bluuebunny/crossref_metadata_2025 huggingface dataset:
810. ROBOTIC ASSISTED CISTERNA CHYLI EMBOLIZATION FOR ABDOMINAL CHYLE LEAKAGE AFTER IVOR LEWIS ESOPHAGECTOMY
Authors: Denissen Laurens , Valk Jody , Jardinet Thomas , de Maat Michiel
Published: September 2024

Background

High output chyle leakage is a challenging complication following esophagectomy, carrying substantial morbidity and even mortality. Initial conservative management with parenteral feeding is commonly advised resulting in lengthy episodes of hospitalization and prolonged chest tube placement. Here, we present a case post Ivor-Lewis esophagectomy with high-output chyle leakage where we localized the leakage site to be at the cysterna chyli and subsequently treated it operatively combining robotics, fluorescence and embolization with glue.

Methods

A 74-year-old male underwent robotic-assisted minimally invasive Ivor Lewis esophagectomy for distal esophageal adenocarcinoma. Postoperatively, chylous fluid was drained from the chest up to 700-1300cc per day despite parenteral feeding. Lipiodol lymphangiography identified extravasation of contrast at the cysterna chyli and correct clipping of the thoracic duct. Due to failure of conservative management, on postoperative day 14, robotic-assisted exploration of the truncal region with intranodal injection of indocyanine green was performed.

Results

This innovative procedure revealed the leakage site medially of the coeliac trunc at the cysterna chyli. Lymphatic sealing was achieved via percutaneous endoluminal embolization using a microcatheter and Histoacryl® injections, resulting in an abrupt resolution of the leak and discharge with oral MCT diet on day 5 after reoperation.

Conclusion

This case demonstrated the feasibility and efficacy of an innovative multimodal technique combining the dexterity and fluorescence of robotic surgery with a laparoscopic application of an interventional radiology embolization technique. Because of the risk of venous emboli, we note that this technique should only be applied in cases of abdominal chyle leakage when the thoracic duct is interrupted.

https://www.dropbox.com/scl/fi/sktltdc1be41jfq4dk3lt/Video-Presentation-ISDE-2024-Robotic-Embolisation-Abdominal-Chyle-leakage-Def.mp4?rlkey=1wni1dpnjg4swiajcjdfa6isn&st=wx30jbi7&dl=0
Environmental conditions elicit a slow but enduring response of histone post-translational modifications in Mozambique tilapia
Authors: Mojica Elizabeth A , Petcu Kathleen A , Kültz Dietmar
Published: September 2024

This study sheds new light on the timescale through which histone post-translational modifications (PTMs) respond to environmental stimuli, demonstrating that the histone PTM response does not necessarily precede the proteomic response or acclimation. After a variety of salinity treatments were administered to Mozambique tilapia (Oreochromis mossambicus) throughout their lifetimes, we quantified 343 histone PTMs in the gills of each fish. We show here that histone PTMs differ dramatically between fish exposed to distinct environmental conditions for 18 months, and that the majority of these histone PTM alterations persist for at least 4 weeks, irrespective of further salinity changes. However, histone PTMs respond minimally to 4-week-long periods of salinity acclimation during adulthood. The results of this study altogether signify that patterns of histone PTMs in individuals reflect their prolonged exposure to environmental conditions.
Pharmacological resynchronisation with flecainide in an infant with Ebstein anomaly and Wolff-Parkinson-White pattern: a case report
Authors: Uthayakumaran Gajon , Asakai Hiroko , Gnanappa Ganesh
Published: September 2024

Background

Conduction abnormalities are frequently encountered in patients with Ebstein anomaly. The following case describes the safe use of flecainide in an infant with accessory-pathway mediated left ventricular dysfunction in the setting of Ebstein anomaly.

Case Summary

An infant with an antenatal diagnosis of Ebstein anomaly developed progressive left ventricular dilatation and dysfunction over the first 2 months of life. ECG demonstrated persistent Wolff-Parkinson-White pattern with delta-wave polarity suggesting a right-sided septal accessory pathway. In the absence of SVT, accessory-pathway mediated dyssynchrony was suspected as the cause for left ventricular dilatation and dysfunction. He was commenced on flecainide which successfully blocked antegrade conduction via the accessory pathway resulting in a reduction in left ventricular volume and improvement in left ventricular systolic function. He remains asymptomatic at 12 months of age.

Discussion

There is a known association between Ebstein anomaly and Wolff-Parkinson-White pattern. Right-sided septal accessory pathways can cause cardiomyopathy secondary to dyssynchronous left ventricular contraction. In patients who are unsuitable for accessory pathway ablation, flecainide can be used to block antegrade conduction via the accessory pathway resulting in improved left ventricular function, which was successful on this occasion.
Anticoagulation in device-detected atrial fibrillation with or without vascular disease: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials
Authors: Schnabel Renate B , Benezet-Mazuecos Juan , Becher Nina , McIntyre William F , Fierenz Alexander , Lee Shun Fu , Goette Andreas , Atar Dan , Bertaglia Emanuele , Benz Alexander P , Chlouverakis Gregory , Birnie David H , Dichtl Wolfgang , Blomstrom-Lundqvist Carina , Camm A John , Erath Julia W , Simantirakis Emmanuel , Kutyifa Valentina , Lip Gregory Y H , Mabo Philippe , Marijon Eloi , Rivard Lena , Schotten Ulrich , Alings Marco , Sehner Susanne , Toennis Tobias , Linde Cecilia , Vardas Panos , Granger Christopher B , Zapf Antonia , Lopes Renato D , Healey Jeff S , Kirchhof Paulus
Published: September 2024

Background and Aims

The optimal antithrombotic therapy in patients with device-detected atrial fibrillation (DDAF) is unknown. Concomitant vascular disease can modify the benefits and risks of anticoagulation.

Methods

These pre-specified analyses of the NOAH-AFNET 6 (n = 2534 patients) and ARTESiA (n = 4012 patients) trials compared anticoagulation with no anticoagulation in patients with DDAF with or without vascular disease, defined as prior stroke/transient ischaemic attack, coronary or peripheral artery disease. Efficacy outcomes were the primary outcomes of both trials, a composite of stroke, systemic arterial embolism (SE), myocardial infarction, pulmonary embolism or cardiovascular death, and stroke or SE. Safety outcomes were major bleeding or major bleeding and death.

Results

In patients with vascular disease (NOAH-AFNET 6, 56%; ARTESiA, 46%), stroke, myocardial infarction, systemic or pulmonary embolism, or cardiovascular death occurred at 3.9%/patient-year with and 5.0%/patient-year without anticoagulation (NOAH-AFNET 6), and 3.2%/patient-year with and 4.4%/patient-year without anticoagulation (ARTESiA). Without vascular disease, outcomes were equal with and without anticoagulation (NOAH-AFNET 6, 2.7%/patient-year; ARTESiA, 2.3%/patient-year in both randomized groups). Meta-analysis found consistent results across both trials (I2heterogeneity = 6%) with a trend for interaction with randomized therapy (pinteraction = .08). Stroke/SE behaved similarly. Anticoagulation equally increased major bleeding in vascular disease patients [edoxaban, 2.1%/patient-year; no anticoagulation, 1.3%/patient-year; apixaban, 1.7%/patient-years; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.55 (1.10–2.20)] and without vascular disease [edoxaban, 2.2%/patient-year; no anticoagulation, 0.6%/patient-year; apixaban, 1.4%/patient-year; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.93 (0.72–5.20)].

Conclusions

Patients with DDAF and vascular disease are at higher risk of stroke and cardiovascular events and may derive a greater benefit from anticoagulation than patients with DDAF without vascular disease.
Exploring the human genomic landscape: patterns of common homozygosity regions in a large middle eastern cohort
Authors: Sagi-Dain Lena , Levy Michal , Matar Reut , Kahana Sarit , Agmon-Fishman Ifaat , Klein Cochava , Gurevitch Merav , Basel-Salmon Lina , Maya Idit
Published: September 2024

Regions of Homozygosity (ROH) typically reflect normal demographic history of a human population, but may also relate to cryptic consanguinity, and, additionally, have been associated with specific medical conditions. The objective of this study was to investigate the location, size, and prevalence of common ROH segments in a Middle Eastern cohort. This retrospective study included 13 483 samples collected from all Chromosomal Microarray analyses (CMA) performed using Single Nucleotide Polymorphism (SNP) arrays at the genetic clinical laboratory of Rabin Medical Center between 2017–2023 (primary data set). An additional replication cohort including 100 842 samples from another SNP array platform, obtained from Maccabi Health Organization, was analyzed. Common ROH locations were defined as those ROH locations involving 1% or more of the samples. A total of 66 710 ROH segments, involving 13 035 samples (96.7%) were identified in the primary data set. Of the 4069 cytogenetic ROH locations, 68 were identified as common. The prevalence of non-common ROH was relatively high in affected individuals, and for acrocentric chromosomes, chromosomes associated with common trisomies, and non-imprinted chromosomes. In addition, differences in common ROH locations were observed between the primary and the replication cohorts. Our findings highlight the need for population-specific guidelines in determining ROH reporting cutoffs, considering factors such as population-specific prevalence and testing platform differences. Future research with larger, varied cohorts is essential to advance understanding of ROH’s associations with medical conditions and to improve clinical practices accordingly.
Unraveling the neurological intricacies: a rare case of Guillain-Barre syndrome in dengue fever
Authors: Rayamajhi Aadesh , Rayamajhi Sandesh , Agrawal Saurav , Gautam Niraj
Published: September 2024

Dengue, caused by the dengue virus, presents with various clinical manifestations, including rare neurological complications. Guillain-Barre Syndrome (GBS), an immune-mediated polyradiculoneuropathy, is a rare complication, often triggered by antecedent infections. Herein, we report the case of a 30-year-old male presenting with GBS following dengue fever. His clinical course revealed classic GBS symptoms, including ascending weakness and bulbar involvement, with no noted infection that could plausibly explain a trigger for GBS. Diagnosis entailed cerebrospinal fluid analysis and nerve conduction studies which confirmed acute inflammatory demyelinating polyradiculoneuropathy. Treatment involved plasmapheresis, yielding a positive response. This case underscores the association between dengue and GBS, emphasizing the need for heightened clinical suspicion in endemic regions like Nepal.
A case of aortitis and saccular aortic aneurysm caused by rare aetiological organisms, Streptococcus constellatus and parvovirus B19, and atherosclerosis
Authors: Amer Aly , Mangrolia Neil , De Silva Ravi
Published: September 2024

Aortitis and mycotic aneurysm are vascular conditions characterized by inflammation of the aortic wall or the presence of an aneurysm resulting from microbial infection. This is a rare case of aortic aneurysm caused by atherosclerosis, with Streptococcus constellatus and Parvovirus B19 infection, in a 60-year-old male. The patient presented with rigors and pleuritic chest pain, and was found to have a saccular aneurysm of the ascending aorta and pericardial effusion. The patient underwent urgent replacement of the ascending aorta and completed 6 weeks of antibiotics with good recovery. This case emphasizes the importance of considering rare organisms in patients with aortitis and mycotic aneurysm, particularly in cases with blood cultures without microbial growth. Early diagnosis and treatment may be essential for the prevention of life-threatening complications.
Proteomic Insights into Trichome Responses to Elevated Elemental Stress in Cation Exchanger (CAX) Mutants
Authors: Guo Qi , Sarkar Shayan , Punshon Tracy , Tappero Ryan , Barkla Bronwyn J , Hirschi Kendal D
Published: September 2024

Research on elemental distribution in plants is crucial for understanding nutrient uptake, environmental adaptation and optimizing agricultural practices for sustainable food production. Plant trichomes, with their self-contained structures and easy accessibility, offer a robust model system for investigating elemental repartitioning. Transport proteins, such as the four functional cation exchangers (CAXs) in Arabidopsis, are low-affinity, high-capacity transporters primarily located on the vacuole. Mutants in these transporters have been partially characterized, one of the phenotypes of the CAX1 mutant being altered with tolerance to low-oxygen conditions. A simple visual screen demonstrated trichome density and morphology in cax1, and quadruple CAX (cax1-4: qKO) mutants remained unaltered. Here, we used synchrotron X-ray fluorescence (SXRF) to show that trichomes in CAX-deficient lines accumulated high levels of chlorine, potassium, calcium and manganese. Proteomic analysis on isolated Arabidopsis trichomes showed changes in protein abundance in response to changes in element accumulation. The CAX mutants showed an increased abundance of plasma membrane ATPase and vacuolar H-pumping proteins, and proteins associated with water movement and endocytosis, while also showing changes in proteins associated with the regulation of plasmodesmata. These findings advance our understanding of the integration of CAX transport with elemental homeostasis within trichomes and shed light on how plants modulate protein abundance under conditions of altered elemental levels.
How anger helps us possess reasons for action
Authors: Gubka Steven
Published: September 2024

I argue that anger helps us possess reasons to intervene against others. This is because fitting anger disposes us to intervene against others in light of reasons to do so. I propose that anger is a presentation of reasons that seems to rationalize such interventions, in much the same way that perceptual experience is a presentation of reasons that seems to rationalize our judgements about our environment. In this way, anger can help us possess reasons that make specific actions rational to perform. Moreover, the significance of anger to practical rationality informs how we should regulate anger, especially the anger of others. Along these lines, I argue that it is wrong to prevent anger to the extent that this prevents someone's possession of reasons to intervene, and it is right to provoke anger to the extent that this enables someone's possession of reasons to intervene.
Impaired mitochondrial function in bipolar disorder and alcohol use disorder: a case study using 18F-BCPP-EF PET imaging of mitochondrial Complex I
Authors: Wigstrom Travis P , Roytman Stiven , Bohnen Jeffrey L B , Paalanen Rebecca R , Griggs Alexis M , Vangel Robert , Barr Jaimie , Albin Roger , Kanel Prabesh , Bohnen Nicolaas I
Published: September 2024

Background

With bipolar disorder (BD) having a lifetime prevalence of 4.4% and a significant portion of patients being chronically burdened by symptoms, there has been an increased focus on uncovering new targets for intervention in BD. One area that has shown early promise is the mitochondrial hypothesis. However, at the time of publication no studies have utilized positron emission tomography (PET) imaging to assess mitochondrial function in the setting of BD.

Case Presentation

Our participant is a 58 year-old male with a past medical history notable for alcohol use disorder and BD (unspecified type) who underwent PET imaging with the mitochondrial complex I PET ligand 18F-BCPP-EF. The resulting images demonstrated significant overlap between areas of dysfunction identified with the 18F-BCPP-EF PET ligand and prior functional magnetic resonance imaging (MRI) techniques in the setting of BD. That overlap was seen in both affective and cognitive circuits, with mitochondrial dysfunction in the fronto-limbic, ventral affective, and dorsal cognitive circuits showing particularly significant differences.

Conclusions

Despite mounting evidence implicating mitochondria in BD, this study represents the first PET imaging study to investigate this mechanistic connection. There were key limitations in the form of comorbid alcohol use disorder, limited statistical power inherent to a case study, no sex matched controls, and the absence of a comprehensive psychiatric history. However, even with these limitations in mind, the significant overlap between dysfunction previously demonstrated on functional MRI and this imaging provides compelling preliminary evidence that strengthens the mechanistic link between mitochondrial dysfunction and BD.
Shorting the Dollar When Global Stock Markets Roar: The Equity Hedging Channel of Exchange Rate Determination
Authors: Ben Zeev Nadav , Nathan Daniel
Published: September 2024

This paper investigates the influence of global equity market value shocks on institutional investors’ (IIs’) hedging behavior and the resultant effects on exchange rates. Employing unique granular daily data on Israeli IIs’ foreign exchange (FX) forward flows and prices and a granular instrumental variable estimation approach, we find that foreign equity market value shocks generate significant selling of U.S. dollar forwards by IIs, as a hedge against heightened FX exposure, along with significant exchange rate appreciation. A value-shock-induced one-standard-deviation increase in IIs’ supply of forward flows appreciates IIs’ forward rate by 0.53%. (JEL E44, F3, F31, G15, G23)
Integrating machine learning for the optimization of polyacrylamide/alginate hydrogel
Authors: Xu Shaohua , Chen Xun , Wang Si , Chen Zhiwei , Pan Penghui , Huang Qiaoling
Published: September 2024

Hydrogels are highly promising due to their soft texture and excellent biocompatibility. However, the designation and optimization of hydrogels involve numerous experimental parameters, posing challenges in achieving rapid optimization through conventional experimental methods. In this study, we leverage machine learning algorithms to optimize a dual-network hydrogel based on a blend of acrylamide (AM) and alginate, targeting applications in flexible electronics. By treating the concentrations of components as experimental parameters and utilizing five material properties as evaluation criteria, we conduct a comprehensive property assessment of the material using a linear weighting method. Subsequently, we design a series of experimental plans using the Bayesian optimization algorithm and validate them experimentally. Through iterative refinement, we optimize the experimental parameters, resulting in a hydrogel with superior overall properties, including heightened strain sensitivity and flexibility. Leveraging the available experimental data, we employ a classification algorithm to separate the cutoff data. The feature importance identified by the classification model highlights the pronounced impact of AM, ammonium persulfate, and N,N-methylene on the classification outcomes. Additionally, we develop a regression model and demonstrate its utility in predicting and analyzing the relationship between experimental parameters and hydrogel properties through experimental validation.
Associations between 6-minute walk distance and physiologic measures and clinical outcomes in myositis-associated interstitial lung disease
Authors: Bae Sangmee Sharon , Markovic Daniela , Saygin Didem , Sullivan Daniel , Yamaguchi Koichi , Moghadam-Kia Siamak , Oddis Chester V , Abtin Fereidoun , Kim Grace Hyun J , Marder Galina , Venuturupalli Swamy , Dellaripa Paul F , Danoff Sonye , Doyle Tracy , Hunninghake Gary , Lee Joyce S , Falk Jeremy , Johnson Cheilonda , Goldin Jonathan , Tashkin Donald , Charles-Schoeman Christina , Aggarwal Rohit
Published: September 2024

Objective

The 6-min walk test (6MWT) is a simple test widely used to assess sub-maximal exercise capacity in chronic respiratory diseases. We explored the relationship of 6-min walk distance (6MWD) with measurements of physiological, clinical, radiographic measures in patients with myositis-associated interstitial lung disease (MA-ILD).

Method

We analysed data from the Abatacept in Myositis Associated Interstitial Lung Disease (Attack My-ILD) study, a 48-week multicentre randomized trial of patients with anti-synthetase antibodies and active MA-ILD. 6MWD, forced vital capacity (FVC), diffusing capacity (DLCO), high-resolution CT and various physician-/patient-reported outcome measures were obtained during the trial. Spearman’s correlations and repeated-measures analysis with linear mixed-effects models were used to estimate the associations between 6MWD and various physiologic, clinical and radiographic parameters both cross-sectionally and longitudinally.

Results

Twenty participants with a median age of 57 years, 55% male and 85% white were analysed. Baseline 6MWD did not associate with baseline pulmonary function tests. Repeated-measures analysis showed 6MWD over time associated with FVC over time, but not with DLCO. 6MWD over time also correlated with University of California San Diego Shortness of Breath questionnaire dyspnoea score, Borg scores, as well as global disease activity and muscle strength over time. Emotional role functioning, vitality, general health and physical functioning scores by Short Form 36 also correlated with 6MWD over time.

Conclusions

Exploratory work in a small cohort of MA-ILD demonstrated 6MWD over time associated with parallel changes in FVC and patient-reported outcomes of dyspnoea, but not with DLCO. Larger studies are needed to validate the reliability, responsiveness and utility of the 6MWT in MA-ILD.

Trial registration

ClinicalTrials.gov, http://clinicaltrials.gov, NCT03215927.
Deep mutational scanning of SARS-CoV-2 Omicron BA.2.86 and epistatic emergence of the KP.3 variant
Authors: Taylor Ashley L , Starr Tyler N
Published: September 2024

Deep mutational scanning experiments aid in the surveillance and forecasting of viral evolution by providing prospective measurements of mutational effects on viral traits, but epistatic shifts in the impacts of mutations can hinder viral forecasting when measurements were made in outdated strain backgrounds. Here, we report measurements of the impact of all single amino acid mutations on ACE2-binding affinity and protein folding and expression in the SARS-CoV-2 Omicron BA.2.86 spike receptor-binding domain. As with other SARS-CoV-2 variants, we find a plastic and evolvable basis for receptor binding, with many mutations at the ACE2 interface maintaining or even improving ACE2-binding affinity. Despite its large genetic divergence, mutational effects in BA.2.86 have not diverged greatly from those measured in its Omicron BA.2 ancestor. However, we do identify strong positive epistasis among subsequent mutations that have accrued in BA.2.86 descendants. Specifically, the Q493E mutation that decreased ACE2-binding affinity in all previous SARS-CoV-2 backgrounds is reversed in sign to enhance human ACE2-binding affinity when coupled with L455S and F456L in the currently emerging KP.3 variant. Our results point to a modest degree of epistatic drift in mutational effects during recent SARS-CoV-2 evolution but highlight how these small epistatic shifts can have important consequences for the emergence of new SARS-CoV-2 variants.
SARS-CoV-2 variant replacement constrains vaccine-specific viral diversification
Authors: Dearlove Bethany L , Fries Anthony C , Epsi Nusrat J , Richard Stephanie A , Ganesan Anuradha , Huprikar Nikhil , Lindholm David A , Mende Katrin , Colombo Rhonda E , Colombo Christopher , Bai Hongjun , Larson Derek T , Ewers Evan C , Lalani Tahaniyat , Smith Alfred G , Berjohn Catherine M , Maves Ryan C , Jones Milissa U , Saunders David , Maldonado Carlos J , Mody Rupal M , Bazan Samantha E , Tribble David R , Burgess Timothy , Simons Mark P , Agan Brian K , Pollett Simon D , Rolland Morgane
Published: September 2024

Coronavirus disease 2019 (COVID-19) vaccine breakthrough infections have been important for all circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant periods, but the contribution of vaccine-specific SARS-CoV-2 viral diversification to vaccine failure remains unclear. This study analyzed 595 SARS-CoV-2 sequences collected from the Military Health System beneficiaries between December 2020 and April 2022 to investigate the impact of vaccination on viral diversity. By comparing sequences based on the vaccination status of the participant, we found limited evidence indicating that vaccination was associated with increased viral diversity in the SARS-CoV-2 spike, and we show little to no evidence of a substantial sieve effect within major variants; rather, we show that rapid variant replacement constrained intragenotype COVID-19 vaccine strain immune escape. These data suggest that, during past and perhaps future periods of rapid SARS-CoV-2 variant replacement, vaccine-mediated effects were subsumed with other drivers of viral diversity due to the massive scale of infections and vaccinations that occurred in a short time frame. However, our results also highlight some limitations of using sieve analysis methods outside of placebo-controlled clinical trials.
Etiology and epidemiology of acute exacerbations of chronic obstructive pulmonary disease in Eastern Nepal: a narrative review
Authors: Adhikari Pratik
Published: September 2024

This narrative review aims to examine the etiology and epidemiology of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in Eastern Nepal. A systematic search was conducted to identify relevant studies published in English, focusing on combinations of keywords such as “acute exacerbation of chronic obstructive pulmonary disease,” “AECOPD,” “Nepal,” “etiology,” “epidemiology,” “environmental exposure,” “comorbidities,” and “socioeconomic factors.” Synthesizing findings from recent studies, it highlights the multifactorial nature of AECOPD, including the roles of respiratory infections, environmental exposures, and comorbidities. Key findings indicate that respiratory infections (both viral and bacterial) and non-infectious factors such as air pollution and biomass fuel combustion significantly contribute to AECOPD. Socio-economic factors, particularly among women using traditional biomass fuels and engaged in smoking, also play a critical role. The review emphasizes the need for targeted interventions and preventive strategies to manage AECOPD effectively in this region. Conclusions suggest that understanding local patterns of AECOPD etiology is crucial for developing region-specific interventions to reduce exposure to risk factors and manage comorbidities, thereby improving clinical outcomes and reducing healthcare utilization.
Gouty Tophus Erodes Nasal Bone But Presents as Painless Hump
Authors: Xia Hou-Fu , Yu Ming-Yang , Ma Si-Rui , Yu Zi-Li , Jia Jun
Published: September 2024

A 32-year-old male presented with a painless swelling on his nasal dorsum, persisting for over 3 months. He reported a gradual increase in the size of the mass, with no identifiable triggers except occasional skin redness. He denied nosebleeds, rhinorrhea, nasal obstruction, trauma, prior surgery, or spontaneous pain. His medical history revealed gout, managed with colchicine and diclofenac. Despite dietary and pharmaceutical interventions, he continued to have bouts of hyperuricemia, with blood uric acid levels measuring 739 μmol/L. Multiple tophi were evident, especially on the left first metatarsophalangeal joint (Figure 1A). Examination revealed an irregularly shaped, immobile, hard swelling at the nasal radix, measuring 3 cm×2 cm. Computerized tomography (CT) imaging of the nose showed bilateral nasal bone destruction from the lesion. Given its impact on the patient’s appearance and his history of gout, the mass was initially diagnosed as unusual gouty tophus. The patient requested surgical removal of the lesion, and the dissection revealed a mass partly encased by a capsule-like connective tissue adherent to the nasal bone. As the lesion damaged the nasal bone, removal of the lesion led to defect of nasal bone. After an extensive rinse of the surgery site, the incision was sutured.
Laparoscopic Pylorus Preserving Gastrectomy vs Distal Gastrectomy for Early Gastric Cancer; A Multicenter Randomized Controlled Trial (KLASS-04)
Authors: Lee Hyuk-Joon , Kim Young-Woo , Park Do Joong , Han Sang Uk , Ryu Keun Won , Kim Hyung-Ho , Hyung Woo Jin , Park Ji-Ho , Suh Yun-Suhk , Kwon Oh-Kyung , Kim Wook , Park Young-Kyu , Yoon Hong Man , Ahn Sang-Hoon , Kong Seong-Ho , Yang Han-Kwang
Published: September 2024

Objective:

To evaluate the long-term outcomes of laparoscopic pylorus preserving gastrectomy (LPPG) with laparoscopic distal gastrectomy (LDG) for early gastric cancer (EGC).

Summary Background Data:

PPG is considered as a function preserving surgery for EGC. However, there has been no multicenter randomized controlled trial comparing PPG with DG until now.

Methods:

A multicenter randomized controlled trial (KLASS-04) with 256 patients with cT1N0M0 gastric cancer located in the mid portion of the stomach was conducted. The primary endpoint was the incidence of dumping syndrome at postoperative 1 year. Secondary endpoints included survival and recurrence, gallstone formation, nutritional parameters, gastroscopic findings, and quality of life (QOL) for 3 years.

Results:

In the intention-to-treat analyses, there was no difference in the incidence of dumping syndrome at one year postoperatively (13.2% in LPPG vs. 15.8% in LDG, P=0.622). Gallstone formation after surgery was significantly lower in LPPG than in LDG (2.33% vs. 8.66%, P=0.026). Hemoglobin (+0.01 vs. −0.76 gm/dL, P<0.001) and serum protein (−0.15 vs. −0.35 gm/dL, P=0.002) were significantly preserved after LPPG. However, reflux esophagitis (17.8% vs. 6.3%, P=0.005) and grade IV delayed gastric emptying (16.3% vs. 3.9%, P=0.001) were more common in LPPG. Changes in body weight and postoperative QOL were not significantly different between groups. Three-year overall survival and disease-free survival were not different (1 case of recurrence of in each group, P=0.98).

Conclusions:

LPPG can be used as an alternative surgical option for cT1N0M0 gastric cancer in the mid portion of the stomach.
Crystalline lens dislocation as a presenting sign of Streptococcus pyogenes invasive infections
Authors: Liberman Paulina , Light Jacob G , Dharssi Shazia , Howard Tracy , Lu Jen , Simner Patricia J. , Carroll Karen C. , Ho Cheng-Ying
Published: September 2024

Introduction
To describe two cases of crystalline lens dislocation as a presenting feature of invasive group A Streptococcus (GAS) infection and its management.
Case presentation
We report on a 58-year-old female and a 36-year-old male who presented with acute vision loss and severe ocular symptoms. Both patients were found to have lens dislocation and were diagnosed with invasive GAS infection. The 58-year-old female had a complicated clinical course leading to enucleation, while the 36-year-old male responded favorably to early and aggressive treatment with systemic and intravitreal antibiotics. The responsible GAS strains were sequence type (ST) 28 and ST433, respectively.
Conclusion
These cases highlight the importance of recognizing crystalline lens dislocation as a potential sign of ocular GAS infection. Two specific strain types of GAS associated with these findings, ST28 and ST433, are reported. In patients with GAS sepsis presenting with corneal edema and zonular loss, clinicians should immediately initiate treatment, including intravitreal antibiotic injections and systemic therapy. Prompt and aggressive management can be crucial in preserving ocular structures.
Cis-Regulatory Element and Transcription Factor Circuitry Required for Cell-Type Specific Expression of FOXP3
Authors: Umhoefer Jennifer M. , Arce Maya M. , Whalen Sean , Dajani Rama , Goudy Laine , Kasinathan Sivakanthan , Belk Julia A. , Zhang Wenxi , Zhou Royce , Subramanya Sanjana , Hernandez Rosmely , Tran Carinna , Kirthivasan Nikhita , Freimer Jacob W. , Mowery Cody T. , Nguyen Vinh , Ota Mineto , Gowen Benjamin G. , Simeonov Dimitre R. , Curie Gemma L. , Li Zhongmei , Corn Jacob E. , Chang Howard Y. , Gilbert Luke A. , Satpathy Ansuman T. , Pollard Katherine S. , Marson Alexander
Published: September 2024

FOXP3 is a lineage-defining transcription factor (TF) for immune-suppressive regulatory T cells (Tregs). While mice exclusively express FOXP3 in Tregs, humans also transiently express FOXP3 in stimulated conventional CD4+ T cells (Tconvs). Mechanisms governing these distinct expression patterns remain unknown. Here, we performed CRISPR screens tiling theFOXP3locus and targeting TFs in human Tregs and Tconvs to discover cis-regulatory elements (CREs) and trans-regulators of FOXP3. Tconv FOXP3 expression depended on a subset of Treg CREs and Tconv-selective positive (TcNS+) and negative (TcNS-) CREs. The CREs are occupied and regulated by TFs we identified as critical regulators of FOXP3. Finally, mutagenesis of murine TcNS- revealed that it is critical for restriction of FOXP3 expression to Tregs. We discover CRE and TF circuitry controlling FOXP3 expression and reveal evolution of mechanisms regulating a gene indispensable to immune homeostasis.

Highlights

Comprehensive CRISPR maps of CREs and TFs controlling FOXP3 in human Tregs and Tconvs

Key TFs that control FOXP3 directly occupy and regulate CREs forming TF-CRE circuits

A previously unknown negative CRE stringently restricts FOXP3 to Tregs in mice
The awareness and practice of female genital mutilation in Lagos State, Nigeria
Authors: Joshua-Raji Esther T. , Dave-Agboola Itunu O.
Published: September 2024

Background

The extensive practice of female genital mutilation (FGM) is common in Nigerian societies, and it is generally done on infants as early as eight days after giving birth to them in early childhood, but it is usually done before marriage or before the first child is delivered. FGM has apparently caused pain to women, varying from infection, haemorrhage to difficulty in childbirth, even emotional distress.

Objectives

This study wherefore investigated the awareness and practice of female genital mutilation in Alimosho local government area, Lagos state, Nigeria to recognize the influence of the practice of FGM and suggest how to stop the danger of FGM in the society. A cross-sectional study was done to appraise the awareness and practices of female genital mutilation among the residents of Alimosho local government area of Lagos state.

Methods

A self-structured questionnaire was given to 301 males and females selected randomly, and the data were analysed using the Chi-square statistical tool.

Result

The result shows that while there is a significant level of knowledge and awareness regarding Female Genital Mutilation (FGM) in this area, there remains a minute section of the populace that are unaware of the danger associated with the practice of FGM.

Conclusion

It is highly commendable that women and men should be educated by the health personnel or people who are well educated on the danger FGM imposes on their health in order to stop the practice of FGM, and the government should enforce the penalties on the violators of FGM laws.
Synthesis and properties of Sr2La2NiW2O12, a new S = 1 triangular lattice magnet
Authors: Smerechuk Anastasiia , Guilherme Buzanich Ana , Büchner Bernd , Wurmehl Sabine , Morrow Ryan
Published: September 2024

Magnetic materials featuring triangular arrangements of spins are frequently investigated as platforms hosting magnetic frustration. Hexagonal perovskites with ordered vacancies serve as excellent candidates for two-dimensional triangular magnetism due to the considerable separation of the magnetic planes. In this work, the effects of chemical pressure on the ferromagnetic ground state of Ba2La2NiW2O12 by substitution of Ba2+ with Sr2+ to produce Sr2La2NiW2O12 are investigated. The two materials are characterized using synchrotron-based XRD, XANES and EXAFS in addition to magnetometry in order to correlate their crystal structures and magnetic properties. Both materials form in space group R
3, yet as a result of the enhanced bending of key bond angles due to the effects of chemical pressure, the T
C value of the magnetic Ni2+ sublattice is reduced from ∼6 K in Ba2La2NiW2O12 to 4 K in Sr2La2NiW2O12.
Industry 4.0 supply chain nexus: sequential mediating effects of traceability, visibility and resilience on performance
Authors: Riaz Adil , Rehman Hafiz Mudassir , Sohail Aamir , Rehman Mobashar
Published: September 2024

Purpose

The research frontier concerning the relationship between Industry 4.0 (I4.0) and supply chain performance (SCP) in manufacturing is currently lacking in a comprehensive examination. This study examines the relationship between I4.0 adoption and SCP. Additionally, the study examines the mediating effects of supply chain traceability (SCT), supply chain visibility (SCV) and supply chain resilience (SCR), both individually and sequentially.

Design/methodology/approach

The data were garnered from 510 managers of manufacturing firms, and PLS-SEM was applied to examine the sequential mediation effect of SCT, SCV and SCR between I4.0 and SCP.

Findings

Results indicate a statistically significant direct relationship between I4.0 adoption and SCP. Furthermore, SCT mediates the impact of I4.0 on SCP. Similarly, results showed that SCV mediates the impact of I4.0 on SCP and SCR mediates the impact of I4.0 on SCP. Moreover, the relation between I4.0 adoption and SCP is substantially influenced by the sequential effects of SCT, SCV and SCR. The study provides novel empirical evidence by investigating the sequential mediation roles of SCT, SCV and SCR between I4.0 adoption and SCP through the lens of the resource-based view (RBV) perspective.

Practical implications

Policymakers must prioritize the promotion of I4.0 integration to strengthen the performance of manufacturing supply chains (SC). This can be achieved by improving traceability, visibility and resilience within these SCs.

Originality/value

The originality of this study lies in its use of the sequential mediation effect of SCT, SCV and SCR between I4.0 and SCP under the theoretical lens of RBV.
Circular economy implementation in the construction industry: an examination of the barriers in a developing country
Authors: Bello Abdulkabir Opeyemi , Isa Rasheed Babatunde , Oke Ayodeji Emmanuel , Arogundade Suhaib , Lewis Joyce Mdananebari Obuso
Published: September 2024

Purpose

This study examines the barriers impeding the implementation of circular economy (CE) practices in the Nigerian architecture, engineering, construction and operation (AECO) industry across diverse regions of Nigeria.

Design/methodology/approach

The study adopts a quantitative approach using a five-Likert scale questionnaire (Google Forms), utilizing various analytical tools, encompassing descriptive and inferential statistics. This methodological approach allows for a multifaceted exploration of the intricacies surrounding the barriers to circular CE.

Findings

The study identifies and examines 24 CE barriers which are determined to be significant to the implementation of CE. These barriers were categorized into four categories: “Economic”, “Market and Information”, “Policy and Operational” and “ product development”.

Research limitations/implications

The adopted sampling technique may restrict the generalizability of the findings within and beyond the selected regions. Furthermore, while the analytical methods offer a comprehensive analysis, they may not capture the nuanced intricacies that qualitative methodology could provide. However, the findings can be applied to other developing countries with characteristics similar to those of the Nigerian construction industry.

Practical implications

The study’s findings are significant for stakeholders such as policymakers, industry and academia. By elucidating CE-specific barriers, the research facilitates the formulation of targeted and tailored strategies, fostering the integration of CE principles in the Nigerian construction industry.

Originality/value

This study presents novel insights into the barriers hindering the implementation of CE in the Nigerian construction industry. Offering tailored strategies and categorizing barriers into clusters adds a unique perspective to CE literature, particularly in developing countries.
The effect of flexible working arrangements on educator performance in Indonesia
Authors: Jimad Habibullah , Roslina Roslina , Yuningsih Yuningsih
Published: September 2024

Purpose

This study aims to investigate the implementation of flexible working arrangements and satisfaction, family work conflicts and the performance of educators. The potential benefits of FWA implementation for life balance highlight the importance of this research. The study’s results can be used as study material to make policies on implementing FWA for educators.

Design/methodology/approach

The research uses the survey method and conducts interviews with educators who are selected and willing to be interviewed. The research sample was taken by the non-probability sampling method from 245 participants. The analysis used is PLS-SEM.

Findings

The findings indicated that flexible working arrangements had no impact on job satisfaction. The variable that has the greatest influence on determining the performance of educators is job satisfaction.

Originality/value

The study provides information about the application of flexible working arrangements, provides flexibility for educators to change work schedules, do work from anywhere, regulate work patterns and regulate work duration. This study is unique as it focuses more on flexible work arrangements related to remote work arrangements for educators, as the authors understand that no previous study was conducted.
Exploring the impact of renovation subsidies on housing markets – evidence from the Swedish property market
Authors: Wilhelmsson Mats , Warsame Abukar
Published: September 2024

Purpose

The primary aim of this research is to examine the effects of the Renovation, Conversion, and Extension (ROT) tax deduction for renovations on the scope and quality of renovations and its subsequent impact on house prices across various Swedish municipalities.

Design/methodology/approach

This study utilises a two-way fixed effect instrument variable (IV) spatial Manski approach, analysing balanced panel data from 2004 to 2020 at the municipal level (290 municipalities) in Sweden. The methodology is designed to assess the impact of the ROT subsidy on the housing market.

Findings

The study reveals that the ROT subsidy has significantly influenced house prices, with noticeable variations between municipalities. These differences are attributed to the varying amounts of tax reductions for renovations and the extent to which property owners utilise these subsidies.

Research limitations/implications

The research is limited to the context of Sweden and may not be generalisable to other countries with different housing and subsidy policies. The findings are crucial for understanding the specific impacts of government subsidies on the housing market within this context.

Practical implications

For policymakers and stakeholders in the housing market, this study highlights the tangible effects of renovation subsidies on property values. It provides insights into how such financial incentives can shape the housing market dynamics.

Social implications

The research underscores the role of government policies in potentially influencing equitable access to housing. It suggests that subsidies like ROT can have broader social implications, including the distribution of housing benefits among different income groups and regions.

Originality/value

This study contributes original insights into the field of applied real estate economics by quantitatively analysing the impact of a specific government subsidy on the housing market. It offers a unique perspective on how fiscal policies can affect property values and renovation activities at the municipal level in Sweden.
A systematic literature review on the network perspective and resource interaction: where are we now and where should we go?
Authors: Morais Catarina Pereira , Ferreira João , Jayantilal Shital
Published: September 2024

Purpose

The study aims to advance the current state-of-the-art and identify the main theories, methodologies and research gaps. In this article, we examine the network perspective on resource interaction in management, systematically reviewing 92 published articles in peer-reviewed journals from 2013 to 2023.

Design/methodology/approach

This systematic literature review is a methodical, transparent and replicable approach to choosing and evaluating scientific works. We have analyzed and combined all the available evidence, giving a comprehensive overview of the current state of the literature.

Findings

The subject is still under development in the literature, so there are still some research gaps, such as lack of information about markets and competitiveness. The main thematic groups we found included the firm’s social media, business performance, innovation in organizations, social media and big data, network analysis and artificial intelligence.

Research limitations/implications

It is important to note that the subject is still under development in the literature, so there are still some research gaps, such as some lack of information about markets and competitiveness, the online presence of luxury brands and the impact of technology on their performance, which is not approached in the literature; some companies find it challenging to adopt new technologies; what level of technology and academic specialization is needed to measure performance; how to measure the level of credibility of information shared on the internet and the psychological impact of artificial intelligence on future generations and communication.

Practical implications

Managers can use this study to improve network strategies for better communication with diverse stakeholders and adopting new technologies, especially to enhance skills among older generations. Networks play a crucial role in fostering social capital among firms, facilitating knowledge management and improving the quality of processes. The resilience of business networks serves as a mediator between responsible innovation and a company's performance. Managers may consider expanding the use of networks to other areas of management to promote organizational collaboration and professional networking. Employees can also act as brand ambassadors for their organizations, helping to establish informal networks and increase visibility.

Originality/value

An integrative framework and a future research agenda are presented, with the potential to advance our understanding in this field.