bluuebunny/crossref_metadata_2025 huggingface dataset:
Postcolonial Identity and Discourse: Foucauldian Analysis of Shamsie’s A God in Every Stone
Authors: Munir Haniya , Shahi Zunaira
Published: October 2024

This research article delves into the intricate interplay between postcolonial identity and discourse in Kamila Shamsie's novel, "A God in Every Stone," employing a Foucauldian analytical framework This paper presents a Foucauldian analysis of Kamila Shamsie's novel, "A God in Every Stone." Drawing upon the works of Michel Foucault (2016), the paper examines the novel through the lens of power, knowledge, and the construction of historical narratives. Through a close reading of key characters and events, this analysis elucidates how colonial power structures and systems of knowledge production intersect in the novel to shape individual and collective identities. The present study has been conducted on Shamsie’s A God in Every Stone to highlight the process of colonization. The interpreter has examined the ways by which the colonized resisted colonial rule. Foucault’s model of Power has been used as the conceptual framework of the study to analyze the postcolonial aspects of Shamsie’s (2014) novel. The present study is qualitative in nature. The data has been collected through the close reading technique of the A God in Every Stone. For data analysis, those textual lines have been selected in which the elements of power and resistance are present covertly. The interpreter has explored different dimensions of Foucault’s power, i.e., Sovereign power and disciplinary power. British Empire justified its colonial rule over the colonized through the colonial discourse which was prejudiced against non-white people. The colonized people resist colonial rule through their dialogues in this novel. In A God in Every Stone, the major protagonist is Vivian Rose Spencer. She is an English woman who carried out digging in Turkey to unearth the ancient silver circlet. The interpreter has inferred that the colonizers used many disciplinary strategies to subjugate the colonized people. The Indian soldiers were trained by the British imperialists to fight in the battlefield on the Western Front. Many innocent Indian soldiers lost their lives in fighting the enemies of the British Empire. The major character of the novel Qayyum Gul, fought bravely in the battlefield. Unfortunately, he lost an eye during the battle. When he returned to Peshawar, he joined a freedom movement, which aimed to liberate India from the British colonizers. Ultimately, this Foucauldian analysis of "A God in Every Stone" underscores the intricate dynamics of power and knowledge in the colonial context and sheds light on the complexities of historical representation and identity formation in a postcolonial world.
Custo-efetividade de teste rápido de detecção de Klebsiella spp. para rastreio hospitalar
Authors: Rocha Hermano , Rocha Sabrina , Alcantara Antônia Celia , Façanha Mônica
Published: October 2024

Introdução: A resistência bacteriana é um problema mundial, atingindo principalmente países em desenvolvimento. Estima-se que no futuro vai matar mais que o câncer e custar 100 trilhões de dólares até 2050. Objetivo: O presente trabalho teve por objetivo identificar a razão de custo-efetividade incremental (RCEI) do rastreio de infecção por Klebsiella pneumoniae produtora de carbapenemase (KPC) conforme protocolo vigente para produção de carbamapenase em comparação com a utilização de protocolo de triagem utilizando teste rápido (PCR em tempo real). Métodos: Foi realizado estudo do tipo análise de custo-efetividade, utilizando um modelo de árvore de decisão e foram utilizados no estudo dados secundários de fontes governamentais e da literatura científica, considerando-se a perspectiva do sistema de saúde público. A população foi composta por adultos internados em hospitais em risco de infecção por KPC. Resultados: O presente trabalho identificou que o uso de testes de identificação de KPC com técnicas em tempo real é dominante em relação ao teste convencional, com razão de custo-efetividade incremental de R$ -426,53/0,3, ou seja, 1.421,76 reais por caso corretamente identificado favorável a teste molecular. Conclusões: O uso de testes rápidos para detecção de KPC pode ser considerado como um método de rastreio eficiente.
Theory and Experiment on Rock-Cutter Interfacial Friction and Rock Mohr-Coulomb Parameter Estimations
Authors: Ling Xianwu , Ji Guodong , Hu Huaigang , Wu Qiang , Li Liu , Huang Hongchun
Published: October 2024

The Mohr-Coulomb (M-C) failure criteria is by far the most widely used model for granular materials (including rocks and soils) in many geotechnical industries due to its simplicity. Its parameters are conventionally obtained by performing a series of pressurized triaxial compression tests (TCTs). The peak stress from each confining pressure is plotted at a single point as the maximum vs. the minimum principal stresses. The M-C parameters are obtained by the best linear fitting through the failure envelope formed by the peak stress points of interest. The TCT is time-consuming, costly, and destructive.

Is there an experiment that can provide the failure envelope with one single test, even at the atmospheric pressure? This seems impossible, at least has never been rigorously reported. In this work, we present our finding of such a test. The paper first provides the experimental setup and the theoretical solution for a hemispherical scratch test of a polycrystalline diamond cutter (PDC) at low rate of cut (ROC) and low depth of cut (DOC); the theoretical characteristic response of the test is identified and validated. Next, the formula for the rock-cutter interfacial coefficient of friction (COF) is derived, which provides a theoretical guide for the friction measurement for shaped cutters. Then, the nominal average drag and thrust stresses are evaluated, which are observed experimentally and then proved theoretically to behave in a linear relation, analogous to the M-C envelope from the TCTs. We also provide a first method that can self-consistently evaluate the M-C parameters for the crushed zone, which plays a very important role in rock cutting. By comparing the M-C results for three rocks at different loading conditions, good agreements under different scratch conditions are made against the M-C parameters for several rocks from the TCTs.
Synthesized Crosslinking Suspension Stabilizer for Spacer Fluid in High-Temperature Conditions: Synthesis, Behavior, and Mechanism Research
Authors: Zhang Baowen , Huang Sheng , Li Zaoyuan , Su Donghua , Tang Shizhong , Gao Yuan , Luo Zhiguo , Chen Jian
Published: October 2024

High-temperature stability of spacer fluid is a vital prerequisite to ensure the safety of cementing operations in deep or ultradeep wells. Faced with this problem, the thermal stability of the suspension agent in the spacer fluid at high temperatures is improved from the aspects of polymerization monomer and molecular chain. A terpolymer SAD was synthesized by free radical polymerization of sodium styrene sulfonate (SSS), acrylamide (AM), and N, N’-diethylacrylamide (DEAA) in aqueous solution. The name of the terpolymer, SAD, is the initial letter composition of the three polymerization monomers. Polyethyleneimine (PEI) can improve the molecular chain structure of SAD by transamidation reaction with the amide group in SAD, so a high temperature suspension agent PSAD (polyethyleneimine + SAD) was obtained by compounding PEI with SAD. The structure and properties of PSAD were characterized by Fourier infrared spectroscopy, hydrogen nuclear magnetic resonance (NMR) spectroscopy, gel permeation chromatography, X-ray photoelectron spectroscopy (XPS), thermogravimetric analysis, scanning electron microscopy (SEM), and viscosity test. In addition, the comprehensive properties of the spacer fluid under the action of PSAD are evaluated. The results showed that the crosslinking degree of PSAD gradually increased with the increase in temperature. After aging at 200°C, the decomposition temperature of PSAD was 305°C, which show terrific thermal stability. At the same time, the spacer fluid prepared by PSAD not only has excellent rheological properties in the range of 90 ~ 200°C but also keeps the density difference between the upper and lower parts of the slurry less than 0.02 g/cm3 and the filtration loss of the slurry less than 50 mL.
Interconvertible and rejuvenated Lewis acidic electrolyte additive
for lean electrolyte lithium sulfur batteries
Authors: Kim Hee-Tak , Cho Hannah , Jung Jinkwan , Kim Ilju , Kim Jinuk , Kim Sejin , Hyun Jonghyun , Lee Chang Hoon , Kwack Hobeom , Oh Wonsik , Lee Jinwoo
Published: October 2024

Realizing practical lithium–sulfur batteries (LSBs) with high energy density requires a lean electrolyte design. However, under low electrolyte/sulfur (E/S) ratios, highly concentrated lithium polysulfides (LiPSs) in the electrolyte phase limit cycling and capacity. Here, we report that a small amount of Lewis acidic calcium cation (Ca2+) in the electrolyte addresses the problems of lean electrolyte LSB. Because of its strong Lewis acidity, Ca2+ readily converts LiPSs into CaS and S8, preventing electrolyte jamming, PS shuttle and Li corrosion. The in situ formed CaS catalyzes the reduction reaction of LiPSs. Ca2+ can be rejuvenated via the electrochemical oxidation of CaS during charging, enabling a sustainable interconversion between Ca2+ and CaS during cycling. Li-S pouch cells with Ca2+ additive delivered an impressive energy density of 493 Wh kg−1 with 70% capacity retention (E/S ratio of 2.4 μL mg-1) at 220 cycle, and 346 Wh kg-1 with 77% capacity retention (2.9 μL mg-1) at 360 cycle. The judicious integration of lithium-sulfur and calcium-sulfur chemistries offers a handy but effective approach to overcome the long-lasting trade-off between energy density and cycling stability in the development of LSBs.
Nanoscale One-Way Valve Permeation Energy Harvesting Technology: Principles, Methods, Experimental Verification and Future Prospects
Authors: Huang Demin
Published: October 2024

This article introduces the concept of a "nanoscale one-way valve" and its underlying principles, pointing out that permeation is a natural manifestation of the nanoscale one-way valve effect. Based on the principles of the nanoscale one-way valve and the phenomenon of permeation, the permeation energy accumulation technology is applied to construct one-way valve so that the high-speed disordered thermal movement of water molecules can be ‘spontaneously rectified into orderly movement for power generation. The kinetic energy of molecular thermal motion is extracted from the environment to generate electricity which is consumed to generate heat that can be returned to the environment for power generation. The process is inexhaustible for it neither consumes energy resources, nor increases the temperature of the earth. This paper introduces the experimental verification. A 2.8 meter water head difference by a single experimental setup demonstrates the feasibility and effectiveness of the permeation energy harvesting principle. This challenges the traditional interpretation of the Second Law of Thermodynamics concerning the extraction of work solely from a single heat source without other effects. In contrast to river-sea osmotic power generation, the permeation energy harvesting technology has practical value and greater potential due to its ability to harness molecular energy from the environment for sustainable green energy production.
Human umbilical cord mesenchymal stem cells restores mTOR-mediated autophagy homeostasis to alleviate placental injury and improve pregnancy outcomes in preeclampsia
Authors: Xu Miao , Ma Huijing , Chen Yuwen , Zhang Xinhuan , Li Mengnan , Yu Hong , Ji Jing , Li Juanwen , Zhang Nan , Wang Fang , Hao Huiniu , Li Lu , Ruidan Zhang , Chen Yinmin , Yang Lijun , Hao Zhuanghui , Song Huifang , HE SHENG , Yang Hailan
Published: October 2024

Background
Preeclampsia is a hypertensive disorder during pregnancy, which seriously threatens both maternal and infant health. Currently, the only treatment available is to induce infant and placenta delivery, resulting in interest in potential fetal-safe treatment strategies. One such strategy is cell therapy with human umbilical cord mesenchymal stem cells (hUC-MSCs), which possesses immunomodulatory, anti-inflammatory and angiogenic functions that could alleviate pre-eclamptic symptoms. However, the precise effects and underlying mechanisms behind their activities are still largely unknown. In this study, we aimed to elucidate the effect of hUC-MSCs, as well as the pathways involved, on placental function in preeclampsia, thereby highlighting potential novel avenue for stem cell therapy.
Methods
Both an in vivo rat model, involving N-nitro-L-arginine methyl ester (L-NAME) injections in pregnant rats, and an in vitro model, entailing HTR8 trophoblasts/human umbilical cord vein endothelial cells (HUVECs) being stimulated with lipopolysaccharide (LPS), were established to simulate pre-eclampsia. In vivo, maternal blood pressure, renal function, as well as placental and fetal weights, were measured. ELISA was used to measure maternal serum levels of angiogenic, inflammatory, and oxidative stress factors. Placental mitochondrial morphology was evaluated using transmission electron microscopy, while autophagic pathways were analyzed by Western blots. With the in vitro model, cell proliferation, invasion, oxidative stress, and apoptosis were evaluated in a Transwell co-cultured with hUC-MSCs.
Results
hUC-MSC administration was found in the in vivo model to increase fetal weights, along with alleviating hypertension and proteinuria, which are owed to those cells promoting placental angiogenesis and blood perfusion, as well as lowering inflammation, oxidative stress, and apoptosis. These findings were further supported by the in vitro model, where hUC-MSC co-culture with LPS-treated HTR8/HUVECs resulted in increased cell proliferation and invasion, along with lowered apoptosis and reactive oxygen species generation. All of these effects are owed to hUC-MSCs improving placental mitochondrial function by lowering autophagy; this is through activating Akt/mTOR and inhibiting AMPK/mTOR pathways, leading to pro-autophagic LC3 and Beclin1 downregulation, as well as anti-autophagic P62 upregulation.
Conclusion
hUC-MSCs are able to alleviate pre-eclampsia by restoring physiological placental autophagic homeostasis, which could serve as a promising therapeutic strategy for the disease.
Successful treatment of an anti-MDA5 antibody-positive Juvenile Dermatomyositis patient with refractory interstitial lung disease using tofacitinib
Authors: Natoli Valentina , Palmeri Serena , Rebollo-Giménez Ana Isabel , Matucci-Cerinic Caterina , Bocca Paola , Caorsi Roberta , Volpi Stefano , Papa Riccardo , Consolaro Alessandro , Gattorno Marco , Ravelli Angelo , Rosina Silvia
Published: October 2024

Juvenile dermatomyositis (JDM) is a rare autoimmune disorder affecting children, mainly characterized by skin rash and muscle weakness (1). Anti-MDA5 antibody-positive JDM represents a distinct phenotype of disease with a high risk of developing life-threatening progressive interstitial lung disease (ILD)(2). The pivotal role of the type I interferon (IFN) pathway in the pathogenesis of anti-MDA5 positive JDM has prompted the exploration of Janus kinase (JAK) inhibitors as a therapeutic option (3). Nevertheless, while the efficacy and safety of JAK inhibitors have been established in clinical trials including adult-onset anti-MDA5-antibody positive DM (4), evidence in paediatric cases with progressive or refractory ILD is limited. In this report we describe the efficacy and safety of tofacitinib, a JAK 1/3 inhibitor, in treating an anti-MDA5-positive JDM young girl with refractory ILD, highlighting the potential of JAK inhibitors as targeted therapy in these patients.
Detection of Low-Frequency Artemisinin Resistance Mutations C469Y, P553L and A675V in Asymptomatic Primary School Children in Kenya
Authors: Osoti Victor , Wamae Kevin , Ndwiga Leonard , Gichuki Paul .M. , Okoyo Collins , Kepha Stella , Keitany Kibor , Kandie Regina , Aricha Stephen , Kiplagat Rosebella , Mwandawiro Charles , Bejon Philip , Snow Robert W. , Ochola-Oyier Lynette Isabella
Published: October 2024

Background: To understand the emergence and spread of drug-resistant parasites in malaria-endemic areas, accurate assessment and monitoring of antimalarial drug resistance markers is critical. Recent advances in next-generation sequencing (NGS) technologies have enabled the tracking of drug-resistant malaria parasites.
Methods: In this study, we used Targeted Amplicon Deep Sequencing (TADs) to characterise the genetic diversity of the Pfk13,Pfdhfr, Pfdhps, and Pfmdr1genes among primary school-going children in 15 counties in Kenya (Bungoma, Busia, Homa Bay, Migori, Kakamega, Kilifi, Kirinyaga, Kisii, Kisumu, Kwale, Siaya, Tana River, Turkana, Vihiga, and West Pokot,). A total of 920 dried blood spot (DBS) samples collected from 121 selected primary schools within the country were used to extract genomic DNA. A nested polymerase chain reaction (PCR) was used to generate amplicons that were sequenced to determine the prevalence of known and novel polymorphisms.
Results:The analysis of Pfk13 mutations associated with artemisinin resistance showed that the C469Y mutation was found in 23 samples (4%), the A675V mutation was identified in 2 samples (1.7%), and the P553L mutation was present as a mixed genotype in 7 samples (1.2%), all as mixed infections. The A578S mutation, one of the most common nonsynonymous mutations found in Africa, was also identified in mixed infections, appearing in 15.2% of the 87 samples analysed. The Pfdhfr 51I and 108N pyrimethamine-resistance mutations were at fixation (100% frequency), and the Pfmdr1 Y184F mutation that has been associated with reduced susceptibility to lumefantrine was found in 97.5% of the samples as mixed genotype infections.
Conclusion:The genomics surveillance of asymptomatic school children in Kenya provides an early warning signal of at least 1 of the 3 validated artemisinin resistance mutations circulating in all regions in Western Kenya sampled except Homa Bay and Kisii Counties. These signals in asymptomatic, mixed infections would have been missed without deep sequencing.
The Predictive Value of Myoglobin for Sepsis-Induced Cardiomyopathy
Authors: Chen Yue , Lin Xiaohong , Yu Guangwei
Published: October 2024

Myoglobin (MYO) levels can be detected in the early stages of sepsis and may serve as a potential biomarker for assessing the severity and prognosis of sepsis. Our study aims to explore the predictive value of MYO for sepsis-induced cardiomyopathy (SICM) in patients with sepsis. A single-center prospective cohort study was conducted, collecting demographic data, admission Sequential organ failure assessment (SOFA) scores, echocardiography results, MYO, N-terminal pro-B-type natriuretic peptide (NT-proBNP) results, and other related records from 158 patients with sepsis. Patients were divided into SICM and non-SICM groups based on the left ventricular ejection fraction (LEVF) results from echocardiography. Propensity score matching (PSM) was used to control for the confounding effects of age, gender, and BMI. Univariate and multivariate Logistic regression analyses were performed to identify factors associated with the occurrence of SICM; the receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of MYO for SICM. MYO levels were higher in the SICM group than in the non-SICM group (395.7 ng/ml vs 108.7 ng/ml, P < 0.05). Multivariate binary Logistic regression analysis showed that MYO is an independent risk factor for SICM in patients with sepsis (95% CI = 0.580–0.782, P < 0.05), with an area under the ROC curve (AUC) of 0.681 (95% CI: 0.580-0.782). MYO has good predictive value for SICM in patients with sepsis.
Effects of burr-hole surgery on MRI cerebral perfusion and stroke risk in adults with moyamoya angiopathy
Authors: Brandicourt Pierre , Calviere Lionel , Michelozzi Catarina , Rousseau Vanessa , Boetto Sergio , Darcourt Jean , Raposo Nicolas , Albucher Jean François , Viguier Alain , Cognard Christophe , Sol Jean Christophe , Olivot Jean Marc , Bonneville Fabrice
Published: October 2024

Purpose. Several surgical techniques have been proposed in moyamoya angiopathy (MMA) to reduce stroke risk; nevertheless, no one has clearly demonstrated its superiority. Burr-hole surgery allows the revascularization of large frontal areas and thus is increasingly used, but it has not been systematically evaluated in adults. We assessed the effect of burr-hole surgery as the only revascularization technique on MRI brain perfusion and stroke recurrence in adult patients with MMA. Methods. Retrospective study of consecutive adults patients with MMA and predominant frontal hypoperfusion treated by burr-hole surgery in a tertiary hospital. Parenchymal hypoperfusion rate on perfusion-weighted imaging (PWI) was compared using TMax before and 6 months after surgery. Perioperative complications and long-term risk of stroke/transient ischemic attack (TIA) were reviewed. Results. A total of 19 patients (11 women, mean age at surgery ± SD 42.4 ± 8.6 years) were included. A median of 7 (4–9) burr holes/hemisphere were performed on 34 hemispheres. Perioperative cerebral infarction occurred in 3 (15.9%) patients on 3 hemispheres (8.8%/hemisphere). The volume of slightly (Tmax ˃ 4 s) and severely (Tmax ˃ 6 s) hypoperfused parenchyma significantly decreased after surgery (p = 0.003 and p = 0.008, respectively). After a median follow-up of 72 (IQR 24.6) months, 4 strokes occurred in 3 patients (11.7%/hemisphere). The 2-year survival probability free of stroke/TIA was 85%. Conclusion. In adults with MMA and predominant frontal hypoperfusion, burr-hole surgery as the sole revascularization technique improved brain perfusion as measured with Tmax. Moreover the long-term risk of ischemic events and the rate of complications seemed similar to other techniques.
Taller forests are globally more drought-resistant
Authors: Chen Jing , Zhao Xingmin , Zhang Zhaoying , Ju Weimin , Gentine Pierre , Yang Yuting
Published: October 2024

Droughts exert a critical impact on forest growth, posing great challenges for forest sustainability globally. However, the mechanistic role of forest height (H) in modulating drought resistance remains poorly understood. Utilizing spaceborne observations of H and solar-induced chlorophyll fluorescence as a proxy for photosynthesis, here we show that taller forests consistently demonstrate higher resistance to drought stress globally, across varying levels of drought severity. This suggests that taller forests maintain higher stability under fluctuating climatic conditions. By synthesizing global forest root data, we found that this enhanced stability is closely tied to the deeper rooting systems of taller forests. Our findings underscore the critical role of H in forest ecosystem functioning and advocate for its inclusion as a key trait in ecosystem models to improve simulations of forest responses to climate change.
VGRCOT: a one-tube visual detection method for group B Streptococcus combining RPA and CRISPR/Cas12a for point-of-care testing in reproductive health
Authors: Ji Caixia , Ru Liqiang , Jiang Yayun
Published: October 2024

Group B Streptococcus (GBS) is a significant pathogen that causes perinatal infections, seriously threatening the health of pregnant women and newborns. Prophylactic antibiotic treatment for pregnant women who screen positive for GBS can notably reduce the incidence and fatality of neonatal infections. Herein, we developed a visual nucleic acid method for GBS that integrates RPA and CRISPR/Cas12a in a one-tube setup, termed VGRCOT. The VGRCOT method achieved one-tube detection by adding the appropriate reagents to the bottom and lid of the EP tube, respectively. By rigorous optimization of ssDNA-FQ reporter concentration, crRNA concentration, RPA reaction time, and CRISPR/Cas12a cleavage time, VGRCOT can exhibit fluorescence under ultraviolet light, enabling visual detection. Under optimal conditions, VGRCOT has a satisfactory selectivity and the detection limit was determined as 101 copies/reaction. Finally, VGRCOT also showed good performance comparable to qPCR in the actual detection of clinical specimens. Due to its ease of operation and convenient signal acquisition, VGRCOT shows promise for point-of-care testing in reproductive health.
The Mediating Effect of Metabolic Score for Insulin Resistance on the Link Between Cardiometabolic Index and Obstructive Sleep Apnea
Authors: Song Shangyi , Li Xuhao , Liu Yecun , Wang Xingxin , Zhang Wenhui , Yang Jiguo , Liu Yuanxiang
Published: October 2024

Background
Although there is considerable evidence that obstructive sleep apnea (OSA) is associated with cardiovascular and metabolic risks, such as insulin resistance and visceral fat accumulation, limited studies have explored how these risks are mediated by specific metabolic markers. The purpose of this study was to explore the relationship between Cardiometabolic Index (CMI) and OSA, and to pay special attention to the mediating role of insulin resistance metabolic score (METS-IR).
Methods
Data from 12,703 participants aged 20 and above were analyzed from the National Health and Nutrition Examination Survey (NHANES). CMI was the primary exposure variable, METS-IR served as the mediating variable, and OSA was the outcome. Multivariate logistic regression models were used to adjust for confounders and assess the relationship between CMI and OSA. Mediation analysis determined the proportion of CMI’s effect on OSA explained by METS-IR.
Results
Among 12,703 subjects, the prevalence of OSA was 30.88%. CMI was significantly associated with increased OSA risk, and participants with the highest quartile of CMI were significantly more likely to have OSA (OR = 2.06, 95% CI : 1.70–2.49). Mediation analysis showed that METS-IR accounted for 89.8% of the association between CMI and OSA, highlighting the key role of insulin resistance in this pathway.
Conclusions
CMI is a key predictor of OSA risk, which is mainly mediated by its effect on insulin resistance, as shown by METS-IR. These findings highlight the importance of addressing metabolic dysfunction in the prevention and management of OSA, and CMI and METS-IR provide valuable insights into clinical risk assessment in high-risk populations.
Cryoballoon vs. Robotic Magnetic Navigation-Guided Radiofrequency Ablation in Patients with Persistent Atrial Fibrillation: 5-year outcomes
Authors: Luo Qingzhi , Li Xiang , Xie Yun , Bao Yangyang , Wei Yue , Lin Changjian , Liu Zhuhui , Zhang Ning , Ling Tianyou , Chen Kang , Pan Wenqi , Wu Liqun , Jin Qi
Published: October 2024

Background
This study aimed to evaluate the long-term efficacy and clinical outcomes of catheter ablation performed with cryoballoon (CRYO) in comparison with robotic magnetic navigation (RMN) in patients with persistent atrial fibrillation (PersAF).
Methods and Results
A total of 200 patients with symptomatic PersAF were prospectively enrolled and assigned (1:1) to the CRYO or RMN guided-ablation group and then followed up over 5 years. The primary endpoint was freedom from atrial tachyarrhythmias (ATs) recurrence following a 3-month blanking period after the initial procedure. The secondary endpoints consisted of all-cause and cardiovascular rehospitalizations, rates of electrical cardioversions (ECs) and repeat ablations, new-onset neurological events, major bleeding events and the difference in CHA2DS2-VASc score at 5-year compared with baseline. After a median follow-up period of 60 months, 184 patients (93 in RMN, 91 in CRYO) completed the follow-up. Freedom from recurrent ATs was achieved in 44 out of 93 patients in the RMN group and 37 out of 91 patients in the CRYO group (47.3% vs. 40.7%, P = 0.32). There were no significant differences in the risk of all-cause and cardiovascular rehospitalizations, rates of ECs and repeat ablations, new-onset neurological events, and major bleeding at 5 years. OAC discontinuation was relatively common after ablation, 48.4% of patients with a CHA2DS2-VASc score ≥ 2 not on OAC therapy.
Conclusion
CRYO is comparable to RMN-guided ablation with respect to long-term freedom from ATs in patients with PersAF. Discontinuation of OAC after ablation is not rare even in patients at risk of stroke for continued OAC therapy.
Loupe-Assisted Thyroidectomy; Experience from Low Volume Centres
Authors: Venkataramani Nithya , Sachidananda Ravi , MK Manjunath , M Arshad Hussain , Rao Suraksha , Dore Suresh Babu , S Sunil Kumar G , Shankarnarayan Saikiran , N Karthik
Published: October 2024

Background
Thyroidectomy is an intricate surgery where nerve injury can cause significant morbidity. The use of magnification has revolutionised the modern-day otolaryngology practice. Its utility is now the standard of care for many ENT surgeries. Surgical loupes in Head and Neck surgery are emerging as a single important tool in reducing complications and improving precision. This retrospective study aimed to analyse the results of complications in thyroidectomy whilst using the loupes.
Methods
A retrospective study was conducted for 6 years. All the loupe-assisted thyroidectomies done by two surgeons were included in the study. All surgeries were performed with 2.5 X and some with 3.5 X magnification loupes. The incidence of voice change, hypocalcaemia, and secondary haemorrhage after thyroidectomy were noted.
Results
80 thyroidectomies were included, 39 were total thyroidectomies and the remaining were hemithyroidectomies. The age group was between 25 and 65 years. The mean stay in the hospital was approximately 2 days. Three patients had recurrent laryngeal nerve palsy, and 3 patients had transient hypocalcaemia which required calcium and magnesium supplementation. All the patients were operated with an intent to save the nerves and parathyroid glands.
Conclusions
The use of microsurgical techniques during thyroidectomy should be the standard of care as it reduces morbidity and minimises nerve injury.
Construction of a Novel Prognostic Risk Warning Model for Bunyavirus Patients Based on Inflammatory Indicators
Authors: Xiang Xu , Li Song , Dai Yue-qing
Published: October 2024

Objective To analyze the risk factors for poor prognosis in patients with SFTS and construct an early warning model. Methods 207 patients with SFTS admitted to Huazhong University of Science and Technology Affiliated Tongji Hospital from April 1, 2023 to July 18, 2024 were selected for retrospective analysis. According to the patients' prognosis, they were divided into survival group (n=133) and death group (n=74). The independent risk factors affecting the prognosis of patients were analyzed by univariate analysis and multivariate logistic regression analysis of general information and inflammatory indicators within 24 hours. An early warning model was established based on the independent risk factors. Results Age (OR = 1.162, 95% CI (1.102 ~ 1.236), P <0.001), viral load (OR = 2.669, 95% CI (1.764 ~ 4.239), P <0.001), PCT (OR = 2.758, 95%CI (1.586 ~ 5.231), P = 0.001), and IL-10 (OR = 1.005, 95% CI (1.001 ~ 1.009), P = 0.19) were independent risk factors affecting the prognosis of patients. A nomogram model was constructed based on the four risk factors, and the predictive performance of the model was good (ROC = 0.905, 95%CI (0.862 ~ 0.949), P <0.001). Conclusion The prognostic risk early warning model constructed in this study has good predictive effect, which can be used as a clinical tool for predicting the prognosis of SFTS patients.
Decoding the Immune Microenvironment of Secondary Chronic Myelomonocytic Leukemia due to DLBCL with CD19 CAR-T Failure by Single-cell RNA-seq
Authors: Li Xudong , Huang Hong , Shi Jianxiang , Liu Yuke , Gao Le , Ma Xiaojia , Gao Mengya , Sun Mingxia , Cao Haixia , Zhang Danfeng , Shen Na , Jiang Zhongxing , Cao Weijie , Bian Zhilei , Song Yongping , Wang Fang , Sun Hao , Xu Linping , Li wei
Published: October 2024

Multiple studies have confirmed the occurrence of second tumors as a rare incidence of CAR-T therapy, but one of the complications that does warrant in-depth exploration. According, given the relatively small number of reported second tumor types thus far, additional comprehensive occurrence and characterization of a new second tumor type after CAR-T therapy remains essential for understanding the risk of potential tumors with this therapy, as well as for defining the role of immune microenvironment in malignant transformation. In this article, a new second tumor type CMML was identified in a patient who had received CD19 CAR-T therapy for DLBCL. The immune microenvironment of both the pre- and post-treatment of secondary CMML and primary CMML were deeply profiled by ScRNA-seq. Our results demonstrated an enhanced inflammatory cytokines, chemokines, and immunosuppression state of monocytes/macrophages, which may inhibit the cytotoxicity of T/NKs in secondary CMML. In contrast, the cytotoxicity of T/NKs were enhanced in secondary CMML after treatment. Collectively, our results highlight a new type of second tumor, CMML after CAR-T therapy and provide a framework for defining the immune microenvironment of second tumor occurrence after CAR-T therapy. Our results also provide a rationale for targeting macrophages to strengthen CMML treatment.
Three-Dimensional Conductive Conjugated Polyelectrolyte Gels Facilitate Interfacial Electron Transfer for Improved Biophotovoltaic Performance
Authors: Bazan Guillermo , Chen Zhongxin , McCuskey Samantha , Zhang Weidong , Peng Benjamin , Quek Glenn , Jiang Yan , Ohayon David , Ong Shujian , Kundukad Binu , Mao Xianwen
Published: October 2024

Living biophotovoltaics represents a potentially green and sustainable method to generate bio-electricity through rewiring of photosynthetic electron transport chains (P-ETCs) to interconnect photosynthetic bacteria to electrodes. However, barriers to electron transfer across the abiotic/biotic interface hinders solar-to-electricity conversion efficiencies. Herein, we report on a facile method to improve interfacial electron transfer by combining the photosynthetic cyanobacterium Synechococcus elongatus PCC 7942 (Syne) with a conjugated polyelectrolyte (CPE) atop indium tin oxide (ITO) charge-collecting electrodes. By self-assembly of the CPE with Syne, soft and semitransparent Syne/CPE biocomposites are formed with three-dimensional conductive networks that exhibit mixed ionic-electronic conduction. These specific structures rewire an artificial P-ETC from bacteria to electrodes, allowing for improved and sustained photocurrent output compared to the performance of bacteria alone. Electrochemical studies confirmed the enhanced interfacial electron transport efficiency via the artificial P-ETC. Furthermore, microscopic photocurrent mapping for the biocomposites down to the single-cell level revealed a ~0.2 nanoampere output per cell, which translates to a 10-fold improvement relative to that of bare Syne, corroborating highly efficient long-range electron transport from Syne to the electrode via the three-dimensional CPE structure. This synergistic combination of biotic and abiotic materials underpins the significantly improved performance of biophotovoltaic devices, providing broader insights into the electron transfer mechanisms in a variety of bio-hybrid systems within semi-artificial photosynthesis and bioelectronic devices.
Exploring the causality and pathogenesis of atrial fibrillation with dilated cardiomyopathy: An integrated multi-omics approach
Authors: Wen Huan , Su Bo , Liu Jinbo , Wang Hongyu
Published: October 2024

Background: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia, and recent evidence indicates the presence of cardiac enlargement in patients with AF. Dilated cardiomyopathy (DCM), the most common form of cardiomyopathy, is characterized by significant heart dilation and AF. However, the risk factors and underlying mechanisms linking DCM to AF remain poorly understood.
Methods: Mendelian randomization (MR) analysis was initially used to explore the potential causal relationship between AF and DCM. Data were sourced from the public database Gene Expression Omnibus (GEO), and differentially expressed genes (DEGs) and significant module genes were identified using the Limma package and weighted gene co-expression network analysis (WGCNA). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses, as well as a protein-protein interaction (PPI) network analysis, were performed on the intersected genes. Hub genes were screened using machine learning algorithms. The identification of hub genes within the DCM GSE17800 dataset was achieved using the receiver operating characteristic (ROC) curve and nomogram, which were employed to assess the diagnostic efficacy of these hub genes. Finally, the immune infiltration of DCM and the microRNA (miRNA) interaction network involving hub genes were evaluated.
Results: MR analysis demonstrated that genetic susceptibility to AF was significantly associated with an increased risk of DCM (β: 20.44, 95% CI: 15.00-25.88, p=0.0002). The AF dataset included 1850 DEGs and 572 significant module genes, and the DCM dataset included 6463 DEGs, which had a total of 209 intersected genes with module genes for AF. After correlation enrichment analysis and PPI interaction network on the intersected genes, machine learning was used to screen two hub genes (VSNL1 and ETNPPL) that had high diagnostic efficacy (area under the curve from 0.81 0.89). Immune infiltration analysis of these genes revealed a relatively normal immune status for DCM, with a wider miRNA interaction network for VSNL1.
Conclusion: MR data suggests that genetic changes in the presence of AF are significantly associated with an increased risk of DCM. The two identified hub genes (VSNL1 and ETNPPL) can be used to diagnose comorbid DCM in patients with AF.
Survival Rate Changes in Children With Congenital Diaphragmatic Hernia Over the Past Three Decades: a Nationwide, Population-based Prospective Nested Case-control Study
Authors: Kutasy Balazs , Burgos CM
Published: October 2024

PURPOSE: The survival rate (SR) for neonates born with congenital diaphragmatic hernia (CDH) remains high. Our aim was to investigate how changed the SR in children with CDH over the past decades.
METHODS: The study was a nationwide, population-based prospective nested case-control study within a cohort of newborn children who was born in Sweden during the observational period from 1st January 1982 until 31st December 2015.
RESULTS: In the study period 4654 (99.6%) control children, and 684 children with CDH (70.4%,p<0.001) were survival at 2-years of age. Any patients who were born with CDH has overall 5,8 times higher chance for not survive 2-years of age than children without CDH. The SR improved significantly in CDH in the past 3 decades. Significantly higher number of patients were premature born in the CDH group than in the controls (23.3%vs6.1%,p<0.001). The SR of premature and non-premature born CDH patients increased significantly over the past 3 decades.
CONCLUSION:
The SR of CDH patients were significantly increased in the past 3 decades. Although, the 2-years survival remains 5,8 times higher than those who were not born with CDH. These changes were mainly attributed to the improved SR of premature and non-premature born CDH patients.
Sugammadex related atypical laryngospasm with unusual rescue A case report
Authors: Ren Hongyuan , Liu Yan , Lu Yuechun
Published: October 2024

Purpose To describe our experience using rocuronium to rescue sugammadex related atypical laryngospasm during a case under general anesthesia.
Clinical features A patient was a 56-year-old, who was admitted for fungal keratitis and underwent a Penetrating Keratoplasty (PKP) on 12th June 2024. The procedure was smooth and took about 100 minutes. An airway spasm just happened after 120mg sugammadex was provided at the end of the procedure and manual ventilation did few work. Then 30mg rocuronium was provided for intubation, about 30 seconds later the ventilation became into effect and intubation successfully. We saw half-closed vocal cords during the intubation.
Conclusions Laryngospasm remains a tenacious problem for unpredictable causes and atypical signs, furthermore rocuronium may be an unusual and brilliant choice for the laryngospasm especially when it was related tosugammadex and presented atypically.
IgG4-related disease characterized by recurrent episodes of transient ischemic attacks: A case report and literature review
Authors: Hu Ya-ting , Chu Xu , Wang Yan-li , Kong Qing-xia , Sun Ran , Yan Huan
Published: October 2024

IgG4-related disease (IgG4-RD) is a rare fibroinflammatory condition that involves multiple organs in the body. The most commonly affected tissues or organs include lymph nodes, submandibular glands, lacrimal glands and the pancreas. However, a minority of cases can involve the central nervous system (CNS), manifesting as hypertrophic pachymeningitis, cerebral vasculitis, cerebellar infarction and other related conditions. The present case report documents a patient with IgG4-RD with recurrent transient ischemic attacks (TIA), aiming to explore the pathogenesis, clinical features, treatment and prognosis of IgG4-RD complicated with TIAs. By analyzing the present case, the aim was to raise clinician awareness of the potential neurological implications caused by IgG4-RD and to explore its possible pathological mechanisms.
Investigating the structural changes in amino acids conformations interacting with a toxic effector molecule within the Hcp1 tail/tube complexes of the type VI secretion system using artificial intelligence and deep learning platform
Authors: Shakibaie Mohammad Reza
Published: October 2024

Background: The primary objective of this study is to understand how a putative toxic effector of the type VI secretion system (T6SS) in Acinetobacter baumannii triggers the contraction of the Hcp1 nanotube through the application of an Artificial Intelligence (AI) and Deep Learning (DL) framework. Furthermore, the virtual assessment of components associated with this secretory system was also investigated.
Methods: The amino acid sequences of T6SS components were retrieved from the GenBank database. AI software such as AlphaFold2, and neural DL software like Rosetta-Fold were used to generate the 3D structures of T6SS protein components. The Rosetta Packer (DLP) program was employed to identify the side chains of the amino acids involved in binding to the effector. A backbone-dependent rotamer library for amino acids side chains was developed based on the Dunbrack rotag package.
Results: Through the machine learning AI system, it has been found that each specific effector molecule binds specifically toa particular set of amino acids (in this case; Lys, Phe, Arg, and His) within the Hcp1 monohexameric ring by H-bound. This interaction induces a rotameric shift in the dihedral angles (Φ/Ψ) of the aforementioned amino acids' side chains launching the contraction of the Hcp1 tail/tube complex and injection effector molecule to the prey cell. Furthermore, TssB/C, TssM, and ClpV ATPase T6SS components are essential for the propulsion of the effector molecule.
Conclusion: This study reveals the mechanism by which the effector molecule induces changes in the conformational of the amino acid side chain from the apo to the hollo state along the Hcp1 tail, resulting in the contraction and propulsion of the substrate into the target cell.
Tonsillitis toxicity for breast cancer radiation therapy and control over this by ARIA Visual Care Path
Authors: Ishkinin Yevgeniy , Nazarbek Serzhan , Zhakhina Gulnur , Datbayev Kairgeldy , Ossikbayeva Saniya , Akhunova Radmila
Published: October 2024

Radiation therapy (RT) is a cornerstone in the treatment of breast cancer, with advances in technology improving both precision and patient outcomes. However, RT can cause various toxicities, traditionally focused on skin, lung, and cardiac complications. Tonsillitis, a less common but emerging complication, may arise due to unintended radiation exposure to nearby structures like the thyroid. This study investigates the occurrence of tonsillitis in breast cancer patients undergoing RT and evaluates the effectiveness of the ARIA Visual Care Path (VCP) in mitigating this complication. A retrospective analysis was conducted on 137 breast cancer patients treated at the Almaty Oncology Center. Patients were divided into two groups: hypofractionated radiation therapy (HFRT, n=68) and standard radiation therapy (SRT, n=69). Tonsillitis was observed in 29.2% of patients, with a higher incidence in the SRT group (33.3%) compared to the HFRT group (25.0%). Tonsillitis development was significantly associated with higher mean thyroid doses (>22 Gy, p=0.009) and lower body mass index (BMI ≤ 25, p=0.001). Following the implementation of the Breast Care Path algorithm, the incidence of tonsillitis was significantly reduced from 29.2% to 4.9% (p=0.0001). Skin reactions were less severe in the HFRT group, and no significant differences were observed in cardiac or lung doses between groups. Tonsillitis toxicity, while not typically a recognized complication of breast cancer RT, was linked to higher thyroid doses and lower BMI. The Breast Care Path algorithm proved effective in reducing tonsillitis rates, highlighting the importance of dosimetric planning and personalized care pathways in improving patient outcomes.
A multiple metastatic colon cancer patient with extra-long survival and acquired BRAF mutation: case report and literature review
Authors: Chen Yan , Kou Zhongyang , He Lulu , Wu Yufei , Lu Yujie , Wang Ying , Guo Pengda , Cai Hongfa , Liu Kaili , Yang Jun , Gu Haidi , Su Jiang , Guo Feng
Published: October 2024

For colorectal cancer patients, metastasis is a major cause of high mortality and short survival. Precision medicine has led to significant advances in targeted therapy and immunotherapy in the treatment of colorectal cancer, providing more options for patients with mCRC and eventually improving their prognosis. However, the use of these drugs is limited by pre-existing intrinsic resistance mechanisms or the ability of cancer cells to acquire resistance. This report presents a colorectal cancer patient who survived 12 years. After the first palliative resection for descending colon cancer, this patient had experienced local recurrence, splenic and diaphragmatic metastases, splenic fossa and incisional implant metastases, renal metastases, and liver metastases. The patient underwent five surgical resection procedures and benefited from surgery combined with chemotherapy. The disease was initially controlled with first-line treatment when the patient developed liver metastases. After the metastases progressed, next-generation sequencing (NGS) revealed the patient's acquired genomic alternation, BRAF V600E. This case highlights the importance of combining local and systemic therapy and the need to be aware of acquired genomic alternations.