLA/LP in Turkish patients with AIH.

Material and methods

We prospectively included patients diagnosed with AIH between January 2018 and May 2023. Autoantibodies were detected using by immunofluorescence and immunoblot.

Results

We included 61 (80%, female) AIH patients with a median age of 31 years (15–78) at the time of diagnosis. Anti-SLA/LP was detected in 20% (n = 12) of the patients. Baseline characteristics, treatment responses and outcomes were similar among anti-SLA/LP-positive and anti-SLA/LP-negative AIH patients. Anti-SLA/LP-positive patients had significantly higher biochemical response rates after 4 weeks (100 vs. 67%, P = 0.027), 3 months (100 vs. 39%, P < 0.001), 6 months (100 vs. 69%, P = 0.041) of therapy but not after 12 months (100 vs. 76%, P = 0.103) and at the end of follow-up (100 vs. 91%, P = 0.328). Relapse rates following treatment response were similar in patients with and without anti-SLA/LP (22 vs. 23%, P = 0.956). Second-line therapies (tacrolimus and mycophenolate mofetil) were given to seven (11%) patients, all were anti-SLA/LP-negative. Two of these progressed into end-stage liver disease and both underwent liver transplantation.

Conclusion

Our study results suggest that anti-SLA/LP positivity does not entail clinically distinct or severe features in AIH. In our cohort, anti-SLA/LP-positive patients showed a quicker response to immunosuppressive therapy.
Clinical outcomes with metformin use in diabetic patients with compensated cirrhosis: a systematic review and meta-analysis
Authors: Peppas Spyros , Doumas Stavros , Suvarnakar Advait , Chou Jiling , Arafat Ayah , Ahmad Akram I. , Lewis James H.
Published: March 2024

Background

Previous studies have demonstrated a beneficial effect of metformin in patients with cirrhosis, but no improvement in liver histology.

Aim

To investigate the impact of metformin on mortality and hepatic decompensation in people with diabetes with compensated cirrhosis.

Methods

Medline, Embase and Cochrane databases were searched from inception to February 2023 for studies reporting results regarding the impact of metformin on all-cause mortality and hepatic decompensation in people with diabetes with compensated cirrhosis. The risk of bias was assessed by ROBINS-I Cochrane tool. R software 4.3.1 was used for all analyses.

Results

Six observational studies were included in the final analysis. Metformin use was associated with reduced all-cause mortality or liver transplantation [hazard ratio (HR): 0.55; 95% confidence interval (CI) 0.37–0.82], while no benefit was shown in the prevention of hepatic decompensation (HR: 0.97; 95% CI: 0.77–1.22). In the subgroup analysis, metformin use was associated with reduced all-cause mortality or liver transplantation (HR: 0.50; 95% CI 0.38–0.65) in patients with metabolic-associated steatohepatitis cirrhosis, while two studies reported no survival benefit in patients with cirrhosis due to hepatitis C (HR: 0.39; 95% CI 0.12–1.20).

Conclusion

Metformin use is associated with reduced all-cause mortality, but not with the prevention of hepatic decompensation in people with diabetes with compensated cirrhosis. The mortality benefit is most likely driven by better diabetes and cardiovascular health control.
Responding to Soul Injury
Authors: Grassman Deborah , Katz Abi , Conforti-Brown Luann , Wilson Josephine F. , Snyder Angie
Published: March 2024

Soul Injury is defined as a wound that separates a person from their real self, caused by unmourned loss and hurt, unforgiven guilt and shame, and fear of helplessness or loss of control. Tools and interventions have been developed to guide people impacted by Soul Injury. This study assessed the effectiveness of 12 tools and interventions provided during a 4-day Soul Injury Leadership Institute. This 2-part investigation included an online survey of participants who had attended a 4-day Institute training and a post-Institute narrative inquiry conducted as virtual structured interviews. Ninety-one professionals completed the online survey, which inquired about the impact of specific Soul Injury tools and interventions on the respondents' personal and professional life. The Anchor Your Heart tool was the most frequently used tool and had the most enduring utilization across time and settings. Qualitative data collected in virtual interviews with 15 volunteers demonstrated the power of the Write/Tell Your Story technique in which storied narratives permit an individual to integrate powerful experiences such as traumatic events, serious illness, and even death, providing further validation that Soul Injury is an important human phenomenon.
Streamlining Telecommunications Center and Interfacility Patient Throughput to a Pediatric Emergency Department by Utilizing an Electronic Handoff: A Quality Improvement Initiative
Authors: Wolski Thomas P. , Kunka Sarah , Smith Elizabeth , Carter Robert , Rajbhandari Prabi
Published: March 2024

Objective

Effective handoffs are critical for patient safety and high-quality care. The pediatric emergency department serves as the initial reception for patients where optimal communication is crucial. The complexities of interfacility handoffs can result in information loss due to lack of standardization. The aim of our project was a 50% reduction in monthly calls routed through the communication center from 157 to 78, for interfacility transfers to the emergency department from outpatient sites within our organization over a 1-year period, through utilization of an electronic handoff activity.

Methods

We designed a quality improvement project in a tertiary care pediatric hospital to improve the process of interfacility transfer. The initiative aimed to streamline the transfer of patients from ambulatory, urgent care, and nurse triage encounters to the pediatric emergency department by using the electronic health record. The primary outcome measure was number of monthly calls received by the telecommunications center for these transfers.

Our process measure was tracked by measuring the utilization of the electronic handoff. In addition, the number of safety events reported because of information lost through using the electronic handoff served as a balancing measure.

Results

One year after the enterprise-wide rollout of the handoff, the telecommunications center was receiving an average of 29 calls per month versus 157 at time of study initiation, a decrease of 81.5%. Monthly usage increased from zero to an average of 544 during the same period. The project was continued after the initial 12-month data collection and demonstrated stability.

Conclusions

Our initiative facilitated the safe and efficient transfer of patients and streamlined workflows without sacrificing quality of patient care. Our telecommunications center has been freed up for other tasks with fewer interruptions during patient throughput. Next steps will analyze the encounters of transferred patients to further optimize patient flow at our organization.
Emergency Department Sepsis Triage Scoring Tool Elements Associated With Hypotension Within 24 Hours in Children With Fever and Tachycardia
Authors: Baker Alexandra H. , Mazandi Vanessa M. , Norton Jackson S. , Melendez Elliot
Published: March 2024

Objective

Pediatric sepsis screening is becoming the standard of care for children presenting to the emergency department (ED) and has been shown to improve recognition of severe sepsis, but it is unknown if these screening tools can predict progression of disease. The objective of this study was to determine if any elements of a sepsis triage trigger tool were predictive of progression to hypotensive shock in children presenting to the ED with fever and tachycardia.

Methods

This study is a retrospective case-control study of children ≤18 years presenting to an ED with fever and tachycardia, comparing those who went on to develop hypotensive shock in the subsequent 24 hours (case) to those who did not (control). Primary outcome was the proportion of encounters where the patient had specific abnormal vital signs or clinical signs as components of the sepsis triage score. The secondary outcomes were the proportion of encounters where the patient had a sepsis risk factor.

Results

During the study period, there were 94 patients who met case criteria and 186 controls selected. In the adjusted multivariable model, the 2 components of the sepsis triage score that were more common in case patients were the presence of severe cerebral palsy (adjusted odds ratio, 9.4 [3.7, 23.9]) and abnormal capillary refill at triage (adjusted odds ratio, 3.1 [1.4, 6.9]).

Conclusions

Among children who present to a pediatric ED with fever and tachycardia, those with prolonged capillary refill at triage or severe cerebral palsy were more likely to progress to decompensated septic shock, despite routine ED care.
Acellular Perfusate is an Adequate Alternative to Packed Red Blood Cells During Normothermic Human Kidney Perfusion
Authors: Longchamp Alban , Fontan Fermin M. , Aburawi Mohamed M. , Eymard Corey , Karimian Negin , Detelich Danielle , Pendexter Casie , Cronin Stephanie , Agius Thomas , Nagpal Sonal , Banik Peony Dutta , Tessier Shannon N. , Ozer Sinan , Delmonico Francis L. , Uygun Korkut , Yeh Heidi , Markmann James F.
Published: March 2024

Background.

Brief normothermic machine perfusion is increasingly used to assess and recondition grafts before transplant. During normothermic machine perfusion, metabolic activity is typically maintained using red blood cell (RBC)–based solutions. However, the utilization of RBCs creates important logistical constraints. This study explored the feasibility of human kidney normothermic perfusion using William’s E–based perfusate with no additional oxygen carrier.

Methods.

Sixteen human kidneys declined for transplant were perfused with a perfusion solution containing packed RBCs or William’s E medium only for 6 h using a pressure-controlled system. The temperature was set at 37 °C. Renal artery resistance, oxygen extraction, metabolic activity, energy metabolism, and histological features were evaluated.

Results.

Baseline donor demographics were similar in both groups. Throughout perfusion, kidneys perfused with William’s E exhibited improved renal flow (P = 0.041) but similar arterial resistance. Lactic acid levels remained higher in kidneys perfused with RBCs during the first 3 h of perfusion but were similar thereafter (P = 0.95 at 6 h). Throughout perfusion, kidneys from both groups exhibited comparable behavior regarding oxygen consumption (P = 0.41) and reconstitution of ATP tissue concentration (P = 0.55). Similarly, nicotinamide adenine dinucleotide levels were preserved during perfusion. There was no evidence of histological damage caused by either perfusate.

Conclusions.

In human kidneys, William’s E medium provides a logistically convenient, off-the-shelf alternative to packed RBCs for up to 6 h of normothermic machine perfusion.
Giant sequoia (
Sequoiadendron giganteum
) in the UK: carbon storage potential and growth rates
Authors: Holland Ross , Castro Guilherme , Chavana-Bryant Cecilia , Levy Ron , Moat Justin , Robson Thomas , Wilkinson Tim , Wilkes Phil , Yang Wanxin , Disney Mathias
Published: March 2024

Giant sequoias (
Sequoiadendron giganteum
) are some of the UK’s largest trees, despite only being introduced in the mid-nineteenth century. There are an estimated half a million giant sequoias and closely related coastal redwoods (
Sequoia sempervirens
) in the UK. Given the recent interest in planting more trees, partly due to their carbon sequestration potential and also their undoubted public appeal, an understanding of their growth capability is important. However, little is known about their growth and carbon uptake under UK conditions. Here, we focus on
S
.
giganteum
and use three-dimensional terrestrial laser scanning to perform detailed structural measurements of 97 individuals at three sites covering a range of different conditions, to estimate aboveground biomass (AGB) and annual biomass accumulation rates. We show that UK-grown
S. giganteum
can sequester carbon at a rate of 85 kg yr
−1
, varying with climate, management and age. We develop new UK-specific allometric models for
S. giganteum
that fit the observed AGB with
r
2
> 0.93 and bias < 2% and can be used to estimate
S. giganteum
biomass more generally. This study provides the first estimate of the growth and carbon sequestration of UK open-grown
S. giganteum
and provides a baseline for estimating their longer-term carbon sequestration capacity.
An approach to assessing subsea pipeline-associated mercury release into the North Sea and its potential environmental and human health impact
Authors: von Hellfeld Rebecca , Hastings Astley
Published: March 2024

Mercury is a naturally occurring heavy metal that has also been associated with anthropogenic sources such as cement production or hydrocarbon extraction. Mercury is a contaminant of concern as it can have a significant negative impact on organismal health when ingested. In aquatic environments, it bioaccumulates up the foodweb, where it then has the potential to impact human health. With the offshore hydrocarbon platforms in the North Sea nearing decommissioning, they must be assessed as a potential source for the environmental release of mercury. International treaties govern the handling of materials placed in the ocean. Studies have assessed the ecologic and economic benefits of (partial)
in situ
abandonment of the infrastructure as artificial reefs. This can be applied to pipelines after substantial cleaning to remove mercury accumulation from the inner surface. This work outlines the application of an approach to modelling marine mercury bioaccumulation for decommissioning scenarios in the North Sea. Here,
in situ
decommissioning of cleaned pipelines was unlikely to have a negative impact on the North Sea food web or human health. However, significant knowledge gaps have been determined, which must be addressed before all negative impacts on ecosystems and organismal health can be excluded.
Heritability of cognitive performance in wild Western Australian magpies
Authors: Speechley Elizabeth M. , Ashton Benjamin J. , Thornton Alex , Simmons Leigh W. , Ridley Amanda R.
Published: March 2024

Individual differences in cognitive performance can have genetic, social and environmental components. Most research on the heritability of cognitive traits comes from humans or captive non-human animals, while less attention has been given to wild populations. Western Australian magpies (
Gymnorhina tibicen dorsalis,
hereafter magpies) show phenotypic variation in cognitive performance, which affects reproductive success. Despite high levels of individual repeatability, we do not know whether cognitive performance is heritable in this species. Here, we quantify the broad-sense heritability of associative learning ability in a wild population of Western Australian magpies. Specifically, we explore whether offspring associative learning performance is predicted by maternal associative learning performance or by the social environment (group size) when tested at three time points during the first year of life. We found little evidence that offspring associative learning performance is heritable, with an estimated broad-sense heritability of just −0.046 ± 0.084 (confidence interval: −0.234/0.140). However, complementing previous findings, we find that at 300 days post-fledging, individuals raised in larger groups passed the test in fewer trials compared with individuals from small groups. Our results highlight the pivotal influence of the social environment on cognitive development.
Super band gaps and periodic approximants of generalised Fibonacci tilings
Authors: Davies Bryn , Morini Lorenzo
Published: March 2024

We present mathematical theory for self-similarity induced spectral gaps in the spectra of systems generated by generalised Fibonacci tilings. Our results characterise super band gaps, which are spectral gaps that exist for all sufficiently large periodic systems in a Fibonacci-generated sequence. We characterise super band gaps in terms of a growth condition on the traces of the associated transfer matrices. Our theory includes a large family of generalised Fibonacci tilings, including both precious mean and metal mean patterns. We apply our analytic results to characterise spectra in three different settings: compressional waves in a discrete mass-spring system, axial waves in structured rods and flexural waves in multi-supported beams. The theory is shown to give accurate predictions of the super band gaps, with minimal computational cost and significantly greater precision than previous estimates. It also provides a mathematical foundation for using periodic approximants (supercells) to predict the transmission gaps of quasicrystalline samples, as we verify numerically.
Exotic predators can sequester and use novel toxins from exotic non-coevolved prey
Authors: Plata Ángel , Züst Tobias , Bermejo Almudena , Beitia Francisco José , Tena Alejandro
Published: March 2024

Defensive chemicals of prey can be sequestered by some coevolved predators, which take advantage of prey toxins for their own defence. The increase in the number of invasive species in the Anthropocene has resulted in new interactions among non-coevolved predator and prey species. While novelty in chemical defence may provide a benefit for invasive prey against non-coevolved predators, resident predators with the right evolutionary pre-adaptations might benefit from sequestering these novel defences. Here, we chose a well-known system of invasive species to test whether non-coevolved predators can sequester and use toxins from exotic prey. Together with the invasive prickly pear plants, cochineal bugs (
Dactylopius
spp.) are spreading worldwide from their native range in the Americas. These insects produce carminic acid, a defensive anthraquinone that some specialized predators sequester for their own defence. Using this system, we first determined whether coccinellids that prey on cochineal bugs in the Mediterranean region tolerated, sequestered, and released carminic acid in reflex bleeding. Then, we quantified the deterrent effect of carminic acid against antagonistic ants. Our results demonstrate that the Australian coccinellid
Cryptolaemus montrouzieri
sequestered carminic acid, a substance absent in its coevolved prey, from exotic cochineal bugs. When attacked, the predator released this substance through reflex bleeding at concentrations that were deterrent against antagonistic ants. These findings reveal that non-coevolved predators can sequester and use novel toxins from exotic prey and highlights the surprising outcomes of novel interactions that arise from species invasions.
On the relationship between foveal mask interference and mental imagery in peripheral object recognition
Authors: Contemori Giulio , Oletto Carolina Maria , Battaglini Luca , Bertamini Marco
Published: March 2024

A delayed foveal mask affects perception of peripheral stimuli. The effect is determined by the timing of the mask and by the similarity with the peripheral stimulus. A congruent mask enhances performance, while an incongruent one impairs it. It is hypothesized that foveal masks disrupt a feedback mechanism reaching the foveal cortex. This mechanism could be part of a broader circuit associated with mental imagery, but this hypothesis has not as yet been tested. We investigated the link between mental imagery and foveal feedback. We tested the relationship between performance fluctuations caused by the foveal mask—measured in terms of discriminability (d′) and criterion (C)—and the scores from two questionnaires designed to assess mental imagery vividness (VVIQ) and another exploring object imagery, spatial imagery and verbal cognitive styles (OSIVQ). Contrary to our hypotheses, no significant correlations were found between VVIQ and the mask's impact on d′ and C. Neither the object nor spatial subscales of OSIVQ correlated with the mask's impact. In conclusion, our findings do not substantiate the existence of a link between foveal feedback and mental imagery. Further investigation is needed to determine whether mask interference might occur with more implicit measures of imagery.