bluuebunny/crossref_metadata_2025 huggingface dataset:
635. FLEXIBLE ENDOSCOPIC SEPTUM DIVISION FOR ZENKER’S DIVERTICULUM: A SINGLE CENTRE EXPERIENCE
Authors: Mandello Marika , Sacco Michele , Massella Arianna , Cerofolini Angelo , Guerzoni Giacomo , Cuce' Federica , De Manzoni Giovanni , Giacopuzzi Simone
Published: September 2024

Background

Zenker diverticulum (ZD) is a pseudodiverticulum of the Killian’s triangle and usually affects males in the 6th-9th decade of life. Symptoms include dysphagia, regurgitation, chronic cough, aspiration, halitosis, and weight loss. The treatment of symptomatic ZD is operative and can surgical or endoscopic. Flexible endoscopic septum division is becoming a prominent treatment option for Zenker's diverticulum (ZD). We report our experience with Flexible endoscopic septum division.

Methods

Data on all consecutive patients that underwent flexible endoscopic treatment for symptomatic Zenker’s diverticulum from February 2021 to December 2023 were retrieved. All patients were diagnosed trough both barium esophagogram and EGDS. All procedures were performed in our centre by the same endoscopist. Dysphagia, regurgitation, and respiratory symptoms severity before the procedure were graded with the Kothari-Haber Scoring System (KH SS). Complications, LOS, symptoms scores and recurrences were recorded. Follow up was performed trough clinical and radiological evaluation.

Results

19 patients were included, 16 (84%) men, mean age 77.2 years (53-79). Pre-operative mean symptoms score was 6.1 (4-9). The pre-operative mean pouch size was 4,16 cm (range 2,3-6). Median length of stay was 3 days (2-18). One patient had an oesophageal leak that was managed endoscopically with clip positioning, nasogastric tube, fasting, and antibiotics, with satisfactory long term clinical outcome. No other complications were reported. All patients reported significant symptom improvement, median post-operative symptoms score was 0,3 (0-3).

Mild relapsing symptoms were present in two patients (10,5%), at 12 and 35 months. Both patients refused further treatments for recurrence.

Conclusions

Treatment of ZD with flexible endoscopic septum division is a feasible, safe and effective option with satisfactory long-term results.
641. COMPARISON OF SURGICAL TREATMENTS FOR GASTROESOPHAGEAL REFLUX IN SYSTEMIC SCLEROSIS
Authors: Szachnowicz Sergio , Ferros Lucas , Friedmann Ilan , Duarte Andre , Bianchi Edno , Seguro Francisco , Sallum Rubens , Júnior Ulysses Ribeiro
Published: September 2024

Background

This study proposes to compare the results of refractory gastroesophageal reflux disease (GERD) in patients with Systemic sclerosis, aiming to compare the results of different surgical approaches.

Methods

44 patients are presented, followed between 2005 and 2024, diagnosed with Systemic Sclerosis and referred to our service. Just 7 patients were submitted to surgical treatment of GERD. Three different were done: partial fundoplication, Roux-en-Y gastroplasty, and Esophagectomy.

Results

Considering the 44 patients, just 15,9 % were operated. Two underwent partial fundoplication, 2 esophagectomies, and 3 gastric bypasses. The patients submitted to esophagectomy had delayed or incomplete esophagic emptying, and the patients who underwent gastric bypass, even with total aperistalsis showed good esophagic emptying during a barium swallow. Only patients without aperistalsis were offered partial fundoplication. We had no mortality, and the morbidity was 33% in gastric Bypass, with no morbidity in the fundoplication and esophagectomy group. The patients submitted to bypass presented better QOL and reflux control.

Conclusion

The surgical approach to the treatment of GERD in Systemic sclerosis is recommended just in selective cases and should be tailored concerning the clinical conditions and the esophagus emptying of each patient.
765. PATTERNS, TIMING, AND SURVIVAL OF RECURRENCE FOLLOWING SURGERY FOR ESOPHAGEAL ADENOCARCINOMA IN THE EUROPEAN MULTICENTRE ENSURE STUDY
Authors: Goense Lucas , Elliott Jessie , Markar Sheraz , Klevebro Fredrik , Johar Asif , Mantziari Styliani , Lagergren Pernilla , Zaninotto Giovanni , van Hillegersberg Richard , van Berge Henegouwen Mark , Nilsson Magnus , Hanna George , Reynolds John
Published: September 2024

Background

After surgery for esophageal cancer approximately half of patients will develop disease recurrence. A more accurate and detailed understanding of the pattern, timing, treatment and prognosis of initial recurrence sites can guide improvements in surveillance and therapy. Therefore, the aim of this study was to accurately describe the pattern and timing of esophageal cancer recurrence, and to assess the distinct survival patterns of these recurrence locations.

Methods

This study included all patients who underwent surgical resection for esophageal and junctional adenocarcinoma registered in the ENSURE study. ENSURE was an international multicenter study of consecutive patients undergoing surgery for esophageal and esophagogastric junction cancers between 2009 and 2015 across 20 centers in Europe and Canada (NCT03461341). The first recurrence site was recorded and recurrence-free survival (RFS) was estimated using Kaplan-Meier curves. Sites of first recurrence were stratified into different groups and survival outcomes post recurrence detection were estimated using Kaplan-Meier curves.

Results

Of 3397 eligible patients, 1310 patients had disease recurrence with comprehensive follow-up data available (median RFS of 12.1 months). First recurrence was detected at multiple distant sites (n=469; 37.3%) or at a single distant site (n=463; 33.7%), while isolated local recurrence occurred in 189 (14.4%) patients. Liver-only recurrence occurred significantly earlier (median 9.0 months), while lung-only (15.2 months) and local-only occurred later (17.8 months). Patients with multiple-sites and liver-only recurrence had significant worse median post recurrence survival (7.4 and 8.3 months, respectively) when compared with lung- or local-only recurrence (10.4 and 15.9 months, respectively).

Conclusion

This study demonstrates that specific recurrence locations of esophageal cancer possess distinct RFS curves. Furthermore, specific recurrence locations result in different post recurrence survival outcomes. This information can help guide improvements in surveillance after esophageal cancer surgery and decisions regarding treatment of esophageal cancer recurrence.
776. THREE-FIELD LYMPHADENECTOMY IN ESOPHAGEAL CANCER: EXPERIENCE OF A PORTUGUESE TERTIARY CENTER
Authors: do Carmo Girão Maria , Silva Francisca Brito , Cabral Francisco , Ramos Paulo , Monteiro Cecília , Casaca Rui
Published: September 2024

Background

The American Joint Committee for Cancer (AJCC) and the Japanese Esophagus Society (JES) differ in the N classification for esophageal cancer, with the former considering the presence of disease in the supraclavicular lymph nodes as M1, and the latter classifying it as loco-regional disease in thoracic esophageal tumors. Patients who would be excluded from a curative intent treatment strategy by the AJCC classification may be candidates for surgery with lymphadenectomy of nodal groups 101 and 104 (JES).

Our goal is to understand the impact of three-field lymphadenectomy on morbidity, loco-regional control and overall survival in patients with esophageal cancer.

Methods

A retrospective cohort study was conducted using data from a prospective database from a single center, which included all consecutive patients undergoing esophagectomy for cancer with either two-field total thoracic lymphadenectomy or three-field lymphadenectomy, between January 2019 and December 2023.

Three-field lymphadenectomy was performed for clinical supraclavicular and recurrent nerve nodal involvement and for proximal third tumors.

We assessed the morbidity and mortality of both types of surgery, and loco-regional and distant recurrence and overall survival for both groups.

Results

Of the 279 esophagectomies for cancer, 137 were included for analysis. The median age was 65 years, with 84% males. 58,4% had squamous cell carcinoma and 41,6% adenocarcinoma. 34.3% of the patients had a 3-field lymphadenectomy, 27,7% of these for supraclavicular N+ and 34% for recurrent nerve N+.

Conclusion

In this large single-center cohort, patients with significant lymph node involvement, treated with esophagectomy and three-field lymphadenectomy, demonstrated comparable loco-regional control and overall survival to more favorable cases, with no statistically significant increase in morbidity and mortality.
816. BRONCHIAL INJURY AND REPAIR DURING MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Harris Caleb
Published: September 2024

Background

Video Assisted Thoracoscopy (VATS) is the preferred approach to Esophagectomy thanks to the improved short term outcomes without any compromise on the oncological outcomes. VATS Esophagectomy is technically difficult and has a steep learning curve, with several potential complications.

Description

This is the video of a patient with early esophageal cancer (T1N0M0) who underwent VATS esophagectomy in the semi-prone position with capnothorax. There was an inadvertent injury to the membranous wall of the left bronchus which was sutured using monofilament absorbable sutures. The omentum was wrapped around and sutured to the anterior wall of the stomach tube, which reinforced the sutures once it was pulled up into the thorax. Patient had an uneventful postoperative recovery.

Importance

This video, apart from stressing on the need for careful dissection around the bronchial tree, shows that such an injury can be managed with minimal invasive techniques.

https://1drv.ms/v/s!AmL6SI2dDeQVh9AzGMuncYi8GT3nIQ?e=IcjfNd
Investigating the Impact of IL-6 and CXCL8 on Neurodegeneration and Cognitive Decline in Alzheimer Disease
Authors: Jin Dongdong , Zhang Min , Shi Lei , Liu Hengfang
Published: September 2024

Background

Alzheimer disease (AD) is a progressive neurodegenerative disorder primarily affecting the elderly, characterized by severe cognitive impairment and memory loss. Emerging evidence suggests that neuroinflammation plays a significant role in AD pathogenesis, with cytokines like interleukin-6 (IL-6) and C-X-C motif chemokine ligand 8 (CXCL8) contributing to the disease progression.

Methods

We utilized Gene Expression Omnibus datasets to identify IL-6 and CXCL8 as pivotal inflammatory markers in AD. In vitro experiments were conducted using SK-N-BE(2)-M17 and THP-1 cell lines treated with IL-6 and CXCL8 to model AD. Additionally, in vivo tests on Amyloid Precursor Protein/Presenilin 1 (APP/PS1) AD mouse models were performed to assess the impact of these cytokines on cognitive functions and brain pathology.

Results

The results indicated a significant decrease in cell viability, increased apoptosis, and elevated inflammatory factor secretion following IL-6 and CXCL8 treatment in vitro. In vivo, AD mouse models treated with these cytokines exhibited exacerbated emotional distress, decreased social interaction, impaired cognitive functions, and increased amyloid protein deposition in neural tissues.

Conclusions

The study highlights the detrimental effects of IL-6 and CXCL8 on neuronal health and cognitive functions in AD. These findings suggest that targeting these cytokines could offer potential therapeutic interventions for improving patient outcomes in Alzheimer disease.
Caring, law, and solidarity—on the need for reorientation
Authors: Scheiwe Kirsten
Published: September 2024

What significance does care have in law? How is solidarity understood in the relationship between individuals, society, and the state, and what needs to be changed? How should the welfare state promote care and caring relationships by granting solidary forms of support and enabling beyond the already existing but insufficient rights and services? These questions guide the analysis; German law and EU law are important points of reference, but the general argument transcends national borders and jurisdictions. It results that solidarities are ambivalent, the recognition of care-related rights and provision of care services and infrastructures is insufficient. There is a need for care policies based on solidarity. Although there are numerous fragmented regulations in family, labour and social law with regard to care and care needs, these are often inadequate. Coherent and solidarity-based care policies, such as those developed by some countries and international organizations, can serve as a stimulus and inspiration for social and legal policies in Germany and elsewhere. Although the contents of solidarity as a legal principle is rather indeterminate and open to the discretion of the state, solidarity can be an important part of the argument, because the social support and organization of care is in the interest of society and of all those who need or provide care and contribute to the public good.
Recombinant collagen for the repair of skin wounds and photo-aging damage
Authors: Liu Taishan , Hao Jiayun , Lei Huan , Chen Yanru , Liu Lin , Jia Liping , Gu Juan , Kang Huaping , Shi Jingjing , He Jing , Song Yangbin , Tang Yuqi , Fan Daidi
Published: September 2024

The skin, being the body’s primary defense mechanism, is susceptible to various injuries such as epidermal wounds, natural aging, and ultraviolet-induced damage. As a result, there is growing interest in researching skin repair methods. Traditional animal-derived collagen, widely available on the market, poses risks due to its immunogenicity and potential for viral contamination. In contrast, recombinant collagen sourced from human genes offers a safer alternative. To investigate the potential of human recombinant collagen in skin repair, our research team applied two types, type I human collagen (Col I) and CF-1552(I), to two different skin injury models: a wound-healing model and a photo-aging model. Our findings indicate that both Col I and CF-1552(I) effectively enhance wound healing and repair skin damaged by ultraviolet exposure. Notably, CF-1552(I) showed effects comparable to Col I in promoting cell proliferation in the wound-healing model and increasing malondialdehyde content in the photo-aging model, suggesting that CF-1552(I) may offer greater potential for skin repair compared to the larger Col I molecule.
Doing Family Before the State. Does Recognition of De Facto Families Lead to More Inclusive Migration Law Practices?
Authors: Bonjour Saskia , Diepenmaat Susan
Published: September 2024

Critical scholars have long called for state recognition of de facto families, beyond legal or biological ties, as a pathway toward inclusion of more diverse family forms. This article asks to what extent recognition of de facto families indeed leads to more inclusion, in the context of a restrictive immigration regime in which families need state permission to live together. It zooms in on migration law practice in the Netherlands, through an analysis of laws and regulations, work instructions of street-level implementers, and interviews with migration lawyers. It finds that conceptions of family-as-doing which focus on practices of dependency and care play a small but significant role in Dutch migration law, enabling inclusion of families beyond the nuclear model. However, recognition of de facto families may lead to new forms of state scrutiny of intimate lives, as well as to new forms of exclusion.
Distinct Trajectories of Prescription Opioid Exposure in Pregnancy and Risk of Adverse Birth Outcomes
Authors: Wang Yi , Ehrenthal Deborah B. , Zhang Liwei
Published: September 2024

Objectives

The aim of this study was to identify distinct trajectories of prescription opioid exposure in pregnancy—encompassing both medication for opioid use disorder (MOUD) and opioid analgesics—and explore their associations with birth outcomes.

Methods

Trajectories were identified using latent class analysis among Wisconsin Medicaid-insured live births 2011–2019. Logistic regression estimated associations between these trajectories and neonatal opioid withdrawal syndrome (NOWS), small for gestational age, preterm birth, birth weight, and gestational age.

Results

Of 138,123 births, 27,293 (19.8%) had prenatal opioid exposure. Five trajectory classes were identified: (1) stable MOUD treatment (5.8%), (2) inconsistent MOUD treatment (3.9%), (3) chronic analgesic use (4.2%), (4) intermittent analgesic use (7.8%), and (5) low-level use of MOUD and analgesics (78.3%). NOWS incidence per 1000 infants was 667 for class 1 (adjusted odds ratio [aOR]: 21.74, 95% confidence interval [CI]: 17.89, 26.41), 570 for class 2 (aOR: 15.35, 95% CI: 12.49, 18.87), 235 for class 3 (aOR: 19.42, 95% CI: 15.93, 23.68), 67 for class 4 (aOR: 6.23, 95% CI: 4.99, 7.76), and 12 for class 5 (aOR: 1.73, 95% CI: 1.47, 2.02). Classes 1–4 had elevated risk of small for gestational age, preterm birth, lower birth weight, and shorter gestational age, with no significant differences among these classes. Among individuals with opioid use disorder, stable MOUD treatment was associated with higher birth weights and longer gestational ages compared to inconsistent treatment, despite higher odds of NOWS.

Conclusions

Early initiation and consistent MOUD treatment may improve birth weight and gestational age. For pregnant individuals with opioid use disorder using chronic analgesics, transition to MOUD may promote birth outcomes.
Outcomes and complications of percutaneous nephrolithotomy as primary versus secondary procedure for kidney stones: a prospective cohort study
Authors: Sakly Aymen , Khaldi Syrine , Touati Anouar , Dimassi Elyes , Zakhama Walid , Binous Yassine
Published: September 2024

Introduction:

Currently, percutaneous nephrolithotomy (PCNL) is the gold standard of treatment for large renal stones. The high prevalence of urolithiasis is associated with a high recurrence rate increasing the risk of re-intervention. This study aimed to compare the effectiveness and complications of PCNL among patients with previous therapeutic interventions for renal stones.

Methods:

Between August 2018 and September 2023, 245 patients were prospectively enrolled in this study and who underwent PCNL for renal stones at our institution. We compared patients who had no previous renal surgery (group 1: n=171) with those who had a history of open renal surgery (group 2: n=45) or previous PCNL on the ipsilateral kidney (group 3: n=31). All patients underwent surgery in the Galdakao-modified Valdivia position. Data on stone characteristics and perioperative and postoperative parameters were collected. Technical features, success rates and morbidity were analyzed and compared between the groups.

Results:

The fluoroscopy time was significantly longer in the group of patients with previous open surgery than in groups 1 and 3 (161.47±52.44, 223.05±33.29, 172.27±30.51 sec, P<0.001). Similarly, the operative time was longer in group 2 (138.20±38.86 min, P<0.001). The immediate stone-free rates in groups 1, 2, and 3 were 74.8%, 72.1%, and 77.4%, respectively (P=0.945). At 1-month, these rates increased to 98.8%, 96.2% and 96.8%, respectively (P=0.857). No difference was detected between the groups in terms of complication rate. The average Hb variation was 1.08±0.82, 1.34±1.01 and 0.94±0.69 g/dl for groups 1, 2 and 3, respectively(P=0.082). Hospital stay was longer in group 2 than in groups 1 and 3 (2.17±1.03, 2.53±1.22, 1.88±1.00 days, P=0.07), respectively.

Conclusion:

PCNL in patients with a history of renal surgery was associated with longer fluoroscopy and operative time. However, the success and morbidity rates as a secondary procedure were similar to those of PCNL in patients with no previous intervention.
Effects of oral montelukast on pulmonary function and clinical symptoms in acute asthma exacerbations: a randomized, double-blind, placebo-controlled trial
Authors: Aliyali Masoud , Abedi Siavash , Sharifpour Ali , Ghadirzadeh Erfan , Fattahi Mahdie , Yazdani Charati Jamshid , Mehravaran Hossein
Published: September 2024

Introduction:

Montelukast is a leukotriene receptor antagonist that helps treat chronic asthma and allergic rhinitis by reducing inflammation and bronchoconstriction. However, oral montelukast’s effectiveness in managing acute asthma attacks has yet to be completely identified.

Methods:

This randomized, double-blind, placebo-controlled trial investigated the efficacy of oral montelukast in acute exacerbations of asthma. Seventy patients between 18 and 65 years of age with a primary diagnosis of asthma attack were included in the study and were randomly assigned to receive 10 mg of montelukast orally daily or placebo. Symptoms, signs, forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate (PEFR) were evaluated.

Results:

Our findings showed a statistically significant difference between montelukast and placebo regarding FEV1 (78.05 ± 7.84 vs. 72.05 ± 12.00, P = 0.016), PEFR (322.86 ± 28.95 vs. 290.86 ± 44.21, P = 0.003), and wheezing (P = 0.022) on the fifth day of treatment. Additionally, FEV1 and PEFR values were compared in two subgroups of patients, ICS users (ICSU) and non-ICS users (NICSU), in both the montelukast and placebo groups. In the montelukast group, while PEFR improved significantly for day 5 in both the ICSU (P = 0.007) and NICSU (P = 0.027) subgroups, FEV1 only improved in the ICSU (P = 0.009) subgroup compared to placebo.

Conclusion:

The present study demonstrated that oral montelukast administered in acute asthma exacerbation could lead to better values of PEFR and FEV1 on pulmonary function and improvement of wheezing in terms of symptoms.
A unique presentation of pericardial epithelioid angiosarcoma with multifaceted complications
Authors: Al Sakan Moied , Chihab Mtanyous , Alkhateb Ouwais , Fakhreddine Omar , Tfayli Arafat
Published: September 2024

Introduction and importance:

Angiosarcomas are rare tumors of endothelial origin and may arise in any organ. Epithelioid angiosarcomas are a subtype of angiosarcoma that are rapidly progressive and typically fatal.

Case presentation:

The authors report a case of a 25-year-old previously healthy female who presented initially for dyspnea and palpitations, on further evaluation she was found to have large bilateral pleural effusions and cardiac tamponade.

Clinical discussion:

Pericardiocentesis and thoracentesis were performed alongside biopsies that revealed atypical cellular proliferation.

Fluorodeoxyglucose-positron emission tomography (FDG-PET) showed avid uptake in the anterior mediastinum, perivascular, paratracheal, subcarinal and pleural lymph nodes with large FDG uptake in the bilateral pleural effusion.

Mediastinoscopy was done and biopsies showed an overtly malignant, epithelioid neoplasm with foci of vaso-formation; Keeping with high-grade epithelioid angiosarcoma of the pericardium.

She received six cycles of weekly paclitaxel, but imaging for abdominal pain incidentally showed evidence of metastasis to the liver and spine so she was switched to Adriamycin-Ifosfamide for which she received one cycle so far.

Her hospital course was complicated by high-output pleural effusions, chylothorax, left atrial thrombus formation and an intensive care unit stay for septic shock.

Conclusion:

Pericardial epithelioid angiosarcoma has been reported rarely in the literature. The authors aim to report a case of extensive metastatic pericardial epithelioid angiosarcoma in a young patient; which we believe can be an addition to the literature of a malignancy associated with poor prognosis and no definitive proven treatment regimen.
Evaluating the Efficacy of Large Language Models in CPT Coding for Craniofacial Surgery: A Comparative Analysis
Authors: Isch Emily L. , Sarikonda Advith , Sambangi Abhijeet , Carreras Angeleah , Sircar Adrija , Self D. Mitchell , Habarth-Morales Theodore E. , Caterson EJ , Aycart Mario
Published: September 2024

Background:

The advent of Large Language Models (LLMs) like ChatGPT has introduced significant advancements in various surgical disciplines. These developments have led to an increased interest in the utilization of LLMs for Current Procedural Terminology (CPT) coding in surgery. With CPT coding being a complex and time-consuming process, often exacerbated by the scarcity of professional coders, there is a pressing need for innovative solutions to enhance coding efficiency and accuracy.

Methods:

This observational study evaluated the effectiveness of 5 publicly available large language models—Perplexity.AI, Bard, BingAI, ChatGPT 3.5, and ChatGPT 4.0—in accurately identifying CPT codes for craniofacial procedures. A consistent query format was employed to test each model, ensuring the inclusion of detailed procedure components where necessary. The responses were classified as correct, partially correct, or incorrect based on their alignment with established CPT coding for the specified procedures.

Results:

The results indicate that while there is no overall significant association between the type of AI model and the correctness of CPT code identification, there are notable differences in performance for simple and complex CPT codes among the models. Specifically, ChatGPT 4.0 showed higher accuracy for complex codes, whereas Perplexity.AI and Bard were more consistent with simple codes.

Discussion:

The use of AI chatbots for CPT coding in craniofacial surgery presents a promising avenue for reducing the administrative burden and associated costs of manual coding. Despite the lower accuracy rates compared with specialized, trained algorithms, the accessibility and minimal training requirements of the AI chatbots make them attractive alternatives. The study also suggests that priming AI models with operative notes may enhance their accuracy, offering a resource-efficient strategy for improving CPT coding in clinical practice.

Conclusions:

This study highlights the feasibility and potential benefits of integrating LLMs into the CPT coding process for craniofacial surgery. The findings advocate for further refinement and training of AI models to improve their accuracy and practicality, suggesting a future where AI-assisted coding could become a standard component of surgical workflows, aligning with the ongoing digital transformation in health care.
Infectious bronchitis virus vaccination, but not the presence of XCR1, is correlated with large differences in chicken caecal microbiota
Authors: Glendinning Laura , Wu Zhiguang , Vervelde Lonneke , Watson Mick , Balic Adam
Published: September 2024

The chicken immune system and microbiota play vital roles in maintaining gut homeostasis and protecting against pathogens. In mammals, XCR1+ conventional dendritic cells (cDCs) are located in the gut-draining lymph nodes and play a major role in gut homeostasis. These cDCs sample antigens in the gut luminal contents and limit the inflammatory response to gut commensal microbes by generating appropriate regulatory and effector T-cell responses. We hypothesized that these cells play similar roles in sustaining gut homeostasis in chickens, and that chickens lacking XCR1 were likely to contain a dysbiotic caecal microbiota. Here we compare the caecal microbiota of chickens that were either heterozygous or homozygous XCR1 knockouts, that had or had not been vaccinated for infectious bronchitis virus (IBV). We used short-read (Illumina) and long-read (PacBio HiFi) metagenomic sequencing to reconstruct 670 high-quality, strain-level metagenome assembled genomes. We found no significant differences between alpha diversity or the abundance of specific microbial taxa between genotypes. However, IBV vaccination was found to correlate with significant differences in the richness and beta diversity of the microbiota, and to the abundance of 40 bacterial genera. In conclusion, we found that a lack of XCR1 was not correlated with significant changes in the chicken microbiota, but IBV vaccination was.
High Precision ECG Digitization Using Artificial Intelligence
Authors: Demolder Anthony , Kresnakova Viera , Hojcka Michal , Boza Vladimir , Iring Andrej , Rafajdus Adam , Rovder Simon , Palus Timotej , Herman Martin , Bauer Felix , Jurasek Viktor , Hatala Robert , Bartunek Jozef , Vavrik Boris , Herman Robert
Published: September 2024

Background

The digitization of electrocardiograms (ECGs) is an important process in modern healthcare, enabling the preservation, transmission, and advanced analysis of ECG data. Traditional methods for digitizing ECGs from paper formats face significant challenges, particularly in real-world scenarios with varying image quality, paper distortions, and overlapping signals. Existing solutions often require manual input and are limited by their dependence on high-quality images and standardized layouts.

Methods

This study introduces a fully automated, deep learning-based approach for high-precision ECG digitization, imple- menting a two-stage process. In the ECG normalization phase, image distortions are corrected, axes are calibrated, and a standardized grid structure is generated. The ECG reconstruction phase uses deep learning techniques to extract and digitize the leads, with subsequent post-processing to refine the digital signal. The tool was evaluated using a custom-built PMcardio ECG Image Database (PM-ECG-ID) comprising 6,000 ECG images generated from 100 unique ECGs, subjected to various augmentations to simulate real-world challenges. Performance was assessed using Pearson’s correlation coefficient (PCC), root mean squared error (RMSE), and signal-to-noise ratio (SNR).

Results

The digitization tool demonstrated an average PCC consistently exceeding 91% across all leads, SNR above 12.5 dB and an RMSE below 0.10 mV. The time to ECG digitization was consistently less than 10 seconds. The failure rate was low, averaging 6.62%, with most failures occurring under extreme conditions such as severe blurring or significant image degradation. The tool maintained robust performance even under challenging scenarios, such as low-resolution images, distorted grids, and overlapping signals. Performance metrics indicated slight variations across different leads, with leads V3-V5 showing marginally higher RMSE and lower PCC, reflecting the complexity of digitizing large amplitude signals.

Conclusion

Our deep learning-based approach for ECG digitization delivers high precision and reliability, effectively addressing real-world challenges such as image distortions, lighting variations, and overlapping signals. This fully automated method enhances the accessibility and utility of ECG data, supporting advanced AI-driven analysis in cardiac healthcare.
Consumption of human-relevant levels of sucrose-water rewires macronutrient uptake and utilization mechanisms in a tissue specific manner
Authors: Ganguly Saptarnab , Chattopadhyay Tandrika , Kazi Rubina , Das Souparno , Malik Bhavisha , Uthpala M.L. , Iyer Padmapriya S. , Kashiv Mohit , Singh Anshit , Ghadge Amita , Nair Shyam D. , Sonawane Mahendra S. , Kolthur-Seetharam Ullas
Published: September 2024

Consumption of sugar-sweetened beverages (SSBs) have been linked to metabolic dysfunction, obesity, diabetes and enhanced risk of cardiovascular diseases across all age-groups globally. Decades of work that have provided insights into pathophysiological manifestations of sucrose overfeeding have employed paradigms that rarely mimic human consumption of SSBs. Thus, our understanding of multi-organ cross-talk and molecular and/or cellular mechanisms, which operate across scales and drive physiological derangement is still poor. By employing a paradigm of sucrose water feeding in mice that closely resembles chronic SSB consumption in humans (10% sucrose in water), we have unraveled hitherto unknown tissue-specific mechanistic underpinnings, which contribute towards perturbed physiology. Our findings illustrate that systemic impaired glucose homeostasis, mediated by hepatic gluconeogenesis and insulin resistance, does not involve altered gene expression programs in the liver. We have discovered the pivotal role of the small intestine, which in conjunction with liver and muscles, drives dyshomeostasis. Importantly, we have uncovered rewiring of molecular mechanisms in the proximal intestine that is either causal or consequential to systemic ill-effects of chronic sucrose water consumption including dysfunction of liver and muscle mitochondria. Tissue-specific molecular signatures, which we have unveiled, clearly indicate that inefficient utilization of glucose is exacerbated by enhanced uptake by the gut. Besides providing systems-wide mechanistic insights, we propose that consumption of SSBs causes intestinal ‘molecular addiction’ for deregulated absorption of hexose-sugars, and drives diseases such as diabetes and obesity.
Species limits and hybridization in Andean leaf-eared mice (Phyllotis)
Authors: Quiroga-Carmona Marcial , Liphardt Schuyler , Bautista Naim M. , Jayat Pablo , Teta Pablo , Malaney Jason L. , McFarland Tabitha , Cook Joseph A. , Blumer Moritz L. , Herrera Nathanael D. , Cheviron Zachary A. , Good Jeffrey M. , D’Elía Guillermo , Storz Jay F.
Published: September 2024

Leaf-eared mice (genusPhyllotis) are among the most widespread and abundant small mammals in the Andean Altiplano, but species boundaries and distributional limits are often poorly delineated due to sparse survey data from remote mountains and high-elevation deserts. Here we report a combined analysis of mitochondrial DNA variation and whole-genome sequence (WGS) variation inPhyllotismice to delimit species boundaries, to assess the timescale of diversification of the group, and to examine evidence for interspecific hybridization. Estimates of divergence dates suggest that most diversification ofPhyllotisoccurred during the past 3 million years. Consistent with the Pleistocene Aridification hypothesis, our results suggest that diversification ofPhyllotislargely coincided with climatically induced environmental changes in the mid- to late Pleistocene. Contrary to the Montane Uplift hypothesis, most diversification in the group occurred well after the major phase of uplift of the Central Andean Plateau. Species delimitation analyses revealed surprising patterns of cryptic diversity within several nominal forms, suggesting the presence of much undescribed alpha diversity in the genus. Results of genomic analyses revealed evidence of ongoing hybridization between the sister speciesPhyllotis limatusandP. vaccarumand suggest that the contemporary zone of range overlap between the two species represents an active hybrid zone.
Quantifying Feral Pig Interactions to Inform Disease Transmission Networks
Authors: Proboste Tatiana , Turnlund Abigail , Bengsen Andrew , Gentle Matthew , Wilson Cameron , Harriott Lana , Fuller Richard A. , Marshall Darren , Soares Magalhães Ricardo J.
Published: September 2024

Feral pigs threaten biodiversity in 54 countries worldwide and cause an estimated $120 billion of damage annually in the United States of America (USA). Feral pigs imperil over 600 native species and have directly driven 14 species into extinction. Moreover, feral pig populations pose a significant zoonotic disease threat to humans such as Japanese encephalitis, and act as reservoir for endemic pathogens such asBrucellaand leptospirosis. Efforts to understand and control disease spread by feral pigs rely on models of social dynamics, how the animals interact with one another. Yet social dynamics are known to vary enormously from place to place, so knowledge generated for example in USA and Europe might not easily transfer to locations such as Australia.

Here, we fill a continental gap in our understanding of feral pig social dynamics by developing a proximity-based social network analysis approach to rapidly assess social interactions using animal tracking data. This method, applied to the continent of Australia, included 146 GPS-monitored feral pigs, and revealed distinct patterns influenced by sex and season, with females demonstrating higher group cohesion (female-female) and males acting as crucial connectors between independent groups. Contact rates are remarkably high within groups, indicating rapid intra-group disease spread that contrasts with much slower potential for inter-group disease spread. Seasonal variations further complicate this dynamic, with contact rates being much higher in summer. The results show that, in Australia, targeting adult males in feral pig control programs could enhance efforts to contain disease outbreaks.

Concern over the economic and human health impacts of animal diseases is higher than ever before. We urge a rapid global effort to use models of feral pig social interactions to develop efficient control strategies tailored to local conditions.
Method for determining of cytotoxicity based on the release of fluorescent proteins
Authors: Lifanov Dmitry , Zorigt Dulamsuren , Shabalina Evgenya , Khalil Abdullah , Gorbunov Konstantin , Petersen Elena
Published: September 2024

This paper describes a method for determining the cytotoxicity of chemical compounds based on the detection of fluorescent proteins - in this case, green fluorescent protein (GFP) and red fluorescent protein (RFP), which are released into the medium from dead cells. This method is similar in principle to the lactate dehydrogenase test (LDH test), but it does not require a reaction with a chromogenic substrate. This method also makes it possible to independently determine the viability of different lines when used in cocultures. Experiments were preformed on a classical monolayer, spheroids and 3D cultures in alginate hydrogel. Capecitabine was used as a model cytotoxic agent. We included liver cells (Huh7) in a coculture model and determined changes in the cytotoxicity levels of capecitabine against NCI-H1299 cells. The experimental part also found that there were differences in sensitivity to capecitabine depending on the type of 3D cultures used.
Genetic analyses identify shared genetic components related to autoimmune and cardiovascular diseases
Authors: Qiao Jun , Chang Minjing , Chen Miaoran , Zhao Yuhui , Hao Jiawei , Zhang Pengwei , Zhou Ruixin , Cai Liuyang , Liu Feng , Fan Xiaoping , Pauklin Siim , Zou Rongjun , Li Zhixiu , Feng Yuliang
Published: September 2024

Objectives

Autoimmune diseases (ADs) play a significant and intricate role in the onset of cardiovascular diseases (CVDs). Our study aimed to elucidate the shared genetic etiology between Ads and CVDs.

Methods

We conducted genome-wide pleiotropy analyses to investigate the genetic foundation comprehensively and shared etiology of six ADs and six CVDs. We analyze the genetic architecture and genetic overlap between these traits. Then, SNP-level functional annotation identified significant genomic risk loci and potential causal variants. Gene-level analyses explored shared pleiotropic genes, followed by pathway enrichment analyses to elucidate underlying biological mechanisms. Finally, we assess potential causal pathways between ADs and CVDs.

Results

Despite negligible overall genetic connections, our results revealed a significant genetic overlap between ADs and CVDs, indicating a complex shared genetic architecture spread throughout the genome. The shared loci implicated several genes, includingATXN2,BRAP,SH2B3,ALDH2(all located at 12q24.11-12),RNF123,MST1R,RBM6, andUBA7(all located at 3p21.31), all of which are protein-coding genes. Top biological pathways enriched with these shared genes were related to the immune system and intracellular signal transduction.

Conclusions

The extensive genetic overlap with mixed effect directions between ADs and CVDs indicates a complex genetic relationship between these diseases. It suggests overlapping genetic risk may contribute to shared pathophysiological and clinical characteristics and may guide clinical treatment and management.
Introducing a framework for within-host dynamics and mutations modelling of H5N1 influenza infection in humans
Authors: Higgins Daniel , Looker Joshua , Sunnucks Robert , Carruthers Jonathan , Finnie Thomas , Keeling Matt J. , Hill Edward M.
Published: September 2024

Avian influenza A(H5N1) poses a public health risk due to its pandemic potential should the virus mutate to become human-to-human transmissible. To date, reported influenza A(H5N1) human cases have typically occurred in the lower respiratory tract with a high case fatality rate. There is prior evidence of some influenza A(H5N1) strains being a small number of amino acid mutations away from achieving droplet transmissibility, possibly allowing them to be spread between humans. We present a mechanistic within-host influenza A(H5N1) infection model, novel for its explicit consideration of the biological differences between the upper and lower respiratory tracts. We then estimate a distribution of viral lifespans and effective replication rates in human H5N1 influenza cases. By combining our within-host model with a viral mutation model, we determine the probability of an infected individual generating a droplet transmissible strain of influenza A(H5N1) through mutation. For three mutations, we found a peak probability of approximately 10−3that a human case of H5N1 influenza produces at least one virion during the infectious period. Our findings provide insights into the risk of differing infectious pathways of influenza A(H5N1) (namely avian-human vs avian-mammal-human routes), demonstrating the three-mutation pathway being a cause of concern in human cases.
Phosphatidylethanolamines are the main lipid class altered in red blood cells from patients with VPS13A disease/chorea-acanthocytosis
Authors: Peikert Kevin , Spranger Adrian , Miltenberger-Miltenyi Gabriel , Glaß Hannes , Falkenburger Björn , Klose Christian , Tyteca Donatienne , Hermann Andreas
Published: September 2024

Background

VPS13A disease (chorea-acanthocytosis) is an ultra-rare disorder caused by loss of function mutations in VPS13A characterized by striatal degeneration and by red blood cell (RBC) acanthocytosis. VPS13A is a bridge-like protein mediating bulk lipid transfer at membrane contact sites.

Objectives

To assess the lipid composition of patient-derived RBCs.

Methods

RBCs collected from 5 VPS13A disease patients and 12 control subjects were analyzed by mass spectrometry (lipidomics).

Results

While we found no significant differences on the overall lipid class level, alterations in certain species were detected: phosphatidylethanolamine species with both longer chain length and higher unsaturation were increased in VPS13A disease samples. Specific ceramide, phosphatidylcholine and sphingomyelin species were also altered.

Conclusions

The presented alterations of particular lipid species in RBCs in VPS13A disease contribute to 1) the understanding of acanthocyte formation and 2) future biomarker identification. Lipid distribution seems to play a key role in the pathophysiology of VPS13A disease.
Large Language Models in Cardiology: A Systematic Review
Authors: Gendler Moran , Nadkarni Girish N , Sudri Karin , Cohen-Shelly Michal , Glicksberg Benjamin S , Efros Orly , Soffer Shelly , Klang Eyal
Published: September 2024

Purpose

This review analyzes the application of large language models (LLMs), in the field of cardiology, with a focus on evaluating their performances across various clinical tasks.

Methods

We conducted a systematic literature search on PubMed for studies published up to April 14, 2024. Our search used a wide range of keywords related to LLMs and cardiology to capture various relevant terms. The risk of bias was evaluated using the QUADAS-2 tool.

Results

Fifteen studies met the inclusion criteria, categorized into four domains: chronic and progressive cardiac conditions, acute cardiac events, cardiology education, and cardiac monitoring. Six studies addressing chronic conditions demonstrated variability in the accuracy and depth of LLM-generated responses. In acute cardiac scenarios, three articles showed that LLMs provided medical advice with mixed effectiveness, particularly in delivering CPR instructions. Two studies in educational cardiology revealed high accuracy in answering assessment questions and interpreting clinical cases. Finally, four articles on cardiac diagnostics showed that multimodal LLMs displayed a range of capabilities in ECGs interpretation, with some models performing at or exceeding the level of human specialists.

Conclusion

LLMs demonstrate considerable potential in the field of cardiology, particularly in educational applications and routine diagnostics. However, their performance remains inconsistent across various clinical scenarios, particularly in acute care settings where precision is critical. Enhancing their accuracy in interpreting real-world complex medical data and emergency response guidance is imperative before integration into clinical practice.
Prevalence of HIV1 Infection and Its Associated Factors among Exposed Infants at Shegaw Motta General Hospital, Ethiopia
Authors: Nigusie Destaw Kebede , Damitew Fantahun Getaneh , Melsew Kirubel Endalamaw , Zerefaw Girma , Nigusie Abebe Feneta
Published: September 2024

Background

Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome is a leading cause of death and disease burden. Following this, vertical transmission is the main source of HIV infection on children globally. Morbidity and mortality among HIV-exposed infants are still the main health challenges in Ethiopia. Therefore, the aim of this study was to determine the prevalence of HIV1infection and its associated factors among exposed infants at Shegaw Motta General Hospital, Ethiopia.

Methods

Hospital-based cross-sectional study was conducted on exposed infants at Shegaw Motta General Hospital from September 1, 2022 to July 30, 2023. The consecutive convenience sampling technique was used to select study participants. Whole blood sample was collected from mothers and infants. Laboratory tests like early infant diagnosis, cluster of differentiation 4 counts and viral load were performed using standard operating procedure. Then, the data were entered into EpiData version 3.1 and analyzed by SPSS version 20. Finally, bivariable and multivariable logistic regressions were carried out to identify factors significantly associated (P<0.05).

Results

Out of 155 infants, about 79(50.9%) infants were females and87(56.1%) was urban resident. Furthermore, majority of infants were born from mothers who could not able to write and read 88(56.8%) and maternal ages range from 25-34years were 138(89.0%). The overall prevalence of HIV1 infection among exposed infants was6(3.87%) with (95%CI: 2.9-8.2). Pregnant women had not antennal care (AOR=7.281,P= 0.001), home delivery (AOR= 3.239,P=0.001), maternal not received antiretroviral prophylaxis (AOR = 9.213,P= 0.001), infants not intake nevirapine prophylaxis (AOR=2.560,P= 0.007) and maternal high viral load (AOR= 5.120,P= 0.004) were the factors associated with HIV infection among exposed infants.

Conclusion

The HIV1 infection among exposed infants was still high (3.87%). Pregnant women had not antenatal care follow up, home delivery, maternal high viral load, and not receiving antiretroviral prophylaxis, infant not intake nevirapine prophylaxis increases the risk of HIV1 infection. Therefore, health facilities should strictly strengthen the PMTCT service by providing maternal antiretroviral prophylaxis, infant nevirapine prophylaxis, promoting antenatal care service, early screening maternal viral load and scale up skilled delivery to eliminate HIV infection among exposed infants.