bluuebunny/crossref_metadata_2025 huggingface dataset:
Obstacle contrast modulates gait behavior in younger and older adults
Authors: Napier-Dovorany Kierstyn , Rietdyk Shirley , Gruber Allison H. , Hassan Shirin E.
Published: January 2025

SIGNIFICANCE

Tripping over an obstacle can cause falls in younger and older adults, potentially causing an injury. Therefore, investigating how adults adjust their behavior to step over obstacles is crucial for safety.

PURPOSE

This study investigated how obstacle contrast altered gait behavior of healthy younger and older adults.

METHODS

Twenty normally sighted adults, 11 older (mean [standard deviation] age, 68.1 [5.1] years) and 9 younger (mean [standard deviation] age, 21.1 [2.1] years), walked along a 6-m, black carpeted walkway and stepped over a single obstacle positioned 4 m from the start. The obstacle varied in height (0 [no obstacle], 1, and 19 cm) and contrast (6% [“low”] and 90% [“high”] Michelson contrast). Each subject completed 10 trials for each of the 5 conditions in an unblocked, random order. Lower limb kinematics were recorded using 13 motion capture cameras. Visual acuity and contrast sensitivity were measured. A repeated-measures analysis of variance was used to assess age group differences in trail toe position before crossing, lead and trail foot clearance over the obstacle, lead heel position after crossing, and obstacle crossing speed. Planned comparisons were done with Bonferroni correction. Independent t tests were used to compare vision and survey variables between groups.

RESULTS

Visual acuity was similar in both groups (p=0.17), although contrast sensitivity was better in the younger than older adults (p=0.001). Main effects were found for age: compared with younger adults, older adults showed a farther back trail foot position, greater trail foot clearance, closer lead heel position, and slower obstacle crossing speed (p<0.001 for all effects). Main effects were found for obstacle contrast: compared with low-contrast obstacles, for high-contrast obstacles, the trail foot position was farther back, both lead and trail foot clearance were greater, and lead heel position was closer (p<0.024 for all effects).

CONCLUSIONS

Obstacle contrast impacts gait behavior for younger and older adults. It is possible that the visual characteristics of an obstacle are enhanced for high-contrast obstacles, causing changes to gait behavior that may increase safety.
Effectiveness of telehealth in patients with spinal cord injury: A randomized controlled trial
Authors: Singh Roop , Malik Manmeet , Verma Bhawna , Jain Mantu , Kaur Svareen
Published: January 2025

Background:

Spinal cord injury (SCI) impacts every aspect of an injured individual’s life and necessitates ongoing surveillance to prevent subsequent complications. The tele-assessment of different diseases has demonstrated encouraging outcomes, and there is limited literature available about SCI. The present study aimed to document the effectiveness of telehealth on clinical outcomes, quality of life improvement, accessibility, psychological health, patient satisfaction and engagement, and caregiver perspective for patients with SCI.

Methods:

This study was carried out in a tertiary care centre. Fifty-six patients with acute SCI were randomized into group “S” (study group), who were followed with telehealth telephonically and through video conferencing plus in-person visits to the hospital at second and sixth months, and group “C” (control group) with in-person visit to the hospital only. Patients were assessed for clinical effectiveness (spinal cord independence measure-III, SCI Secondary Conditions Scale, and pressure ulcer scale for healing), psychological health (World Health Organization Quality of Life, patient health questionnaire, and purdue posttraumatic stress disorder), and patient and caregiver’s perspectives (patient satisfaction questionnaire-18, Patient Health Engagement Scale, and Caregiver Strain Index). The outcome measures were compared between the groups at baseline and follow-up using an independent sample t test at a significance level of P <0.05.

Results:

The mean age of patients was 38.00 ± 14.15 years with predominantly males. The telehealth group showed statistically significant (P = 0.042) improvement in total spinal cord independence measure III (SCI-III) score at 6-month follow-up. The SCI Secondary Conditions Scale, which shows the presence of secondary conditions, had a significantly lower score in the S group at the 6-month follow-up (P = 0.01). The World Health Organization Quality of Life domain 1 was higher in the S group at 6-month follow-up (P < 0.05). Of patients, 50% in the telehealth group were satisfied according to the Modified Reintegration to Normal Living Index scale at monthly follow-up compared with 28.6% in the control group (P < 0.05). The Patient Health Engagement Scale showed that 42.9% of patients reached the final stage of the eudaimonic project in the S group at 6-month follow-up compared with only 14.3% in the control group.

Conclusions:

Telehealth is an effective tool in the continued care of SCI patients post-hospital discharge. Our findings indicate that patients in the telehealth group report improved physical quality of life, enhanced quality of daily living, and decreased occurrence of medical complications. We suggest that multiple centres at the national level should collaborate to further evaluate telehealth. In the future, we should promote telehealth in the rehabilitation of SCI patients.
Rectal Douche as HIV Pre-Exposure Prophylaxis for Receptive Anal Intercourse: An End User Tenofovir Powder Sachet Preparation Feasibility Study (DREAM-04)
Authors: Diniz Clarissa P. , Abdul-Massih Sandra , Bagia Christina , Giguere Rebecca , Rohan Lisa C. , Wang Lin , Dolezal Curtis , Yu Michelle , Bui Vy , Beselman Sasha , Bakshi Rahul , Alvarez-Arango Santiago , Marzinke Mark , Fuchs Edward J. , Hendrix Craig W.
Published: January 2025

BACKGROUND:

Unprotected receptive anal intercourse (RAI) carries the highest sexual HIV transmission risk. The need for diverse pre-exposure prophylaxis (PrEP) options has encouraged the development of on-demand, topical PrEP products for those preferring non-systemic or occasional PrEP. We assessed end-users’ proficiency in preparing tenofovir douches from sachets containing two different powder types, lyophilized and spray-dried, and evaluated their experience.

METHODS:

Cisgender adult men with a history of RAI-related douching were consented, screened, and randomized 1:1 to the order of the powder type prepared. All participants prepared at least three enema bottles of each powder type. Aliquots from each prepared douche bottle were analyzed for TFV concentration, osmolality, and pH. User experience and likelihood of future product use were assessed by questionnaire.

RESULTS:

Twenty-one eligible participants were enrolled. Most participants reported both products as easy or very easy to prepare and likely or very likely to be used. Participants preferred the lyophilized product. The lyophilized and spray-dried douche bottles prepared met the osmolality specifications 89% and 61% of the time and TFV content specifications 81% and 29% of the time, respectively. Questionnaires indicated the most common challenges were tearing open the sachets and transferring the spray-dried product.

CONCLUSIONS:

The majority of participants reported the douches were easy to prepare and indicated likely future use. While the lyophilized sachets were prepared sufficiently to establish preparation feasibility, the spray-dried sachets often fell outside specifications. Failure analysis provided insights to guide product modifications to improve the proficiency of douche preparation and future product use.
Clinical Translation of a Dual-Integrin αvβ3- and CD13-Targeting PET Tracer
Authors: Zhang Xiao , Yang Biao , Qin Chunxia , Song Xiangming , Lv Xiaoying , Zeng Dexing , Gai Yongkang , Lan Xiaoli
Published: January 2025

Purpose

Angiogenesis is essential in the development and progression of tumors. This study aimed to investigate the clinical application of 68Ga-labeled heterodimeric peptide (68Ga-HX01) targeting integrin αvβ3 and CD13 in tumor neovascularization.

Patients and Methods

Six healthy volunteers were recruited to study the biodistribution, pharmacokinetics, and radiation of 68Ga-HX01. Twelve patients with various malignancies were enrolled to seek the preliminary clinical value of 68Ga-HX01. In healthy volunteers, SUVs of each major organ on 68Ga-HX01 PET were measured. The clinical data, lesion numbers, and uptake were recorded in patients. The integrin αvβ3 and CD13 expression of the resected tumors was checked via immunohistochemistry staining.

Results

With a mean injected dose of 167.98 ± 26.32 MBq, 68Ga-HX01 was well tolerated and safe without side effects in 6 healthy volunteers. The radiation absorbed effective dose of 68Ga-HX01 was 1.94 × 10−2 mSv/MBq, and the urinary bladder wall held the highest absorbed effective dose (0.15 ± 5.87 × 10−2 mSv/MBq). In 12 patients with various malignancies, 68Ga-HX01 PET could clearly visualize the lesions from the surrounding tissues. The SUVmax values in tumors were significantly higher than those in the surrounding tissues (P < 0.05). A positive correlation trend between tumor SUVmax and semiquantitative integrin αvβ3 and CD13 expression was determined (P < 0.05).

Conclusions

For clinical use, 68Ga-HX01 is safe with low radiation absorbed effective dose. It also indicates the efficiency of dual integrin αvβ3 and CD13-targeting PET radiotracer in tumor diagnosis, which may assist in patient prognosis and selecting eligible patients for antiangiogenic therapy.
Quantitative Evaluation of 99mTc-Galactosyl Human Serum Albumin SPECT/CT for the Prediction of Posthepatectomy Liver Failure
Authors: Okajima Yukinori , Yanagisawa Shin , Yamada Akira , Notake Tsuyoshi , Shimizu Akira , Soejima Yuji , Fujinaga Yasunari
Published: January 2025

Purpose

To evaluate the predictive ability of 99mTc-galactosyl human serum albumin SPECT/CT quantitative parameters for posthepatectomy liver failure (PHLF).

Methods

Sixty-eight patients who underwent 99mTc-galactosyl human serum albumin scintigraphy as a preoperative examination for hepatectomy between July 2021 and December 2023 were prospectively evaluated. The patients were divided into PHLF and non-PHLF groups. The clearance index (HH15) and receptor index (LHL15) were calculated from planar images. Quantitative parameters for the total liver (SUVmax, SUVmean, peak SUV [SUVpeak], functional liver volume [FLV], SUVmean × FLV), remnant liver (r-SUVmax, r-SUVmean, r-SUVpeak, r-FLV, and r-SUVmean × r-FLV), and r-FLV/FLV were calculated from SPECT/CT images. The areas under the curve (AUCs) of parameters from planar images and SPECT/CT parameters of the total and remnant livers were calculated to evaluate the predictive ability of PHLF.

Results

PHLF occurred in 9 patients. AUC of r-FLV was significantly higher than that of HH15 (0.93; 95% confidence interval [CI], 0.84–0.99 vs 0.66; 95% CI, 0.46–0.84; P = 0.026) and LHL15 (0.93; 95% CI, 0.84–0.99 vs 0.72; 95% CI, 0.55–0.86; P = 0.043). AUC of r-SUVmean × r-FLV was significantly higher than that of HH15 (0.90; 95% CI, 0.80–0.97 vs 0.66; 95% CI, 0.46–0.84; P = 0.037). There were no significant differences between the AUC of other SPECT/CT, r-FLV/FLV, and planar image parameters.

Conclusions

r-FLV can predict PHLF more accurately than HH15 or LHL15.
Factors Affecting Patient Outcomes of Abdominoplasty After Bariatric Surgery
Authors: West William , Rizk Mehdi , Alford Nicholas , Khadka Monica , Docimo Salvatore , Sujka Joseph , Mhaskar Rahul , DuCoin Christopher
Published: January 2025

Background

Postoperative complications in body contouring surgery have been linked to several factors, including body mass index, diabetes, cardiovascular disease, and skin resection weight. Prior weight loss by surgical means is another predisposing factor for postoperative complications following body contouring. This study aims to examine these previously identified variables, and several others, in the context of a spectrum of abdominal body contouring techniques following bariatric surgery. Our goal is to highlight that current evidence supports the notion that the prior history of bariatric surgery does not significantly impact body contouring surgery's success and its associated complications.

Methods

A retrospective cohort study including all consecutive patients (N = 198) who underwent abdominal body contouring between January 2011 and January 2022 following bariatric surgery was performed. Data collected included patient demographics, medical history, perioperative variables, and postoperative outcomes. Univariate and multivariate statistical analysis was performed.

Results

Sixty-four (32%) patients developed a postoperative complication. In the univariate analysis, patients who developed a postoperative complication were more likely to have a mental health disorder (63% vs 44%, P = 0.015) and to have undergone abdominal surgery other than panniculectomy (P = 0.002). They also had significantly longer median operative time (160 minutes, σ = 68.9, vs 140 minutes, σ = 72.3, P = 0.037) and longer follow-up time (99 days, σ = 471.1 vs 23 days, σ = 430.5, P < 0.001). In a multivariate logistic regression model including diabetes, hypertension, abdominoplasty type, operative time, skin excision weight, and concurrent body contouring procedure, the only significant factor in complication rate was the type of abdominal body contouring. Specifically, the traditional (odds ratio: 2.72, 95% confidence interval: 1.25–5.93) and vertical abdominoplasty (odds ratio: 5.50, 95% confidence interval: 1.17 to 25.87) techniques were more likely to lead to complications compared with panniculectomy abdominoplasty, respectively.

Conclusions

Previously cited risk factors such as diabetes, body mass index, and skin resection weight did not increase the chance of complications. Panniculectomy appears to be a safer option for those with a history of bariatric surgery.
Surgical Management of Giant Basal Cell Carcinoma in the Maxillofacial Region
Authors: Pupić-Bakrač Jure , Pupić-Bakrač Ana , Matoc Lovro , Knežević Josip
Published: January 2025

Introduction

Giant basal cell carcinoma (GBCC) is a rare and aggressive subtype of basal cell carcinoma (BCC), characterized by a diameter of ≥5 cm and a potential for deep tissue invasion. This study aimed to present our experience with the surgical management of GBCC in the maxillofacial region, focusing on resection and immediate reconstruction strategies.

Methods

We conducted a retrospective analysis of 5926 patients with BCC in the maxillofacial region from 2010 to 2020, with a specific emphasis on 32 patients diagnosed with GBCC. Associations between patient and tumor characteristics were analyzed, treatment approaches evaluated, and clinical outcomes assessed.

Results

The cohort comprised 20 males (62.5%) and 12 females (37.5%) (P > 0.05), with a median age of 71 years (range: 40–86 years). The median time from tumor onset to presentation was 4 years (range: 2–7 years). A total of 24 GBCCs (75%) developed de novo, whereas 8 (25%) were recurrent BCCs (P < 0.05). The median tumor diameter was 8 cm (range: 5–15 cm), with local invasiveness extending to cartilage in 31.25% of cases, facial muscles in 29.41%, neural tissues in 21.87%, and bone in 18.75%. Surgical resections included orbital exenteration (3 cases, 9.38%), total parotidectomy (2 cases, 6.25%), partial maxillectomy (2 cases, 6.25%), frontal craniofacial resection (2 cases, 6.25%), partial petrosectomy with mastoidectomy (1 case, 3.13%), and near-total rhinectomy (1 case, 3.13%). For reconstruction, a skin graft was used in 3 patients (9.38%), local skin flaps in 15 (46.88%), locoregional flaps in 10 (31.25%), and free flaps in 4 (12.5%). The 5-year overall survival, disease-free survival, and disease-specific survival for the cohort were 87.5%, 93.75%, and 96.88%, respectively.

Conclusions

Our findings suggest that a single-stage procedure featuring aggressive surgical resection and reconstruction achieves low complication rates, excellent oncologic control, and acceptable cosmetic outcomes.
Sorafenib as Adjuvant Therapy Post–Liver Transplant: A Single-center Experience
Authors: Hassanain Hala , Connor Ashton A. , Brombosz Elizabeth W. , Patel Khush , Elaileh Ahmed , Basra Tamneet , Kodali Sudha , Victor David W. , Simon Caroline J. , Cheah Yee Lee , Hobeika Mark J. , Mobley Constance M. , Saharia Ashish , Dhingra Sadhna , Schwartz Mary , Maqsood Anaum , Heyne Kirk , Kaseb Ahmed O. , Vauthey Jean-Nicolas , Gaber A. Osama , Abdelrahim Maen , Ghobrial R. Mark
Published: January 2025

Background.

Hepatocellular carcinoma (HCC) has a rising incidence and mortality in North America. Liver transplantation (LT) with adjunctive therapies offers excellent outcomes. However, HCC recurrences are associated with high mortality. We investigate whether adjuvant systemic therapy can reduce recurrence, as shown with other malignancies.

Methods.

Medical records of patients undergoing LT for HCC at a single center between January 2016 and December 2022 were retrospectively reviewed. Patients were stratified into 3 groups: (1) recipients of adjuvant sorafenib, (2) nonrecipients at high recurrence risk, and (3) nonrecipients at low risk by explant pathology features. The outcomes were overall survival (OS) and recurrence-free survival (RFS). Adjuvant sorafenib recipients were also propensity score matched 1:2 to nonadjuvant recipients based on recurrence risk features.

Results.

During the study period, 273 patients with HCC underwent LT and 16 (5.9%) received adjuvant sorafenib therapy. Adjuvant sorafenib recipients were demographically similar to nonrecipients and, on explant pathology, had greater tumor burden, lymphovascular invasion, and poorer differentiation (all P < 0.001). Adverse events were observed in 12 adjuvant sorafenib recipients (75%). OS was similar among the 3 groups (P = 0.2), and adjuvant sorafenib was not associated with OS in multivariable analysis (hazard ratio, 1.31; 95% confidence interval, 0.45-3.78; P = 0.62). RFS was significantly lower in sorafenib patients (hazard ratio, 6.99; 95% confidence interval, 2.12-23.05; P = 0.001). Following propensity matching, adjuvant sorafenib use was not associated with either OS (P = 0.24) or RFS rates (P = 0.65).

Conclusions.

In this single-center analysis, adjuvant sorafenib was not associated with OS. Recipients were observed to have shorter RFS, likely due to the increased prevalence of high-risk features, and sorafenib use was associated with high frequencies of adverse events.
Association of a Liver Allocation Policy Change With Domestic Travel for Liver Transplantation
Authors: Ross-Driscoll Katie , Kubal Chandrashekhar , Ayuk-Arrey Arrey-Takor , Fridell Jonathan , Axelrod David
Published: January 2025

Background.

In 2020, liver allocation policy in the United States was changed to allow for broader organ sharing, which was hypothesized to reduce patient incentives to travel for transplant. Our objective was to describe patterns of travel for domestic liver transplant pre- and post–acuity circle (AC) implementation.

Methods.

Incident adult liver transplant listings between August 16, 2016, and February 3, 2020 (pre-AC) or June 13, 2020, and December 3, 2023 (post-AC) were obtained from the Scientific Registry of Transplant Recipients. We used previously defined geographic catchment areas to classify patients as (1) no travel, (2) travel to a neighboring region, and (3) travel beyond a neighboring region. We used multinomial logistic regression to identify characteristics associated with travel and cause-specific hazards modeling to estimate the association between travel and time to deceased donor transplant, stratified by model for end-stage liver disease (MELD) score and AC era.

Results.

Among 83 033 liver candidates, 76% were listed in their home region. Black race, lower educational attainment, increased neighborhood social deprivation, and Medicaid were significantly associated with decreased odds of traveling beyond a neighboring region. After AC, traveling beyond a neighboring region was associated with an increased hazard of transplant for patients with a MELD score <15 (cause-specific hazard ratio [csHR]: 1.25; 95% confidence interval [CI], 1.11-1.40), MELD score 15–24 (csHR: 1.19; 95% CI, 1.07-1.31), and MELD score 25–34 (csHR: 1.15; 95% CI, 1.01-1.32).

Conclusions.

Travel frequency, geographic patterns of travel, and characteristics associated with travel were largely unchanged after AC. Changes to allocation policy alone may not equalize patient means or desire to travel for transplant care.
Analysis of Outcomes and Factors Influencing Community-Acquired Pressure Injury
Authors: Yang Xiuru , Zhang Dan , Zhang Hongmei , Cui Liangliang , Hu Qin , Hu Yang , Wen Dan , Ma Yanfei , He Qiuhong
Published: January 2025

PURPOSE:

The purpose of this study was to analyze the outcomes and influencing factors of patients with community-acquired pressure injuries (CAPIs) and provide insights for clinical practice.

DESIGN:

Retrospective cohort study.

SUBJECTS AND SETTING:

We reviewed medical records of 413 patients with a total of 522 CAPIs. Patients with CAPIs who were hospitalized at Mianyang Central Hospital, Sichuan Province, China, between December 2021 and December 2022.

METHODS:

Depending on CAPI outcome at the time of discharge, the patients were split into “improvement” and “no improvement” groups. Factors influencing CAPI outcomes were examined using univariate analysis followed by multivariate analysis (logistic regression).

RESULTS:

A majority of patients (n = 324, 78.5%) showed improvement, and 89 (21.5%) showed no improvement. Logistic regression analysis showed statistically significant associations between CAPI outcomes and Braden Scale for Pressure Sore Risk scores, Barthel Index for Activities of Daily living scores, along with serum albumin, hemoglobin, interleukin-6, and C-reactive protein levels.

CONCLUSIONS:

The outcomes of patients with CAPIs were influenced by the Braden score, the Barthel score, serum albumin and hemoglobin levels, as well as inflammatory markers, including interleukin-6 and C-reactive protein. To effectively treat and care for patients with CAPIs, nurses should develop customized nursing interventions based on the unique characteristics of patients.
Quality of Life and Adaptation of People With a Colostomy Plug
Authors: Diniz Iraktânia Vitorino , Mendonça Ana Elza Oliveira de , Almeida Ana Maria de , Oliveira Simone Helena Dos Santos , Silva Isabelle Pereira da , Costa Isabelle Katherinne Fernandes , Soares Maria Júlia Guimarães Oliveira
Published: January 2025

PURPOSE:

The purpose of this study was to examine health-related quality of life and adaptation of persons with a colostomy before and after use of a colostomy plug.

DESIGN:

Single group before-and-after study.

SUBJECTS AND SETTING:

The study sample comprised 19 people with a colostomy who attended an outpatient clinic João Pessoa, in Paraiba, Brazil. Inclusion criteria were: over 18 years, protruding colostomy, diameter 20 to 45 mm, elimination pattern of up to 3 solid or pasty fecal stools per day, and medical prescription for the use of the colostomy plug.

METHODS:

Data were collected between November 2018 and February 2019. Three outpatient visits per participant were completed; informed consent and baseline data were collected during clinic visit one. Data collected at baseline included demographic and pertinent clinic data. Stoma specific quality of life was measured using the City of Hope Quality of Life – Ostomy Questionnaire; adaptation to an ostomy was measured using the Scale for the Level of Adaptation of Ostomy Patients (SLAOP). Participants were also taught to use a colostomy plug during this visit. A second visit occurred between the 8th and 10th day of use; participants’ ability to use the device was assessed during this visit. A third visit occurred 30 to 35 days after plug use; instruments used to measure adaptation and health-related quality of life were readministered.

RESULTS:

Participants who had significantly higher scores for quality of life and adaptation were identified in people who used the plug in all dimensions of the Scale for Level of Adaptation of people with stomas and City of Hope Quality of Life – Ostomy Questionnaire, except for the interdependence mode. Significant, positive and strong correlations were identified between adaptation and quality of life before (r = 0.823; P = .000015) and after (r = 0.808; P = .000028) use of the colostomy plug.

CONCLUSION:

Findings suggest that use of a colostomy plug improved adaptation and quality of life in some patients living with a colostomy.
Diaper Dermatitis Algorithm and Scoring Tool in the Neonatal Intensive Care Unit (NICU)
Authors: Sharp Meredith
Published: January 2025

PURPOSE:

The purpose of this quality improvement project was to implement and evaluate an algorithm for management and prevention of diaper dermatitis (DD) embedded in a scoring tool. The specific aim of the project was to decrease DD occurrences with a severity score of 3 to 4 by 25%.

PARTICIPANTS AND SETTING:

Quality improvement participants comprised 164 neonates; 89 were cared for prior to project implementation and 75 post-implementation. Data were collected over a 3-month period. The setting of this quality improvement project was a 98-bed, Level IV neonatal intensive care unit (NICU) located in the Midwestern United States (Oklahoma City, OK). The NICU is part of a freestanding children’s hospital affiliated with a university.

APPROACH:

Diaper dermatitis occurrences and severity scores were collected prior to and 3 months after the protocol was implemented in the NICU. We collected pre-implementation data, followed by staff education concerning the DD protocol. We also provide guidance for protocol implementation at the bedside and in our Electronic Medical Record. Data on DD rates and severity were provided during the National Database for Nurse Quality Indicators (NDNQI) prevalence days the 4th quarter of 2020 and the 1st quarter of 2021. We compared data before and after protocol implementation to evaluate its effect on DD rates and severity.

OUTCOMES:

Analysis before and after implementation of the protocol showed no significant differences in DD occurrences or severity scores. The unintended introduction of water-based cleansing wipes was identified as a confounding factor that we believe influenced outcomes. The DD scoring system and algorithm were permanently implemented for DD score quantification, DD management and treatment guidance, and ease of DD documentation with interventions, despite non-significant group differences.

IMPLICATIONS FOR PRACTICE:

Next steps for this project are to implement the water-based cleansing wipes facility wide, along with the scoring tool and DD prevention protocol.
Rapid and Sustained Resolution of Peristomal Pyoderma Gangrenosum With Aerosol Steroid Treatment
Authors: Mitsaki Kyriaki Stefania , Gaglani Bindi , Sethi Mieran
Published: January 2025

BACKGROUND:

Peristomal pyoderma gangrenosum (PPG) is a non-infectious neutrophilic dermatosis most commonly seen in the context of ostomies in inflammatory bowel disease. The lack of established treatment guidelines and high-quality evidence in the form of randomized controlled trials present a major challenge in PPG management, owing to the rarity of the condition. Treatment can be further complicated by difficulties in maintaining the stoma pouch seal with conventional topical corticosteroids.

CASE:

We present a case of PPG treated with aerosol steroid inhaler, highlighting the need for innovative solutions in the management of the condition to maintain the stoma pouch seal.

CONCLUSION:

We achieved rapid and sustained resolution with the aerosol steroid, thus sparing the need for systemic agents, and we would like to advocate for its licensed use in PPG.
Geographic and Demographic Disparity in Firearm Injury: A 33-Year Retrospective Cohort Analysis of Florida Communities
Authors: Villa Brian P , Farach Sandra M , Velanovich Vic , Coughlin Emily , Penny Parker , Henning Jonathan , Lorch Steven , Herron Thomas , Mhaskar Rahul S , Diaz Jose J
Published: January 2025

Background:

Firearm violence in America has been declared a public health crisis. This study investigates variation in firearm injuries by county-level characteristics and intent of firearm use.

Study Design:

The open-access FLHealthCHARTS was searched for firearm injuries from 1989-2022. Intentional firearm injury rates (IFIR) and unintentional firearm injury rates (UFIR) were collected as the number of injuries per 100,000 citizens, race and ethnicity. They were then stratified by severity of injury across county-level characteristic categories such as ruralness, Distressed Communities Index (DCI), and Concealed Carry Weapons (CCW) permit rates.

Results:

Of 123,484 firearm injuries reported, 109,745 were intentional and 13,739 unintentional. Since the late 1990s intentional firearm related deaths and hospitalizations have increased over time, with higher rates in socioeconomically at-risk and larger counties. Unintentional non-fatal hospitalizations have increased exponentially, with higher rates in distressed counties, but no effects of county size or ruralness. Unintentional deaths declined over time, with no significant county-level effects. Based on heatmap patterns, white citizens appear to be victims of more intentional firearm injuries in rural areas, while Black citizens were victims of more intentional firearm injuries in urban areas. The rate of CCW permit holders did not correlate to changes in UFIR or IFIR but patterns can be identified on a county-by-county basis.

Conclusion:

These results suggest that deaths remain a problem in all Florida county communities while hospitalizations are highly influenced by socioeconomic factors and county size. Heatmaps may inform level one trauma hospitals to implement tailored education for high risk surrounding communities.
Seasonal plasticity in daily timing of flight activity in
Anopheles stephensi
is driven by temperature modulation of dawn entrainment
Authors: Rund Samuel S. C. , O'Donnell Aidan J. , Prior Kimberley F. , van der Veen Daan R.
Published: January 2025

The Asian malaria vector
Anopheles stephensi
is invading Africa, requiring it to adapt to novel climates and ecosystems. In part, this may be facilitated by
An. stephensi
’s poorly understood seasonal behavioural plasticity in flight timing, leading to earlier biting activity in cold Asian winters and later biting times in the warm summer. Changes in behavioural timing could be directly imposed by seasonal variation in ambient light and temperature levels or result from altered entrainment of intrinsically expressed circadian rhythms by these factors. We demonstrate that
An. stephensi
entrained flight activity timing is phase-locked to dawn and is not affected by constant ambient temperature, which cannot explain earlier biting activity in colder winters with later dawn. Instead, we show that where night temperatures are the colder part of daily temperature cycle; the entrained phase-angle between dawn and flight activity is altered, hereby increasingly colder, winter-like nights progressively advance flight activity onset. We propose that seasonal timing plasticity optimizes behaviour to warmer daytime in winter, and colder nights in summer, providing protection against both heat-desiccation and cold immobility. The adaptive advantage of this plasticity could be relevant to the successful invasion and survival of
An. stephensi
in African climates, and changing climate worldwide.

This article is part of the Theo Murphy meeting issue, ‘Circadian rhythms in infection and immunity’.
Immune regulation of host energy metabolism and periodicity of malaria parasites
Authors: Hirako Isabella Cristina , Ramalho Theresa , Gazzinelli Ricardo Tostes
Published: January 2025

The synchronization of
Plasmodium
parasites as they replicate within red blood cells of their vertebrate host remains largely unexplored. Understanding this synchronization could reveal how parasites optimize their lifecycle to maximize transmission, evade the immune response and maximize energy acquisition. Rhythmic replication fulfils some criteria of an endogenous oscillator with time of day cues potentially provided by temperature, oxygen levels, hormones and/or nutrient availability. Recent research on a rodent malaria model has highlighted that rhythms associated with the host’s feeding/fasting cycle are a crucial factor influencing the synchronization of the erythrocytic stages of
Plasmodium
to the host’s circadian cycle. Innate immune responses are also rhythmic and can regulate host metabolism, suggesting that the innate immune response triggered by
Plasmodium
contributes to its rhythmic replication. Here, we outline how the interplay between immune responses and metabolism could influence the timing and synchronization of
Plasmodium
’s replication rhythm, focusing on the roles of the cytokine tumour necrosis factor, mitochondrial function and metabolites generated by the tricarboxylic acid cycle in highly activated monocytes. These processes are pivotal in controlling parasitemia and determining disease outcome, suggesting that a better understanding of energy metabolism on rhythmic host–parasite interactions may provide new insights for therapeutic interventions against malaria.

This article is part of the Theo Murphy meeting issue ‘Circadian rhythms in infection and immunity’.
Histone methyltransferase DOT1L maintains identity and restricts cytotoxic potential of CD8 T cells
Authors: Malik Muddassir , de Leeuw Willem-Jan , Aslam Muhammad Assad , Kwesi-Maliepaard Eliza Mari , van den Brand Teun , van den Broek Bram , Kempers Maxime , Hoekman Liesbeth , Proost Natalie , van Welsem Tibor , de Wit Elzo , Borst Jannie , Jacobs Heinz , van Leeuwen Fred
Published: January 2025

The histone methyltransferase DOT1L is emerging as a central epigenetic regulator in immune cells. Loss of DOT1L during development of CD8 T cellsin vivoleads to gain of memory-features but has also been reported to compromise CD8 T cell viability and activity. Here, we determined the cell-intrinsic role of DOT1L in mature mouse CD8 T cells. After conditional deletion ofDot1L in vitro,CD8 T cells retainedin vivoproliferative capacity and anti-tumor reactivity. Moreover,Dot1Lknock-out CD8 T cells showed increased antigen-specific cytotoxicity towards tumor cellsin vitro.Mechanistically, loss of DOT1L resulted in an altered cell-identity program with loss of T-cell and gain of NK-cell features. These transcriptional changes were mediated by loss of DOT1L methyltransferase activity in a dose-dependent manner. Our findings show that ablation of DOT1L activity in mature CD8 T cells is well-tolerated and rewires their cell identity towards the NK-cell lineage, concomitantly enhancing intrinsic cytotoxic capacity.

Highlights

Differentiation and identity of cytotoxic T cells depend on the methyltransferase DOT1L

DOT1L intrinsically limits the cytotoxic activity of mature CD8 T cells

DOT1L prohibits the acquisition of NK cell features in CD8 T cells

DOT1L maintains CD8 T cell identity through its catalytic activity in a dose-dependent manner
MenstLLaMA: A specialized large language model for menstrual health education in India
Authors: Adhikary Prottay Kumar , Motiyani Isha , Oke Gayatri , Joshi Maithili , Pathak Kanupriya , Singh Salam Michael , Chakraborty Tanmoy
Published: January 2025

Background

The quality and accessibility of menstrual health education in developing nations, including India, remain inadequate due to challenges such as poverty, social stigma, and gender inequality. While community-driven initiatives aim to raise awareness, artificial intelligence (AI) offers a scalable solution for disseminating accurate information. However, existing general-purpose large language models (LLMs) are ill-suited for this task, suffering from low accuracy, cultural insensitivity, and overly complex responses. To address these limitations, we developedMenstLLaMA, a specialized LLM tailored to the Indian context, designed to deliver menstrual health education empathetically, supportively, and accessible.

Methods

We curated a novel, domain-specific dataset and benchmarked state-of-the-art LLMs to developMenstLLaMA, an empathic companion model. The evaluation employed an open-label benchmark design with a four-stage framework: (1) overlap with ground truth, (2) clinical relevance, (3) response diversity, and (4) user satisfaction. A panel of clinical experts (n=118) conducted expert evaluations, while participants (n=1,200) interacted with chatbots, includingMenstLLaMA, in 15–20-minute randomized sessions for user satisfaction assessment.

Findings

MenstLLaMAwas compared against state-of-the-art general-purpose LLMs such as GPT-4o, Claude-3, and Mistral during the evaluation period using automated and human-based metrics.MenstLLaMAachieved the highest BLEU score (0.059) and BERTScore (0.911), outperforming competitors without requiring few-shot learning. Clinical experts consistently rated its responses superior to gold-standard answers. User case studies revealed high ratings in Understandability (4.7/5) and Relevance (4.3/5), with a moderate rating in Context Sensitivity (3.9/5).

Interpretation

MenstLLaMAdemonstrates exceptional accuracy, empathy, and user satisfaction in menstrual health education, bridging critical gaps left by general-purpose LLMs. Its potential for integration into broader health education platforms positions it as a transformative tool for menstrual well-being. Future research may explore its long-term impact on public perception and menstrual hygiene practices.
Polygenic contributions to lithium augmentation outcomes in antidepressant non-responders with unipolar depression
Authors: Kraft Julia , Buspavanich Pichit , Braun Alice , Panagiotaropolou Georgia , Schlattmann Peter , Buchbauer Hannah , Heilbron Karl , Heilbronner Urs , Schulze Thomas G. , Ripke Stephan , Ricken Roland , Adli Mazda
Published: January 2025

Objective

Lithium augmentation (LA) is an effective treatment for patients with major depression after inadequate antidepressant response, but therapeutic outcomes vary considerably between individuals. Molecular studies could yield novel insights into treatment prediction to enable personalized therapy choices. Here, we investigated the effects of polygenic risk scores (PRS) for schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BIP) on clinical outcomes following LA.

Methods

Recent GWAS summary statistics were used to construct disorder-specific PRS in lithium-augmented MDD patients who participated in a prospective study after poor response to at least one antidepressant drug. Depressive symptoms were assessed for four weeks or longer using the Hamilton Depression Rating Scale (HAMD). Hazard ratios (HR) of favorable outcomes, response (≥ 50% reduction in HAMD composite scores) and remission (HAMD ≤ 7), were estimated by Cox proportional hazards regression models adjusted for ancestry, demographic, and clinical covariates.

Results

In 193 patients, BIP-PRS was positively associated with both response (HR = 1.29, 95% CI = 1.02-1.63, p = 0.03, Nagelkerke R2= 2.51%) and remission (HR = 1.52, 95% CI = 1.14-2.04, p = 0.004, Nagelkerke R2= 4.53%) after LA. Our data further suggest that individuals who carry a lower polygenic burden for MDD tend to respond better to LA (HR = 0.81, 95% CI = 0.66-1.00, p = 0.048, Nagelkerke R2= 1.99%). No associations were observed between SCZ-PRS and either clinical outcome (p > 0.05).

Conclusions

Our findings indicate that individuals at higher polygenic risk for BIP and lower polygenic risk for MDD are more likely to benefit from augmentation with lithium. If replicated, PRS may inform future efforts to establish clinical prediction models for LA outcomes in unipolar depression.
Family matters! The influence of family, peers, mentors, and professors on STEM college students’ motivational beliefs and career decision making
Authors: Tuma Trevor T. , Rosenzweig Emily Q. , Chen Xiao-Yin , Lemons Paula P.
Published: January 2025

Support from family, peers, mentors, and professors has a crucial role in the development of students’ motivational beliefs about learning. However, therelativeimportance of each of these social supports in affecting students’ motivation, and the precise processes through which these social factors motivate students, are not well understood at the college level. The present study examined how family, peers, mentors, and professors shaped science, technology, engineering, and mathematics (STEM) college students’ motivational beliefs for career decision making, defining motivational beliefs in accordance with situated expectancy-value theory. We collected survey and open-ended responses from a large sample of college students (n= 2,229) in 42 unique STEM courses at a large, public southeastern university in the United States. We examined how, why, and for whom different social supports influenced students’ task-value and/or competence related motivational beliefs for career-decision making. Results indicated that students most often selected interactions with family members as influencing their career decision-making, both in terms of overall influences and as the strongest influence, relative to interactions with peers, mentors, or professors. For all social influences, most students reported being attracted in a positive way towards certain careers as a result of social interactions, as opposed to socializers making students disenchanted with careers. Most students described how social supports influenced motivational beliefs related to task values, with comparatively fewer referencing social influences on competence-related beliefs. Findings highlight the important role of multiple social supports, particularly family, in shaping students’ motivational beliefs and career decision-making throughout emerging adulthood.

Educational Impact and Implications Statement

Preparing a qualified and diverse STEM workforce requires a robust understanding of the factors that influence college students’ motivational beliefs and decisions about their career paths. We examined how, why, and for whom support from family, peers, mentors, and professors impacted STEM college students career motivation and decision making, using both qualitative and quantitative data. Results suggest that family plays a particularly crucial role in shaping college students’ career motivation, especially by helping them see the positive value of particular career paths. Findings help illustrate the importance of different kinds of social support in guiding career choices throughout emerging adulthood.
GEI-17-Mediated SUMOylation of GDI-1 Regulates Apoptotic Cell Clearance
Authors: Yuan Lei , Li Peiyao , Ma Aiying , Li Chao , Liu Fuqiao , Xie Yunmin , Zheng Qian , Wang Hui , Xiao Hui
Published: January 2025

Apoptotic cell clearance represents the final stage of apoptosis, and involves phagosome formation, maturation, and digestion. Here, we found that SUMO modifications participate in apoptotic cell clearance by influencing phagosomal degradation activity inC. elegans. The SUMO E3 ligase, GEI-17, SUMOylates GDP dissociation inhibitor (GDI-1) at K270 to trigger phagosomal degradation. Upon SUMOylation, GDI-1 facilitates release of GDP-bound RAB-1, which is subsequently converted to the GTP-bound form in a manner dependent on GDI displacement factor, PRAF-3. RAB-1 conversion enables binding and translocation of RAB-7 from the endoplasmic reticulum to Golgi to promote phagosome maturation and degradation activity. In the absence of GDI-1 SUMOylation, GDI-1 binds to GDP-RAB-1, sequestering it in the cytoplasm, resulting in impaired phagosomal degradation. Furthermore, we found SUMOylation of GDI1 at a conserved site plays a crucial role in efferocytosis regulation in mammals. This study defines a previously unrecognized mechanism by which SUMOylation drives apoptotic cell clearance.
Individual differences in punished alcohol self-administration are unaltered by alcohol vapor exposure
Authors: Bluitt Maya N , Munoz Ana C , Besheer Joyce
Published: January 2025

Continued alcohol use despite negative consequences is a defining feature of alcohol use disorder (AUD). It remains poorly understood whether individual variability in drinking despite negative consequences is due to inherent differences or emerges after prolonged alcohol use. The goal of the present study was to use a rat model of drinking despite negative consequences to assess individual differences in foot shock-punished alcohol self-administration prior to and following alcohol vapor exposure in male Wistar rats. After baseline operant self-administration was established, rats underwent additional self-administration sessions in which random, response-contingent foot shock punishment was introduced. Average percent change from baseline was calculated for each rat during punished sessions and rats were classified into shock-sensitive (SS) and shock-resistant (SR) subgroups using the top and bottom thirds. Rats then underwent 3 cycles of air or alcohol vapor exposure every other week, with unpunished self-administration sessions occurring during the intervening weeks. Following the last vapor cycle, rats were re-assessed for resistance to foot shock during punished self-administration sessions. Alcohol vapor exposure had no effect on punished self-administration overall, nor by subgroup. Examination of individual differences showed that rats classified as SR showed increased unpunished self-administration relative to baseline regardless of air vs. vapor condition. These data suggest that alcohol history has a minimal effect on individual differences in foot shock-punished self-administration.
Sign of gauge-Higgs boson couplings at future lepton colliders
Authors: de Lima Carlos Henrique , Tuckler Douglas
Published: January 2025

This work investigates the capability of future lepton colliders to determine the sign of the gauge-Higgs coupling through the vector boson fusion Zh process. This channel offers a model-independent way to probe the sign of the gauge-Higgs coupling. Its sensitivity to interference effects and universal coupling with new physics makes it particularly effective. We show that a high-energy lepton collider such as CLIC can fully determine the sign of the gauge-Higgs coupling in a model-independent way and with high confidence.

Published by the American Physical Society
2025
Conic sections on the sky: Shadows of linearly superrotated black holes
Authors: Lin Feng-Li , Patel Avani , Payne Jason
Published: January 2025

Soft hairs are an intrinsic infrared feature of a black hole, which may also affect near-horizon physics. In this work, we study some of the subtleties surrounding one of the primary observables with which we can study their effects in the context of Einstein’s gravity: the black hole shadow. First, we clarify the singular pathology associated with black holes with soft hairs and demonstrate that the metrics of linearly superrotated black holes are free of near-zone pathologies due to appropriate asymptotic falloff conditions being imposed on the event horizon. We then analytically construct the photon orbits around such black holes, derive the shadow equation for near-zone observers, and find that the linear superrotation hairs deform the circular shadow of a bald Schwarzchild black hole into an ellipse. This is in sharp contrast to their supertranslated counterparts, which only shift the position of the center of the circular shadow but do not change its shape. Our results suggest a richness to the observable effects due to the infrared structures of Einstein’s gravity.

Published by the American Physical Society
2025