bluuebunny/crossref_metadata_2025 huggingface dataset:
AI IR: Charting International Relations in the Age of Artificial Intelligence
Authors: Baele Stephane J , Bukhari Iqraa , Whyte Christopher , Cuomo Scott , Jensen Benjamin , Payne Kenneth , Garcia Eugenio V
Published: May 2024

Over the past decade, rapid progress in artificial intelligence (AI) has transformed a range of areas, from medicine to strategic games and communication technologies, from art and culture to everyday office work. It would be naïve to assume that this evolution does not permeate and alter international affairs. Building on, and solidifying, a thriving yet still fragmented emerging literature on “AI IR,” this forum gathers several critical diagnoses of the way AI technologies impact on various areas of international relations. Introducing new concepts and charting emerging empirical realities, contributors explore how AI advances, such as autonomous lethal systems, synthetic imagery and text, or intelligent systems, are already creating new landscapes of violent and nonviolent international interactions. Yet, behind their distinct takes, contributions together stress the need to correctly locate and evaluate specific sites of AI impact, thus offering a nuanced appraisal scrutinizing grand declarations of an “AI revolution” in global politics.
Skin pharmacokinetics of miltefosine in the treatment of post-kala-azar dermal leishmaniasis in South Asia
Authors: Palić Semra , Chu Wan-Yu , Sundar Shyam , Mondal Dinesh , Das Pradeep , Pandey Krishna , Raja Sheeraz , Rijal Suman , Roseboom Ignace C , Hamadeh Abdullah , Malik Paul R V , Beijnen Jos H , Huitema Alwin D R , Sjögren Erik , Alves Fabiana , Dorlo Thomas P C
Published: May 2024

Introduction

Post-kala-azar dermal leishmaniasis (PKDL) arises as a dermal complication following a visceral leishmaniasis (VL) infection. Current treatment options for PKDL are unsatisfactory, and there is a knowledge gap regarding the distribution of antileishmanial compounds within human skin. The present study investigated the skin distribution of miltefosine in PKDL patients, with the aim to improve the understanding of the pharmacokinetics at the skin target site in PKDL.

Methods

Fifty-two PKDL patients underwent treatment with liposomal amphotericin B (20 mg/kg) plus miltefosine (allometric dosing) for 21 days. Plasma concentrations of miltefosine were measured on study days 8, 15, 22 and 30, while a punch skin biopsy was taken on day 22. A physiologically based pharmacokinetic (PBPK) model was developed to evaluate the distribution of miltefosine into the skin.

Results

Following the allometric weight-based dosing regimen, median miltefosine concentrations on day 22 were 43.73 µg/g (IQR: 21.94–60.65 µg/g) in skin and 33.29 µg/mL (IQR: 25.9–42.58 µg/mL) in plasma. The median individual concentration ratio of skin to plasma was 1.19 (IQR: 0.79–1.9). In 87% (45/52) of patients, skin exposure was above the suggested EC90 PK target of 10.6 mg/L associated with in vitro susceptibility. Simulations indicated that the residence time of miltefosine in the skin would be more than 2-fold longer than in plasma, estimated by a mean residence time of 604 versus 266 hours, respectively.

Conclusion

This study provides the first accurate measurements of miltefosine penetration into the skin, demonstrating substantial exposure and prolonged retention of miltefosine within the skin. These findings support the use of miltefosine in cutaneous manifestations of leishmaniasis. In combination with parasitological and clinical data, these results are critical for the future optimization of combination therapies with miltefosine in the treatment of PKDL.
Unveiling novel Neocosmospora species from Thai mangroves as potent biocontrol agents against Colletotrichum species
Authors: Klomchit Anthikan , Calabon Mark S , Worabandit Sompradtana , Weaver Jack A , Karima Elfina M , Alberti Fabrizio , Greco Claudio , Mahanil Siraprapa
Published: May 2024

Aims

Neocosmospora species are saprobes, endophytes, and pathogens belonging to the family Nectriaceae. This study aims to investigate the taxonomy, biosynthetic potential, and application of three newly isolated Neocosmospora species from mangrove habitats in the southern part of Thailand using phylogeny, bioactivity screening, genome sequencing, and bioinformatics analysis.

Methods and results

Detailed descriptions, illustrations, and a multi-locus phylogenetic tree with large subunit ribosomal DNA (LSU), internal transcribed spacer (ITS), translation elongation factor 1-alpha (ef1-α), and RNA polymerase II second largest subunit (RPB2) regions showing the placement of three fungal strains, MFLUCC 17–0253, MFLUCC 17–0257, and MFLUCC 17–0259 clustered within the Neocosmospora clade with strong statistical support. Fungal crude extracts of the new species N. mangrovei MFLUCC 17–0253 exhibited strong antifungal activity to control Colletotrichum truncatum CG-0064, while N. ferruginea MFLUCC 17–0259 exhibited only moderate antifungal activity toward C. acutatum CC-0036. Thus, N. mangrovei MFLUCC 17–0253 was sequenced by Oxford nanopore technology. The bioinformatics analysis revealed that 49.17 Mb genome of this fungus harbors 41 potential biosynthetic gene clusters.

Conclusion

Two fungal isolates of Neocosmospora and a new species of N. mangrovei were reported in this study. These fungal strains showed activity against pathogenic fungi causing anthracnose in chili. In addition, full genome sequencing and bioinformatics analysis of N. mangrovei MFLUCC 17–0253 were obtained.
A novel N-acetylglucosamine-6-phosphate deacetylase that is essential for chitin utilization in the chitinolytic bacterium, Chitiniphilus shinanonensis
Authors: Ichioka Ryotaro , Kitazawa Yuri , Taguchi Goro , Shimosaka Makoto
Published: May 2024

Aims

We aimed to investigate the function of an unidentified gene annotated as a PIG-L domain deacetylase (cspld) in Chitiniphilus shinanonensis SAY3. cspld was identified using transposon mutagenesis, followed by negatively selecting a mutant incapable of growing on chitin, a polysaccharide consisting of N-acetyl-d-glucosamine (GlcNAc). We focused on the physiological role of CsPLD protein in chitin utilization.

Methods and results

Recombinant CsPLD expressed in Escherichia coli exhibited GlcNAc-6-phosphate deacetylase (GPD) activity, which is involved in the metabolism of amino sugars. However, SAY3 possesses two genes (csnagA1 and csnagA2) in its genome that code for proteins whose primary sequences are homologous to those of typical GPDs. Recombinant CsNagA1 and CsNagA2 also exhibited GPD activity with 23 and 1.6% of catalytic efficiency (kcat/Km), respectively, compared to CsPLD. The gene-disrupted mutant, Δcspld was unable to grow on chitin or GlcNAc, whereas the three mutants, ΔcsnagA1, ΔcsnagA2, and ΔcsnagA1ΔcsnagA2 grew similarly to SAY3. The determination of GPD activity in the crude extracts of each mutant revealed that CsPLD is a major enzyme that accounts for almost all cellular activities.

Conclusions

Deacetylation of GlcNAc-6P catalyzed by CsPLD (but not by typical GPDs) is essential for the assimilation of chitin and its constituent monosaccharide, GlcNAc, as a carbon and energy source in C. shinanonensis.
IGF2BP2 regulates the proliferation and migration of endometrial stromal cells through the PI3K/AKT/mTOR signaling pathway in Hu sheep
Authors: Deng Kaiping , Li Xiaodan , Liu Zhipeng , Su Yalong , Sun Xuan , Wei Wurilege , Fan Yixuan , Zhang Yanli , Wang Feng
Published: May 2024

Insulin-like growth factor 2 mRNA binding protein 2 (IGF2BP2), a significant member of the conserved RNA-binding protein family, plays various roles in numerous physiological and pathological processes. However, the specific function of IGF2BP2 in regulating endometrial function in sheep remains largely unknown. In this study, we observed a significant upregulation in IGF2BP2 mRNA abundance in the endometrium during the luteal phase compared to the follicular phase in Hu sheep. The knockdown of IGF2BP2 resulted in accelerated cell proliferation and migration of Hu sheep endometrial stromal cells (ESCs). Moreover, RNA sequencing analysis revealed that genes with significantly altered expression in IGF2BP2 knockdown cells were predominantly enriched in endometrial receptivity-related signaling pathways, such as cytokine-cytokine receptor interaction, NOD-like receptor, PI3K-AKT, and JAK-STAT signaling pathway. Additionally, the knockdown of IGF2BP2 significantly increased the expression of matrix metalloprotein 9 (MMP9), vascular endothelial growth factor, and prolactin (PRL) in ESCs. The knockdown of IGF2BP2 was also observed to stimulate the PI3K/AKT/mTOR pathway by upregulating integrin β4 (ITGB4) expression. Notably, the downregulation of ITGB4 attenuates IGF2BP2 knockdown-induced facilitation of proliferation and migration of Hu sheep ESCs by inhibiting the PI3K/AKT/mTOR pathway. Collectively, these findings highlight the important role of IGF2BP2 in regulating endometrial function, particularly through the modulation of ESC proliferation and migration via the PI3K/AKT/mTOR pathway.
Production and characterization of novel monoclonal antibodies against pathological human TDP-43 proteins
Authors: Zheng Xiaojing , Wang Mengtian , He Qiongyan , Chen Shuyu , Simayi Dilihumaer , Ma Xia , Zhao Junli , Sun Xiaohong , Yang Peiyan , Mao Qinwen , Xia Haibin
Published: May 2024

The RNA/DNA-binding protein TDP-43 plays a pivotal role in the ubiquitinated inclusions characteristic of TDP-43 proteinopathies, including most cases of frontotemporal lobar degeneration (FTLD-TDP) and Alzheimer disease (AD). To understand the mechanisms of pathological TDP-43 processing and identify potential biomarkers, we generated novel phosphorylation-independent monoclonal antibodies (MAbs) using bacteria-expressed human full-length recombinant TDP-43. Remarkably, we identified a distinctive MAb, No. 9, targeting an epitope in amino acid (aa) region 311–360 of the C-terminus. This antibody showed preferential reactivity for pathological TDP-43 inclusions, with only mild reactivity for normal nuclear TDP-43. MAb No. 9 revealed more pathology in FTLD-TDP type A and type B brains and in AD brains compared to the commercial p409/410 MAb. Using synthetic phosphorylated peptides, we also obtained MAbs targeting the p409/410 epitope. Interestingly, MAb No. 14 was found to reveal additional pathology in AD compared to the commercial p409/410 MAb, specifically, TDP-43-immunopositive deposits with amyloid plaques in AD brains. These unique immunopositivities observed with MAbs No. 9 and No. 14 are likely attributed to their conformation-dependent binding to TDP-43 inclusions. We expect that this novel set of MAbs will prove valuable as tools for future patient-oriented investigations into TDP-43 proteinopathies.
Nurse Attrition: Content Analysis of Free-Text Responses From Two Military Nursing Practice Environment Surveys
Authors: Miller Melissa J , Korbut Nickalous , Amador Garcia Lidilia , Agazio Janice B , Cartwright Joel
Published: May 2024

Introduction

Staff nurse attrition negatively impacts readiness of the warfighter and the health and wellbeing of all beneficiaries of the Military Health System (MHS). To promote the retention of a robust nursing workforce, a complete understanding of nurses’ perceptions regarding their intent to leave is necessary. The purpose of this study was to explore the free-text responses of 1,438 nurses working among military medical treatment facilities for factors influencing their intent to leave, as an indicator of potential turnover, or attrition.

Materials and Methods

This study employed thematic analysis to investigate the qualitative responses from the 2016 and 2018 Military Nursing Practice Environment Surveys. The study was determined to be exempt from Institutional Review Board review through the Womack Army Medical Center’s Human Research Protection Program.

Results

Findings indicate that leadership and management (n = 647), staffing (n = 353), career opportunities (n = 345), staff outcomes (n = 247), culture (n = 153), quality of care (n = 99), patient care barriers (n = 86), non-patient care activities (n = 79), lack of formal professional development (n = 75), and area or care environment (n = 67) were among the top factors influencing staff nurse intent to leave, respectively.

Conclusions

Our findings support the evaluation of retention strategies using implementation science for nurses and nurse resource personnel (e.g., nursing assistants, technicians, medics, and corpsman) to ensure a robust nursing work force throughout the MHS. Staff nurses and resource personnel working among military treatment facilities and embedded in units supporting combat and humanitarian missions ensure access to care and health promotion of the warfighter and all MHS beneficiaries.
DEVILS/MIGHTEE/GAMA/DINGO: the impact of SFR time-scales on the SFR-radio luminosity correlation
Authors: Cook Robin H W , Davies Luke J M , Rhee Jonghwan , Hale Catherine L , Bellstedt Sabine , Thorne Jessica E , Delvecchio Ivan , Collier Jordan D , Dodson Richard , Driver Simon P , Holwerda Benne W , Jarvis Matt J , Knowles Kenda , Lagos Claudia , Maddox Natasha , Meyer Martin , Robotham Aaron S G , Roychowdhury Sambit , Rozgonyi Kristof , Seymour Nicholas , Siudek Malgorzata , Whiting Matthew , Whittam Imogen
Published: May 2024

The tight relationship between infrared luminosity (LTIR) and 1.4 GHz radio continuum luminosity ($L_\mathrm{1.4\, GHz}$) has proven useful for understanding star formation free from dust obscuration. Infrared emission in star-forming galaxies typically arises from recently formed, dust-enshrouded stars, whereas radio synchrotron emission is expected from subsequent supernovae. By leveraging the wealth of ancillary far-ultraviolet – far-infrared photometry from the Deep Extragalactic VIsible Legacy Survey and Galaxy and Mass Assembly surveys, combined with 1.4 GHz observations from the Meer Karoo Array Telescope International GHz Tiered Extragalactic Exploration survey and Deep Investigation of Neutral Gas Origin projects, we investigate the impact of time-scale differences between far-ultraviolet – far-infrared and radio-derived star formation rate (SFR) tracers. We examine how the spectral energy distribution (SED)-derived star formation histories (SFHs) of galaxies can be used to explain discrepancies in these SFR tracers, which are sensitive to different time-scales. Galaxies exhibiting an increasing SFH have systematically higher LTIR and SED-derived SFRs than predicted from their 1.4 GHz radio luminosity. This indicates that insufficient time has passed for subsequent supernovae-driven radio emission to accumulate. We show that backtracking the SFR(t) of galaxies along their SED-derived SFHs to a time several hundred megayears prior to their observed epoch will both linearize the SFR–$L_\mathrm{1.4\, GHz}$ relation and reduce the overall scatter. The minimum scatter in the SFR(t)–$L_\mathrm{1.4\, GHz}$ is reached at 200 – 300 Myr prior, consistent with theoretical predictions for the time-scales required to disperse the cosmic ray electrons responsible for the synchrotron emission.
Tannic acid and silicate-functionalized polyvinyl alcohol–hyaluronic acid hydrogel for infected diabetic wound healing
Authors: Diao Zhentian , Li Longkang , Zhou Huan , Yang Lei
Published: May 2024

Healing of chronic diabetic wounds is challenging due to complications of severe inflammatory microenvironment, bacterial infection and poor vascular formation. Herein, a novel injectable polyvinyl alcohol–hyaluronic acid-based composite hydrogel was developed, with tannic acid (TA) and silicate functionalization to fabricate an ‘all-in-one’ hydrogel PTKH. On one hand, after being locally injected into the wound site, the hydrogel underwent a gradual sol–gel transition in situ, forming an adhesive and protective dressing for the wound. Manipulations of rheological characteristics, mechanical properties and swelling ability of PTKH could be performed via regulating TA and silicate content in hydrogel. On the other hand, PTKH was capable of eliminating reactive oxygen species overexpression, combating infection and generating a cell-favored microenvironment for wound healing acceleration in vitro. Subsequent animal studies demonstrated that PTKH could greatly stimulate angiogenesis and epithelization, accompanied with inflammation and infection risk reduction. Therefore, in consideration of its impressive in vitro and in vivo outcomes, this ‘all-in-one’ multifunctional hydrogel may hold promise for chronic diabetic wound treatment.
Long-term use of interleukin-1 inhibitors reduce flare activity in patients with fibrodysplasia ossificans progressiva
Authors: Haviv Ruby , Zeitlin Leonid , Moshe Veronica , Ziv Amit , Rabinowicz Noa , De Benedetti Fabrizio , Prencipe Giusi , Matteo Valentina , De Cunto Carmen Laura , Hsiao Edward C , Uziel Yosef
Published: May 2024

Objectives

Fibrodysplasia ossificans progressiva (FOP) is one of the most catastrophic forms of genetic heterotopic ossification (HO). FOP is characterized by severe, progressive inflammatory flare-ups, that often lead to HO. The flare-ups are associated with increased inflammatory cytokine production, suggesting auto-inflammatory features driven by IL-1β. This study describes the short- and long-term responses of FOP patients to anti-IL-1 therapy.

Methods

Previously, we reported that a patient with FOP treated with anti-IL-1 agents showed dramatically lower rates of flare-ups, improved flare-up symptoms, decreased use of glucocorticoids and apparently decreased size of residual lesions. Plasma analyses also showed marked elevation in IL-1β levels during a FOP flare, further supporting a role of IL-1β in the pathogenesis of FOP flares. Here, we report results from long-term therapy with IL-1 inhibitors in that patient and describe 3 additional patients, from two medical centres.

Results

All 4 patients showed persistent improvement in flare activity during treatment with IL-1 inhibitors, with minimal formation of new HO sites. Two patients who stopped therapy experienced a resurgence of flare activity that was re-suppressed upon re-initiation. These patients had IL-1β levels comparable to those in IL-1β-driven diseases. Child Health Assessment Questionnaires confirmed extensive subjective improvements in the pain and general health visual analogue scales.

Conclusion

This case series demonstrates significant benefits from IL-1 inhibitors for reducing flare activity and improving the general health of patients with FOP. These data provide strong support for additional studies to better understand the function of IL-1 inhibition, primarily in reducing the formation of new HO.

Funding

RH received support from the International FOP Association ACT grant; ECH received support from NIH/NIAMS R01AR073015 and the UCSF Robert Kroc Chair in Connective Tissue and Rheumatic Diseases III.
Predictive factors and treatment outcomes associated with difficult-to-treat rheumatoid arthritis conditions: the ANSWER cohort study
Authors: Watanabe Ryu , Ebina Kosuke , Gon Takaho , Okano Tadashi , Murata Koichi , Murakami Kosaku , Maeda Yuichi , Jinno Sadao , Shirasugi Iku , Son Yonsu , Amuro Hideki , Katayama Masaki , Hara Ryota , Hata Kenichiro , Yoshikawa Ayaka , Yamamoto Wataru , Tachibana Shotaro , Hayashi Shinya , Etani Yuki , Katsushima Masao , Fukumoto Kazuo , Yamada Shinsuke , Hashimoto Motomu
Published: May 2024

Objectives

To investigate the predictive factors for difficult-to-treat rheumatoid arthritis (D2T RA) and assess the efficacy of biologic DMARDs (bDMARDs) and Janus kinase inhibitors (JAKi).

Methods

Retrospective analysis was conducted on data from the ANSWER cohort comprising 3623 RA patients treated with bDMARDs or JAKi in Japan. Multivariate Cox proportional hazards modelling was used to analyse the hazard ratios (HRs) for treatment retention.

Results

Of the 3623 RA patients, 450 (12.4%) met the first two criteria of the EULAR D2T RA definition (defined as D2T RA in this study). Factors contributing to D2T RA included age over 75 (compared with those under 65, hazard ratio [HR] = 0.46; 95% CI: 0.31, 0.69), higher rheumatoid factor (RF) titres (HR = 1.005; 95% CI: 1.00, 1.01), higher clinical disease activity index (HR = 1.02; 95% CI: 1.01, 1.03), lower methotrexate dosage (HR = 0.97; 95% CI: 0.95, 0.99), and comorbidities like hypertension (HR = 1.53; 95% CI: 1.2, 1.95) and diabetes (HR = 1.37; 95% CI: 1.09, 1.73). Anti-IL-6 receptor antibodies (aIL-6R, HR = 0.53; 95% CI: 0.37, 0.75) and JAKi (HR = 0.64; 95% CI: 0.46, 0.90) were associated with fewer discontinuations due to ineffectiveness compared with TNF inhibitors. Oral glucocorticoid usage (HR = 1.65; 95% CI: 1.11, 2.47) was linked to increased discontinuation due to toxic adverse events.

Conclusion

Younger onset, higher RF titres, and comorbidities predicted D2T RA development. For managing D2T RA, aIL-6R and JAKi exhibited superior drug retention.
Hsa_circ_0004214 involved in the epithelial–mesenchymal transition induced by beryllium sulfate through modulating JAK-STAT signaling pathway
Authors: Jin Huiyun , Liu Yanping , Lei Yuandi , Li Guilan , Huang Lian , Zhang Zhaohui
Published: May 2024

Background

Chronic beryllium disease is characterized by granulomas and pulmonary fibrosis. Recent studies have shown that microRNAs (miRNAs) and circular RNAs (circRNAs) play critical roles in the pathogenesis and development of many diseases. However, the role of miRNAs and circRNAs in pulmonary fibrosis induced by beryllium sulfate (BeSO4) has not been elucidated.

Methods

Previous studies demonstrated hsa-miR-663b was down-regulated in the 150 μmol/L BeSO4-treated 16HBE cells, while hsa_circ_ 0004214 was up-regulated. Here we found epithelial-mesenchymal transition (EMT) involved in pulmonary fibrosis induced by BeSO4 (4, 8, and 12 mg/kg·BW) in SD rats.

Results

Elevated expression of hsa-miR-663b blocked the EMT progression of 16HBE cells induced by 150 μmol/L BeSO4. Notably, the overexpression of hsa-miR-663b decreased the expression of leukemia inhibitory factor (LIF), which was predicted as a target gene of hsa-miR-663b by bioinformatics tools. Furthermore, elevated miR-663b inhibited the activation of the downstream Janus kinase-signal transducers and activators of transcription (JAK-STAT) signaling pathway induced by BeSO4 in 16HBE cells. Previous study suggested that hsa_circ_0004214 had binding sites for hsa-miR-663b. The results indicated hsa_circ_0004214 alleviated the BeSO4-induced EMT via JAK-STAT pathway in 16HBE cells.

Conclusions

Collectively, the overexpression of hsa-miR-663b and knockdown of hsa_circ_0004214 attenuated the EMT induced by BeSO4 through the inhibition of JAK-STAT signaling pathway. The aberrant expressed hsa-miR-663b and hsa_circ_0004214 stimulated by BeSO4 may exert an important function in the toxic mechanism of beryllium exposure to 16HBE cells, providing the potential therapeutic targets in chronic beryllium disease.
Protective effects of dopamine against non-alcoholic steatohepatitis via inhibiting p65 pathways in vivo and in vitro
Authors: Ma Peng , Wang Xu , Wen Xiuqi , Pu Lingyun , Ou Yu
Published: May 2024

Introduction

Currently, the role and mechanism of dopamine in non-alcoholic steatohepatitis (NASH) remains unclear.

Methods

In vitro experiments utilized FFA and LPS to establish NASH cell models, while a fibrotic cell model was created using TGFβ1 to investigate the impact of dopamine on cellular lipid metabolism, inflammation, and fibrosis. In vivo experiments involved the use of MCD and HFD diets to induce NASH in mouse models for observing the effects of dopamine on NASH disease progression.

Results

Our study showed that dopamine significantly downregulated the expression levels of Caspase 1, IL-1β and IL18 in the HepG2 NASH cell model. In addition, dopamine could inhibit the TGF-β1-induced accumulation of collagen I and α-SMA in LX2 cells. In vivo experiments have shown that dopamine attenuation in mice is associated with MCD diet-induced and HFD-induced steatohepatitis. Mechanically, dopamine inhibits the p65 signaling pathway in NASH.

Conclusion

In conclusion, the present study demonstrates the role of dopamine in ameliorating the symptoms of NASH and provides a direction for future research on the application of the dopaminergic system to liver disease.
Determination of the effects of sunset yellow on mouse liver and pancreas using histological methods
Authors: ŞENSOY Erhan
Published: May 2024

Background

Sunset Yellow (SY) is an azo synthetic food dye. Although the amount of SY consumed varies in different periods of life, it increases especially in children and adolescents. It may cause pathologic effects in organs at early ages. The aim of this study was to determine the effects of SY on the liver and pancreas of mice of different age groups using histological methods.

Methods

The study included Swiss albino mice that were divided into three treatment groups and three control groups based on age (4, 8, and 10 weeks old), with six mice in each group (n = 6/group). SY was administered at 30 mg/kg/bw/week orally for 28 days to treatment groups. The liver and pancreas tissues were kept in 10% formaldehyde, then passed through alcohol and xylene series and stained with Hematoxylin-Eosin.

Results

They were evaluated using light and electron microscopy. In SY groups, the mean body weight (p: 0.026) and the mean liver weight (p: 0.013) of the mice increased, and their mean pancreas weight decreased (p: 0.045).The numbers of degenerative cells in the liver tissues of the mice in the SY groups were high. Severe dilation in the sinusoids and haemorrhages focused around the Vena Cava were detected. In the pancreatic tissues of the SY groups, increases in fibroblasts and lymphocytic infiltration were observed.

Conclusions

Pathologies interpreted as chronic pancreatitis were more intense in the weaning group (4 weeks old). SY may be more harmful at an early age, and it may be beneficial to limit its use during this period.
Nursing Care for Patients After Urostomy Surgery
Authors: Cross Heidi H. , Schempp Bethany A.
Published: May 2024

When an ostomy care nurse is not available, bedside nurses must assume responsibility for providing necessary care and educating patients who undergo a urinary diversion. However, staff nurses often lack the necessary knowledge and experience to provide the best care, rehabilitation, and patient education. This article details pre- and postoperative interventions for nurses who encounter patients undergoing urostomy surgery in order to help eliminate gaps in care, increase nurses' and patients' competence and confidence, and optimize patient outcomes and quality of life. It also includes a tear sheet that nurses can use to provide patients with the basic information and skills they need for effective self-care.
Perioperative Acute Renal Injury: Revisiting Pathophysiology
Authors: Sladen Robert N.
Published: May 2024

Background

Acute renal dysfunction and subsequent acute renal failure after cardiac surgery are associated with high mortality and morbidity. Early therapeutic or preventive intervention is hampered by the lack of an early biomarker for acute renal injury. Recent studies showed that urinary neutrophil gelatinase–associated lipocalin (NGAL or lipocalin 2) is upregulated early (within 1 to 3 h) after murine renal injury and in pediatric acute renal dysfunction after cardiac surgery. The authors hypothesized that postoperative urinary NGAL concentrations are increased in adult patients developing acute renal dysfunction after cardiac surgery compared with patients without acute renal dysfunction.

Methods

After institutional review board approval, 81 cardiac surgical patients were prospectively studied. Urine samples were collected immediately before incision and at various time intervals after surgery for NGAL analysis by quantitative immunoblotting. Acute renal dysfunction was defined as peak postoperative serum creatinine increase by 50% or greater compared with preoperative serum creatinine.

Results

Sixteen of 81 patients (20%) developed postoperative acute renal dysfunction, and the mean urinary NGAL concentrations in patients who developed acute renal dysfunction were significantly higher early after surgery (after 1 h, mean ± SD, 4,195 ± 6,520 vs. 1,068 ± 2,129 ng/ml; P < 0.01) compared with patients who did not develop acute renal dysfunction. Mean urinary NGAL concentrations continued to increase and remained significantly higher at 3 and 18 h after cardiac surgery in patients with acute renal dysfunction. In contrast, urinary NGAL in patients without acute renal dysfunction decreased rapidly after cardiac surgery.

Conclusions

Patients developing postoperative acute renal dysfunction had significantly higher urinary NGAL concentrations early after cardiac surgery. Urinary NGAL may therefore be a useful early biomarker of acute renal dysfunction after cardiac surgery. These findings may facilitate the early detection of acute renal injury and potentially prevent progression to acute renal failure.
A new comprehensive and stratified concept for supportive care in cancer patients
Authors: Klastersky Jean , Libert Isabelle , Libert Yves , Echterbille Marie-Aline
Published: May 2024

Purpose of review

Supportive care in oncology has evolved alongside effective anticancer treatments since the 1960s, beginning with the advent of chemotherapy for acute leukemia. It was initially focused on managing treatment-induced complications, and expanded to address broader aspects of patient well being; the scope of supportive care needs to be periodically re-assessed.

Recent findings

Early palliative care interventions, and more recently advance care planning emerged as vital components, improving patient outcomes and quality of life. Despite barriers, such as prognostic uncertainty, these approaches have demonstrated significant benefits for patients with advanced disease. Additionally, the management of cancer survivors requires ongoing medical surveillance and psycho-social support. In the last years, integrative medicine has also emerged as a complementary approach to address survivors’ holistic needs.

A proposed stratified model of supportive care emphasizes interventions based on patients’ prognosis, with interdisciplinary collaboration ensuring comprehensive care across all stages of the cancer journey. This model provides a framework for the development of integrated supportive care units.
Role of maternal–fetal immune tolerance in the establishment and maintenance of pregnancy
Authors: Wang Jingjing , Han Tao , Zhu Xiaoming
Published: May 2024

Normal pregnancy is a contradictory and complicated physiological process. Although the fetus carries the human leukocyte antigen (HLA) inherited from the paternal line, it does not cause maternal immune rejection. As the only exception to immunological principles, maternal–fetal immune tolerance has been a reproductive immunology focus. In early pregnancy, fetal extravillous trophoblast cells (EVTs) invade decidual tissues and come into direct contact with maternal decidual immune cells (DICs) and decidual stromal cells (DSCs) to establish a sophisticated maternal–fetal crosstalk. This study reviews previous research results and focuses on the establishment and maintenance mechanism of maternal–fetal tolerance based on maternal–fetal crosstalk. Insights into maternal–fetal tolerance will not only improve understanding of normal pregnancy but will also contribute to novel therapeutic strategies for recurrent spontaneous abortion, pre-eclampsia, and premature birth.
A Review of Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Combined with Medication and Psychotherapy for Depression
Authors: Kochanowski Brian , Kageki-Bonnert Karina , Pinkerton Elizabeth A. , Dougherty Darin D. , Chou Tina
Published: May 2024

Learning Objectives

After participating in this CME activity, the psychiatrist should be better able to:

• Compare and contrast therapies used in combination with transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) for treating MDD.

Background

Noninvasive neuromodulation, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), has emerged as a major area for treating major depressive disorder (MDD). This review has two primary aims: (1) to review the current literature on combining TMS and tDCS with other therapies, such as psychotherapy and psychopharmacological interventions, and (2) to discuss the efficacy, feasibility, limitations, and future directions of these combined treatments for MDD.

Method

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched three databases: PubMed, PsycInfo, and Cochrane Library. The last search date was December 5, 2023.

Results

The initial search revealed 2,519 records. After screening and full-text review, 58 studies (7 TMS plus psychotherapy, 32 TMS plus medication, 7 tDCS plus psychotherapy, 12 tDCS plus medication) were included.

Conclusions

The current literature on tDCS and TMS paired with psychotherapy provides initial support for integrating mindfulness interventions with both TMS and tDCS. Adding TMS or tDCS to stable doses of ongoing medications can decrease MDD symptoms; however, benzodiazepines may interfere with TMS and tDCS response, and antipsychotics can interfere with TMS response. Pairing citalopram with TMS and sertraline with tDCS can lead to greater MDD symptom reduction compared to using these medications alone. Future studies need to enroll larger samples, include randomized controlled study designs, create more uniform protocols for combined treatment delivery, and explore mechanisms and predictors of change.
Improving patient education in hospitalized patients with chronic obstructive pulmonary disease: A quality improvement initiative using LEAN methodology
Authors: Stewart Jacquelyn M. , Shah Freny , Thomas Jolly , White Myrtle
Published: May 2024

Background:

Chronic obstructive pulmonary disease (COPD) is a costly chronic disease affecting more than 15 million Americans. The prevalence among US veterans is 3 times higher than the general population.

Local problem:

The Veteran Health Administration developed a standardized, evidence-based COPD educational tool called Green Light to Go (GLTG) designed to educate patients on managing their COPD symptoms at home. Despite the availability of this resource, inpatient education on COPD self-management practices is highly variable across different medical teams. This quality improvement (QI) initiative sought to standardize inpatient COPD patient education using the GLTG tool. This initiative also assessed whether patients receiving standardized patient education during their index hospitalization had lower COPD 30-day readmission rates.

Method:

The QI initiative followed the LEAN methodology and the A3 framework. The team performed rapid tests of change (plan-do-study-act cycles) to increase the percentage of veterans receiving COPD education.

Interventions:

The interventions implemented for this QI initiative focused on clinical, patient, and system improvements.

Results:

This initiative standardized COPD patient education and increased the percentage of veterans receiving (a) daily COPD education from 0% to 66%, (b) verbal COPD education on discharge from a baseline of 20% to 100%, (c) receipt of written educational material on discharge from 20% to 100%, and (d) the cohort all-cause 30-day readmission rate declined from 19.3% to 14.3%.

Conclusions:

Given the substantial economic burden of COPD readmissions on the health care system and patients, evidence-based educational interventions may potentially improve outcomes and reduce hospital readmissions in this veteran population.
Non-surgical treatment of idiopathic gingival enlargement: A case report
Authors: Ge Mingjie , Li Mengli , Shen Liheng
Published: May 2024

Background:

Idiopathic gingival enlargement is associated with plaque, but other contributing factors are unclear. The prognosis of idiopathic gingival enlargement is closely related to the patient’s oral hygiene habits and regular follow-up.

Case Presentation:

This article reports a case of a 32-year-old male patient with idiopathic gingival enlargement. The patient presented to the department of stomatology with a 2-month history of gingival swelling and pain on the right upper posterior teeth. During the treatment, oral hygiene instruction, supragingival cleaning, subgingival scaling, and root planning were carried out, and part of the hyperplastic gingiva was taken and sent for pathology. Pathological examination showed gingival enlargement with chronic suppurative inflammation. At 4-month follow-up, the patient’s periodontal condition remained basically stable, and the gingival enlargement did not recur.

Conclusion:

The treatment of this case resulted in significant reduction of gingival swelling and patient’s pain reduction through non-surgical treatment and good plaque control, indicating that patients with idiopathic gingival enlargement can also achieve ideal results through non-surgical treatment. Through oral hygiene instruction, the patient mastered the method of self-plaque control, which is conducive to the long-term stabilization of the periodontal situation.
Clinical use and efficacy of Chinese patent medicines for external use containing pyritum, a mineral medicine mainly used for oral administration: A systematic review
Authors: Hwang Ji Hye , Choi Su Hyeon
Published: May 2024

Background:

Pyritum, a mineral drug, has been used primarily orally in traditional medicine to treat traumatic injuries, broken tendons, and fractures. Due to growing concerns about the accumulation of heavy metals in the body, this systematic review aims to evaluate the efficacy and safety of Chinese patent medicine containing pyritum for external use (CPMPE) to determine the effectiveness of external use of pyritum.

Methods:

A literature search was performed through China National Knowledge Infrastructure, Wanfang, EMBASE, Cochrane Library, and PubMed from inception to February 2023. “Pyrite,” “pyritum,” “zirantong,” “traditional medicine,” “oriental medicine,” etc, were the keywords from the database. In this systematic review, RCTs and case reports were referred to analyze the efficacy rate and clinical status of CPMPE.

Results:

About 36 studies were reviewed. Of 36 studies, 23 were RCTs and 13 were case reports. The total effective rate in 34 studies was used to evaluate the efficacy of CPMPE for various disease classifications. The effectiveness of CPMPE was confirmed in case reports, and RCTs showed that using CPMPE as a single or combined treatment had a more significant effect than not using CPMPE in anorectal diseases, orthopedic diseases, obstetrics and gynecology diseases, and skin diseases.

Conclusions:

This review concluded that CPMPE might be a safe and effective alternative treatment method for various diseases and has potential benefits in preventing postoperative complications, reducing pain, relieving symptoms, and accelerating healing compared to the control group, which employs unused CPMPE.
Acute ischemic stroke with a diagnosis of Marfan syndrome: A report of 3 cases in multifaceted settings
Authors: Chen Licong , Liu Yuan , Jiang Jianhua , Fang Qi , Zhang Quanquan
Published: May 2024

Rationale:

Marfan syndrome (MFS), which is a dominantly inherited connective tissue disease resulting from a mutation in the FBN1 gene, exhibits variable manifestations affecting the cardiovascular, musculoskeletal, ophthalmologic, and pulmonary systems. Notably, neurologic deficiency, which involves ischemic or hemorrhagic stroke, is a rare but severe manifestation. The safety of rt-PA treatment for ischemic stroke caused by MFS is still under discussion.

Patient concerns:

In the current report, we discuss 3 atypical MFS cases presented as acute ischemic stroke, compared to those exhibiting cardiovascular and musculoskeletal abnormalities.

Diagnoses:

Three patients were diagnosed with acute ischemic stroke accompanied by MFS based on clinical manifestations, imaging examinations, and genetic testings.

Interventions:

The first case underwent intravenous thrombolytic therapy with rt-PA, the second case received antiplatelet therapy, and the third case received anticoagulant therapy and perfusion therapy.

Outcomes:

The neurologic deficiency of all three patients showed improvement upon discharge, and there were no symptoms of recurrence observed during the follow-up period.

Lessons subsections:

MFS is a rare etiology in young people with embolic stroke of undetermined source. Physicians should take MFS into consideration when they observe the characteristic symptoms during a consultation. The potential pathogenesis of ischemic stroke secondary to MFS may include cardio-embolism, arterial dissection, and hypoperfusion. Although intravenous thrombolysis is a promising therapy to treat acute ischemic stroke, further examinations should be conducted to rule out contraindications in patients with a suspicion of MFS.
An examination of the usefulness of a quantitative appraisal method in nursing human resource management in primary hospital operating rooms: An example of integrated collaborative scheduling
Authors: Ding Lijun
Published: May 2024

In recent years, China medical and health services have made great development. However, the management of nursing human resources in operating room of primary hospitals still faces a series of challenges. In the nursing work of operating room, high-quality nursing human resource management is important for improving the efficiency of operating room and ensuring the safety of patients. From January 2022 to December 2022, comprehensive collaborative scheduling and quantitative scoring evaluation methods were carried out in our hospital, and relevant data were collected. The flexible scheduling combined quantitative scoring performance appraisal system and the traditional scheduling plus average distribution performance appraisal system were statistically analyzed and compared in terms of annual surgical cases, annual overtime hours, annual back work hours, annual compensatory rest hours, and average daily working hours. This study was based on 30 medical staff (27 females and 3 males) in the operating room of a primary hospital. The annual operation volume increased by 387 cases compared with before, and the attitudes of patients to the service attitude and preoperative waiting time were significantly improved, reaching more than 95%. In addition, in the survey of surgeons, it was found that their satisfaction with preoperative preparation and operation time was significantly higher than that of the traditional scheduling method, and reached more than 95%. In the survey of nursing staff, it was found that the satisfaction with the traditional scheduling method was about 80%, and the satisfaction directly reached 100% after the comprehensive collaborative scheduling system. Based on the above survey, the satisfaction of nurses, doctors and patients with the new comprehensive collaborative scheduling system has improved compared with before. After the implementation of the comprehensive collaborative scheduling system, the annual surgical volume has increased significantly, and the average daily working hours of nursing staff have decreased. Comprehensive collaborative scheduling is an effective method of nursing human resource management in operating room, which can effectively improve the work efficiency of nurses and the satisfaction of patients, doctors and nurses. In practice, this method needs to be continuously explored and refined to adapt to different application scenarios and requirements.
Evaluating the impact of Sacubitril/valsartan on diastolic function in patients with heart failure: A systematic review and meta-analysis
Authors: Li Jinfu , Song Yanbin , Chen Fengyun
Published: May 2024

Background:

Heart failure is a common and severe condition, often complicated by diastolic dysfunction. Current standard therapies such as ACEIs and ARBs have limited efficacy in managing diastolic function. Sacubitril/Valsartan, an emerging therapy, warrants rigorous investigation to elucidate its impact on diastolic function in heart failure patients.

Methods:

This systematic review and meta-analysis were conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and utilized the PICO schema. Searches were performed on 4 databases—PubMed, Embase, Web of Science, and Cochrane Library—without temporal restrictions. Inclusion and exclusion criteria were strictly defined, and quality assessments were conducted using the Cochrane Collaboration Risk of Bias tool. Both fixed-effects and random-effects models were used for statistical analysis, depending on inter-study heterogeneity assessed by I
2 statistics and Chi-square tests.

Results:

Out of 1129 identified publications, 8 studies met the criteria and were included in the meta-analysis. These studies consisted of both randomized controlled trials and cohort studies and featured diverse global populations. Significant reductions were found in the echocardiographic parameter E/e’ ratio and LAVi upon treatment with Sacubitril/Valsartan compared to standard therapies, with mean differences of −1.38 and −4.62, respectively, both with P values < .01.

Conclusions:

This meta-analysis demonstrates that Sacubitril/Valsartan significantly improves diastolic function parameters in heart failure patients compared to standard treatments. These findings underscore the potential benefits of Sacubitril/Valsartan in the management of heart failure, particularly for patients with diastolic dysfunction.
Edema of the upper extremity on the unaffected side in unilateral breast cancer patients
Authors: Kim Ju Hyeon , Seong Seung Tae , Lee Jae Hyun , Kim Ghi Chan , Jeong Ho Joong , Sim Young-Joo
Published: May 2024

Breast cancer-related lymphedema (BCRL) occurs usually on the affected side, and its cause and pathophysiology are well known. However, the cause of edema of the upper extremity on the unaffected side is barely known. It is often considered to be chemotherapy-induced general edema, and clinical evaluation is rarely performed in these patients. This study aimed to present the clinical characteristics of unilateral breast cancer patients with edema of upper extremity on the unaffected side, and to emphasize the importance of early diagnosis and medical interventions. This study retrospectively analyzed the medical records of unilateral breast cancer patients complaining edema of upper extremity on the unaffected side, from January 2020 to May 2021. Lymphoscintigraphy was used to assist in confirming the diagnosis of lymphedema, and Doppler ultrasonography or 3D computed tomography angiography were performed to differentiate vascular problems. Fourteen patients were enrolled in the study. Seven, 3, and 4 patients had edema of both upper extremities, edema of the upper extremity on the unaffected side only, and edema of all extremities, respectively. None of the 4 patients with edema of all extremities showed abnormal findings on examination. In patients with edema in the upper extremity on the unaffected side alone, lymphatic flow dysfunction was seen in 2 patients, and deep vein thrombosis (DVT) was diagnosed in 1. In patients with edema of both upper extremities, lymphatic flow dysfunction was seen in 2 patients, and DVT was diagnosed in 3. One patient had DVT and accompanying lymphatic flow dysfunction. Lymphedema and DVT were diagnosed in a number of patients with edema of the upper extremity on the unaffected side, and lymphedema can occur without direct injury to the lymphatic flow system. Therefore, clinicians should not overlook the fact that diseases that require early diagnosis and treatment can occur in patients with edema of the unaffected upper extremity.