bluuebunny/crossref_metadata_2025 huggingface dataset:
Jus Cogens and Interpretation of International Law
Authors: Tladi Dire
Published: June 2024

Chapter 12 concerns jus cogens and interpretation, which is the subject of Draft Conclusion 20. The chapter describes the purpose underlying the rule contained in the Draft Conclusion. It also describes its basis in international law. Based on the principle of systemic integration the rule in Draft Conclusion 20 is also sourced from case law. The chapter places the rule in the context of the consequences of invalidity (Chapters 8 and 9), seeing the rule as one designed to avoid the far-reaching consequences of invalidity. In so doing the chapter assesses the possible tension between the objective of coherence and the fear of modification by interpretation.
Recommended Dispute Settlement Procedure
Authors: Tladi Dire
Published: June 2024

Chapter 13 addresses a procedure for resolving disputes which is provided for in Draft Conclusion 21. Draft Conclusion 21 provides a recommended procedure for addressing disputes relating to the invalidation of a rule of international law on account of conflict with jus cogens. Draft Conclusion 21 is, thus, an essential part of the set of Draft Conclusions and is intended to prevent, or more accurately, reduce the potential of auto-interpretation inherent in the system of international law. The chapter assesses and evaluates the arguments made from different quarters against the recommended procedure. Given the nature of the provision, as one that is a creation of the International Law Commission, the chapter describes its content, while at the same time pointing out ambiguities in the text.
Theorizing Affect in Mahler
Authors: Li Edwin K. C
Published: June 2024

This article examines ways of theorizing affect in Mahler’s music, focusing on reading Adorno’s material theory of form as an affective theory of form, and shedding light on the potential critiques that this reading may face, and, more broadly, the ramifications it holds for Mahler studies and affect studies. It begins with an exploration of the dialectical nature of Adorno’s material theory of form, then posits that one’s affective experience of the categories laid out in the theory can be theorized by what Adorno calls the ‘shudder’ in the form of an ungraspable petrification. After discussing two other theoretical angles in literature on Mahler through which my reading of Adorno’s Formenlehre can be evaluated, the article throws into relief how Adorno’s affective theory of form may contribute to affect studies in simultaneously subjecting affect and music to critique.
Crystal structure of a tetrameric RNA G-quadruplex formed by hexanucleotide repeat expansions of C9orf72 in ALS/FTD
Authors: Geng Yanyan , Liu Changdong , Xu Naining , Suen Monica Ching , Miao Haitao , Xie Yuanyuan , Zhang Bingchang , Chen Xueqin , Song Yuanjian , Wang Zhanxiang , Cai Qixu , Zhu Guang
Published: June 2024

The abnormal GGGGCC hexanucleotide repeat expansions (HREs) in C9orf72 cause the fatal neurodegenerative diseases including amyotrophic lateral sclerosis and frontotemporal dementia. The transcribed RNA HREs, short for r(G4C2)n, can form toxic RNA foci which sequestrate RNA binding proteins and impair RNA processing, ultimately leading to neurodegeneration. Here, we determined the crystal structure of r(G4C2)2, which folds into a parallel tetrameric G-quadruplex composed of two four-layer dimeric G-quadruplex via 5′-to-5′ stacking in coordination with a K+ ion. Notably, the two C bases locate at 3′- end stack on the outer G-tetrad with the assistance of two additional K+ ions. The high-resolution structure reported here lays a foundation in understanding the mechanism of neurological toxicity of RNA HREs. Furthermore, the atomic details provide a structural basis for the development of potential therapeutic agents against the fatal neurodegenerative diseases ALS/FTD.
Loops are geometric catalysts for DNA integration
Authors: Battaglia Cleis , Michieletto Davide
Published: June 2024

The insertion of DNA elements within genomes underpins both genetic diversity and disease when unregulated. Most of DNA insertions are not random and the physical mechanisms underlying the integration site selection are poorly understood. Here, we perform Molecular Dynamics simulations to study the insertion of DNA elements, such as viral DNA or transposons, into naked DNA or chromatin substrates. More specifically, we explore the role of loops within the polymeric substrate and discover that they act as ‘geometric catalysts’ for DNA integration by reducing the energy barrier for substrate deformation. Additionally, we discover that the 1D pattern and 3D conformation of loops have a marked effect on the distribution of integration sites. Finally, we show that loops may compete with nucleosomes to attract DNA integrations. These results may be tested in vitro and they may help to understand patterns of DNA insertions with implications in genome evolution and engineering.
Super-enhancer-driven IRF2BP2 enhances ALK activity and promotes neuroblastoma cell proliferation
Authors: Chen Yanling , Zhuo Ran , Sun Lichao , Tao Yanfang , Li Gen , Zhu Frank , Xu Yunyun , Wang Jianwei , Li Zhiheng , Yu Juanjuan , Yin Hongli , Wu Di , Li Xiaolu , Fang Fang , Xie Yi , Hu Yizhou , Wang Hairong , Yang Chun , Shi Lei , Wang Xiaodong , Zhang Zimu , Pan Jian
Published: June 2024

Background

Super-enhancers (SEs) typically govern the expression of critical oncogenes and play a fundamental role in the initiation and progression of cancer. Focusing on genes that are abnormally regulated by SE in cancer may be a new strategy for understanding pathogenesis. In the context of this investigation, we have identified a previously unreported SE-driven gene IRF2BP2 in neuroblastoma (NB).

Methods

The expression and prognostic value of IRF2BP2 were detected in public databases and clinical samples. The effect of IRF2BP2 on NB cell growth and apoptosis was evaluated through in vivo and in vitro functional loss experiments. The molecular mechanism of IRF2BP2 was investigated by the study of chromatin regulatory regions and transcriptome sequencing.

Results

The sustained high expression of IRF2BP2 results from the activation of a novel SE established by NB master transcription factors MYCN, MEIS2, and HAND2, and they form a new complex that regulates the gene network associated with the proliferation of NB cell populations. We also observed a significant enrichment of the AP-1 family at the binding sites of IRF2BP2. Remarkably, within NB cells, AP-1 plays a pivotal role in shaping the chromatin accessibility landscape, thereby exposing the binding site for IRF2BP2. This orchestrated action enables AP-1 and IRF2BP2 to collaboratively stimulate the expression of the NB susceptibility gene ALK, thereby upholding the highly proliferative phenotype characteristic of NB.

Conclusions

Our findings indicate that SE-driven IRF2BP2 can bind to AP-1 to maintain the survival of tumor cells via regulating chromatin accessibility of the NB susceptibility gene ALK.
Serological Responses to Streptococcus pyogenes Vaccine Candidate Antigens Suggests That Streptococcus dysgalactiae Is the Predominant Cause of Lower Limb Cellulitis
Authors: Taggart Michael , Langworthy Kristyn , Hui Siong , Boyder Conchita , Fulurija Alma , Morici Michael , Raby Edward , Manning Laurens
Published: June 2024

Background

A future Streptococcus pyogenes (Strep A) vaccine will ideally prevent a significant burden of lower limb cellulitis; however, natural immune responses to proposed vaccine antigens following an episode of cellulitis remain uncharacterized.

Methods

We enrolled 63 patients with cellulitis and 26 with invasive beta hemolytic streptococci infection, using a multiplexed assay to measure immunoglobulin G against Strep A vaccine candidate antigens, including: streptolysin O (SLO), deoxyribonuclease B (DNB), group A carbohydrate (GAC), C5a peptidase (ScpA), cell envelope proteinase (SpyCEP), and adhesion and division protein (SpyAD). Responses in the invasive cohort were used to predict the infecting etiology in the cellulitis cohort.

Results

Of 41 patients with cellulitis and paired serological samples, 68.3% had evidence of beta hemolytic streptococci infection by conventional anti-SLO and/or anti-DNB criteria. A positive serological response to at least 1 of the tested antigens was seen in 78.0% of the cellulitis cohort. Individually, anti-SLO (58.5%), anti-SpyAD (46.3%), and anti-ScpA (39.0%) were the most common. Based on principal component analysis, increases in these 3 antibodies, without responses to DNB, GAC, and SpyCEP characterized Streptococcus dysgalactiae subspecies equisimilis (SDSE) infection.

Conclusions

SDSE appears to be the predominant cause of lower limb cellulitis. Effective Strep A vaccines incorporating antigens that provide additional cross protection against SDSE may prevent a significant burden of lower limb cellulitis.
Retained radial artery catheter fragment
Authors: Smith Alan I
Published: June 2024

It is estimated that 8 million arterial lines are placed in the United States yearly, with a low incidence of complications reported as less than 1% Gardner RM. (Direct arterial pressure monitoring. Curr Anaesth Crit Care 1990;1:239–46.), Scheer B, Perel A, Pfeiffer UJ. (Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care 2002;6:199–204.) Fracture of a radial arterial catheter is a very rare complication of radial arterial line placement or removal, with surgical removal of a retained catheter fragment being reported infrequently in the literature. We report the first occurrence of this complication at our institution, with proximal migration of the retained catheter fragment, requiring surgical removal. This case serves to reinforce the care and attention to detail required in the placement, securing of and removal of radial arterial lines.
A clinical case of insulin autoimmune syndrome with monoclonal gammopathy of uncertain significance; complexity in management
Authors: Clifford Liam , Joseph Flavian , Joshi Tripti
Published: June 2024

Insulin autoimmune syndrome (IAS) is a rare cause of spontaneous hypoglycaemia. We discuss a 91-year-old Caucasian lady who presented with syncope and episodic adrenergic and neuroglycopenic symptoms. Despite significantly elevated insulin, C-peptide, and proinsulin levels with the presence of anti-insulin antibodies, a pancreatic mass was not identified. Serum immunoelectrophoresis demonstrated monoclonal gammopathy of undetermined significance (MGUS). Treatment involved high-dose steroids, diazoxide, corn starch and acarbose, however the patient passed away four months later due to worsening co-morbidities. The management of IAS in the setting of MGUS is challenging.
Aseptic pyomyositis in rheumatoid arthritis treated with corticosteroid and DMARDs
Authors: Karmacharya Sudhir , Shrestha Adheep Arun , Nakarmi Shweta , Bhochhibhoya Manisha , Vaidya Binit
Published: June 2024

Pyomyositis is a purulent infection of skeletal muscle that is mostly observed in tropical countries. Aseptic pyomyositis is a rare, potentially life-threatening disorder characterized by the formation of sterile pus in muscle. We present a case of 53-years old female, diagnosed case of seropositive rheumatoid arthritis, presented with pain and swelling of the right calf muscle for 2 weeks. There was no history of fever, cough, skin erythema, no history of prolonged standing or immobility, or fetal loss. The diagnosis was made as rheumatoid arthritis with autoimmune pyomyositis, and the patient was treated with oral prednisolone 1mg/kg body weight in tapering dose, cs DMARDS, (methotrexate 25 mg once a week, and leflunomide 20mg daily hydroxychloroquine 200 mg daily orally) and another supportive treatment along with surgical drainage of pus was done. There was complete resolution of the initial lesion and remission of the primary disease in 3 months.
Two challenging cases of anti-MDA-5 dermatomyositis with rapidly progressive interstitial lung disease
Authors: Biddle Kathryn , Agaoglu Elif , Brent Geoffrey , Adam John , Nockels Rachel , Loveridge Adam , Bazari Farid , Natkunarajah Janakan , Al-Shakarchi Israa
Published: June 2024

Anti-MDA-5 dermatomyositis (DM) is a subtype of idiopathic inflammatory myopathy, commonly presenting as clinically amyopathic dermatomyositis. It is associated with rapidly progressive interstitial lung disease and a poor prognosis. Here, we present two cases of anti-MDA-5 DM and discuss the challenges associated with timely diagnosis, and the importance of early and aggressive treatment.
Ceftriaxone-induced symptomatic cholelithiasis in a child: case report and literature review
Authors: Smerat Mohammad I , Shawer Balqis , AbuIrayyeh Bara M , Natsheh Shahd T , Diab Laila , Shahin Farah B , Manasra Mahmoud R
Published: June 2024

Ceftriaxone is a third-generation cephalosporin. Due to its wide range of activity and acceptable safety profile, it is frequently prescribed to paediatric patients. However, there are several documented cases of reports of uncommon adverse events, such as cholecystitis, linked to the use of ceftriaxone. This study discusses the case of an 8-year-old female patient who developed cholecystitis, an inflammation of the gallbladder, after being treated with ceftriaxone. The patient presented with right upper quadrant pain, associated with nausea. Imaging studies showed the presence of stones and shadowing sludge, leading to acute inflammation of the gallbladder. Prompt cessation of ceftriaxone and supportive treatment led to the resolution of cholecystitis and the complete disappearance of the sludge and stones. The study highlights that early identification and withdrawal of the antibiotic can lead to successful therapy and the avoidance of unnecessary surgical procedures.
Pigmentary retinal dystrophy associated with peroxisome biogenesis disorder-Zellweger syndrome spectrum
Authors: Zou Henry , Sutherland Liliya , Geddie Brooke
Published: June 2024

Pigmentary retinal dystrophy (PRD) is a group of inherited disorders involving the progressive degeneration of rod and cone photoreceptors and the retinal pigment epithelium (RPE), which can progress to pigmentary retinopathy (PR). We present a case of PRD in a female pediatric patient who has pathogenic variants in the PRPH2 and PEX1 genes. The patient has associated macular edema and secondary visual impairment. Treatment has included serial dexamethasone intravitreal implant injections and topical dorzolamide. The PEX1 gene mutation is associated with peroxisome biogenesis disorder-Zellweger syndrome spectrum (PBD-ZSS) and resulting retinal dystrophies. The PRPH2 mutation may play a role in macular edema and PRD, as it is implicated in macular degeneration, choroid defects, and photoreceptor dysfunction. In this case, we review multiple gene mutations playing potential etiologic roles for PRD and discuss care management.
Phytoplankton stoichiometry along the salinity gradient under limited nutrient and light supply
Authors: Orizar Iris D S , Repetti Sonja I , Lewandowska Aleksandra M
Published: June 2024

Ongoing climate warming alters precipitation and water column stability, leading to salinity and nutrient supply changes in the euphotic zone of many coastal ecosystems and semi-enclosed seas. Changing salinity and nutrient conditions affect phytoplankton physiology by altering elemental ratios of carbon (C), nitrogen (N) and phosphorus (P). This study aimed to understand how salinity stress and resource acquisition affect phytoplankton stoichiometry. We incubated a phytoplankton polyculture composed of 10 species under different light, inorganic nutrient ratio and salinity levels. At the end of the incubation period, we measured particulate elemental composition (C, N and P), chlorophyll a and species abundances. The phytoplankton polyculture, dominated by Phaeodactylum tricornutum, accumulated more particulate organic carbon (POC) with increasing salinity. The low POC and low particulate C:N and C:P ratios toward 0 psu suggest that the hypoosmotic conditions highly affected primary production. The relative abundance of different species varied with salinity, and some species grew faster under low nutrient supply. Still, the dominant diatom regulated the overall POC of the polyculture, following the classic concept of the foundation species.
Novel approaches for bacterial toxin neutralization; current advances and future perspectives
Authors: Doroudian M , Ardalan M A , Beheshti M , Soezi M
Published: June 2024

This review outlines diverse strategies for neutralizing bacterial toxins which are a significant threat to human health. Effective toxin neutralization is crucial in preventing and treating bacterial infections, especially those caused by antibiotic-resistant strains. Promising approaches include using monoclonal antibodies that target toxins and combining them with agents that directly target bacteria. Aptamers, synthetic molecules that bind to specific targets, provide a rapid and tailored method for inhibiting toxin activity and detecting pathogens. Cell-membrane-coated nanoparticles mimic host cells and effectively neutralize toxins by diverting them and stimulating immune responses. These advancements have the potential to combat bacterial infections and alleviate the associated public health burden.
Symbolic Pollution and Religious Change: The Religious Imaginary of Anglo-CanadianSpiritual but Not ReligiousMillennials
Authors: Watts Galen , Reimer Sam
Published: June 2024

In this article, we advance a cultural sociological approach to religious change that foregrounds the role of symbolic pollution and shifting religious imaginaries. Leveraging interviews with 50 Anglo-Canadian Millennials who identify as spiritual but not religious, and ethnographic research at three field sites, we sketch a religious imaginary comprising four discourses of “religion.” According to our informants, “religion” is (1) anti-modern; (2) conservative; (3) American; and (4) colonial. Next, we draw from a combination of modern intellectual history and social histories of twentieth-century Canada to trace each of these discourses genealogically, thereby elucidating how “religion” became symbolically polluted for a large cohort of Canadian Millennials. We conclude with a discussion of the implications our account holds for secularization theory and the study of religious change more broadly.
Hungary: Unlocking wealth—a guide to maximizing benefits with Hungarian Asset Management Foundations for single-family offices
Authors: Menyhei Ákos
Published: June 2024

Hungarian Asset Management Foundations (AMFs) present a distinct legal entity tailored for wealth management by blending traditional trust principles with the flexibility of foundations. This article explores the evolution and significance of AMFs within the Hungarian legal framework, examining their role in wealth preservation, asset protection, and estate planning for single-family offices. Key findings reveal that AMFs offer a sophisticated platform for managing and preserving assets, with founders enjoying substantial control over foundation activities. Notably, AMFs provide a robust framework for asset protection, by ensuring separation of assets and shielding them from creditor claims. The confidentiality afforded by AMFs adds an extra layer of security, crucial for maintaining privacy in family wealth matters. Moreover, AMFs demonstrate adaptability to changing circumstances, allowing for dynamic adjustments to wealth management strategies and governance structures. This flexibility, coupled with tax efficiency and compliance mechanisms, positions AMFs as a comprehensive solution for single-family offices seeking to safeguard and grow their wealth across generations.
Algorithmic mistakes in machine-made contracts: the legal consequences of errors in automated contract formation
Authors: Frattone Cristina
Published: June 2024

Automated contract formation is on the rise. The legal consequences of computer errors in the conclusion of machine-made contracts are not straightforward though. This article makes three main contributions to the existing literature. First, it provides a bird’s-eye view of computer errors and proposes a taxonomy for algorithmic mistakes. Specifically, it introduces a distinction between automation mistakes and autonomy mistakes. Second, it illustrates how the rules on mistake under traditional contract law can be applied to algorithmic mistakes de iure condito. Third, and after highlighting the main shortcomings of the application of traditional contract law, it elaborates on the scope and remedial scheme of a specific provision on algorithmic mistake de iure condendo.
Chronic kidney disease in postmenopausal women is associated with tooth loss
Authors: Kim Na-Yeong , Kim Ji-Eun , Choi Choong-Ho , Chung Ki-Ho
Published: June 2024

Objective

Menopause is characterized by changes in reproductive hormone levels that can negatively affect bone. Chronic kidney disease (CKD) and tooth loss are also important and common health issues after menopause. This study aimed to evaluate the association between CKD and tooth loss in postmenopausal women.

Methods

The study evaluated 64,971 participants who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) from 2010-2018, including postmenopausal women, aged 40 to 79 years. Participants were divided into two groups based on the number of teeth in their dentition (≥20 and <20).

Main Outcome Measures

The association between CKD and tooth loss was analyzed using multivariate logistic regression. Age, income, education, smoking, alcohol intake, body mass index, hypertension, diabetes, annual oral examination, toothbrushing, and the use of oral care products were considered. Subgroup analyses were further conducted according to age (40-65 yr and 66-79 yr).

Results

After adjusting for covariates, CKD and estimated glomerular filtration rate were significantly associated with having ≥20 teeth (PT20; CKD: odds ratio [OR] 1.41, 95% confidence interval [CI] 1.04-1.90; estimated glomerular filtration rate (10 mL/min/1.73 m2): OR 0.90, 95% CI 0.86-0.94). Importantly, the association between CKD and PT20 was significant in postmenopausal women, aged 66 to 79 years (OR 1.45, 95% CI 1.05-2.01).

Conclusions

In postmenopausal women, CKD and tooth loss may be associated. The association is significant in postmenopausal women, aged 66 to 79 years.
Cognitive function and bladder health among midlife adult women in the Coronary Artery Risk Development in Young Adults (CARDIA) study
Authors: Brady Sonya S. , Arguedas Andrés , Huling Jared D. , Hellemann Gerhard , Yaffe Kristine , Lewis Cora E. , Fok Cynthia S. , Van Den Eeden Stephen K. , Markland Alayne D.
Published: June 2024

Objective

The aim of this study was to examine whether different aspects of women's cognitive function are associated with lower urinary tract symptoms (LUTS) and their impact.

Methods

In 2010-2011, women aged 42 to 57 years in the Coronary Artery Risk Development in Young Adults study completed different tests of cognitive function, including the Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and Stroop test. Two years later, data on LUTS and their impact were collected. LUTS/impact, a four-level composite variable ranging from bladder health to mild, moderate, and severe LUTS/impact, was regressed on each cognitive test separately, as well as a cognitive function composite variable. The analytic sample was composed of 1,021 women with complete data.

Results

When adjusting for sociodemographic variables (age, race, education) and gynecologic/obstetric variables (parity, menopausal status, hysterectomy, hormonal use), better performance on the cognitive function composite and Digit Symbol Substitution Test were both associated with lower odds of membership to a more severe LUTS/impact category (odds ratio, 0.90 [95% confidence interval, 0.83-0.98] and 0.89 [95% confidence interval, 0.82-0.97], respectively). These associations became nonsignificant when additionally adjusting for mechanisms that might explain an association between cognitive function and LUTS/impact, including health behaviors and health conditions that may covary with cerebral and peripheral vascular health and cognitive function.

Conclusions

In this sample of midlife adult women, a modest association was found between better cognitive function and lower likelihood of LUTS/impact. Longitudinal studies are needed to further investigate the association between cognitive function and LUTS/impact, as well as potential explanatory mechanisms, particularly as women age and cognitive function varies to a greater degree.
Quality of life in postmenopausal women and its association with sarcopenia
Authors: Sriramaneni Nikitha , Selvan Chitra , Kumar S Nanda , Kalra Pramila , P Ganavi Y. , R Manjunath P. , Naushad Altaf Ali , Sourabh Sagar , U Chirag L.
Published: June 2024

Objectives

With the menopausal transition, there is a decline in estrogen concentration with potential health consequences affecting the quality of life. The loss of muscle mass, strength, and function, known as sarcopenia is common in postmenopausal women. The primary objective of this study is to assess the quality of life in postmenopausal women and its association with sarcopenia.

Methods

This was a cross-sectional study conducted in 106 postmenopausal women. Menopausal symptoms and risk of sarcopenia were assessed with Menopause Rating Scale (MRS) and Strength Assistance walking Rising from a chair Climbing stairs and Falls (SARC-F) questionnaires, respectively. Sarcopenia was defined and assessed according to the Asian Working Group for Sarcopenia guidelines 2019.

Results

The mean age was 59.34 ± 7.21 years and the mean age at menopause was 49.50 ± 2.67 years. The majority (80.2%) of the women had high MRS scores (≥9). The majority had mild somatic, moderate psychologic, and severe urogenital symptoms. SARC-F score was low in 85.8% of women. Most of the women (45.3%) had sarcopenia. Somatic symptoms were significant in women with sarcopenia. Urogenital symptoms were significant with greater menopausal duration. Appendicular skeletal muscle mass index was significantly less with greater menopausal duration. MRS score positively correlated with both SARC-F score and sarcopenia. Sarcopenia was significantly associated with greater menopausal duration.

Conclusions

Most of the women had moderate to severe MRS scores suggestive of a poor quality of life. The majority of the women had sarcopenia. Most of the women felt they were strong (according to SARC-F score) despite sarcopenia. Although quality of life did not differ significantly with the duration of menopause, urogenital symptoms were significantly severe with greater menopausal duration. Despite no significant association between quality of life and sarcopenia in postmenopausal women, somatic symptoms were significant in women with sarcopenia. The greater menopausal duration was associated significantly with sarcopenia.
The Hemerocallis citrina extracts ameliorate radiation-induced ferroptosis in LO2 cells through the Nrf2-xCT/GPX4 pathway
Authors: Zhu Zihao , Wang Yan , Deng Zhengzheng , Lei Pengyuan , Liu Qi , Guo Jinjing , Qing Qiancheng , Huang Bo
Published: June 2024

Background:

Radiotherapy, a primary approach in cancer treatment, damages normal cells while targeting cancer cells. Therefore, it is crucial to identify drugs with minimal side effects, high reliability, and radioprotective effects to develop novel radiotherapy strategies. Hemerocallis citrina extracts (HCE), which are derived from plants with medicinal and culinary applications, possess antioxidative and anticancer properties.

Methods:

In this study, we investigated the radioprotective effects of HCE on LO2 cells exposed to radiation to determine whether these effects were mediated through the nuclear factor erythroid 2–related factor 2-cystine–glutamate antiporter/glutathione peroxidase 4 pathway.

Results:

Cell proliferation experiments demonstrated the radioprotective effect of HCE on LO2 cells. Western blot analysis revealed that HCE regulated B-cell lymphoma protein 2-associated X, Cleaved-caspase 3, and B-cell lymphoma protein 2, thereby inhibiting radiation-induced apoptosis, which was consistent with the flow cytometry results.

Conclusions:

Moreover, the detection of ferroptosis-related markers indicated that HCE alleviated radiation-induced ferroptosis in LO2 cells through the nuclear factor erythroid 2–related factor 2-cystine–glutamate antiporter/glutathione peroxidase 4 pathway. These findings provide a theoretical basis for the radioprotective effects of HCE on LO2 cells and offer new insights into the development of radioprotective drugs.
Image- and Impression-Based Technology in Scleral Lens Fitting for Keratoconus: Availability and Utilization
Authors: Fogt Jennifer Swingle , Schornack Muriel , Nau Cherie , Harthan Jennifer , Nau Amy , Shorter Ellen
Published: June 2024

Objective:

Scleral lenses (SLs) can be customized using traditional diagnostic lens fitting or by using image- and/or impression-based technologies. This study describes the availability and usage of SL fitting technology in patients with keratoconus.

Methods:

An online survey queried practitioners on the mode of practice, country of residence, and estimated number of SL fits completed for keratoconus. Practitioners were asked whether they had access to image- and/or impression-based technology and to estimate the percentage of fits completed using diagnostic fitting, image-based technology, and impression-based technology. Access and usage of technology was compared between academic and community practices, United States and non–United States, and high-volume (≥60 SLs) and low-volume fitters.

Results:

423 practitioners who fit SL for keratoconus participated. Image- and impression-based technologies were more frequently available in academic practices compared with community practices and high-volume compared with low-volume practitioners (P<0.005). Practitioners with image-based technology used it for a median [interquartile range] 5 [25]% of SL fittings; those with impression-based technology used it for 8 [9]% of fittings, and those with both types of technology used image-based devices for 12 [23]% of fittings and impression-based for 5 [8]% of fittings.

Conclusions:

In this study, most participants report using diagnostic lenses to fit SLs for patients with keratoconus.
Fueling the success of transplantation through nutrition: recent insights into nutritional interventions, their interplay with gut microbiota and cellular mechanisms
Authors: Koehler Felix C. , Späth Martin R. , Meyer Anna M. , Müller Roman-Ulrich
Published: June 2024

Purpose of review

The role of nutrition in organ health including solid organ transplantation is broadly accepted, but robust data on nutritional regimens remains scarce calling for further investigation of specific dietary approaches at the different stages of organ transplantation. This review gives an update on the latest insights into nutritional interventions highlighting the potential of specific dietary regimens prior to transplantation aiming for organ protection and the interplay between dietary intake and gut microbiota.

Recent findings

Nutrition holds the potential to optimize patients’ health prior to and after surgery, it may enhance patients’ ability to cope with the procedure-associated stress and it may accelerate their recovery from surgery. Nutrition helps to reduce morbidity and mortality in addition to preserve graft function. In the case of living organ donation, dietary preconditioning strategies promise novel approaches to limit ischemic organ damage during transplantation and to identify the underlying molecular mechanisms of diet-induced organ protection. Functioning gut microbiota are required to limit systemic inflammation and to generate protective metabolites such as short-chain fatty acids or hydrogen sulfide.

Nutritional intervention is a promising therapeutic concept including the pre- and rehabilitation stage in order to improve the recipients’ outcome after solid organ transplantation.
Reexploring cytomegalovirus serology in allogeneic hematopoietic cell transplantation
Authors: Royston Léna , Neofytos Dionysios
Published: June 2024

Purpose of review

Discuss the recent evidence on cytomegalovirus (CMV) serology in allogeneic hematopoeic cell transplant (HCT) recipients.

Recent findings

Whereas the role CMV-specific cellular mediated immunity has recently emerged as an important factor of CMV DNAemia posttransplant, the value of CMV serology has remained unchanged through decades, associated with donor selection and posttransplant prophylactic and monitoring strategies. In this review, we describe and discuss the emerging reports on the association between the magnitude of pretransplant CMV immunoglobulin G (IgG) titer and the posttransplant incidence of CMV DNAemia, as CMV IgG titer could become an additional tool in CMV risk assessment in the future.

Pretransplant recipient CMV serology may have significant implications in posttransplant CMV reactivation in allogeneic HCT recipients.
Intraureteral Metastasis From Colon Cancer Mimicking Primary Ureteral Carcinoma on FDG PET/CT
Authors: Ji Xia , Dong Aisheng , Zhu Yan
Published: June 2024

Hematogenous or lymphatic intraureteral metastasis from distant primary cancer is very rare. We present contrast-enhanced CT and FDG PET/CT findings in a case of intraureteral metastasis from colonic adenocarcinoma 3 years after colectomy. The intraureteral showed moderate enhancement on contrast-enhanced CT and increased FDG uptake on PET/CT mimicking a primary ureteral carcinoma. This case suggests that metastatic tumor of the ureter should be considered in the differential diagnosis in patients with hypermetabolic ureteral lesion and known malignancy.
The Maxillary Nerve Block in Cleft Palate Care: A Review of the Literature and Expert’s Opinion on the Preferred Technique of Administration
Authors: Peters Jess J. , Jacobs Karl , Munill Montserrat , Top Anke P.C. , Stevens Markus F. , Ronde Elsa M. , Don Griot J. Peter W. , Lachkar Nadia , Breugem Corstiaan C.
Published: June 2024

Introduction:

Although the maxillary nerve block (MNB) provides adequate pain relief in cleft palate surgery, it is not routinely used globally, and reported techniques are heterogeneous. This study aims to describe relevant anatomy and to present the preferred technique of MNB administration based on the current literature and the expert opinion of the authors.

Method and materials:

First, a survey was sent to 432 registrants of the International Cleft Palate Master Course Amsterdam 2023. Second, MEDLINE (PubMed interface) was searched for relevant literature on maxillary artery (MA) anatomy and MNB administration in pediatric patients.

Results:

Survey response rate was 18% (n=78). Thirty-five respondents (44.9%) used MNB for cleft palate surgery before the course. A suprazygomatic approach with needle reorientation towards the ipsilateral commissure before incision was most frequently reported, mostly without the use of ultrasound. Ten and 20 articles were included on, respectively, MA anatomy and MNB administration. A 47.5% to 69.4% of the MA’s run superficial to the lateral pterygoid muscle and 32% to 52.5% medially. The most frequently described technique for MNB administration is the suprazygomatic approach. Reorientation of the needle towards the anterior aspect of the contralateral tragus appears optimal. Needle reorientation angles do not have to be adjusted for age, unlike needle depth. The preferred anesthetics are either ropivacaine or (levo)bupivacaine, with dexmedetomidine as an adjuvant.

Conclusion:

Described MNB techniques are heterogeneous throughout the literature and among survey respondents and not routinely used. Further research is required comparing different techniques regarding efficacy and safety.
What are the Characteristics of Oral Injuries Caused by Playground Equipment?
Authors: Yamada Miki , Hino Shunsuke , Iijima Yosuke , Horie Norio , Kaneko Takahiro
Published: June 2024

Purpose:

Studies regarding oral injuries from playground equipment in children remain limited. This study aimed to clarify the characteristics of oral injury caused by playground equipment and identify associations with concomitant head injury.

Methods:

Children treated between 2011 and 2021 at an oral surgery clinic for oral injuries from playground equipment were retrospectively investigated. The following factors were analyzed: demographic characteristics, mechanism of injury, type of equipment causing the injury, classification of oral injury, and whether the Department of Emergency and Critical Care Medicine was consulted regarding the head injury. The data collected were statistically analyzed using the Fisher-Freeman-Halton test with significance adopted at the 5% level.

Results:

This study analyzed data from 82 children. Injuries were concentrated in age groups of 2 to 3 years (32.9%), 4 to 5 years (28.0%), and 6 to 7 years (25.6%). Regarding the mechanism of injury, falls were more common (89.0%) than impact/striking (11.0%). The type of equipment most frequently causing injury was slides (29.3%), followed by swings (23.2%) and iron bars (18.3%). Injuries were classified as soft tissue injury alone (56.1%) or tooth injury and/or jaw fracture (43.9%). Consultation with the Department of Emergency and Critical Care Medicine for head injury was uncommon (13.4%), and all consultations for brain injury diagnosed minor injuries.

Conclusion:

Oral injuries caused by playground equipment were frequent between 2 and 7 years old. The most common cause was falls, with most injuries caused by slides, swings, or iron bars. Approximately half of the oral injuries were soft tissue injuries only, while the other half were associated with tooth and/or jaw injuries. Department of Emergency and Critical Care Medicine consultations for head trauma were uncommon and consistently confirmed minor injuries.
The Lost and Variable Cause: A Systematic Review of Shunt-Related Craniosynostosis Occurrence
Authors: LaValley Myles N. , Asadourian Paul A. , Valenti Alyssa B. , Hoffman Caitlin E. , Imahiyerobo Thomas A.
Published: June 2024

Objective:

Shunt-related craniosynostosis (SRC) is the premature fusion of cranial sutures possibly due to a loss of tension across dura and suture lines after placement of a shunt for hydrocephalus. As modifications in approaches toward shunting represent a modifiable risk factor, prior literature has investigated the determinants and outcomes. However, the data remain highly variable and are limited by single-institution studies.

Methods:

A systematic search of PubMed, Embase, and Web of Science from inception to February 2022 was conducted. Studies were screened by 2 reviewers for eligibility based on predefined inclusion/exclusion criteria.

Results:

In the 9 included articles, the average follow-up time for the entire cohort ranged from 1.5 to 4.2 years. The pooled incidence of SRC across all 9 studies was 6.5% (140/2142), with an individual range of 0.53% (1/188) to 48.8% (61/125). The average time from shunt placement to SRC diagnosis ranged from 0.25 years to 4.6 years. 61% (65/110) of cases included only one suture, 88% (25/28) of these involved the sagittal suture, and those cases with multiple fusions also had 98% involvement of the sagittal suture (45/46). Overall, 94% (1783/1888) of patients had a fixed shunt placed.

Conclusions:

Shunt-related craniosynostosis is likely an underreported complication in the treatment of hydrocephalus. Older age at shunt placement, increased number of shunt revision procedures, and lower valve pressure settings may be risk factors for SRC development. Results also indicate that craniosynostosis can develop months to years after shunting. Future quality studies with standardization of data reporting processes are warranted to investigate this clinical problem.
Scar Hypertrophy Causing Nasal Obstruction Reconstruction
Authors: Wang Xueying , Cui Yong , Liu Jingyi , Wang Yanhua
Published: June 2024

Reconstructive surgery plays a crucial role in addressing congenital defects, posttraumatic deformities, and related conditions, providing transformative solutions for patients. Its primary goal is to restore or enhance damaged tissue structures, improving both functionality and appearance, and empowering individuals to lead fulfilling lives. Take, for example, a female patient who experienced a nasal infection after a cat bite. Despite initial treatment, she developed severe scar contractures and excessive scar tissue within her nostrils, significantly impacting her quality of life. Seeking assistance, she consulted the authors’ plastic and reconstructive surgery team. By utilizing various flap techniques, the authors embarked on the intricate journey of reconstructing her nasal framework, ultimately restoring both form and function.
Extended Pharmacologic Prophylaxis for Venous Thromboembolism After Colon Cancer Surgery Is Associated With Improved Long-term Survival
Authors: Booth Alexander , Brinton Daniel , Donahue Colleen , Westfal Maggie , George Virgilio , Maxwell Pinckney J. , Simpson Kit , Mahvi David , Curran Thomas
Published: June 2024

Objective:

This large database study assessed whether extended pharmacologic prophylaxis for venous thromboembolism after colon cancer resection was associated with improved oncologic survival.

Background:

Heparin derivatives may confer an antineoplastic effect via a variety of mechanisms (eg, inhibiting angiogenesis in the tumor microenvironment). Studies evaluating the oncologic benefit of heparin and its derivatives have been limited in postsurgical patients. Multiple society guidelines recommend consideration of 30-day treatment with low molecular weight heparin to reduce venous thromboembolism risk after abdominopelvic cancer surgery. However, utilization of extended prophylaxis remains low.

Methods:

Surveillance, Epidemiology, and End Results-Medicare data were used to identify patients (age 65+) undergoing resection for nonmetastatic colon cancer from 2016 to 2017. The primary outcomes were overall and cancer-specific survival. Log-rank testing and multivariable Cox regression compared survival in patients who received extended prophylaxis versus those who did not in an inverse propensity treatment weighted cohort.

Results:

A total of 20,102 patients were included in propensity-weighting and analyzed. Eight hundred (3.98%) received extended pharmacologic prophylaxis. Overall survival and cancer-specific survival were significantly higher in patients receiving prophylaxis on log-rank tests (P=0.0017 overall, P=0.0200 cancer-specific). Multivariable Cox regression showed improved overall survival [adjusted hazard ratio 0.66 (0.56–0.78)] and cancer-specific survival [adjusted hazard ratio 0.56 (0.39–0.81)] with prophylaxis after controlling for patient, treatment, and hospital factors.

Conclusions:

Extended pharmacologic prophylaxis after colon cancer resection was independently associated with improved overall and cancer-specific survival. These results suggest a potential antineoplastic effect from heparin derivatives when used in the context of preventing postsurgical venous thromboembolism.
Adding Patient-reported Outcomes to the American College of Surgeons National Surgical Quality Improvement Program
Authors: Liu Jason B. , Pusic Andrea L. , Melucci Alexa D. , Brajcich Brian C. , Fordham Matthew J. , Lapsley Jakob C. , Ko Clifford Y. , Temple Larissa K.F.
Published: June 2024

Objective:

To investigate the initial set of patient-reported outcomes (PROs) in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and their associations with 30-day surgical outcomes.

Background:

PROs provide important information that can be used to improve routine care and facilitate quality improvement. The American College of Surgeons conducted a demonstration project to capture PROs into the NSQIP to complement clinical data.

Methods:

From February 2020 to March 2023, 65 hospitals collected Patient-Reported Outcomes Measurement Information System measures assessing global health, pain interference, fatigue, and physical function from patients accrued into the NSQIP. Using multivariable mixed regression, we compared the scores of patients with and without 30-day complications and further analyzed scores exceeding 1-SD worse than national benchmarks.

Results:

Overall, 33842 patients completed the Patient-Reported Outcomes Measurement Information System measures with a median of 58 days (IQR: 47–72) postoperatively. Among patients without complications (n = 31210), 33.9% had PRO scores 1-SD worse than national benchmarks. Patients with complications were 1.7 times more likely to report worse PROs (95% CI: 1.6–1.8). Patients with complications had lower scores for global physical health [adjusted mean difference (AMD): 2.6, 95% CI: 2.2–3.0], lower for global mental health (AMD: 1.8, 95% CI: 1.4–2.2), higher for pain interference (AMD: 2.4, 95% CI: 2.0–2.8), higher fatigue (AMD: 2.7, 95% CI: 2.3–3.1), and lower physical function (AMD: 3.2, 95% CI: 2.8–3.5).

Conclusions:

Postoperative complications negatively affect multiple key dimensions of patients’ health-related quality of life. PROs were well below national benchmarks for many patients, even among those without complications. Identifying solutions to improve PROs after surgery remains a tremendous quality improvement opportunity.
Recent insights into haematology and peripheral nerve disease
Authors: Tomkins Oliver , Lunn Michael P.
Published: June 2024

Purpose of review

The association between clonal haematological disorders and peripheral nerve disease is recognized. Paraproteinaemic phenomena are the most common mechanism, but direct neural lymphomatous infiltration is seen and can be challenging to diagnose. Traditional and novel anticancer therapies have neuropathic side effects.

Recent findings

Novel studies using sensitive techniques are refining the incidence of peripheral neuropathy in patients with a monoclonal gammopathy, and the pathogenesis of IgM Peripheral neuropathy (PN) and POEMS syndrome. Recent series give insight into the characteristics and diagnostic challenges of patients with neurolymphomatosis and amyloid light chain amyloidosis. There is an increasing repertoire of effective anticancer drugs in haematological oncology, but chemotherapy-related neuropathy remains a common side effect.

This review of the current literature focuses on recent updates and developments for the paraproteinaemic neuropathies, and the evaluation, diagnosis and treatment of peripheral nerve disease due to high-grade and low-grade lymphomas and lymphoproliferative disorders.