bluuebunny/crossref_metadata_2025 huggingface dataset:
Parallel Spectral Tuning of a Cone Visual Pigment Provides Evidence for Ancient Deep-Sea Adaptations in Cetaceans
Authors: Chi Hai , Sun Linxia , Li Na , Zhan Yue , Guo Jinqu , Lei Lei , Irwin David M , Yang Guang , Xu Shixia , Liu Yang
Published: October 2024

Dichromatic color vision is mediated by two cone visual pigments in many eutherian mammals. After reentry into the sea, early cetaceans lost their violet-sensitive visual pigment (short wavelength-sensitive 1) independently in the baleen and toothed whale ancestors and thus obtained only monochromatic cone vision. Subsequently, losses of the middle/long wavelength-sensitive (M/LWS) pigment have also been reported in multiple whale lineages, leading to rhodopsin (RH1)-mediated rod monochromatic vision. To further elucidate the phenotypic evolution of whale visual pigments, we assessed the spectral tuning of both M/LWS and RH1 from representative cetacean taxa. Interestingly, although the coding sequences for M/LWS are intact in both the pygmy right whale and the Baird's beaked whale, no spectral sensitivity was detected in vitro. Pseudogenization of other cone vision-related genes is observed in the pygmy right whale, suggesting a loss of cone-mediated vision. After ancestral sequence reconstructions, ancient M/LWS pigments from cetacean ancestors were resurrected and functionally measured. Spectral tuning of M/LWS from the baleen whale ancestor shows that it is green sensitive, with a 40-nm shift in sensitivity to a shorter wavelength. For the ancestor of sperm whales, although no spectral sensitivity could be recorded for its M/LWS pigment, a substantial sensitivity shift (20 to 30 nm) to a shorter wavelength may have also occurred before its functional inactivation. The parallel phenotypic evolution of M/LWS to shorter wavelength sensitivity might be visual adaptations in whales allowing more frequent deep-sea activities, although additional ecological differentiations may have led to their subsequent losses.
The prescriptive nature of market timing and predictive portfolios
Authors: Kyriazi Foteini
Published: October 2024

Accepted by: Konstantinos Nikolopoulos

We explore the ability of market timing, model-based forecasts that include incremental information over and above momentum, to create long-short portfolios that consistently provide superior returns to traditional benchmarks, and frame our analysis in the idea of “prediction-led prescription” for forward-looking decision making. Our methodology consists of linear and non-linear forecasts with model selection, that predict the direction of future returns and apply then into the construction of portfolios. Our results strongly recommend that predictive-based portfolio allocation can produce excess returns and higher Sharpe ratios, above and beyond the individual return series that are utilized to create the forecasts and traditional portfolio benchmarks. The use of “predictive methods in portfolio construction reinforces the idea of prediction-led prescription” as portfolios are prescriptions for investment management and have an exclusively forward-looking nature.
Biological and experimental factors that define the effectiveness of microbial inoculation on plant traits: a meta-analysis
Authors: Azarbad Hamed , Junker Robert R
Published: October 2024

Bacterial and fungal microbiomes associated with plants can significantly affect the host’s phenotype. Inoculating plants with one or multiple bacterial and fungal species can affect specific plant traits, which is exploited in attempts to increase plant performance and stress tolerance by microbiome engineering. Currently, we lack a comprehensive synthesis on the generality of these effects related to different biological (e.g. plant models, plant traits, and microbial taxa) and experimental factors. In a meta-analysis, we showed that the plant trait under consideration and the microbial taxa used to inoculate plants significantly influenced the strength of the effect size. In a methodological context, experiments under sterilized conditions and short-term periods resulted in larger positive effects on plant traits than those of unsterilized and long-term experiments. We recommend that future studies should not only consider (short-term) laboratory experiments with sterilized plants and single inoculants but also and more often (long-term) field or greenhouse experiments with naturally occurring microbial communities associated with the plants and inoculated consortia including both bacteria and fungi.
Enhancing learning to solve multicomponent fractional viscoelastic equations with U-net Fourier neural operators
Authors: Tian Wenbin , Liu Yang , Zhang Yibo
Published: October 2024

The research of viscoelastic media is currently a hot topic in the interpretation and processing of seismic data. To accurately simulate the propagation of seismic waves in viscoelastic media, the fractional viscoelastic equation has emerged as an indispensable method. However, solving this equation numerically has proven to be challenging due to the complexity introduced by its fractional Laplacian operators. Recently, deep learning, especially Fourier neural operators (FNO), has shown excellent performance in learning to fast solve partial differential equations. Traditional FNO methods may face crosstalk problems and this make it difficult to achieve satisfactory accuracy when solving the multicomponent fractional order viscoelastic equation. To solve this problem, we introduce a novel approach based on U-net Fourier neural operator (U-FNO). As an enhanced learning method to the traditional FNO-based method, the U-FNO-based method integrates a U-Fourier layer following the standard Fourier layer as a form of regularization, thereby achieving superior prediction accuracy for multicomponent equations. Specifically, both the Fourier layers and U-Fourier layers in U-FNO are trained with the solutions of the equation from previous time steps as inputs. This training process enables the U-FNO to efficiently produce more accurate solutions for subsequent wavefield. Numerical simulations reveal that the U-FNO-based method efficiently learns to solve the fractional viscoelastic wave equation independent of fractional Laplacian operators. Additionally, U-FNO-based method offers superior prediction accuracy in comparison with the traditional FNO-based method.
Breast cancer screening in women with SCD: a single-center exploratory study
Authors: Elmileik Eiman , Farooqui Marwah , Zhang Xu , Hussain Faiz , Haqqani Rayyan , Sung Kaitlin , Saraf Santosh L
Published: October 2024

Objectives

SCD is one of the most common inherited blood disorders and is associated with reduced life expectancy. As a result of prophylactic and disease-modifying medications, morbidity and mortality have improved, and research focusing on cancer screening has become more relevant. This study therefore aimed to identify patterns regarding breast cancer screening and breast composition in women with SCD.

Methods

This was a single-center retrospective study. Medical records of 156 individuals with SCD between 2018 and 2022 were analyzed.

Results

Of 156 individuals, 56% had screening mammography within the past 2 years. In comparison, the latest Centers for Disease Control and Prevention report showed that 70.8% of non-Hispanic Black women aged 40 and over had undergone screening mammography within the past 2 years. The difference was not statistically significant. Fifty-four percent of those screened had dense breasts. There was an inverse relationship between body mass index (BMI) and breast density.

Conclusion

The results suggest that there was no statistically significant difference in breast cancer screening rates between women with SCD and those without SCD. Our study found that there was an inverse relationship between BMI and breast density in women with SCD, which was consistent with well-established data about breast density and BMI in the general female population. Prospective studies with larger cohorts are recommended to enhance statistical power, fostering a comprehensive understanding of cancer and cancer risk in individuals with SCD.
Dapagliflozin for rheumatic musculoskeletal disease in patients with chronic kidney disease
Authors: Hanaoka Hironari , Kikuchi Jun , Hiramoto Kazuoto , Akiyama Mitsuhiro , Saito Shutaro , Kondo Yasushi , Azegami Tatsuhiko , Kaneko Yuko
Published: October 2024

Objectives

To elucidate the effectiveness of dapagliflozin, a sodium–glucose cotransporter 2 inhibitor, on renal function in patients with rheumatic musculoskeletal diseases complicated by chronic kidney disease (CKD).

Methods

We conducted a retrospective analysis of patients with rheumatic musculoskeletal disease and chronic kidney disease who were treated with dapagliflozin for more than a year. The good response was defined as an improvement in the estimated glomerular filtration rate slope per year after dapagliflozin treatment compared to that before treatment. Additionally, we investigated the response rate and its predictive factors.

Results

In this analysis, 43 patients were included. The average estimated glomerular filtration rate slope demonstrated a significant improvement after dapagliflozin treatment compared to that before the treatment (0.04 vs −0.55 ml/min/1.73 m2/year, P = .001). A good response rate was 69.8% and was associated with low average levels of C-reactive protein, a high frequency of angiotensin II receptor blocker (ARB) use, and a low frequency of tacrolimus use compared to nonresponse (0.08 ± 0.18 vs 0.25 ± 0.29 mg/dl, P = .03; 80.0 vs 38.4%, P = .01; 10.0 vs 76.9%, P < .01).

Conclusions

Dapagliflozin is effective for rheumatic musculoskeletal disease patients with CKD for preventing deterioration of renal function. Antihypertensive treatment with ARB and inflammation control without tacrolimus was associated with a high likelihood of favourable response to dapagliflozin.
Nose-to-brain delivery of stem cells in stroke: the role of extracellular vesicles
Authors: Borlongan Cesar V , Lee Jea-Young , D’Egidio Francesco , de Kalbermatten Matthieu , Garitaonandia Ibon , Guzman Raphael
Published: October 2024

Stem cell transplantation offers a promising therapy that can be administered days, weeks, or months after a stroke. We recognize 2 major mitigating factors that remain unresolved in cell therapy for stroke, notably: (1) well-defined donor stem cells and (2) mechanism of action. To this end, we advance the use of ProtheraCytes, a population of non-adherent CD34+ cells derived from human peripheral blood and umbilical cord blood, which have been processed under good manufacturing practice, with testing completed in a phase 2 clinical trial in post-acute myocardial infarction (NCT02669810). We also reveal a novel mechanism whereby ProtheraCytes secrete growth factors and extracellular vesicles (EVs) that are associated with angiogenesis and vasculogenesis. Our recent data revealed that intranasal transplantation of ProtheraCytes at 3 days after experimentally induced stroke in adult rats reduced stroke-induced behavioral deficits and histological damage up to 28 days post-stroke. Moreover, we detected upregulation of human CD63+ EVs in the ischemic brains of stroke animals that were transplanted with ProtheraCytes, which correlated with increased levels of DCX-labeled neurogenesis and VEGFR1-associated angiogenesis and vasculogenesis, as well as reduced Iba1-marked inflammation. Altogether, these findings overcome key laboratory-to-clinic translational hurdles, namely the identification of well-characterized, clinical grade ProtheraCytes and the elucidation of a potential CD63+ EV-mediated regenerative mechanism of action. We envision that additional translational studies will guide the development of clinical trials for intranasal ProtheraCytes allografts in stroke patients, with CD63 serving as a critical biomarker.
Urticarial vasculitis
Authors: Ergun Tülin
Published: October 2024

Purpose of review

Urticarial vasculitis is a rare condition manifesting with a variety of clinical presentations ranging from skin limited lesions to life-threatening systemic illnesses. This review aims to highlight the recent findings on the etiology, diagnostic modalities, and therapeutic strategies and course of urticarial vasculitis.

Recent findings

In addition to well established triggers, urticarial vasculitis (UV) cases associated with severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) disease and COVID-19 vaccines, vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome, and adenosine deaminase (ADA) deficiency have been reported. A clinical-dermoscopic model for differentiating urticarial vasculitis has been developed with purpuric patches and globules favoring UV diagnosis and thus diminishing the need for histopathology. The efficacy of treatment modalities has been reviewed, and antihistamines, systemic corticosteroids, omalizumab, cyclophosphamide, tocilizumab, anti-interleukin (IL)-1 agents, and rituximab were shown to have the highest success rates. Regarding the durability of remission, rituximab, dapsone, and MMF were related to long-lasting treatment free responses. The course of hypocomplementemic urticarial vasculitis was investigated in an epidemiological study, revealing 5- and 10-year survival rates of 92% and 83%, respectively. Chronic obstructive pulmonary disease, septicemia, and end-stage renal disease were identified as causes of mortality.

With the aid of dermoscopy, a noninvasive tool, differentiation from chronic spontaneous urticaria can be made, and the need for histopathological examination can be diminished. Although clear definitions and consensus criteria for performing disease severity are lacking, careful screening is needed to tailor the treatment on an individual basis. Emerging infections like SARS-CoV 2, vaccines, and autoinflammatory disorders like VEXAS syndrome and ADA deficiency are new associations. The optimal use of well established agents like systemic corticosteroids and immunomodulators are mainstay treatment modalities, whereas IL-1 inhibitors, omalizumab, rituximab and Janus Kinase inhibitors may represent viable alternatives in selected cases.
Polymyalgia rheumatica and giant cell arteritis: diagnosis and management
Authors: Sun Margaret Man-Ger , Pope Janet E.
Published: October 2024

Purpose of review

There have been advances in the diagnosis and treatment of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR).

Recent findings

Themes in PMR and GCA include classification criteria, ultrasound imaging of temporal and axillary arteries replacing biopsies for diagnosis of GCA, faster diagnosis and treatment with rapid access clinics for suspected GCA, and expanding treatment options with the goal of rapid suppression of inflammation and sparing steroids.

Treatment is aimed at suppressing inflammation quickly in both GCA and PMR. Randomized trials have demonstrated success in reducing glucocorticoids when adding advanced therapies such as interleukin 6 (IL6) inhibitors. Other treatments including Janus kinase (JAK) inhibitors (especially a phase 3 trial of upadacitinib at 15 mg daily and secukinumab (an IL17 inhibitor) are being tested. Some uncontrolled GCA protocols are limiting glucocorticoids to initial IV pulse therapy only or rapid tapering of oral glucocorticoids with upfront treatment with tocilizumab. There is uncertainty of who should have an advanced therapy and how long to use it for and what order to consider advanced therapies when treatment fails. In PMR, studies are performed when patients cannot taper glucocorticoids effectively, whereas in GCA, advanced therapies are started with disease onset or with recurrent GCA.
Cost-effectiveness Improves for Operative vs Nonoperative Treatment of Adult Symptomatic Lumbar Scoliosis at Eight-Year Follow-up
Authors: Carreon Leah Y. , Glassman Steven D. , Smith Justin S. , Kelly Michael P. , Yanik Elizabeth L. , Baldus Christine R. , Lurie Jon D. , Edwards Charles , Lenke Lawrence G. , Buchowski Jacob M. , Crawford Charles H. , Koski Tyler , Lafage Virginie , Gupta Munish , Kim Han Jo , Ames Christopher P. , Bess Shay , Schwab Frank J. , Shaffrey Christopher I. , Bridwell Keith H.
Published: October 2024

Study Design.

Secondary data analysis of the NIH sponsored study on Adult Symptomatic Lumbar Scoliosis (ASLS).

Objectives.

The purpose of this study is to perform a cost-effectiveness analysis comparing operative versus non-operative care for ASLS eight years after enrollment.

Summary of Background Data.

A prior cost-effectiveness analysis of the current cohort comparing operative to non-operative care at five years after enrollment showed and ICER of $44,033 in the As-Treated analysis and a ICER of $27,480 in the Intent-to-treat analysis.

Methods.

Data was collected every three months for the first two years, then every six months for the remainder of the study. Data included use of non-operative modalities, medications and employment status. Costs for index and revision surgeries and non-operative modalities were determined using Medicare Allowable rates. Medication costs were determined using the RedBook and indirect costs were calculated based on reported employment status and income. Quality Adjusted Life Years (QALY) was determined using the SF6D.

Results.

There were 101 cases in the Operative (Op) and 103 in the Non-operative (Non-Op) group with complete eight year data. Thirty-eight patients (37%) in the Non-Op group had surgery from 3 to 72 months after enrollment. An As-Treated analysis including only cases who never had surgery (N=65) or cases with complete eight-year post-operative data (N=101) showed that operative treatment was favored with an ICER of $20,569 per QALY gained which is within Willingness-to-Pay (WTP) thresholds. An Intent-to-Treat analysis demonstrated greater QALY gains and lower cost in the Op group (ICER = $-13,911). However, Intent-to-Treat analysis is influenced by Non-Op patients who crossed over to operative treatment at variable times during follow-up.

Conclusion.

Operative treatment was more cost-effective than non-operative treatment for ASLS at eight-year follow-up. The ICER continued to improve as compared to the five-year values ($20,569 vs. $44,033).
Surgical Deroofing and Trichloroacetic Acid Application: A Novel Treatment for Digital Mucous Cysts
Authors: Jung Yeon Woo , Jung Jin Woong , Ryu Hyang Joo , Oh Byung Ho
Published: October 2024

BACKGROUND

Digital mucous cysts (DMCs) are benign cysts located in digital interphalangeal joints or the proximal nail fold. Despite various treatments, standardized guidelines are lacking, and recurrence rates remain high.

OBJECTIVE

This study evaluates the efficacy and safety of a novel treatment combining surgical deroofing with trichloroacetic acid application.

MATERIALS AND METHODS

This study was conducted on 27 patients with DMCs treated from 2019 to 2022. Clinical features and therapeutic responses were documented with photographic records at the initial presentation and follow-ups. Histopathological examinations confirmed diagnoses and classified histopathological types.

RESULTS

Among 27 lesions, 20 were within the proximal nail fold, 7 were beneath the proximal nail fold; 26 were ganglionic, and 1 was myxomatous. Four patients required multiple treatments within 6 months due to recurrences. Long-term follow-up showed clinical improvement in all patients: 17 achieved complete remission, and 8 showed partial improvement. The treatment was effective regardless of cyst type, with minimal complications and mild postoperative pain resolving within days.

CONCLUSION

The combination of surgical deroofing and trichloroacetic acid application minimizes complications and enhances efficacy. It allows for repetitive treatments in case of recurrence, making it a viable option for managing persistent DMCs, with favorable outcomes and minimal complications.
Secondary Multiple Evanescent White Dot Syndrome in a patient with North Carolina Macular Dystrophy
Authors: Bommakanti Nikhil , Procopio Rebecca , Pulido Jose S.
Published: October 2024

Purpose:

To describe a novel case of secondary multiple evanescent white dot syndrome in a patient with North Carolina Macular Dystrophy (NCMD).

Methods:

The patient was evaluated with ultra-widefield color and autofluorescence imaging, fluorescein angiography, and spectral-domain optical coherence tomography.

Results:

A 43-year-old man with longstanding blurred vision in both eyes acutely developed glare in the right eye after an upper respiratory illness. He had chorioretinal atrophy in both eyes consistent with North Carolina Macular Dystrophy, which was later confirmed by genetic testing. He alsyo had white spots in the macula of the right eye consistent with secondary MEWDS. The diagnosis of secondary MEWDS was confirmed with fundus autofluorescence and fluorescein angiography, as well as a negative infectious workup. His symptoms and the retinal lesions had resolved by 11 weeks and after a short course of oral corticosteroids.

Conclusion:

Prior studies have suggested a link between disruption of the RPE/Bruch’s membrane complex and secondary MEWDS. This report describes the first case of secondary MEWDS after NCMD and provides further support for this association.
Promoting multidisciplinary pain management in low- and middle-income countries—challenges and achievements
Authors: Cardosa Mary Suma
Published: October 2024

The burden of pain in low- and middle income countries (LMICs) is high and expected to rise further with their ageing populations. Multidisciplinary pain management approaches based on the biopsychosocial model of pain have been shown to be effective in reducing pain-related distress and disability, but these approaches are still lacking in many LMICs due to various factors, including low levels of awareness about the role of multidisciplinary pain clinics, lack of prioritisation for pain services, and lack of healthcare professionals trained in pain management. The International Association for the Study of Pain (IASP) has several educational programs to promote multidisciplinary pain management in LMICs, in the form of education grants, pain fellowships, pain camps and, most recently, the development of a Multidisciplinary Pain Centre Toolkit. This article describes the various educational programs, focusing on Southeast Asia, that demonstrate how targeted educational programs which include skills training, follow-up and mentorship, can translate into the formation of new multidisciplinary pain management services in settings with limited resources.
Strengthening the pain care ecosystem to support equitable, person-centered, high-value musculoskeletal pain care
Authors: Slater Helen , Briggs Andrew M.
Published: October 2024

Improving health and wellbeing outcomes for people experiencing chronic musculoskeletal pain requires collective efforts across multiple levels of a healthcare ecosystem. System-wide barriers to care equity must however be addressed (eg, lack of co-designed services; overuse of low value care/underuse of high value care; inadequate health workforce; inappropriate funding models; inequitable access to medicines and technologies; inadequate research and innovation). In this narrative review, utilizing a systems’ thinking framework, we synthesize novel insights on chronic musculoskeletal pain research contextualized through the lens of this complex, interconnected system, the “pain care ecosystem.” We examine the application of systems strengthening research to build capacity across this ecosystem to support equitable person-centred care and healthy ageing across the lifespan. This dynamic ecosystem is characterized by three interconnected levels. At its centre is the person experiencing chronic musculoskeletal pain (micro-level). This level is connected with health services and health workforce operating to co-design and deliver person-centred care (meso-level), underpinned further upstream by contemporary health and social care systems (macro-level context). We provide emerging evidence for how we, and others, are working towards building ecosystem resilience to support quality musculoskeletal pain care: at the macro-level (eg, informing musculoskeletal policy and health strategy priorities); at the meso-level (eg, service co-design across care settings; health workforce capacity); and downstream, at the micro-level (eg, person-centred care). We outline the mechanisms and methodologies utilized and explain the outcomes, insights and impact of this research, supported by real world examples extending from Australian to global settings.
Hemodynamic Support With the Impella 5.5 Acute Mechanical Circulatory Support Device
Authors: Schurr James W. , Pearson Adrian , Delfiner Matthew S. , Brown Alyson , Quinn Mary Frances , Karpenshif Yoav , Ortega-Legaspi Juan , Parikh Aditya , Cevasco Marisa , Wald Joyce W.
Published: October 2024

The Impella 5.5 is increasingly used as a bridge to recovery or heart replacement therapies despite lack of clinical trial evidence. We report real-world outcomes and hemodynamic effects of 150 consecutive patients from a single, high-volume center. Primary outcome was incidence of recovery, durable left ventricular assist device (LVAD), or heart transplant compared with incidence of death at 90 days. Secondary outcomes included hemodynamic trends and upgrade to veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. The composite endpoint occurred in 59.3% and death in 18.8% of patients (incidence rate ratio: 8.1 [95% confidence interval {CI}: 5.4–12.2], p < 0.001). Decreases in pulmonary artery diastolic pressure (PADP) (p = 0.026), estimated pulmonary effective arterial elastance (Ea) (p < 0.001), and vasoactive-inotropic score (VIS) (p < 0.001) occurred during Impella 5.5 support. Pulmonary artery diastolic pressure correlated with estimated Ea (p < 0.001), suggesting improved right ventricle (RV) afterload with left ventricle (LV) unloading. Veno-arterial extracorporeal membrane oxygenation upgrade occurred in 11.3% of patients who had higher baseline right atrial pressure (RAP) (16.0 [9.0–20.5] vs. 9.0 [7.0–12.0], p = 0.022), PADP (28.5 [25.0–31.0] vs. 23.0 [18.0–28.0], p = 0.011), and lower pulmonary artery pulsatility index (PAPi) (1.45 [0.82–3.45] vs. 2.5 [1.65–3.86], p = 0.029). Upgrade patients had higher repeated measures trends in RAP (p < 0.001) and PADP (p = 0.015). The Impella 5.5 improved hemodynamics and effectively bridged to recovery or heart replacement therapies. Co-existing RV dysfunction can be supported on Impella 5.5 with careful hemodynamic trend monitoring.
Utility of a Smart Device Infrared Camera in Localizing Acute Pediatric Long Bone Fractures
Authors: Korattiyil Manju , Long Rachel , Guiner Alessandra , Huang Rong , Nesiama Jo-Ann
Published: October 2024

Background

Musculoskeletal injuries are one of the top 10 reasons children present to the emergency department (ED). Infrared thermal imaging (IRT) is a noninvasive and nonradiating imaging modality that can detect subtle temperature differences. IRT may be used to detect the presence of musculoskeletal injury.

Objective

This study aimed to assess the utility of a smart device infrared camera attachment's ability to localize acute pediatric long bone fractures in patients less than 5 years of age.

Methods

This was a prospective pilot study comparing thermal imagery on an injured extremity to radiographs. All IRT images were obtained via an iPad with an infrared camera attachment. Using two different IRT images (Hi/Lo and Span and Level), the area of maximum temperature (T
max) was identified and compared to radiographs.

Results

A total of 31 patients were enrolled in the study. Twenty-four (77.50%) were identified as having fractures, and 7 (22.50%) did not have any fractures. IRT correctly identified an injury in the fracture group 91.67% of the time when using the Span and Level IRT image compared to standard x-rays (P < 0.0002). When using the Span and Level image to identify T
max to localize a fracture on x-ray, sensitivity is 0.92, specificity is 0.86, positive predictive value is 0.96, and negative predictive value is 0.75. A receiver operating characteristic (ROC) curve was completed with area under the curve (AUC) being 0.89.

Conclusions

This pilot study shows that the use of smart device infrared camera attachments is feasible and has promising results in fracture localization. This could allow for a decrease in radiographs and be particularly useful in resource-limited areas.
Validation of a holistic composite outcome measure for the evaluation of chronic pain interventions
Authors: Taylor Rod S. , Neville Quinton , Mullin Christopher M. , Mekhail Nagy A. , Kallewaard Jan W. , Hayek Salim , Pope Jason E. , Hunter Corey W. , Costandi Shrif J. , Kapural Leonardo , Gilmore Christopher A. , Petersen Erika A. , Patel Kiran V. , Eldabe Sam , Levy Robert M. , Gilligan Christopher , Durbhakula Shravani , Abd-Elsayed Alaa , Bedder Marshall , Buchanan Patrick , Hanson Erin , Leitner Angela , Soliday Nicole , Duarte Rui V. , Clauw Daniel J. , Nurmikko Turo J.
Published: October 2024

Introduction:

Chronic pain is a personal experience influenced by multiple biopsychosocial factors. Using a pain intensity measure alone to assess the effectiveness of a chronic pain intervention fails to fully evaluate its impact on the multifaceted chronic pain experience. The holistic minimal clinically important difference (MCID) is a composite outcome developed to provide a comprehensive assessment of chronic pain in response to intervention, across 5 outcome domains: pain intensity, health-related quality of life, sleep quality, physical, and emotional function. To focus on domains where the individual need is greatest, the holistic MCID reflects the cumulative MCID averaged over only the domains where subjects were impaired preintervention.

Objectives:

To assess the internal and construct validity of the Holistic MCID score to inform its future use as an evidence-based tool.

Methods:

This validation study was undertaken using data from the EVOKE trial with 111 patients up to 24-month follow-up. Internal consistency of the holistic MCID was assessed using Cronbach alpha statistic and dimensional exploration using principal component analysis.

Results:

The holistic MCID measure demonstrated strong internal consistency with Cronbach alpha >0.7 at all follow-ups. Principal component analysis showed one overarching holistic dimension to be present in the composite. Construct validity was demonstrated by an increase in the holistic MCID score being associated with both increased Patients' Global Impression of Change, EuroQol visual analogue scale score, and each of the outcome domains in a “leave-one-out” analysis (all P < 0.001).

Conclusion:

The holistic MCID provides a valid measure for the comprehensive, personalized assessment of response after a chronic pain intervention. The validity of the holistic MCID requires further confirmation in other chronic pain populations and with different interventions.
Efficacy of adding ketamine to levobupivacaine in paravertebral block on acute and chronic pain in thoracotomy: a randomized controlled double-blinded trial
Authors: Moharam Saad Ahmed , Elshikh Amgad , Abdelbadie Mohamed , Ibrahim Ahmed Mohamed , Shaheen Mostafa Mohamed Khedr , ElSharkawy Mohammed Said
Published: October 2024

Background:

The inappropriate management of pain after thoracotomy results in serious complications. Several adjuvants have been added to the thoracic paravertebral block (TPVB) to enhance its effects. This work aimed to evaluate the effect of adding ketamine to TPVB on thoracotomy-related acute and chronic pain.

Methods:

This randomized controlled double-blinded trial included 60 patients scheduled for open thoracotomy. Patients were equally randomized into 2 groups: group K: received TPVB + 1 mL ketamine (50 mg). Group C (n = 30): received TPVB (19 mL of 0.5% levobupivacaine + 1 mL normal saline) as a control arm.

Results:

Group K exhibited a significant delay in requesting analgesia, required less morphine in the first 24 and 48 hours, and reported lower numerical rating scale at rest and at deep breathing at various time points compared with the control group. However, both groups were comparable in post-thoracotomy pain syndrome and the incidence of complications at 2 months and 3 months.

Conclusions:

Adding ketamine to TPVB resulted in better analgesia as demonstrated by significantly delayed time to first rescue analgesia, lower total amount of consumed opioid, and pain score without considerable effect on chronic pain and complications in patients undergoing thoracotomy.
Exploring the Relationship Between Hospital Patient Safety Culture and Performance on Measures of Hospital-Acquired Conditions
Authors: Noghrehchi Pejmon , Hefner Jennifer L. , Stegall Hendrik , Walker Daniel M.
Published: October 2024

Objective

The aim of the study is to examine the relationship between hospital perceptions of patient safety culture and the incidence of hospital-acquired conditions (HACs) included in Medicare’s HAC Reduction Program utilizing updated and standardized metrics.

Methods

The pooled cross-sectional study design utilized the 2018 and 2021 datasets from (1) the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture (HSOPS), (2) the American Hospital Association’s annual survey, and (3) the Center for Medicare and Medicaid’s Hospital Compare dataset. The final analytic sample included 131 acute care, nonfederal, U.S. facilities. Multivariable linear regression models were used to compare the HSOPS domains of patient safety culture to CMS’s HAC metrics.

Results

Controlling for hospital structural and patient-mix characteristics, hospitals with higher staff-reported ratings of overall patient safety culture (‘overall perceptions of patient safety’ and ‘patient safety grade’) had significantly lower rates of HACs, including total HAC rate, catheter-associated urinary tract infections, and central line-associated blood stream infections (P’s < 0.000–0.044). Higher HSOPS domain scores were variably associated with lower HAC rates, with consistently significant associations found for domains related to nonpunitive, open communication (P’s < 0.05).

Conclusions

Our relatively robust results suggest that while patient safety culture may not be the only strategy necessary to improve HAC rates, it needs to be aligned with other efforts to improve quality and safety. This underscores the importance of cultivating a culture of psychological safety that promotes open feedback and communication about errors.
Multifocal Hemorrhagic Choriocarcinoma With Diffuse Pancreatic FDG Uptake on 18F-FDG PET/CT
Authors: Dai Sheng , Dong Youwen
Published: October 2024

Choriocarcinoma is a rare and highly malignant trophoblastic tumor. We present a case involving a 30-year-old woman with abdominal pain, hemoptysis, and elevated serum amylase levels. Initial clinical suspicion included acute pancreatitis. Noncontrast and contrast-enhanced CT revealed hemorrhagic and hypervascular lesions in the lungs, pancreas, liver, and kidneys. 18F-FDG PET/CT showed diffuse pancreatic enlargement with increased FDG uptake (SUVmax, 5.3), consistent with malignancy. Histopathology confirmed choriocarcinoma with elevated HCG levels. Following chemotherapy, HCG levels declined, indicating a positive therapeutic response. 18F-FDG PET/CT effectively detected choriocarcinoma and assessed its systemic involvement.
Reversal of Basal Ganglia Hypermetabolism Following Surgical Removal of Adrenocorticotropic Hormone–Producing Lung Carcinoid in a Patient of Cushing Syndrome With Unusual Presentation of Acute Psychosis
Authors: Malhotra Gaurav , Kasaliwal Rajeev , Rupani Karishma , Lila Anurag R. , Upadhye Trupti , Bandgar Tushar , Shah Nalini S.
Published: October 2024

A 34-year-old woman who presented with severe psychosis and clinical features of Cushing syndrome underwent 18F-FDG PET/CT that revealed hypermetabolic lung lesion along with predominantly increased metabolism of bilateral basal ganglia, a scintigraphic correlate of acute psychosis. The lesion was surgically excised and histopathologically proven to be adrenocorticotropic hormone–producing lung carcinoid. Posttreatment 18F-FDG PET scan showed restoration of normal brain metabolism with complete reversal of psychosis. Even though rare, one should be aware of psychosis as an initial presentation of Cushing syndrome and use of 18F-FDG PET/CT for mapping brain metabolism as shown in this case.
Leadership Lingo
Authors: Brara Amrita , Chang Chloe , Kerins Joanne , Smith Samantha E. , Tallentire Victoria R.
Published: October 2024

Introduction

Leadership in medical emergencies is variable and frequently suboptimal, contributing to poor patient care and outcomes. Simulation training can improve leadership in both simulated practice and real clinical emergencies. Thoughtful debriefing is essential. However, unclear language around leadership limits facilitators' capacity for transformative reflective discussion.

Methods

Internal medicine trainees participated in simulated medical emergency scenarios. Video recordings of consenting participants were analyzed using template analysis. A priori codes from existing literature formed an initial coding template. This was modified with inductive codes from the observed behaviors to develop a taxonomy of leadership behaviors in simulated medical emergencies. The taxonomy was then transformed into an infographic, to be used as a leadership debriefing tool.

Results

The taxonomy of leadership behaviors consisted of the following 4 themes: Structuring, Decision making, Supporting, and Communicating. Structuring behaviors shaped the team, ensuring that the right people were in the right place at the right time. Decision-making behaviors steered the team, setting a direction and course of action. Communicating behaviors connected the team, sharing valuable information. Supporting behaviors nurtured the team, guiding team members to perform at their optimum level.

Conclusions

Debriefing-as-imagined is not always debriefing-as-done. A shared language of leadership can connect educators and learners, advancing critical debriefing conversations and enabling facilitators to drive meaningful reflective discussion. The use of infographics in simulation offers an opportunity to support educators in facilitating complex debriefing conversations.
Depopulating the sky: changing patterns of stellar identification in the
Philosophical Transactions
Authors: Kutrovátz Gábor
Published: October 2024

The article provides a quantitative survey of the ways in which individual stars were identified in astronomical articles published in the
Philosophical Transactions of the Royal Society of London
between 1665 and 1829. The great majority of stellar references fall into one or more of the following four categories: figural references (identifying objects as structural parts of constellation figures), proper names, Bayer letters, and catalogue numbers (primarily, Flamsteed numbers). The survey investigates how the quantities and proportions of these referential types changed over time, and what identification patterns each referential type displayed. The results are interpreted under the assumption that the dynamics of the mixture of practices were not only a matter of convenience and increasing practicality, but that they were also tied to underlying transformations in the conceptual identity of fixed stars. The gradual, spontaneous, and unreflected disappearance of figural identifications, and their replacement with references to designated catalogue entries, is tied to a transition from sidereal identity—stars being position markers in the celestial sphere—to stellar identity belonging to spatially distributed physical bodies.
RSYD-BASIC: a bioinformatics pipeline for Routine Sequence analYsis and Data processing of BActerial iSolates for clInical miCrobiology
Authors: Steinke Kat , Thomsen Karina Gravgaard , Hoegh Silje Vermedal , Larsen Sanne Løkkegaard , Kubel Vilhelmsen Karina , Jensen Thøger Gorm , Skov Marianne Nielsine , Sydenham Thomas Vognbjerg
Published: October 2024

Background
Whole genome sequencing of bacterial isolates is increasingly becoming routine in clinical microbiology; however, subsequent analysis often needs to be started by a bioinformatician even for comprehensive pipelines. To increase the robustness of our workflow and free up bioinformatician work hours for development and advanced analysis, we aimed to produce a robust, customizable bioinformatic pipeline for bacterial genome assembly and routine analysis results that could be initiated by non-bioinformaticians.
Results
We introduce the RSYD-BASIC pipeline for bacterial isolate sequence analysis and provide a demonstration of its functionality with two datasets composed of publicly available sequences,  in which comparable results are obtained in most cases. In some instances, the pipeline provided additional information, corresponding to in vitro results where these could be obtained. In routine use at our department, the pipeline has already yielded clinically relevant results, allowing us to type a variety of bacterial pathogens isolated in our clinical laboratory. We also demonstrate how RSYD-BASIC results aided in disproving a potential outbreak.
Conclusion
With the RSYD-BASIC pipeline, we present a configurable reads-to-results analysis pipeline operated by non-expert users that greatly eases investigation of potential outbreaks by expert end-users. Results obtained with publicly available sequences show comparable performance to the original methods, while underlining the importance of standardized methods.
CYP168A1 from Pseudomonas aeruginosa may not be involved in the hydroxylation of medium chain-length fatty acids
Authors: Bonaldo Chiara , Thomas Nerissa E. , Price Claire Louise
Published: October 2024

Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen and the main cause of chronic lung infections in patients with cystic fibrosis (CF). Its resistance to multiple antibiotics poses a significant challenge in eradicating the bacteria from CF’s patients airways. Consequently, the World Health Organization (WHO) has classified it as priority health concern, underscoring the urgent need to identify new antibiotic targets. While the function of cytochrome P450 (P450) enzymes in P. aeruginosa remains unclear, these enzymes are involved in fatty acid metabolism in Mycobacterium tuberculosis, a closely related bacterium, aiding its survival and growth in the lung. This suggests that P. aeruginosa P450 enzymes might contribute to CF airway colonization and the lung destruction by hydroxylating fatty acids in the lung surfactant. Previous research has demonstrated that CYP168A1, a P450 enzyme in P. aeruginosa, can biochemically hydroxylate fatty acids. To explore the biological role of CYP168A1, we monitored changes in gene expression after fatty acids exposure using RT-PCR. Our analyses revealed no change in CYP168A1 expression, suggesting that CYP168A1 is not involved in hydroxylation of medium-chain length fatty acids. Further knock-out analyses are essential to elucidate the biological role of CYP168A1, and its potential as an antimicrobial target against P. aeruginosa.
Polymorphospora lycopeni sp. nov., a lycopene-producing actinomycetes isolated from lakeside soil sample of Baiyangdian
Authors: Liu Jiashan , Li Shilong , Duan Xiaomin , Li Hongmei , Zhang Xiumin
Published: October 2024

A novel actinomycetes producing lycopene, designated HBU208002T, was isolated from a lakeside soil sample collected in Baiyangdian, located in Xiong’an New Area of China, and its taxonomic position was investigated by a polyphasic approach. Phylogenetic analysis based on 16S rRNA gene sequence comparisons revealed that the strain HBU208002T fell within the genus Polymorphospora and was closely related to Polymorphospora rubra JCM 14904T (99.73% identity). However, the average nucleotide identity (ANI), digital DNA–DNA hybridization (dDDH) and average amino acid identity (AAI) values between the strain HBU208002T and P. rubra JCM 14904T were 91.78, 44.7 and 91.6%, respectively, which were lower than the ANI (95–96%), DDH (>70%) and AAI (>95%) thresholds of prokaryotic microbial defined species. The predominant fatty acids of the strain HBU208002T were iso-C16:0, C17:1 ω8c. The menaquinones of the strain HBU208002T were MK-8(H8) and MK9(H4), while those of P. rubra JCM 14904T were MK-10(H6), MK-10(H4), MK-9(H6) and MK-9(H4). Meanwhile, some phenotypic characterizations and antibacterial activities distinguished the strain HBU208002T from P. rubra JCM 14904T. The strain HBU208002T exhibited inhibitory effects on Fusarium graminearum, Fusarium verticillioides and Botrytis cinerea, but P. rubra JCM 14904T had no activity. Therefore, the strain HBU208002T should be assigned as representing a novel species of the genus Polymorphospora, for which the name Polymorphospora lycopeni was proposed. The type strain is HBU208002T (=KCTC49833T = GDMCC4.236T).
Applying rearrangement distances to enable plasmid epidemiology with pling
Authors: Frolova Daria , Lima Leandro , Roberts Leah Wendy , Bohnenkämper Leonard , Wittler Roland , Stoye Jens , Iqbal Zamin
Published: October 2024

Plasmids are a key vector of antibiotic resistance, but the current bioinformatics toolkit is not well suited to tracking them. The rapid structural changes seen in plasmid genomes present considerable challenges to evolutionary and epidemiological analysis. Typical approaches are either low resolution (replicon typing) or use shared k-mer content to define a genetic distance. However, this distance can both overestimate plasmid relatedness by ignoring rearrangements, and underestimate by over-penalizing gene gain/loss. Therefore a model is needed which captures the key components of how plasmid genomes evolve structurally – through gene/block gain or loss, and rearrangement. A secondary requirement is to prevent promiscuous transposable elements (TEs) leading to over-clustering of unrelated plasmids. We choose the ‘Double Cut and Join Indel’ (DCJ-Indel) model, in which plasmids are studied at a coarse level, as a sequence of signed integers (representing genes or aligned blocks), and the distance between two plasmids is the minimum number of rearrangement events or indels needed to transform one into the other. We show how this gives much more meaningful distances between plasmids. We introduce a software workflow pling (https://github.com/iqbal-lab-org/pling), which uses the DCJ-Indel model, to calculate distances between plasmids and then cluster them. In our approach, we combine containment distances and DCJ-Indel distances to build a TE-aware plasmid network. We demonstrate superior performance and interpretability to other plasmid clustering tools on the ‘Russian Doll’ dataset and a hospital transmission dataset.