bluuebunny/crossref_metadata_2025 huggingface dataset:
In-hospital Mortality Following Suicidal Burns: A Propensity Score-Matched Analysis
Authors: Obed Doha , Gruber Lisa , Salim Mustafa , Knoedler Samuel , Panayi Adriana C , Krezdorn Nicco , Dastagir Khaled , Bingoel Alperen S , Vogt Peter M
Published: March 2023

We carried out a retrospective single-center study and analyzed all patients who have been admitted to our intensive care burn unit following suicide attempt and accidental burns within 14 years. Clinical and demographic parameters were collected and evaluated. Propensity score matching was performed in order to minimize the confounding effect of the parameters age, sex, total body surface area (TBSA), and the presence of full-thickness burns and inhalation injury. 45 burn patients following attempted suicide by burning and 1266 patients following accidental burn injury were admitted. Patients with suicidal burn injuries were significantly younger and showed significantly higher burn severity, reflected by larger TBSA affected, higher incidence of full-thickness burns and inhalation injury. They also experienced increased hospital length of stay (LOS) and longer ventilation durations. Their in-hospital mortality was significantly higher. Following propensity score matching in 42 case pairs, no differences were detected with regard to in-hospital mortality, hospital LOS, duration of mechanical ventilation, and frequency of surgical interventions. Attempted suicide by burning is associated with overall worse outcomes and higher mortality rates. Following propensity score matching, significant differences in outcomes were no longer detectable. Given the comparable survival probability compared to accidentally burned patients, life-sustaining treatment should not be withheld in burn patients following suicide attempt.
Long COVID and children’s rights
Authors: Bhatt Vivek
Published: March 2023

This policy note calls for the recognition of long COVID as a children’s rights issue in the UK. While children have been affected by school closures and lockdown restrictions throughout the pandemic, the relatively low rates of COVID-related hospitalizations and deaths among children have led to their de-prioritization in efforts to reduce the spread of the SARS-CoV-2 virus. Yet infection rates are extremely high among children in the UK, particularly secondary school students, and early studies suggest that many are not recovering for up to a year after infection. Prolonged illness following infection, ‘long COVID’, has implications for children’s rights to education, health, and a private and family life, among others. By extension, children have a right to have their best interests taken into consideration in policy-making processes relating to long COVID. The policy note thus argues that we must recognize the significance of long COVID in children and, upon this basis, call upon the State to address its human rights implications.
Governing nonconventional genetic experimentation
Authors: Mehlman Maxwell J , Conlon Ronald A , Pearlman Alex
Published: March 2023

A large and highly heterogeneous group of individuals conducts genetic and genomic research outside of traditional corporate and academic settings. They can be an important source of innovation, but their activities largely take place beyond the purview of existing regulatory systems for promoting safe and ethical practices. Historically the gene-targeting technology available for non-traditional genomic research has been limited, and therefore these activities have attracted little regulatory attention. New technologies such as CRISPR/Cas9, however, give nonconventional experimenters more extensive gene editing abilities at an unprecedented level of accessibility. The affordability and accessibility of these powerful technologies are raising questions about whether the current largely laissez-faire governance approach is adequate. This article recommends steps to enhance self-governance, including establishing umbrella organizations to represent community interests, creating a community IRB modelled on the DIYBio Ask a Safety Expert Service, and adopting an ethical obligation to report rogue experiments.
Food caching by a solitary large carnivore reveals importance of intermediate-sized prey
Authors: Allen Maximilian L , Elbroch L Mark , Bauder Javan M , Wittmer Heiko U
Published: March 2023

Pumas (Puma concolor) are solitary large carnivores that exhibit high energetic investments while hunting prey that often take multiple days to consume. Therefore, pumas should behave in a way to maximize their energetic gains, including using caching, which is a behavior used by many mammal species to preserve and store food or to conceal it from conspecifics and scavengers to limit their losses. Yet pumas do not always cache their kills. In order to understand caching behavior, we used variables associated with the kills such as prey mass, search time, climate, and habitat to test 20 ecological models (representing four a priori hypotheses: food perishability, resource pulse, consumption time, and kleptoparasitism deterrence) in an information-theoretic approach of model selection to explore factors related to the caching behavior. Models were run with information from tracked radio-collared pumas in California over a 2.5-year period and identified a total of 352 kills. Overall, we documented pumas caching 61.5% of their kills, including 71.6% of Black-tailed Deer (Odocoileus hemionus columbianus), their primary prey in the study area. The model with a quadratic effect of adjusted mass of prey on puma caching probability had all of the empirical support (w = 1.00). Specifically, pumas were most likely to cache intermediate-sized prey, such as yearling and adult female deer, and also fed from cached kills for longer periods of time. Larger prey may be too large to easily cache, making it less energetically efficient—while small prey can often be consumed quickly enough to not require caching. This suggests that intermediate-sized prey may be the optimal size for caching, allowing a puma to feed for multiple days while not greatly increasing energetic output. The hypotheses we tested were not mutually exclusive and pumas caching their prey may occur for several reasons; nevertheless, our study demonstrated that pumas use caching to extend their foraging time and maximize energetic gains when preying on intermediate-sized prey.
Laparoscopic adrenalectomy for large adrenal tumor guided by a 3D anatomic model. New frontiers in abdominal surgery
Authors: Giordano Alessio , Moroni Francesco , Filippo Giacomo di , Cammelli Francesca , Guagni Tommaso , Perini Davina , Cantafio Stefano
Published: March 2023

If until few years ago the surgeon could study a complex surgery only on the basis of two-dimensional images, today can use 3D physical models on a scale of 1 to 1 of an organ. We report the case of a 53 years old woman with Cushing’s syndrome and a giant right adrenal tumor. To better define the relationship between the neoplasm and inferior vena cava, the vascularization of the adrenal gland, any anatomical anomalies and the specific location of the middle adrenal vein, a 3D printed model was created in 1: 1 size based on the preoperative CT. A laparoscopic right adrenalectomy was performed. No intraoperative and postoperative complications were observed with resolution of the adrenal disorder. This case highlights the feasibility and clinical effectiveness of 3D anatomical models for correct preoperative planning, the surgeon’s intraoperative guidance to reduce possible errors and therefore improve the patient’s postoperative outcome.
Postoperative Venous Thromboembolism Following Hysterectomy in the Department of Defense
Authors: Kopelman Zachary A , Baker Tieneka M , Aden James K , Ramirez Christina I
Published: March 2023

Introduction

Hysterectomy is the most common major gynecologic procedure performed in the USA. Surgical complications, such as venous thromboembolism (VTE), are known risks that can be mitigated by preoperative risk stratification and perioperative prophylaxis. Based on recent data, the current post-hysterectomy VTE rate is found to be 0.5%. Postoperative VTE significantly impacts health care costs and patients’ quality of life. Additionally, for active duty personnel, it can negatively impact military readiness. We hypothesize that the incidence of post-hysterectomy VTE rates will be lower within the military beneficiary population because of the benefits of universal health care coverage.

Materials and Methods

The Military Health System (MHS) Data Repository and Management Analysis and Reporting Tool was used to conduct a retrospective cohort study of postoperative VTE rates within 60 days of surgery among women who underwent a hysterectomy at a military treatment facility between October 1, 2013, and July 7, 2020. Patient demographics, Caprini risk assessment, preoperative VTE prophylaxis, and surgical details were obtained by chart review. Statistical analysis was performed using the chi-squared test and Student t-test.

Results

Among the 23,391 women who underwent a hysterectomy at a military treatment facility from October 2013 to July 2020, 79 (0.34%) women were diagnosed with VTE within 60 days of their surgery. This post-hysterectomy VTE incidence rate (0.34%) is significantly lower than the current national rate (0.5%, P < .0015). There were no significant differences in postoperative VTE rates with regard to race/ethnicity, active duty status, branch of service, or military rank. Most women with post-hysterectomy VTE had a moderate-to-high (4.29 ± 1.5) preoperative Caprini risk score; however, only 25% received preoperative VTE chemoprophylaxis.

Conclusion

MHS beneficiaries (active duty personnel, dependents, and retirees) have full medical coverage with little to no personal financial burden for their health care. We hypothesized a lower VTE rate in the Department of Defense because of universal access to care and a presumed younger and healthier population. The postoperative VTE incidence was significantly lower in the military beneficiary population (0.34%) compared to the reported national incidence (0.5%). Additionally, despite all VTE cases having moderate-to-high preoperative Caprini risk scores, the majority (75%) received only sequential compression devices for preoperative VTE prophylaxis. Although post-hysterectomy VTE rates are low within the Department of Defense, additional prospective studies are needed to determine if stricter adherence to preoperative chemoprophylaxis can further reduce post-hysterectomy VTE rates within the MHS.
Population III X-ray binaries and their impact on the early universe
Authors: Sartorio Nina S , Fialkov A , Hartwig T , Mirouh G M , Izzard R G , Magg M , Klessen R S , Glover S C O , Chen L , Tarumi Y , Hendriks D D
Published: March 2023

The first population of X-ray binaries (XRBs) is expected to affect the thermal and ionization states of the gas in the early Universe. Although these X-ray sources are predicted to have important implications for high-redshift observable signals, such as the hydrogen 21-cm signal from cosmic dawn and the cosmic X-ray background, their properties are poorly explored, leaving theoretical models largely uninformed. In this paper we model a population of X-ray binaries arising from zero metallicity stars. We explore how their properties depend on the adopted initial mass function (IMF) of primordial stars, finding a strong effect on their number and X-ray production efficiency. We also present scaling relations between XRBs and their X-ray emission with the local star formation rate, which can be used in sub-grid models in numerical simulations to improve the X-ray feedback prescriptions. Specifically, we find that the uniformity and strength of the X-ray feedback in the intergalactic medium is strongly dependant on the IMF. Bottom-heavy IMFs result in a smoother distribution of XRBs, but have a luminosity orders of magnitude lower than more top-heavy IMFs. Top-heavy IMFs lead to more spatially uneven, albeit strong, X-ray emission. An intermediate IMF has a strong X-ray feedback while sustaining an even emission across the intergalactic medium. These differences in X-ray feedback could be probed in the future with measurements of the cosmic dawn 21-cm line of neutral hydrogen, which offers us a new way of constraining population III IMF.
Assessing indirect methods to determine black hole masses using NGC 4151
Authors: Williams James K , Gliozzi Mario , Bockwoldt Kyle A , Shuvo Onic I
Published: March 2023

Accurately determining the black hole mass (MBH) in active galactic nuclei (AGNs) is crucial to constraining their properties and to studying their evolution. While direct methods yield reliable measurements of MBH in unobscured type 1 AGNs, where the dynamics of stellar or gas components can be directly observed, only indirect methods can be applied to the vast majority of heavily absorbed type 2 AGNs, which represent most of the AGN population. Since it is difficult to evaluate the accuracy and precision of these indirect methods, we utilize the nearby X-ray bright Seyfert galaxy NGC 4151, whose MBH has been tightly constrained with several independent direct methods, as a laboratory to assess the reliability of three indirect methods that have been applied to obscured AGNs. All three, the X-ray scaling method, the Fundamental Plane of BH activity, and the M–σ correlation, yield MBH values consistent with those inferred from direct methods and can therefore be considered accurate. However, only the X-ray scaling method and the M–σ correlation are precise because the substantial scatter in the Fundamental Plane of BH activity allows only for crude estimates. Of the four M–σ correlations we used, only the one from Kormendy and Ho yields a value consistent with the dynamical estimates. This study suggests that the best approach to estimating the BH mass in systems where direct dynamical methods cannot be applied is to utilize a combination of indirect methods, taking into account their different ranges of applicability.
Galaxy image deconvolution for weak gravitational lensing with unrolled plug-and-play ADMM
Authors: Li Tianao , Alexander Emma
Published: March 2023

Removing optical and atmospheric blur from galaxy images significantly improves galaxy shape measurements for weak gravitational lensing and galaxy evolution studies. This ill-posed linear inverse problem is usually solved with deconvolution algorithms enhanced by regularisation priors or deep learning. We introduce a so-called ’physics-informed deep learning’ approach to the Point Spread Function (PSF) deconvolution problem in galaxy surveys. We apply algorithm unrolling and the Plug-and-Play technique to the Alternating Direction Method of Multipliers (ADMM), in which a neural network learns appropriate hyperparameters and denoising priors from simulated galaxy images. We characterize the time-performance trade-off of several methods for galaxies of differing brightness levels, as well as our method’s robustness to systematic PSF errors and network ablations. We show an improvement in reduced shear ellipticity error of 38.6 per cent (SNR=20)/45.0 per cent (SNR=200) compared to classic methods and 7.4 per cent (SNR=20)/33.2 per cent (SNR = 200) compared to modern methods (https://github.com/Lukeli0425/Galaxy-Deconv).
Recommendations for the establishment and operation of a donor human milk bank
Authors: Arslanoglu Sertac , Moro Guido E , Tonetto Paola , De Nisi Giuseppe , Ambruzzi Amalia Maria , Biasini Augusto , Profeti Claudio , Gagliardi Luigi , Salvatori Guglielmo , Bertino Enrico
Published: March 2023

In Europe, an increasing number of human milk banks (HMBs) collect donor human milk to feed preterm infants when their mother’s milk is not available or not enough. Moreover, donor milk is a bridge to breastfeeding, with positive clinical and psychological advantages for both mother and infant. Italy, with 41 HMBs actively operating in 2022, has the highest number of HMBs in Europe. The process of human milk donation is complex, so activity of HMBs must be regulated according to well-established rules. The present recommendations have been prepared as a tool to standardize the organization, management, and procedures of HMBs operating in Italy and to determine the minimal essential requirements to establish new HMBs. This article covers all the aspects of human milk donation and human milk banking, including general recommendations, donor recruitment and screening, expression, handling and storage of donor human milk, milk screening, and milk treatment (pasteurization). A pragmatic approach was taken to drafting the recommendations. Items for which there was consensus or robust published evidence on which to base recommendations were included. When there were differences that could not be resolved by reference to published research, a statement of explanation based on the expert opinion of the authors (all members of the Italian Association of Human Milk Banks) was included. Implementation of these recommendations can contribute to promotion of breastfeeding.
Functional interdependence of N6-methyladenosine methyltransferase complex subunits in Arabidopsis
Authors: Shen Lisha
Published: March 2023

Addition of N6-methyladenosine (m6A), the most prevalent internal mRNA modification in eukaryotes, is catalyzed by an evolutionarily conserved m6A methyltransferase complex. In the model plant Arabidopsis thaliana, the m6A methyltransferase complex is composed of 2 core methyltransferases, mRNA adenosine methylase (MTA) and MTB, and several accessory subunits such as FK506-BINDING PROTEIN 12 KD INTERACTING PROTEIN 37KD (FIP37), VIRILIZER (VIR), and HAKAI. It is yet largely unknown whether these accessory subunits influence the functions of MTA and MTB. Herein, I reveal that FIP37 and VIR are indispensable for stabilizing the methyltransferases MTA and MTB, thus functioning as key subunits to maintain the functionality of the m6A methyltransferase complex. Furthermore, VIR affects FIP37 and HAKAI protein accumulation, while MTA and MTB mutually influence each other. In contrast, HAKAI has little effect on protein abundance or localization of MTA, MTB, and FIP37. These findings uncover unique functional interdependence at the post-translational level among individual components in the Arabidopsis m6A methyltransferase complex, suggesting that maintenance of protein homeostasis among various subunits of the m6A methyltransferase complex is essential for maintaining the protein stoichiometry required for the proper function of the m6A methyltransferase complex in m6A deposition in plants.
Polar localization of a rice silicon transporter requires isoleucine at both C- and N-termini as well as positively charged residues
Authors: Konishi Noriyuki , Mitani-Ueno Namiki , Yamaji Naoki , Ma Jian Feng
Published: March 2023

Silicon (Si) is important for stable and high yields in rice (Oryza sativa), a typical Si hyperaccumulator. The high Si accumulation is achieved by the cooperation of 2 Si transporters, LOW SILICON 1 (OsLsi1) and OsLsi2, which are polarly localized in cells of the root exodermis and endodermis. However, the mechanism underlying their polar localization is unknown. Here, we identified amino acid residues critical for the polar localization of OsLsi1. Deletion of both N- and C-terminal regions resulted in the loss of its polar localization. Furthermore, the deletion of the C-terminus inhibited its trafficking from the endoplasmic reticulum to the plasma membrane. Detailed site-directed mutagenesis analysis showed that Ile18 at the N-terminal region and Ile285 at the C-terminal region were essential for the polar localization of OsLsi1. Moreover, a cluster of positively charged residues at the C-terminal region is also required for polar localization. Phosphorylation and Lys modifications of OsLsi1 are unlikely to be involved in its polar localization. Finally, we showed that the polar localization of OsLsi1 is required for the efficient uptake of Si. Our study not only identified critical residues required for the polar localization of OsLsi1, but also provided experimental evidence for the importance of transporter polarity for efficient nutrient uptake.
ETHYLENE-INSENSITIVE 3-LIKE 2 regulates β-carotene and ascorbic acid accumulation in tomatoes during ripening
Authors: Chen Chong , Zhang Meng , Zhang Mingyue , Yang Minmin , Dai Shanshan , Meng Qingwei , Lv Wei , Zhuang Kunyang
Published: March 2023

ETHYLENE-INSENSITIVE 3/ETHYLENE-INSENSITIVE 3-LIKEs (EIN3/EILs) are important ethylene response factors during fruit ripening. Here, we discovered that EIL2 controls carotenoid metabolism and ascorbic acid (AsA) biosynthesis in tomato (Solanum lycopersicum). In contrast to the red fruits presented in the wild type (WT) 45 d after pollination, the fruits of CRISPR/Cas9 eil2 mutants and SlEIL2 RNA interference lines (ERIs) showed yellow or orange fruits. Correlation analysis of transcriptome and metabolome data for the ERI and WT ripe fruits revealed that SlEIL2 is involved in β-carotene and AsA accumulation. ETHYLENE RESPONSE FACTORs (ERFs) are the typical components downstream of EIN3 in the ethylene response pathway. Through a comprehensive screening of ERF family members, we determined that SlEIL2 directly regulates the expression of 4 SlERFs. Two of these, SlERF.H30 and SlERF.G6, encode proteins that participate in the regulation of LYCOPENE-β-CYCLASE 2 (SlLCYB2), encoding an enzyme that mediates the conversion of lycopene to carotene in fruits. In addition, SlEIL2 transcriptionally repressed L-GALACTOSE 1-PHOSPHATE PHOSPHATASE 3 (SlGPP3) and MYO-INOSITOL OXYGENASE 1 (SlMIOX1) expression, which resulted in a 1.62-fold increase of AsA via both the L-galactose and myoinositol pathways. Overall, we demonstrated that SlEIL2 functions in controlling β-carotene and AsA levels, providing a potential strategy for genetic engineering to improve the nutritional value and quality of tomato fruit.
The taste of success: how to live and thrive as black scholars in inequitable and racialized professional contexts
Authors: Busari Jamiu O
Published: March 2023

Successful black or nonwhite healthcare scholars represent ideal role models for young, aspiring, and underrepresented healthcare professionals. Unfortunately, their successes are often celebrated by many who do not have a proper understanding of the rough journey they went through, to get to the positions they attained. Most black healthcare professionals, if asked, would share that the secret behind their success is working twice as hard as their white peers. Based on the author’s lived experience, a recent academic promotion triggered some personal reflections that resulted in a teachable case story presented in this article. Unlike most conversations that focus on the career challenges of black healthcare physicians and scholars, this discourse uses an empowering context to highlight how scholars can excel within inequitable professional contexts. The author uses this case to describe the 3Rs of resilience, which is a construct that can help black scholars thrive in inequitable and racialized professional contexts.
Self-assembled supramolecular immunomagnetic nanoparticles through π–π stacking strategy for the enrichment of circulating tumor cells
Authors: Mao Yanchao , Zhang Yujia , Yu Yue , Zhu Nanhang , Zhou Xiaoxi , Li Guohao , Yi Qiangying , Wu Yao
Published: March 2023

Owing to their high-specific binding toward targets as well as fast and convenient separation operations, immunomagnetic beads (IMBs) are widely used in the capture and detection of circulating tumor cells (CTCs). To construct the IMBs, surface modifications are generally performed to functionalize the magnetic cores (e.g. Fe3O4 nanoparticles), and the employed surface modification strategies normally influence the structure and functions of the prepared IMBs in return. Different from the existing work, we proposed the use of supramolecular layer-by-layer (LBL) self-assembly strategy to construct the IMBs. In general, owing to the π–π stacking interactions, the polydopamine, graphene oxide and ‘molecular glue’ γ-oxo-1-pyrenebutyric acid were self-assembled on Fe3O4 nanoparticles sequentially, thereby accomplishing the integration of different functional components onto magnetic cores to prepare the self-assembled supramolecular immunomagnetic beads (ASIMBs). The ASIMBs showed high sensitivity, specificity and good biocompatibility to the model CTCs and low nonspecific adsorption to the negative cells (∼93% for MCF-7 cells and 17% for Jurkat cells). Meanwhile, ASIMBs possessed a remarkable potential to screen the rare MCF-7 cells out of large amounts of interfering Jurkat cells with the capture efficiency of 75–100% or out of mouse whole blood with the capture efficiency of 20–90%. The captured cells can be further recultured directly without any more treatment, which showed huge applicability of the ASIMBs for in vitro detection in clinical practices.
On the development of modular polyurethane-based bioelastomers for rapid hemostasis and wound healing
Authors: Guo Wanxin , Zhao Binan , Shafiq Muhammad , Yu Xiao , Shen Yihong , Cui Jie , Chen Yujie , Cai Pengfei , Yuan Zhengchao , EL-Newehy Mohamed , EL-Hamshary Hany , Morsi Yosry , Sun Binbin , Pan Jianfeng , Mo Xiumei
Published: March 2023

Massive hemorrhage may be detrimental to the patients, which necessitates the advent of new materials with high hemostatic efficiency and good biocompatibility. The objective of this research was to screen for the effect of the different types of bio-elastomers as hemostatic dressings. 3D loose nanofiber sponges were prepared; PU-TA/Gel showed promising potential. Polyurethane (PU) was synthesized and electrospun to afford porous sponges, which were crosslinked with glutaraldehyde (GA). FTIR and 1H-NMR evidenced the successful synthesis of PU. The prepared PU-TA/Gel sponge had the highest porosity and water absorption ratio. Besides, PU-TA/Gel sponges exhibited cytocompatibility, negligible hemolysis and the shortest clotting time. PU-TA/Gel sponge rapidly induced stable blood clots with shorter hemostasis time and less bleeding volume in a liver injury model in rats. Intriguingly, PU-TA/Gel sponges also induced good skin regeneration in a full-thickness excisional defect model as revealed by the histological analysis. These results showed that the PU-TA/Gel-based sponges may offer an alternative platform for hemostasis and wound healing.
The role of objecthood and animacy in apparent movement processing
Authors: Cracco Emiel , Linthout Tilia , Orgs Guido
Published: March 2023

Although the ability to detect the actions of other living beings is key for adaptive social behavior, it is still unclear if biological motion perception is specific to human stimuli. Biological motion perception involves both bottom-up processing of movement kinematics (‘motion pathway’) and top-down reconstruction of movement from changes in the body posture (‘form pathway’). Previous research using point-light displays has shown that processing in the motion pathway depends on the presence of a well-defined, configural shape (objecthood) but not necessarily on whether that shape depicts a living being (animacy). Here, we focused on the form pathway. Specifically, we combined electroencephalography (EEG) frequency tagging with apparent motion to study how objecthood and animacy influence posture processing and the integration of postures into movements. By measuring brain responses to repeating sequences of well-defined or pixelated images (objecthood), depicting human or corkscrew agents (animacy), performing either fluent or non-fluent movements (movement fluency), we found that movement processing was sensitive to objecthood but not animacy. In contrast, posture processing was sensitive to both. Together, these results indicate that reconstructing biological movements from apparent motion sequences requires a well-defined but not necessarily an animate shape. Instead, stimulus animacy appears to be relevant only for posture processing.
Incorporating Combinatorial Approaches to Encourage Targeted Neural Stem/Progenitor Cell Integration Following Transplantation in Spinal Cord Injury
Authors: Pieczonka Katarzyna , Fehlings Michael G
Published: March 2023

Spinal cord injury (SCI) severely diminishes quality of life and presents patients with a substantial financial burden. The lack of a curative treatment has guided efforts toward identifying potential regenerative treatments. Neural stem/progenitor cell (NSPC) transplantation represents a promising strategy for the regeneration of the injured spinal cord due to the ability of these cells to replace neural cells lost post-injury. However, the transplant-derived oligodendrocytes and neurons need to be able to associate and integrate within the appropriate endogenous circuits to guarantee optimal functional recovery. To date, the integration of these transplant-derived cells has lacked specificity and remains a challenge. As such, it appears that the transplanted cells will require additional guidance cues to instruct the cells where to integrate. In the present review, we propose a variety of combinatorial techniques that can be used in conjunction with NSPC transplantation to direct the cells toward particular circuits of interest. We begin by introducing distinct molecular signatures that assist in the formation of specific circuits during development, and highlight how favorable molecular cues can be incorporated within the cells and their environment to guide the grafted cells. We also introduce alternative methods including task-specific rehabilitation, galvanotaxis, and magnet-based tools, which can be applied to direct the integration of the grafted cells toward the stimulated circuits. Future research examining these combinatorial efforts may serve to improve outcomes following SCI.
TaqMan Quantitative PCR Detection of Xylella taiwanensis in Taiwan
Authors: Su Chiou-chu , Fung Jie-An , Chang Ruey-Jang , Chang Chung-Jan , Jan Fuh-Jyh , Shih Hsien-Tzung , Chen Jianchi
Published: March 2023

Xylella taiwanensis (Xt) is a nutritionally fastidious bacterial pathogen causing pear leaf scorch disease (PLSD) in Taiwan. The disease causes early defoliation, loss of tree vigor, and reduction in fruit yield and quality. No cure for PLSD is available. The only option for growers to control the disease is to use pathogen-free propagation material, which requires early and accurate detection of Xt. Currently, only one simplex PCR method is available for the diagnosis of PLSD. We developed five Xt-specific TaqMan quantitative PCR (TaqMan qPCR) systems (primers-probe sets) for the detection of Xt. The PCR systems target three conserved genomic loci commonly used in bacterial pathogen detection: the 16S rRNA gene (rrs), the 16S-23S rRNA intergenic transcribed sequence (16S-23S rRNA ITS), and the DNA gyrase gene (gyrB). BLAST analysis using the GenBank nr sequence database, including whole genome sequences of 88 Xanthomonas campestris pv. campestris (Xcc) strains, 147 X. fastidiosa (Xf) strains, and 32 Xt strains, showed that all primer and probe sequences were specific only to Xt. Single nucleotide polymorphisms (SNPs) provided the primer/probe specificity to Xt. The PCR systems were evaluated by using DNA samples from pure cultures of two Xt strains, one Xf strain, one Xcc strain, and 140 plant samples collected from 23 pear orchards in four counties in Taiwan. The two-copy rrs and 16S-23S rRNA ITS-based PCR systems (Xt803-F/R, Xt731-F/R, and Xt16S-F/R) showed higher detection sensitivity than the two single-copy gyrB-based systems (XtgB1-F/R and XtgB2-F/R). A metagenomic analysis of a representative PLSD leaf sample detected the presence of non-Xt proteobacteria and fungal pathogens that should be taken into consideration in PLSD, as they might interfere with diagnosis.
Hydrocortisone, vitamin C, and thiamine may not improve the outcome of patients with sepsis or septic shock: a systematic review and meta-analysis
Authors: Li Zhuangli , Zhang Xiaoli , Wu Yongliang , Xie Chao , Liu Chengjiang , He Xiuyu , Wu Zehua , Hua Guofang , Li Yuedong
Published: March 2023

Background

This study aimed to conduct a systematic review and meta-analysis of the efficacy of hydrocortisone, vitamin C, and thiamine (HVT) in patients with sepsis or septic shock.

Methods

A literature search was performed in PubMed, Embase, Cochrane Library, and Web of Science from their inception to April 2021. Search terms included hydrocortisone, thiamine, vitamin C, sepsis, and septic shock. Only randomized controlled trials on HVT in treating sepsis and septic shock were analyzed. Risk ratio (RR) was generated using Review Manager 5.3 to evaluate binary variants, whereas mean ± standard deviation (MD) was generated to assess continuous variants.

Results

A total of 7 randomized controlled trials, with 1233 patients, were included in this meta-analysis. There was no significant difference in long-term mortality (35.3% vs 33.2%; RR: 1.07; 95% confidence interval [95% CI]: 0.90–1.27; P = 0.45; I
2 = 0%), intensive care unit (ICU) mortality (17.4% vs 17.5%; RR: 0.99; 95% CI: 0.75–1.30; P = 0.95; I
2 = 0%), in-hospital mortality (27.4% vs 25.8%; RR: 1.06; 95% CI: 0.84–1.34; P = 0.63; I
2 = 0%), and acute kidney injury morbidity (RR: 1.04; 95% CI: 0.91–1.18; P = 0.60; I
2 = 0%) between HVT and control groups. For continuous variables, there was no significant effect of HVT therapy on delta Sequential Organ Failure Assessment (△SOFA) score (MD: −0.44; 95% CI: −1.00 to 0.12; P = 0.12; I
2 = 49%), length of ICU stay (MD: 0.43; 95% CI: −0.27 to 1.14; P = 0.23; I
2 = 0%), and length of hospital stay (MD: 0.80; 95% CI: −0.38 to 1.97; P = 0.18; I
2 = 0%). Only vasopressor duration was significantly reduced in the HVT group (MD: −17.75; 95% CI: −25.56 to −9.94; P < 0.00001; I
2 = 38%). Vasopressor duration refers to the time to shock reversal. Alternatively, it is the amount of time (in hours) required for patients to withdraw all vasoactive medication support. Neither HVT nor control △SOFA reached statistical significance.

Conclusion

Hydrocortisone, vitamin C, and thiamine use was not associated with improved mortality, lower acute kidney injury incidence, lower △SOFA, and shorter ICU and in-hospital stays among patients with sepsis and septic shock. However, the use of vasopressors decreased significantly. Further direct head-to-head studies are needed.
Effect of packed red blood cell transfusion on the prognosis of patients with upper gastrointestinal bleeding: a retrospective analysis of eICU-CRD v2.0 multicenter critically ill patients database
Authors: Lv Zhifa , Zhang Yun
Published: March 2023

Background

The effects of packed red blood cell (PRBC) transfusion on the prognosis of patients with upper gastrointestinal bleeding (UGIB), particularly on the 30-day mortality rate, are unclear. This study aimed to determine the prognostic influence of PRBC transfusion in patients with UGIB with different hemoglobin (Hb) levels.

Methods

The subjects in this study were selected from the Philips Electronic ICU Collaborative Research Database Version 2.0 multicenter critically ill patient database from January 2014 to December 2015. A total of 4689 patients were included in this study. The Hb levels were divided into 3 groups: Hb <6 g/dL (Group 1), 6 g/dL ≤ Hb < 8 g/dL (Group 2), and Hb ≥8 g/dL (Group 3). Based on the administration of PRBC transfusion, each group was subdivided into PRBC and non-PRBC groups.

Results

A total of 4689 patients were enrolled in the study, including 825, 2195, and 1669 patients in Groups 1, 2, and 3, respectively. Furthermore, the PRBC and non-PRBC groups consisted of 1847 and 2842 patients, respectively. There was no significant difference in the 30-day mortality rate between Group 1 and Group 2 or between the PRBC and non-PRBC subgroups. In Group 3, the 30-day mortality rate of patients who received transfusion was higher than that of patients who did not (13.29% vs 9.14%,P= 0.029). For the PRBC group, the difference in 30-day mortality rate was not statistically significant among the 3 groups, whereas for the non-PRBC group, the 30-day mortality rate in Group 3 was the lowest, and there was a significant difference among the 3 groups (P= 0.003). There was no significant difference in the subgroup analysis of bleeding at different sites and etiologies.

Conclusion

Packed red blood cell transfusion does not improve prognosis or reduce mortality in patients with UGIB but may increase mortality in patients with Hb levels greater than 8 g/dL.
Influence of positive end-expiratory pressure upregulation on the right ventricle in critical patients with acute respiratory distress syndrome: an observational cohort study
Authors: Liu Hui , Song Mengjie , Wang Li , Xiao Jianguo , Zhou Feihu
Published: March 2023

Background

This study aimed to investigate the influence of positive end-expiratory pressure (PEEP) on the right ventricle (RV) of mechanical ventilation–assisted patients through echocardiography.

Methods

Seventy-six patients assisted with mechanical ventilation were enrolled in this study. Positive end-expiratory pressure was upregulated by 4 cm H2O to treat acute respiratory distress syndrome, wherein echocardiography was performed before and after this process. Hemodynamic data were also recorded. All variables were compared before and after PEEP upregulation. The effect of PEEP was also evaluated in patients with and without decreased static lung compliance (SLC).

Results

Positive end-expiratory pressure upregulation significantly affected the RV function. Remarkable differences were observed in the following: Tei index (P = 0.027), pulmonary artery pressure (P = 0.039), tricuspid annular plane systolic excursion (P = 0.014), early wave/atrial wave (P = 0.002), diaphragm excursion (P < 0.001), inferior vena cava collapsing index (P < 0.001), and SLC (P < 0.001). There were no significant changes in heart rate, respiratory rate, central venous pressure, mean arterial pressure, and base excess (P > 0.05). Furthermore, the cardiac output of the RV was not significantly affected. In patients with decreased SLC (n = 41), there were more significant changes in diaphragm excursion (P < 0.001), inferior vena cava collapse index (P = 0.025), pulmonary artery pressure (P < 0.001), and tricuspid annular plane systolic excursion (P = 0.007) than in those without decreased SLC (n = 35).

Conclusion

Positive end-expiratory pressure upregulation significantly affected the RV function of critically ill patients with acute respiratory distress syndrome, especially in those with decreased SLC.
Novel Antiplatelet Activity of Ginsenoside Re Through the Inhibition of High Shear Stress–Induced Platelet Aggregation
Authors: Huang Xiaojing , Zhang Tiancong , Gao Xuemei , Huan Xuanrong , Li Yuan
Published: March 2023

Bleeding is one of the most serious side effects of antiplatelet drugs. Efforts have been made to find new antiplatelet agents without bleeding complications. Shear-induced platelet aggregation (SIPA) occurs only under pathological conditions and is a promising target for overcoming bleeding problems. This work demonstrates that the ginsenoside Re selectively inhibits platelet aggregation induced by high shear stress. Human platelets were exposed to high shear stress using microfluidic chip technology, and aggregation, activation, and phosphatidylserine (PS) exposure were measured. The Von Willebrand Ristocetin Cofactor (vWF:RCo) assay and western blot were used to evaluate the effect of the vWF-GPⅠb/PI3K/Akt signal pathway. The coagulation and bleeding risk were evaluated by measuring the coagulation parameters PT, APTT, TT, and thromboelastography. The 3-dimensional morphology of platelet aggregates was observed by a microscopic 3-dimensional imaging. Re was a potent inhibitor of SIPA, with an IC50 of 0.071 mg/mL. It effectively blocked shear stress–induced platelet activation without any significant toxicity. It was highly selective against SIPA, effectively inhibiting vWF–GPIb and the downstream PI3K/Akt signaling pathway. Most importantly, Re did not affect normal blood coagulation and did not increase the risk of bleeding. In conclusion, Re inhibits platelet activation through the inhibition of the vWF-GPIb/PI3K/Akt pathway. Thus, it might be considered as a new antiplatelet drug in the prevention of thrombosis without increasing the risk of bleeding.
RETINAL VASCULITIS OR VASCULAR OCCLUSION AFTER BROLUCIZUMAB FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Wykoff Charles C. , Matsumoto Hidetaka , Barakat Mark R. , Karcher Helene , Lozama Anthony , Mayhook Andrew , Oshagbemi Olorunfemi A. , Zorina Olessia , Hassan Tarek S. , Khanani Arshad M. , Heier Jeffrey S.
Published: March 2023

Purpose:

Retinal vasculitis or vascular occlusion (RV/RO) have been reported after brolucizumab for neovascular age-related macular degeneration. This systematic literature review evaluated RV/RO events after brolucizumab in real-world practice.

Methods:

Systematic literature searches identified 89 publications; 19 were included.

Results:

Publications described 63 patients (70 eyes) with an RV/RO event following brolucizumab. Mean age was 77.6 years and 77.8% of patients were women; 32 eyes (45.7%) received one brolucizumab injection before RV/RO. Mean (range) time to event from last brolucizumab injection was 19.4 (0–63) days, with 87.5% of events occurring within 30 days. Among eyes with preevent and postevent visual acuity (VA) assessments, 22/42 eyes (52.4%) showed unchanged (±0.08 logMAR) or improved vision from last recorded preevent assessment at latest follow-up, whereas 15/42 eyes (35.7%) showed ≥0.30 logMAR (≥15 letters) VA reduction. Patients with no VA loss were on average slightly younger and had a higher proportion of nonocclusive events.

Conclusion:

Most RV/RO events reported after brolucizumab in early real-world practice occurred in women. Among eyes with VA measurements, approximately half experienced VA loss; overall, about one-third had VA reduction of ≥0.30 logMAR at latest follow-up, with indications of regional variations.
Evolution of the Chief Medical Officer Role in Teaching Hospitals and Health Systems
Authors: Onyango Rebecca , Baker Matthew C. , Faerberg Jennifer , Haberman Merle , McCoy Rosha , Orlowski Janis
Published: March 2023

Goal:

Clinical physician leaders have become an increasingly important asset to hospitals and hospital systems in a changing healthcare environment. Specifically, the role of the chief medical officer (CMO) has expanded and evolved amid the shift to value-based payment models and sharpened focus on patient safety, quality, community engagement, and equity in healthcare, as well as a global pandemic. In light of these changes, this study examined the transformation of CMOs and similar roles and evaluated the current needs, challenges, and responsibilities of clinical leaders today.

Methods:

The primary data source used in this analysis was a survey fielded to 391 clinical leaders in 290 Association of American Medical Colleges–member hospitals and health systems in 2020. In addition, this study compared responses to the 2020 survey with findings from two prior iterations of the survey from 2005 and 2016. The surveys collected information regarding demographics, compensation, administrative titles, qualifications for the position, and the scope of the role, among other questions. All surveys consisted of multiple-choice, free response, and rating questions. The analysis was conducted using frequency counts and percentage distributions.

Principal Findings:

Thirty percent of eligible clinical leaders responded to the 2020 survey. Twenty-six percent of the clinical leader respondents identified as female. Ninety-one percent of the CMOs were members of the senior management team in their hospital or health system. CMOs reported that they were responsible for five hospitals, on average, with 67% indicating they were responsible for more than 500 physicians.

Practical Applications:

This analysis provides hospital and health systems with insight into the expanding scope and complexity of CMOs as they take on greater leadership responsibilities within their institutions amidst a shifting healthcare landscape. In reflecting on our results, hospital leaders can understand the current needs, barriers, and responsibilities of today's clinical leaders.
When States Mandate Hospital Community Benefit Reports, Provision Increases
Authors: Zare Hossein , Logan Corinne , Anderson Gerard F.
Published: March 2023

Goal:

We examined the variation in community benefit and charity care reporting standards mandated by states to determine whether state-mandated community benefit and charity care reporting is associated with greater provision of these services.

Methods:

We used 2011–2019 data from IRS Form 990 Schedule H for 1,423 nonprofit hospitals to create a sample of 12,807 total observations. Random effects regression models were used to examine the association between state reporting requirements and community benefit spending by nonprofit hospitals. Specific reporting requirements were analyzed to determine whether certain requirements were associated with increased spending on these services.

Principal Findings:

Nonprofit hospitals in states that required reports spent a higher percentage of total hospital expenditures on community benefits (9.1%,SD= 6.2%) compared to states without these requirements (7.2%,SD= 5.7%). A similar association between the percentage of charity care and total hospital expenditures (2.3% and 1.5%) was found. The greater number of reporting requirements was associated with lower levels of charity care provision, as hospitals allocated more resources to other community benefits.

Practical Applications:

Mandating the reporting of specific services is associated with greater provision of certain specific services, but not all. A concern is that when many services must be reported, the provision of charity care might be reduced as hospitals choose to allocate their community benefit dollars to other categories. As a result, policymakers may want to focus their attention on the services they most want to prioritize.
Organization-Level Factors Associated With Burnout
Authors: Thompson Helaina G. , Askelson Natoshia M. , Bucklin Rebecca , Gauthreaux Nicole , Faber Elizabeth , Ball Coltin , Yang Suejin , Steere Eliza
Published: March 2023

Objective

To understand how micropolitan public health workers (PHWs) experienced burnout antecedents during the COVID-19 pandemic.

Methods

We conducted in-depth guided discussions with 34 representatives from 16 micropolitan public health departments using semistructured, open-ended questions about departments' experiences during the COVID-19 pandemic. We coded discussion transcripts to develop themes according to the Six Areas of Worklife model.

Results

PHWs described antecedents of burnout that stemmed from organizational and external forces, most notably within the workload, control, reward, and values dimensions of the Six Areas of Worklife model, as well as instances of workplace violence.

Conclusions

Our findings support organization-level approaches to reducing and preventing burnout in the micropolitan public health workforce. We discuss addressing specific dimensions of the Six Areas of Worklife model when designing burnout solutions for this essential workforce.