bluuebunny/crossref_metadata_2025 huggingface dataset:
Dipole pattern in aerosol-induced atmospheric warming trends over the Indian subcontinent in the last two decades
Authors: Srivastava Shreya , Dey Sagnik
Published: February 2025

Understanding the patterns of aerosol-induced perturbation in radiation budget and its drivers is crucial in climate science. Here, we examined spatio-temporal trends in aerosol-induced atmospheric warming and the top-of-the-atmosphere (TOA) and surface cooling over the Indian Subcontinent under clear-sky and all-sky conditions using Clouds and the Earth’s Radiant Energy System (CERES) data for the period 2000-2021. Overall, the regional mean TOA and surface cooling were found to increase by 0.06 W m-2 year-1 and 0.09 W m-2 year-1, respectively. Over the last two decades, the aerosol-induced atmospheric warming in all-sky conditions increased over the subcontinent landmass and outflow regions over the ocean while it declined over dust-dominated arid regions. This dipole pattern was driven by a combination of an overall increase in aerosol optical depth (AOD), a gradual increase in the fraction of scattering aerosols over the Indian landmass dominated by anthropogenic sources, a decline in dust loading over the arid sources. As a result, atmospheric warming efficiency declined in most parts of the Indian subcontinent. A comparative meta-analysis revealed that aerosol-induced atmospheric warming was over-estimated by the existing studies where aerosol direct radiative forcings were estimated by 1-D radiative transfer model utilizing modelled optical properties based on incomplete information about in-situ physico-chemical properties derived from ground-based measurements. Our analysis showed that TOA and surface cooling by aerosols were higher in clear-sky conditions relative to the actual all-sky condition by up to 11 W m-2 and 16 W m-2, respectively; therefore, atmospheric warming reported for clear-sky conditions would be biased high over the subcontinent. As India embarked on a clean air mission, changes in aerosol loading and its composition are expected to alter the dipole pattern further in the future, impacting the regional climate via dynamic feedback.
Global optimization of photovoltaic tilt angles: Reducing solar power losses using reanalysis data
Authors: Lu Ning , Qin Jun
Published: February 2025

Solar photovoltaic (PV) systems play a crucial role in addressing the growing demand for clean energy and mitigating climate change impacts. However, PV system performance is heavily influenced by the incident solar radiation on panel surfaces, with suboptimal tilt angles leading to significant power losses. Despite the critical importance of tilt angle optimization, many existing PV installations worldwide operate suboptimally due to simplified estimation methods or lack of site-specific optimization. This study presents a novel hybrid approach combining empirical and computational methods to determine optimal annual and monthly PV panel tilt angles using long-term hourly ERA5 reanalysis radiation data. Our results validate the effectiveness of ERA5 data for global tilt angle optimization, demonstrating a strong correlation with established cubic relations. Analysis of spatial and temporal patterns of optimized tilt angles reveals the influence of latitude, local atmospheric conditions, and seasonal variations on optimal PV panel inclination. A comprehensive assessment of the global PV inventory in 2018 shows that 44.6% of installed capacity is located in regions with solar power losses exceeding 1%, resulting in a total loss of 6,154 GWh/year – equivalent to Luxembourg's annual electricity consumption. Comparison between optimized tilt angles and those estimated using empirical cubic schemes reveals significant discrepancies in some regions, with annual power losses surpassing 3% when using empirical methods. These findings underscore the importance of accurate, location-specific tilt angle optimization to minimize solar power losses and maximize global PV inventory performance. Our research highlights the potential for substantial energy yield improvements through widespread adoption of optimized tilt angles in PV system design and retrofitting, contributing to enhanced renewable energy production and accelerated progress towards global sustainability goals.
Aggregate Stress Contribution in Asphalt Mixtures with the Splitting Tests Based on the Three-Dimensional (3D) Discrete Element Method (DEM)
Authors: Yao Hui , Ma Pengrui , Xu Mei , Liu Huijie , Cao Dandan , Cui Xuhao , Liu Yu
Published: February 2025

In this study, the discrete element method (DEM) simulations were employed to assess the asphalt mixture's splitting strength to investigate the mechanical aspects of asphalt mixtures under various loading conditions, including the stress transmission characteristics of individual aggregate and the contribution or response to the load-bearing capacity. The study involved an analysis of splitting tests on fine-graded AC-13 and medium-graded AC-20 asphalt mixtures at different temperatures. The mechanical responses of aggregates at different sizes were examined, and the relationships between aggregate loading contribution and mechanical interactions were explored by combining laboratory experiments with DEM simulations. The research shows that the load-displacement patterns in DEM simulations and lab experiments are very similar. This demonstrates that DEM simulations are applicable for conducting splitting tests on asphalt mixtures and the results are valid. The splitting strength decreases with increasing temperature under identical gradation conditions. At the constant temperature level, splitting strength is enhanced with large-sized aggregates/gradations in asphalt mixtures. As temperature rises, smaller-sized aggregates in both gradations bear a greater loading proportion, while the load-bearing ratio of intermediate-sized aggregates decreases. Comparing the two gradations of asphalt mixtures, it is evident that, at the same temperature, an increase in the gradation leads to a gradual increase in the load-bearing ratio of aggregates in the intermediate size range. In the case of the AC-20 gradation asphalt mixture, the largest-sized aggregates also exhibit an increasing load-bearing ratio compared to the AC-13 gradation, indicating that larger gradations result in a greater proportion of coarse aggregates carrying the loading. These research findings provide valuable insights and references for the cracking resistance performance of the asphalt pavement.
Micromagnetic Stimulation (μMS) Controls Dopamine Release: An in vivo Study Using WINCS Harmoni
Authors: Saha Renata , Goyal Abhinav , Yuen Jason , Oh Yoonbae , Bloom Robert , Benally Onri J. , Wu Kai , Netoff Theoden I , Low Walter C , Bennet Kevin , Lee Kendall H , Shin Hojin , Wang Jian-Ping
Published: February 2025

Research into the role of neurotransmitters in regulating normal and pathologic brain functions has made significant progress. Yet, clinical trials that aim to improve therapeutic interventions do not take advantage of the in vivo changes in the neurochemistry that occur in real time during disease progression, drug interactions or response to pharmacological, cognitive, behavioral, and neuromodulation therapies. In this work, we used the WINCS Harmoni tool to study the real time in vivo changes in dopamine release in rodent brains for the micromagnetic neuromodulation therapy. Although still in its infancy, micromagnetic stimulation (µMS) using micro-meter sized coils or microcoils (μcoils) has shown incredible promise in spatially selective, galvanic contact free and highly focal neuromodulation. These μcoils are powered by a time-varying current which generates a magnetic field. As per Faraday’s Laws of Electromagnetic Induction, this magnetic field induces an electric field in a conducting medium (here, the brain tissues). We used a solenoidal-shaped μcoil to stimulate the medial forebrain bundle (MFB) of the rodent brain in vivo. The evoked in vivo dopamine releases in the striatum were tracked in real time by carbon fiber microelectrodes (CFM) using fast scan cyclic voltammetry (FSCV). Our experiments report that μcoils can successfully activate the MFB in rodent brains, triggering dopamine release in vivo. We further show that the successful release of dopamine upon micromagnetic stimulation is dependent on the orientation of the μcoil. Furthermore, varied intensities of µMS can control the concentration of dopamine releases in the striatum. This work helps us better understand the brain and its conditions arising from a new therapeutic intervention, like µMS, at the level of neurotransmitter release. Despite its early stage, this study potentially paves the path for µMS to enter the clinical world as a precisely controlled and optimized neuromodulation therapy.
Photon-mediated dipole-dipole interactions as a resource for quantum science and technology in cold atoms
Authors: Jen H. H.
Published: February 2025

Photon-mediated dipole-dipole interactions arise from atom-light interactions, which are universal and prevalent in a wide range of open quantum systems. This pairwise and long-range spin-exchange interaction results from multiple light scattering among the atoms. A recent surge of interests and progresses in both experiments and theories promises this core mechanism of collective interactions as a resource to study quantum science and to envision next-generation applications in quantum technology. Here we summarize recent developments in both theories and experiments, where we introduce several central theoretical approaches and focus on cooperative light scattering from small sample of free-space atoms, an atom-waveguide coupled interface that hosts the waveguide QED, and topological quantum optical platforms. The aim of this review is to manifest the essential and distinct features of collective dynamics induced by resonant dipole-dipole interactions and to reveal unprecedented opportunities in enhancing the performance or offering new applications in light manipulations, quantum metrology, quantum computations, and light harvesting innovations.
Strategies for crisis and risk management in sustainable construction: communication and green culture in Pakistan
Authors: Abid Sheikh Kamran , Al-Wathinani Ahmed M. , Goniewicz Krzysztof
Published: February 2025

The Pakistani construction industry faces significant challenges that hinder project success, including poor risk management, communication gaps, a lack of organizational cohesion, and inadequate green human resource management practices. This study investigates the impact of these critical factors on project outcomes within Pakistan's unique economic and regulatory landscape. Using semi-structured interviews with project managers across various construction firms, we conducted a thematic analysis to explore how proactive risk management, effective communication strategies, a supportive green organizational culture, and green strategic human resource management practices contribute to project durability of the building and timely completion. The durability of a building entails the utilization of long-lasting resources, environmentally friendly building processes, and ideas that maintain the structure so that it stays operational and practical for its planned duration. Findings reveal that comprehensive crisis and risk management minimizes disruptions and budget overruns, while robust communication management reduces misunderstandings, fostering collaboration and efficiency. Furthermore, a positive green organizational culture enhances teamwork and motivation and targeted green human resource strategies support skill alignment and improve workforce performance. This study provides actionable insights for construction firms in Pakistan aiming to optimize green management strategies to enhance project success rates, suggesting that an integrated approach to risk, communication, green culture, and green human resource practices is essential to meet the demands of this growing sector.
Assessing Fingerprint Image Quality: An Ensemble Technique Perspective
Authors: Choudhary Parul , Pathak Pooja , Gupta Phalguni
Published: February 2025

Fingerprint recognition has become a cornerstone technology in various applications, ranging from law enforcement to smartphone security. However, the quality of fingerprint images can significantly affect the performance of recognition systems. Traditional methods of assessing fingerprint image quality (FIQ) often rely on handcrafted features and simplistic models, which cannot capture the complexity of real-world scenarios. This research propose an enhanced machine learning-based approach for fingerprint image quality assessment (FIQA) to address this limitation. Collecting and pre-processing a dataset of 6,000 fingerprint images from 600 individuals, each with varying clarity, contrast, illumination, and noise levels, from the Sokoto Coventry Fingerprint (SOCOFing) dataset. Apply image enhancement techniques such as Gabor filtering for texture feature enhancement and minutiae extraction to extract distinctive features. Authors’ perform feature extraction using the histogram of oriented gradients (HOG) descriptors. Next, divide the dataset into training and testing sets, and design and train various machine learning models such as convolutional neural networks (CNN), support vector machines (SVM), and multi-layer perceptron's (MLP) for the proposed model classification. Evaluate the performance of model on the testing dataset using accuracy and other relevant metrics to ensure robust performance estimation. Implementation results shows that the proposed model has higher accuracy in comparison to the existing conventional methods.
A dual adaptive generalized remaining life prediction method based on GP-Wiener
Authors: Liao Hongzhi , Deng Lei , Xu Rui , li jiaxin , miao jiazhen
Published: February 2025

Remaining useful life prediction (RUL), as an important part of equipment health management (PHM), how to improve its prediction accuracy becomes the key of the problem. In this paper, a digital-model fusion method for RUL prediction with dual adaptive nature is proposed for complex systems with multiple sensor monitoring signals. Aiming at multiple ideal properties of health indicators (HIs), a nonlinear fusion method based on genetic programming (GP) is used to construct composite virtual health indicators (VHIs) to realize adaptive selection and fusion of sensors; a degradation model is established using a nonlinear Wiener process with implicit scale transformations, and the a priori parameters of the model are estimated based on the historical data using the method of great likelihood (MLE) and updated a posteriori through the Kalman filter (KF) to update the model parameters a posteriori based on the field measurement data; At the same time, an adaptive RUL correction method is used to reduce the huge error of RUL prediction due to the difference between the filtered and measured values, and the corresponding corrected RUL probability density function is obtained. Finally, the proposed method is validated in the simulated degradation data and C-MPASS dataset, and compared with various methods horizontally and vertically, the proposed method has the highest prediction accuracy and the highest prediction stability, which proves the validity and generalizability of the proposed method.
Nonlinear Gaussian process tomography with imposed non-negativity constraints on physical quantities for plasma diagnostics.
Authors: Ueda Kenji , Nishiura Masaki
Published: February 2025

We propose a novel tomographic method, nonlinear Gaussian process tomography (nonlinear GPT), that uses the Laplace approximation to impose constraints on non-negative physical quantities, such as the emissivity in plasma optical diagnostics. While positive-valued posteriors have previously been introduced through sampling-based approaches in the original GPT method, our alternative approach implements a logarithmic Gaussian process (log-GP) for faster computation and more natural enforcement of non-negativity. The effectiveness of the proposed log-GP tomography is demonstrated through a case study using the Ring Trap 1 (RT-1) device, where log-GPT outperforms existing methods, standard GPT, and the Minimum Fisher Information (MFI) methods in terms of reconstruction accuracy. The results highlight the effectiveness of nonlinear GPT for imposing physical constraints in applications to an inverse problem.
Approaches to Sellar Reconstruction
Authors: Papuc Melissa , Gibbs Hannah , Marino Michael
Published: February 2025

Multiple options are available for sellar reconstruction after endoscopic endonasal resection of pituitary masses. Neurosurgeons and otolaryngologists must be adept at assessing sellar defects and choosing appropriate repair techniques to minimize the risk of CSF leaks and complications. This activity addresses essential competencies, including evaluating the extent of CSF leaks, selecting optimal grafts, and applying multilayered reconstruction techniques for complex defects. Key takeaways include the importance of tailoring reconstruction to the severity of CSF leaks, the effectiveness of nasoseptal flaps for high-grade leaks, and the potential for minimalistic reconstructions in cases without intraoperative leaks. Understanding the historical evolution and current best practices in sellar repair enhances patient outcomes and reduces postoperative morbidity.
Clinical Performance of Cell-Free DNA for Fetal RhD Detection in RhD-Negative Pregnant Individuals in the United States
Authors: Mateus-Nino Julio F. , Wynn Julia , Wiggins-Smith Jenny , Bryant J. Brett , Citty J. Kris , Citty J. Kyle , Ahuja Samir , Newman Roger
Published: February 2025

OBJECTIVE:

To evaluate the performance of a cell-free DNA (cfDNA) assay that uses next-generation sequencing with quantitative counting templates for the clinical detection of the fetal RHD genotype in a diverse RhD-negative pregnant population in the United States.

METHODS:

This retrospective cohort study was conducted in four U.S. health care centers. The same next-generation sequencing quantitative counting template cfDNA fetal RhD assay was offered to nonalloimmunized RhD-negative pregnant individuals as part of clinical care. Rh immune globulin (RhIG) was administered at the discretion of the clinician. The sensitivity, specificity, and accuracy of the assay were calculated considering the neonatal RhD serology results.

RESULTS:

A total of 401 nonalloimmunized RhD-negative pregnant individuals who received clinical care in the period from August 2020 to November 2023 were included in the analysis. The D antigen cfDNA result was 100% concordant with the neonatal serology, resulting in 100% sensitivity, 100% positive predictive value (95% CI, 98.6–100% for both), 100% specificity, and 100% negative predictive value (95% CI, 97.4–100% for both). There were 10 pregnant individuals in whom the cfDNA analysis identified a non-RHD gene deletion, including RhDΨ (n=5) and RHD–CE–D hybrid variants (n=5). Rh immune globulin was administered antenatally to 93.1% of pregnant individuals, with cfDNA results indicating an RhD-positive fetus compared with 75.0% of pregnant individuals with cfDNA results indicating an RhD-negative fetus, signifying that clinicians were using the cfDNA results to guide pregnancy management.

CONCLUSION:

This next-generation sequencing with quantitative counting templates cfDNA analysis for detecting fetal RhD status is highly accurate with no false-positive or false-negative results in 401 racially and ethnically diverse pregnant individuals with 100% follow-up of all live births. This study and prior studies of this assay support a recommendation to offer cfDNA screening for fetal Rh status as an alternative option to prophylactic RhIG for all nonalloimmunized RhD-negative individuals, which will result in more efficient and targeted prenatal care with administration of RhIG only when medically indicated.
Diagnostic Algorithms for Adnexal Masses in the Hands of a Novice Operator
Authors: De Vitis Luigi A. , Schivardi Gabriella , Grcevich Leah , Capasso Ilaria , Fumagalli Diletta , Dahal Sarju , Lembo Antonio , Breitkopf Daniel M. , Laughlin-Tommaso Shannon K. , Fought Angela J. , Johnson Noah E. , Caserta Melanie P. , Clingan Jennings J. , Aletti Giovanni D. , Mariani Andrea , Packard Annie T. , Langstraat Carrie L.
Published: February 2025

OBJECTIVE:

To compare the performance of four commonly used algorithms to differentiate benign from malignant adnexal masses when used by a novice operator.

METHODS:

Women with adnexal masses treated at Mayo Clinic, Rochester, Minnesota, in 2019 were identified retrospectively. Patients were included if they underwent surgery within 3 months of diagnosis or had at least 10 months of follow-up. A nonexpert operator (European Federation of Societies for Ultrasound in Medicine and Biology level I) classified each lesion using ADNEX (Assessment of Different Neoplasias in the Adnexa), two-step strategy (benign descriptors followed by ADNEX), O-RADS (Ovarian-Adnexal Reporting and Data System) 2019, and O-RADS 2022. The primary outcome measure was the area under the receiver operating characteristic curve (AUC) compared across the four algorithms.

RESULTS:

A total of 556 women were included in the analyses: 452 with benign and 104 with malignant masses. The AUCs of ADNEX, the two-step strategy, O-RADS 2019, and O-RADS 2022 were 0.90 (95% CI, 0.87–0.94), 0.91 (95% CI,0.88–0.94), 0.88 (95% CI,0.84–0.91), and 0.88 95% CI, (0.84–0.91), respectively. The two-step strategy performed significantly better than the O-RADS algorithms (P=.005 and P=.002). With all the algorithms, the observed malignancy rate was 1.9–2.2% among lesions categorized as almost certainly benign, twofold higher than the expected less than 1.0%. Lesions wrongly classified as almost certainly benign were borderline tumors (n=4) and metastases (n=3).

CONCLUSION:

In the hands of a novice operator, all algorithms performed well and were able to distinguish benign from malignant lesions. Although the two-step strategy performed slightly better than the O-RADSs, the difference did not appear to be clinically meaningful. The malignancy rate among lesions classified as almost certainly benign was unexpectedly high at 1.9–2.3%, approximately double the expected rate of less than 1.0%.
Prenatal Cannabis Use and Depressive Symptoms
Authors: Pitt Taylor L. , Allshouse Amanda A. , Kim Pilyoung , McMillin Gwen , Silver Robert M. , Chung Judith H. , Grobman William A. , Haas David M. , Mercer Brian M. , Parry Samuel , Reddy Uma M. , Saade George R. , Simhan Hyagriv N. , Metz Torri D.
Published: February 2025

OBJECTIVE:

To evaluate whether cannabis use during pregnancy was associated with depressive symptoms and whether ongoing use beyond the first trimester and higher amounts of cannabis use were associated with increased depressive symptoms.

METHODS:

This was a secondary analysis of the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers to Be) study with participants enrolled from October 2010 to September 2013 at eight academic centers. Individuals with pregnancy outcome data who completed the EPDS (Edinburgh Postnatal Depression Scale) in the first and third trimesters and had available frozen stored urine samples were included. Cannabis exposure was ascertained by urine immunoassay for THC-COOH (11-nor-9-carboxy-delta-9-tetrahydrocannabinol); positive results were confirmed with liquid chromatography tandem mass spectrometry. Cannabis exposure groups for the primary analysis were classified as any exposure (positive urine assay at any of the three time points: 6 0/7–13 6/7 weeks of gestation, 16 0/7–21 6/7 weeks, and 22 0/7–29 6/7 weeks) or no exposure. In a secondary analysis, cannabis exposure was classified as no, only first trimester, or ongoing exposure beyond the first trimester. The primary outcome was depressive symptoms (EPDS score higher than 10) at 22–29 weeks of gestation. The association between cannabis exposure and later depressive symptoms was assessed with multivariable logistic. In an exploratory analysis, first-trimester urine THC-COOH was quantified to determine whether heavier use was associated with greater odds of depressive symptoms later in pregnancy.

RESULTS:

Of 10,038 nuMoM2b participants, 8,424 met the inclusion criteria, and 6.4% (n=535) were exposed to cannabis. Of those exposed, 32.1% (n=172) had only first-trimester exposure, and 67.9% (n=363) had ongoing exposure. Any cannabis use was not significantly associated with later depressive symptoms (adjusted odds ratio [aOR] 1.3, 95% CI, 0.97–1.6) compared with no exposure. However, ongoing exposure beyond the first trimester was associated with later depressive symptoms (aOR 1.6, 95% CI, 1.2–2.2). Higher levels of urine THC-COOH in the first trimester and across pregnancy were associated with increased odds of subsequent depressive symptoms.

CONCLUSION:

Any cannabis exposure was not associated with later-pregnancy increased depressive symptoms. However, ongoing use beyond the first trimester and higher levels of cannabis metabolite in first-trimester urine were associated with greater odds of depressive symptoms in later pregnancy. Directionality of this association cannot be determined given the study design.
Effect of Lumbar Erector Spinae Plane Blocks After Lumbar Fusion Surgery
Authors: Holderread Brendan , Syed Ishaq , Shin Caleb , Toussaint Leonide , Lewis Andrew , Botros David , Avramis Ioannis , Rizkalla James
Published: February 2025

Study Design:

Randomized control trial.

Objective:

To examine erector spinae plane block on a large, comprehensive scale, and investigate the management of postoperative pain and recovery process after lumbar spine surgery using this block.

Summary of Background Data:

Pain management is a key aspect of a patient’s care and overall surgical outcome regarding spinal surgery. While most patients have no issues when undergoing spinal surgery, many have pain that will persist postoperation. Our goal was to evaluate the efficacy of erector spinae plane (ESP) blocks before lumbar arthrodesis in helping manage the persisting pains and opioid consumption postsurgery.

Methods:

A single-blinded randomized control trial was designed and executed on patients who were to undergo lumbar spine fusion. Before their surgical intervention, patients were randomly assigned to receive the erector spinae plane block or the normal anesthesia/pain management routine.

Results:

Of a total of 49 patients, 23 (47%) underwent a spinal block before their respective lumbar spine procedure. Patients with spinal block required fewer supplemental opioids postoperatively (69.9±6.66 vs. 71.7±5.70, P= 0.0002) while reporting less severe pain on VAS pain scoring throughout the first 3 postoperative days (P< 0.0001).

Conclusions:

The patient population that received the erector spinae block had significantly lower pain scores on days 1–3 postsurgery, showing that the spine block is effective in helping patients recover from spinal surgery quicker and with less persisting pain. In addition, the number of patients who filled their first opioid prescription was approaching significance, with the ESP block group filling those prescriptions less frequently. ESP blocks appear to be efficacious at reducing pain and opioid consumption in the immediate postoperative period. No additional complications or readmissions were apparent between subgroups.
Coupling Interval Ratio to Predict the Beta Blocker Response against Premature Ventricular Complexes
Authors: Atmaca Hasan , Yetkin Ertan
Published: February 2025

Despite the wide-spread use of beta blockers, unpredictable response and overall low efficacy are the major pitfalls of beta blocker use for premature ventricular complexes (PVC). Accordingly, we aimed to reveal Holter-guided electrocardiographic criteria to predict the beta blocker responder ones of PVCs.

A total of 89 patients who had pre- and post- treatment Holter ECG recordings and fulfilled the inclusion criteria were retrospectively included in the study. Holter recordings were screened for heart rate variability (HRV), numbers of PVC, heart rate, pre and post coupling intervals (CI) in three different time intervals (24:00 to 08:00am, 08:00 am to 16:00 pm and 16:00pm to 24:00) .

Forty three patients were defined as beta blocker responder group in respect to 70% decrease in PVCs burden. HRV analysis revealed that there were not statistically significant differences between beta blocker responder and non-responder group. CI ratio ((post-PVC CI+ pre-PVC CI)/Pre-PVC CI) of responder and non-responder groups in 24.00 to 8.00 am time interval was statistically different (3.19 vs. 2.91, p=0.006 respectively). Logistic regression analysis revealed that CI ratios of the PVCs during the 24:00-08:00 am intervals have significantly associated with the beta blocker responsiveness for PVCs (Odds ratio: 9.54 95% CI: 1,89-48.7, P value: 0.006)

Night-time increased CI ratio i.e shorter CI time has been found to be an independent predictor of beta blocker response against PVCs. Therefore, beta blockers may be preferably recommended for PVCs, especially in those with shorter CI or increased CI ratio.
Danicopan’s FDA approval: a breakthrough in the treatment of paroxysmal nocturnal hemoglobinuria
Authors: Gul Muhammad Hamza , Mughal Muhammad Zain Ul Abideen , Fareed Ashan , Azad Shehryar , Khan Gulmeena Aziz , Shahid Minha , Noori Samim , Qayyum Sardar Noman
Published: February 2025

The FDA’s approval of Danicopan (Vodeya) on 1 April 2024, represents a significant advancement in the treatment of Paroxysmal Nocturnal Hemoglobinuria (PNH). As the first oral serine protease factor D inhibitor, Danicopan complements existing C5 inhibitors by addressing both intravascular and extravascular hemolysis. In the phase 3 ALPHA trial, Danicopan as an add-on therapy to ravulizumab or eculizumab significantly improved hemoglobin levels, with a least squares mean difference of 2.44 g/dL compared to placebo (P < 0.0001). Key advancements include its ability to reduce transfusion dependency, improve patient quality of life, and its convenient oral administration compared to intravenous therapies. Potential side effects include severe headache, fever, blurred or tunnel vision, sudden dizziness, and an increased risk of infections by encapsulated organisms, along with rare adverse events such as elevated liver enzymes and neutropenia. Danicopan’s approval fills a critical therapeutic gap, offering a transformative approach to managing PNH.
Cholesterol Granuloma Mimicking CSF Otorrhea by beta-Trace-Protein Production
Authors: Radeloff Andreas , Radeloff Katrin , Henke Rolf-Peter , Hahnke Sarah , Loewenthal Maureen
Published: February 2025

Objective

To report a patient who was misdiagnosed and operated on for cerebrospinal fluid (CSF) otorrhea and to demonstrate that cholesterol granulomas mimic CSF leakage by secreting beta-trace protein (BTP).

Patients

Eleven consecutive patients undergoing ear surgery in whom cholesterol granulomas were discovered intraoperatively.

Intervention

Biochemical and histologic analysis of liquid and solid fractions of cholesterol granulomas.

Main Outcome Measures

BTP and beta-2-transferrin concentrations and BTP mRNA levels in surgical specimens.

Results

Cholesterol granulomas produce BTP and express high levels of BTP mRNA, but do not produce beta-2-transferrin.

Conclusions

Beta-2 transferrin analysis is preferable to BTP analysis for the detection of CSF otorrhea because BTP may be false positive in the presence of cholesterol granulomas.
Efficacy of esketamine nasal spray for treatment-resistant depression: A meta-analysis of randomized controlled studies
Authors: Ouyang Yannan , Li Juan
Published: February 2025

Background:

The efficacy of esketamine nasal spray for treatment-resistant depression remains controversial. This systematic review and meta-analysis was conducted to explore the influence of esketamine nasal spray on treatment efficacy for treatment-resistant depression.

Methods:

We conducted a comprehensive search across multiple databases, including PubMed, EMbase, Web of Science, EBSCO, and Cochrane library through March 2024 for randomized controlled trials (RCTs) assessing the effect of esketamine nasal spray on the treatment efficacy of depression. This meta-analysis was performed using the random-effect model.

Results:

Five RCTs are included in the meta-analysis. Overall, compared with control group treatment-resistant depression, esketamine nasal spray is associated with significantly reduced MADRS scores (SMD = −3.88; 95% confidence interval [CI] = −5.71 to −2.05; P < .0001), increased response rates (RR = 1.99; 95% CI = 1.28–3.10; P = .002), decreased Sheehan Disability Scale (SMD = −3.01; 95% CI = −4.39 to −1.64; P < .0001) and PHQ-9 scores (SMD = −2.32; 95% CI = −3.51 to −1.13; P = .0001), but leads to the increase in dizziness (RR = 3.55; 95% CI = 2.37–5.32; P < .00001) and nausea (RR = 3.88; 95% CI = 2.10–7.18; P < .0001).

Conclusion:

Esketamine nasal spray is beneficial to improve the efficacy of treatment-resistant depression.
Assessment of causal association between autoimmune thyroiditis and thyroid cancer: A Mendelian randomization study
Authors: Zhang Qihong , Lan Xiabin
Published: February 2025

Currently, the precise interplay between autoimmune thyroiditis, particularly Hashimoto thyroiditis, and thyroid cancer remains ambiguous. While certain observational studies suggest autoimmune thyroiditis (including Hashimoto thyroiditis) as a predisposing factor for thyroid cancer. Nevertheless, it is still uncertain whether autoimmune thyroiditis is independently associated with thyroid cancer. We employed Mendelian randomization (MR) study methodology, a genetic analysis approach, to evaluate the causal impact of autoimmune thyroiditis on the occurrence of thyroid cancer. We obtained and synthesized statistical data by utilizing public available genome-wide association studies (GWAS). Our study utilized GWAS summary statistics datasets associated with autoimmune thyroiditis (including Hashimoto thyroiditis) as the exposure data source and selected GWAS summary statistics datasets related to thyroid cancer as the outcome data source. Single nucleotide polymorphisms closely associated with autoimmune thyroiditis were chosen as instrumental variables. We conducted 2-sample MR analyses to elucidate the causal association between autoimmune thyroiditis and thyroid cancer. The inverse variance-weighted (IVW) method was employed as the primary methodology, supplemented by additional MR methods including MR-Egger regression, weighted median, simple mode, and weighted mode analyses, to bolster the robustness of our findings. The MR analysis conducted using the IVW method did not confirm a causal relationship between autoimmune thyroiditis and thyroid cancer (odds ratio [OR] = 0.8554, 95% confidence interval [CI]: 0.7193 to 1.0172, P = .0772; OR = 0.8477, 95% CI: 0.7159 to 1.0039, P = .0555; and OR = 1.1324, 95% CI: 0.9342 to 1.3725, P = .2052, from 3 eligible dataset analyses, respectively). Additionally, MR analysis did not observe a causal association between Hashimoto thyroiditis and thyroid cancer (OR = 1.0449, 95% CI: 0.9400 to 1.1615, P = .4155; and OR = 0.9897, 95% CI: 0.8174 to 1.1984, P = .9159, from 2 eligible dataset analyses, respectively). Consistency in results across alternative MR methods was observed. This study employing MR methodology indicates the absence of significant causal relationship between exposure to autoimmune thyroiditis (including Hashimoto thyroiditis) and thyroid cancer. Further validation through larger-scale studies with increased sample sizes is warranted in future investigations.
M1 enrichment facilitates virus detection in patients with allogeneic hematopoietic stemcell transplantation
Authors: Zheng Hao , Li Sai , Liang Ze-Yin , Feng Ru-Li , Lu Jin-Xing , Dong Yu-Jun , Chen Xiao-Ping
Published: February 2025

Due to the severe consequences of viral infection in allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients, the routine use of polymerase chain reaction (PCR) screening of viruses is common in clinic, while the sensitivities of molecular methods are not always sufficient for blood samples. We aimed to increase the detection efficiency of viremia in allo-HSCT patients with M1 bead enrichment. Blood samples of allo-HSCT patients with fever were collected. Simultaneously with analyses of real-time PCR without enrichment, M1 bead enrichment followed by real-time PCR was applied to detect possible viruses in these samples, and metagenomic next-generation sequencing analyses were also applied in 10 samples negative with real-time PCR without enrichment. Various species of viruses were detected with M1 enrichment method. Significantly, some viruses that had not been found by real-time PCR without M1 enrichment were also detected by those with M1 enrichment and verified by metagenomic next-generation sequencing analyses. Furthermore, blood samples enriched with M1 beads had lower Ct values of real-time PCR assay than those that had not been treated. In conclusion, M1 bead enrichment increased the detection efficiency of most viruses in hematological malignancy patients.
A Prospective Study on Postmethylphenidate Treatment Changes in Premature Ejaculation Among Adults With Attention-Deficit/Hyperactivity Disorder
Authors: Takım Uğur , Gökçay Hasan
Published: February 2025

Background:

Methylphenidate is widely used to treat attention-deficit/hyperactivity disorder (ADHD), but its impact on comorbid conditions such as premature ejaculation (PE) and impulsivity in adult patients with ADHD is underexplored.

Study Question:

How does methylphenidate treatment affect impulsivity and PE symptoms in adults with ADHD?

Study Design:

A prospective cohort study at Erzurum City Hospital included 53 adult patients with ADHD diagnosed through the Structured Clinical Interview for DSM-5 Disorders. Of these, 34 had comorbid PE and 19 did not.

Measures and Outcomes:

Primary outcomes were changes in ADHD symptoms, impulsivity, and PE, measured by the Adult ADHD Self-Report Scale (ASRS), Urgency, Premeditation, Perseverance, and Sensation Seeking Impulsive Behavior Scale, and the Arabic Index of Premature Ejaculation (AIPE). Secondary outcomes included the correlation between methylphenidate dosage and symptom improvement and predictors of changes in PE symptoms.

Results:

A significant reduction was observed in the ASRS total score, which decreased from 51.7 ± 9.0 (mean ± SD) to 32.5 ± 8.4 (P < 0.001). Urgency, Premeditation, Perseverance, and Sensation Seeking Impulsive Behavior Scale scores also showed a significant decrease from 125.1 ± 14.3 to 97.0 ± 5.0 (P < 0.001). The AIPE scores, measured in points, increased from 22.4 ± 9.3 to 32.5 ± 8.4 (P < 0.001), suggesting improved control over ejaculation. Correlation analysis revealed a significant positive correlation between the immediate-release methylphenidate dose and improvements in ASRS total scores (r = 0.485, P < 0.001). Regression analysis indicated that the pretreatment AIPE score (β = −0.529, P < 0.001) was a significant predictor of posttreatment changes.

Conclusions:

Treatment with methylphenidate was associated with a decrease in both impulsivity and PE symptoms in adults with ADHD, particularly with immediate-release formulations. These findings highlight the importance of considering comorbid conditions in ADHD treatment.
Zilucoplan: A Novel Strategy for Management of Myasthenia Gravis
Authors: Shah Veedhi , Quintana Marla , Steinberg Michael , Willett Kristine C. , Kakucs Cristian , Dima Lorena
Published: February 2025

Background:

Generalized myasthenia gravis is an autoimmune disease that leads to eventual end-organ damage. Zilucoplan is a new agent for the treatment of generalized myasthenia gravis for patients who are acetylcholine receptor antibody positive.

Pharmacodynamics, And Pharmacokinetics:

It is the first in its class that exerts its effect by binding to complement protein C5 and inhibiting activation to C5a and C5b-9. Zilucoplan may increase the risk of bacterial infections in patients, as its mechanism does heavily rely on altering components of the immune system. Zilucoplan has a black box warning because of the risk of meningococcal infections. Zilucoplan is the first subcutaneous, at-home treatment for generalized myasthenia gravis, which may allow for increased adherence. It is supplied as a prefilled syringe and the dosing varies based on the bodyweight. Onset of action was seen as early as 1 week in clinical studies.

Clinical Trials: There were 2 major trials that led to Food and Drug Administration approval. A 12-week phase 2 study identified 0.3 mg/kg as the clinically efficacious dose for patients with generalized myasthenia gravis. A phase 3 trial (RAISE) showed clinical benefit in patients randomized to zilucoplan compared with placebo. There was a significant change in Myasthenia Gravis Activities of Daily Living score after 12 weeks of treatment. There was no difference in safety end points in both the phase 2 and phase 3 studies. Most patients experienced treatment-emergent adverse events, COVID-19 infections, and exacerbation of myasthenia gravis symptoms being among the most commonly reported.

Therapeutic Advance: Zilucoplan is a new agent with a novel mechanism of action and provides an additional treatment option for patients who do not respond to standard of care. Evidence from postmarketing studies assessing the benefit–risk profile of zilucoplan in real-world settings, in addition to randomized controled trials, as well as pharmacoeconomic studies, is necessary to establish its place in therapy.
Unusual radiographic appearance of fecalith leading to acute abdomen in a patient consuming iron: a case report
Authors: Pathak Niharika , Thapa Megha , Sah Sushil , Pandey Prakash , Joshi Padam Raj
Published: February 2025

Background and importance:

Fecalith is common clinical condition, delay in diagnosis and management can lead to life threatening complications.

Case presentation:

We are reporting the case of an 18-year- old lady which have unusual radiographic appearance of fecalith which was diagnosed in rural emergency setting and managed with simple conservative approach.

Clinical discussion:

Fecalith can also be present in background of iron consumption without chronic constipation and anatomical abnormality. Large fecalith can have confusing radiographic picture.

Conclusion:

Fecalith can present with acute abdomen and confusing radiographic picture. It can lead to life-threatening bowel complications but can be managed conservatively with early diagnosis.
Treatment of JAK2 V617F-positive primary myelofibrosis and advanced chronic myelogenous leukemia with ruxolitinib and flumatinib: a case report
Authors: Zhu Feng , Wang Hui , Qiu Lei
Published: February 2025

Introduction and importance:

Chronic myeloid leukemia (CML) is characterized by a BCR-ABL1 fusion gene of the Philadelphia chromosome, which is mutually exclusive of genetic abnormalities associated with the myeloproliferative neoplasms polycythemia vera, essential thrombocythemia, and primary myelofibrosis (PMF). These conditions are commonly linked to driver mutations in JAK2, CALR, and MPL. Rare cases with both BCR-ABL1 rearrangement and JAK2 V617F mutation have been reported. However, standardized and effective treatments are lacking.

Case presentation:

Herein, we report a patient with PMF who progressed to accelerated CML. Initially, molecular genetic analyses revealed a JAK2 V617F mutation but no BCR-ABL1 rearrangement and the patient was diagnosed with PMF. Nine years after the initial PMF diagnosis, the patient was diagnosed with accelerated CML. Next-generation sequencing confirmed the presence of a BCR-ABL fusion and JAK2 V617 mutation. A combination of 20 mg ruxolitinib twice daily and 0.6 g flumatinib daily was prescribed as treatment.

Discussion:

Serial quantitative measurements of the expression of BCR-ABL and JAK2 V617F following treatment with flumatinib demonstrated a marked reduction in the levels of the BCR-ABL transcripts, with a concomitant increase in the JAK2 V617F allele burden, suggesting that the two disorders arose from independent clones. The case presented suggests that the JAK2 V617F mutation and BCR-ABL fusion can coexist in early progenitor cells.

Conclusion:

In the current case, the BCR-ABL fusion was detected and CML was confirmed after the recurrence of splenomegaly. Subsequent treatment with a combination of flumatinib and ruxolitinib was demonstrated to be safe and effective.
Unnoticed for 14 years: an asymptomatic forgotten common bile duct stent – a case report
Authors: Elsharif Swsan A. , Elamin Mustafa A.M. , Rafei Ahmed , Abdelraheem Elaf M. , Abdo Abdelmounem E.
Published: February 2025

Introduction:

Choledocholithiasis is the presence of gallstones within the common bile duct (CBD), affecting 10–20% of gallbladder stone patients. Endoscopic retrograde cholangiopancreatography (ERCP) with stent insertion is a common treatment of CBD obstruction and stenosis to maintain duct patency, with stents typically replaced within 3–6 months. However, prolonged stent presence can lead to complications such as pancreatitis and cholangitis. We report a rare case of a neglected CBD stent left in situ for 14 years without complications.

Case presentation:

A 77-year-old female with controlled hypertension and diabetes presented to the hospital for a routine check-up. Physical examination was unremarkable except for mild scleral jaundice. She had a history of obstructive jaundice treated with ERCP and stent placement in 2010 but missed follow-ups for stent replacement. Laboratory tests revealed mildly elevated total bilirubin and low serum albumin. An abdominal ultrasound showed gallbladder sludge and a mildly dilated CBD. ERCP confirmed a dilated CBD and common hepatic duct stricture. A new plastic stent was placed, with follow-up ERCP scheduled every 6 months.

Clinical discussion:

Forgotten biliary stents (FBS) are plastic stents left in place for more than a year. They can cause complications such as cholangitis, jaundice, stent migration, and pancreatitis. Elderly patients are more susceptible due to physical limitations and potentially inadequate follow-up. Our case highlights the unusual presentation of an asymptomatic FBS for 14 years.

Conclusion:

This case emphasizes the importance of regular monitoring and timely stent replacement to prevent complications. Effective patient education and adherence to follow-up protocols are crucial in managing biliary stents.