bluuebunny/crossref_metadata_2025 huggingface dataset:
Eastern Europe
Authors: Dolbunova Ekaterina , Mazurkevich Andrey
Published: February 2025

Eastern Europe encompasses a huge area with different ecotones settled non-uniformly during Mesolithic from c. 10,400–9,200 bc. The end of the Mesolithic in eastern Europe corresponds to the beginning of the Atlantic period when pottery spread over vast areas rather rapidly (c. 6,000–5,600 bc). The Mesolithic strategies increasingly relied on the exploitation of aquatic resources, waterfowl, edible plants, and hunting of animals adapted to the forest and forest-steppe environments. The development of effective use of aquatic resources allowed breaking through ecological barriers posed by large bodies of wetlands and turn them to transport routes and as source of food. Different eastern European Mesolithic cultures were formed on the basis of the local Palaeolithic cultures or under the influence of neighbouring cultures, which resulted in the formation of a number of different technocomplexes. Substantial changes in the social organization of Mesolithic groups are marked by the appearance of large ‘communal’ cemeteries and new forms of art, restricted to several smaller areas within the forest zone of eastern Europe. The Late Mesolithic is characterized by cultural diversity manifested through diversification of complexes.
Human–Animal Relationships
Authors: Mannermaa Kristiina
Published: February 2025

This chapter provides an overview of relations between humans and animals in prehistoric hunter-gatherer cultures. I approach the subject by using archaeological and ethnographic examples from northern Mesolithic contexts, concerning fish, birds, and mammals from various points of view. The approach is based on the generally accepted idea that the worldviews of many recent indigenous and prehistoric groups were relational and multivocal. Relations between humans, animals, plants, landscapes, artefacts, and other things in the past were varied, fluid, and included the notification of agency of other-than-human beings. For Mesolithic groups objects, things, and non-humans may have possessed souls, and these could have been perceived as persons. However, understanding what this may have meant for the people who lived thousands of years ago may be challenging.
Sculpture and Art (Portable and Non-Portable)
Authors: Płonka Tomasz
Published: February 2025

This chapter describes the Mesolithic portable art of Europe and its interpretations. It analyses objects in the form of engravings on tools and ceremonial objects, and non-portable monumental sculptures. The engravings were usually manufactured on artefacts made of bone, antler, wood, and stone, and on amber beads, the latter known only in southern Scandinavia. Most of the artefacts were found in northern Europe where the conditions for the preservation of organic artefacts are favourable. Engraved patterns are rather geometrical; anthropomorphic and zoomorphic motifs are rare. One can distinguish some stylistic differences in this art in Europe. They concern northeastern, northwestern, southwestern, and southern parts of the continent. The patterns relate to the symbolic culture of Mesolithic hunters and gatherers and mirrored their worldview, religious concepts, and mythical relationships. Some of them seem to refer to the shamanistic vision of the world because they present a zonal organization of the motifs which is related to a shamanistic concept how the world is built. This meaning of ornamentation implies that the decoration was a ritual activity and the decorated artefacts themselves were also objects of complex rituals.
Introduction
Authors: Stutz Liv Nilsson , Peyroteo Stjerna Rita , Tõrv Mari
Published: February 2025

Mesolithic research has undergone a series of important transformations over the past several decades, making it one of the most dynamic and prolific fields of archaeology today. The handbook captures our ambition to demonstrate the plurality of perspectives and developments in Mesolithic research, combining theoretically new and innovative questions strongly valuing the methodological connection to the empirical record. It consists of fifty-nine chapters giving voice to a diverse set of authors including established senior researchers and scholars at the beginning of their career, from across the study area. This has enabled us to deliver broad overviews and case studies on the seven key topics of Mesolithic Europe: Mesolithic geographies; hunter-fisher-gatherer landscapes; Mesolithic life; meaningful technology; death and the dead; cosmologies; and ritual and symbolism. We believe that the archaeology of Mesolithic Europe will continue to develop from the strengths demonstrated in this volume, which is its diversity, its commitment to collaborative research, and to a unique connection of exciting exploratory theory, a grounding in the empirical evidence, and a potential to continue to grow with the development of scientific methods.
Orwell and John Milton
Authors: Cook Elizabeth , Waddell Nathan
Published: February 2025

This chapter considers George Orwell’s creative literary relationship with the poet John Milton. Our claim is that the character and function of Milton’s ‘impress’ on Orwell takes a different shape in his fiction and in his non-fiction. In Orwell’s fiction, which mainly (though not exclusively) features quotations from and allusions to Paradise Lost, the relationship is a matter of often straightforward, sometimes ironic evocation. Thematically pertinent lines and ideas in Milton’s work are quoted or alluded to in order to help Orwell clinch a point, or to make a satiric intervention. Orwell’s non-fiction, by contrast, tends to draw Milton into a more directly articulated concern with the question of human liberty—here, the touchstone is Areopagitica (1644). Milton’s availability to Orwell, as a source to imitate and to appropriate, was to some extent a matter of slotting him into a broader spiritual imaginary. But it was also a matter of direct literary influence, with Keep the Aspidistra Flying (1936) and Nineteen Eighty-Four (1949) in particular showing a deep Miltonic strain; and a case of ideological difference, with Milton’s appointment as a state-approved censor providing one very clear point of political discrepancy between the two figures. For Orwell, Milton was a touchstone that could be called upon when required—sometimes praised, sometimes rejected, but always influential, even in negation.
Orwell and George Gissing
Authors: Taylor D. J.
Published: February 2025

The Victorian novelist who meant the most to Orwell and who left the most profound impression on his own work was George Gissing. ‘Perhaps the best novelist England has produced’, Orwell wrote in a Tribune essay from 1943. Compliments to Gissing are scattered through Orwell’s writings like confetti at a wedding, and Orwell repeatedly proselytized on the earlier writer’s behalf. This chapter considers the implications of Orwell’s esteem, and reflects on the Gissing novels he read; on his own writings about Gissing; and on Gissing’s influence on Orwell’s fiction. There were significant gaps in Orwell’s knowledge of Gissing’s writing. However, a Gissing ‘presence’ in Orwell’s fiction is undeniable, as A Clergyman’s Daughter (1935), Keep the Aspidistra Flying (1936), Coming Up for Air (1939), and Animal Farm (1945) make clear. In the end, though, all these occasional diggings beneath the topsoil of Gissing’s work are overshadowed by a wider and more ideological debt—itself all the more remarkable in that Gissing’s ideological tendencies, such as they are, sharply opposed almost everything Orwell held dear. Gissing realized, as Orwell himself was to do, that economic insecurity hits the petit bourgeoisie far more than the working classes, for the thing that is taken away from them in times of crisis is their respectability, the sense of who they are. In Gissing’s gloomy back-streets and depressed lower-middle-class interiors, which were to prove so important for Orwell, the seeds of totalitarianism take root and flourish.
Orwell and Trotskyism
Authors: Goodway David
Published: February 2025

This chapter explores the assertions that Orwell ascribed to some form of Trotskyism. Central to these is his fighting with the quasi-Trotskyist POUM militia in the Spanish Civil War. But this and the following suppression of the POUM were experiences that fostered his analysis of the degeneration of the Russian Revolution and hence were the seed-plot of both Animal Farm and Nineteen Eighty-Four. He saw the Kronstadt mutiny of 1921 (for the repression of which Trotsky had responsibility) as the pivotal event in Russia and hence the reason for the emergence of what he termed ‘oligarchical collectivism’. His almost certain intellectual indebtedness to the American James Burnham, himself a former Trotskyist, is emphasized, as is his assessment of Trotsky whom, unsurprisingly, he held in low esteem.
Orwell and Kindness
Authors: Faragher Megan
Published: February 2025

By centralizing the role of kindness in Orwell’s work, this chapter underscores that while the concept of kindness does not achieve the notoriety of other more central concepts like decency or fair play, instances of it across Orwell’s work are paramount to his vision of a more just future. Where concepts like decency are subject to the flattening impacts of propaganda and polemic, instances of interpersonal kindnesses in works like Homage to Catalonia emerge as incorruptible moments of solidarity. These acts, often in the context of the deadening interpersonal impacts of war and struggle, provide alternatives to the history of spiritual faith that Orwell diagnosed as in decline. This chapter argues that, commanding the role once reserved for faith, kindness in Orwell’s work recenters acts of sacrifice and comradery at the center of anti-fascist resistance.
Orwell, Afrofuturism, and Queer Speculative Fiction
Authors: Dini Rachele
Published: February 2025

This chapter examines the legacy of George Orwell’s Nineteen Eighty-Four in a selection of queer speculative and Afrofuturist novels by British, Japanese, Ghanaian-American, Nigerian, and American writers published between the late 1970s and early 2020s. Kay Dick’s They (1977, reprinted 2022), Yoko Ogawa’s The Memory Police (1994; translated 2019), Nana Kwame Adjei-Brenyah’s ‘Zimmer Land’ (2018), Namwali Serpell’s The Old Drift (2019), and Marisa Crane’s I Keep My Exoskeletons to Myself (2023), I argue, dismantle the white supremacist, patriarchal, heteronormative, and western imperialist principles undergirding Orwell’s text and its most famous descendants, the majority of which are by white Anglo-American male writers. By replacing the individual narrative with a collective one, centring the stories of the oppressed, and sidelining the structures and systems that render their worlds oppressive to focus, instead, on the everyday and, very often, the home, Dick, Ogawa, Serpell, and Crane problematize the Orwellian tradition and reconceptualize the genre of dystopian fiction. I contextualize these texts both within the respective histories to which they allude and within the history of queer speculative and Afrofuturist fiction more generally.
Orwell and Social Media
Authors: Losh Elizabeth
Published: February 2025

Today’s internet critics often draw analogies with the dystopian scenarios in Orwell’s Nineteen Eighty-Four (1949). However, the purpose of these analogies is often to draw attention to the ways that the surveillance depicted in the novel differs significantly from modes of digital surveillance today. The book also seems to remain current in public conversations about social media, because it presents citizens as victims of disinformation and collective amnesia, unable to comprehend basic facts in a paper-free world. However, these characterizations of why Orwell’s work remains relevant in the digital age are necessarily incomplete, and they often ignore the timeliness of material other than Nineteen Eighty-Four as a critical lens for social media, such as Burmese Days (1934) or “Notes on Nationalism” (1945).
Digital Constitutionalism in Australia
Authors: Mann Monique , Murray Angus
Published: February 2025

This chapter examines expansions in telecommunications surveillance law in Australia and highlights the lack of constitutionally protected rights and values that underpin the project of digital constitutionalism. The core critique mounted here is not directed at the project of digital constitutionalism, however. Rather it highlights challenges in realizing or achieving it under certain constitutional frameworks such as Australia’s. While Australia is signatory to numerous international human rights instruments such as the United Nations Declaration of Human Rights, the International Covenant on Civil and Political Rights, and the International Covenant on Economic, Social and Cultural Rights, and is a member of the Freedom Online Coalition and has made commitments to the Declaration for the Future of the Internet, it remains the only Western democracy that lacks a comprehensive and enforceable human rights framework. The absence of such enforceable protections in the ‘offline’ world means there are also limited, if indeed any, protections for rights online (ie ‘digital rights’). The analysis here focuses on aspects of surveillance laws that have significant consequences for the rule of law, democracy, and state power, and that erode the right to privacy. The authors conclude that in the absence of a comprehensive and enforceable human rights framework enshrined in a constitutional or statutory framework (protecting both ‘offline’ and ‘digital’ rights), it will not be possible to realize digital constitutionalism in Australia.
Competition Law in the Spotlight
Authors: Martínez Alba Ribera
Published: February 2025

Digital constitutionalism boils down to the relocation of power across different vectors in the digital arena. Abuses of power crystallize into the functioning of complex systems of governance. Competition law captures those abuses of power via the prohibition of abuse of a dominant position which has permeated public enforcement over conduct taking place in the digital sector. In this field of law, the legal regime meets economics in providing the operable framework for maintaining the competitive dynamics of digital platforms. These efforts to merge both disciplines have not come without friction since the tools at the disposal of competition authorities do not directly pursue the protection of fundamental rights and freedoms. The scales of the antitrust analysis have repeatedly turned in favour of the separation of the discipline from its constitutional outset. Against this background, the chapter drives two critical insights into the study of digital constitutionalism. First, the chapter addresses the transformation of the application of competition law from a punitive framework primarily focused on sanctioning private undertakings to a steering instrument to curb the governance mechanisms of digital platforms. The chapter considers the concept of business ecosystems to narrow that gap and draw out its implications in relation to the constitutional scheme. Second, the chapter reviews the most salient development that the European Union’s competition policy has produced to submit the conduct of digital platforms to the rule of law: the Digital Markets Act.
The MADS6, JAGGED, and YABBY proteins synergistically determine floral organ development in rice
Authors: Cai Zhengzheng , Li Jieqiong , Su Yuanyuan , Zheng Lili , Zhang Jianwei , Zhu Miaomiao , Qiu Bingwen , Kong Lan , Ye Yanfang , Xue Yongbiao , Wu Weiren , Duan Yuanlin
Published: February 2025

MADS6, JAGGED (JAG), and DROOPING LEAF (DL) are key regulators of floral organ patterns in rice (Oryza sativa); however, how they work together in specifying floral organs remains to be determined. Here, we extensively analyzed the coordination mechanism. Genetic interactions showed that all double/triple mutant combinations of mads6-5 with jag and/or dl-sup7 generated an inflorescence from the spikelet center and lemma-like organs (LLOs) at the periphery, indicating that these genes synergistically promote floral organ specification, inhibit inflorescence initiation, and terminate the floral meristem (FM). Particularly, a fully developed mads6-5 jag spikelet appeared as a large bouquet composed of numerous multi-floral complexes (MFC), while the triple mutant was generally similar to mads6-5 jag, except for a longer pedicel and fewer MFCs. Expression analysis revealed that JAG directly inhibits the transcription of MADS6 in stamens but not in pistils, as JAG and DL co-express in pistils and form a JAG-DL complex, indicating that JAG and DL may coordinate the transcription of MADS6 in sexual organs. Protein interactions revealed that MADS6 and JAG bind to five spikelet-related YABBY proteins (including DL), forming ten heterodimers, suggesting that they may promote floral differentiation through various pathways. However, MADS6 and JAG neither bound together nor formed a heterotrimer with any of the five YABBY proteins. These findings revealed specific synergistic patterns between MADS6, JAGGED, and YABBY proteins, which may contribute to the unique characteristics of rice spikelets and provide insights into the diversity regulation mechanisms of floral specification in plants.
Jasmonic acid and nitric oxide orchestrate a hierarchical melatonin cascade for Botrytis cinerea resistance in tomato
Authors: Shan Qing , Zhao Dan , Cao Bili , Zhu Xueying , Wang Chengqiang , Deng Lei , Li Chuanyou , Zhang Yang , Shi Qinghua , Gong Biao
Published: February 2025

Tomato gray mold, caused by Botrytis cinerea (B. cinerea), poses a major challenge to tomato production. In plants, B. cinerea resistance is positively regulated by melatonin; however, the regulatory mechanism of melatonin biosynthesis during B. cinerea infection is not known. Here, we established the working model of jasmonic acid (JA) and nitric oxide (NO) on melatonin biosynthesis in the state of B. cinerea infection. NO responded to B. cinerea infection earlier than JA. In the early stage of infection, tomato caffeic acid O-methyltransferase 2 (SlCOMT2) was S-nitrosylated by NO at Cys344, enhancing the stability of SlCOMT2 and preventing its degradation via the 26S proteasome. In the late stage of infection, JA-triggered SlMYC2 bound to SlCOMT1 and SlCOMT2 promoters for their transcription. NO and JA synergistically enhanced COMT-mediated melatonin biosynthesis during B. cinerea infection via post-translational modification and transcriptional activation. The accumulation of melatonin in tomato leaves inhibited cell death by scavenging reactive oxygen species (ROS), thereby preventing B. cinerea from establishing infection sites. We propose that SlCOMT2Cys344 is a genetic manipulation site or biological breeding target that can be used to enhance melatonin synthesis and B. cinerea resistance in tomato.
Antimycin A induces light hypersensitivity of photosystem II in the presence of quinone QB-site binding herbicides
Authors: Imaizumi Ko , Takagi Daisuke , Ifuku Kentaro
Published: February 2025

Photosynthetic electron transport consists of linear electron flow and two cyclic electron flow (CEF) pathways around photosystem I (PSI) (CEF-PSI). PROTON GRADIENT REGULATION 5 (PGR5)-dependent CEF-PSI is thought to be the major CEF-PSI pathway and an important regulator of photosynthetic electron transfer. Antimycin A (AA) is commonly recognized as an inhibitor of PGR5-dependent CEF-PSI in photosynthesis. Although previous findings imply that AA may also affect photosystem II (PSII), which does not participate in CEF-PSI, these “secondary effects” tend to be neglected, and AA is often used for inhibition of PGR5-dependent CEF-PSI as if it were a specific inhibitor. Here, we investigated the direct effects of AA on PSII using isolated spinach (Spinacia oleracea) PSII membranes, and thylakoid membranes isolated from spinach, Arabidopsis thaliana (wild-type Columbia-0 and PGR5-deficient mutant pgr5hope1), and Chlamydomonas reinhardtii. Measurements of quinone QA− reoxidation kinetics showed that AA directly affects the acceptor side of PSII and inhibits electron transport within PSII. Furthermore, repetitive Fv/Fm measurements revealed that, in the presence of quinone QB-site binding inhibitors, AA treatment results in severe photodamage even from a single-turnover flash. The direct effects of AA on PSII are non-negligible and caution is required when using AA as an inhibitor of PGR5-dependent CEF-PSI. Meanwhile, we found that the commercially available compound AA3, which is a component of the AA complex, inhibits PGR5-dependent CEF-PSI without having notable effects on PSII. Thus, we propose that AA3 should be used instead of AA for physiological studies of the PGR5-dependent CEF-PSI.
Lessons learned from evaluating defined chemical mixtures in a high throughput estrogen receptor assay system
Authors: Parham Fred , Eccles Kristin M , Rider Cynthia V , Sakamuru Srilatha , Xia Menghang , Huang Ruili , Tice Raymond R , Dinse Gregg E , devito Michael J
Published: February 2025

In this paper, we provide a proof of concept evaluating the utility of the U.S. Tox21 high-throughput screening approach to assess the hazard of chemical mixtures using two estrogen receptor assays. A subset of chemicals identified in Phase I of the Tox21 program as active in the estrogen receptor (ER) agonist assay were used to design mixtures for testing in Phase II. Individual chemicals and mixtures were evaluated in two cell-based estrogen receptor alpha (ERα) activation assays: One incorporating a transfected ligand-binding domain in an ERα β-lactamase reporter cell line (ER-bla) and the full-length endogenous receptor in the MCF7 cell line with a luciferase reporter gene (ER-luc). Concentration-response data from individual chemicals were used to predict the joint effect based on mixtures modeling methods and were compared to observed mixtures data to assess model fit. The models tended to overpredict mixture responses in the ER-bla assay, while predictions were closer to observed responses in the ER-luc assay, indicating that a full-length endogenous estrogen receptor is a preferred model for high-throughput mixture analysis. Lessons learned from this research include the importance of analyzing the individual chemicals used for predictions and the mixtures in the same experimental paradigm to minimize variation, developing methods for imputing missing values from incomplete concentration-response curves, and establishing criteria to determine when inactive chemicals should be omitted from mixture predictions.
March of Dimes Gives United States a D+ for Preterm Birth Rates
Authors: Roush Karen
Published: February 2025

Only 16 states meet the Healthy People 2030 infant mortality target.
Medicare Advantage Plans
Authors: Fauteux Nicole
Published: February 2025

A gamble for providers and patients
Addressing Barriers to Career Advancement in Nursing
Authors: Laurent Farah
Published: February 2025

How diverse nursing candidates can position themselves for success
Comparison of Abdominal Aorta Palpation With Ultrasound Imaging Measurements in Healthy Individuals
Authors: Calley Darren Q. , Brennan Peter C. , LeClair Dylan W. , Nogosek Garrett P. , Vaassen Mykenzie E. , Hollman John H.
Published: February 2025

Purpose:

Palpation is a traditional physical exam tool used to screen for abdominal aorta aneurysm. The purpose of this study was to determine agreement and reliability of abdominal aorta palpation measurements compared to point of care ultrasound (POCUS) measurements by novice physical therapy examiners in healthy individuals.

Methods:

Fifty healthy subjects over age 18 participated (age 25.2 ± 3.4). Two novice physical therapy examiners, blinded to each other's findings, measured infrarenal abdominal aorta width using a two-finger palpation technique and with POCUS, using a Vscan Air™ handheld ultrasound device, in randomized order. Bland–Altman analysis and paired t-tests compared agreement between palpation and POCUS measurements. Twenty-five participants returned within a month to assess intrarater reliability.

Results:

POCUS abdominal aorta width measurements averaged 1.54 cm (SD = 0.21), whereas palpation measurements averaged 2.51 cm (SD = 1.07), with a mean difference of 0.97 cm (SD = 1.03; 95% CI [0.67, 1.26]; P < .001). Palpation and POCUS measurements showed a positive correlation of 0.319 (P = .025); however, agreement decreased as aorta size increased. Intrarater reliability for POCUS had an intraclass correlation coefficient (ICC) of 0.58 (95% CI [0.25, 0.79]), and palpation showed intrarater reliability ICC of 0.59 (95% CI [0.25, 0.80]).

Conclusions:

Palpation overestimates infrarenal abdominal aorta width compared to POCUS in healthy individuals when performed by novice physical therapy examiners. While moderate agreement with POCUS exists, palpation accuracy decreases as aorta size increases, showing more variability. Further validation is needed in physical therapy examiners with more experience and in individuals with abdominal aortic aneurysm.
Role of the presence of interatrial block as a prediction pathway of atrial fibrillation during the postoperative period of patients undergoing cardiac surgery
Authors: Meza-Delgado Alfredo J. , Centurión Osmar Antonio , Chavez-Alfonso Christian O. , del Pilar Falcón-Fleytas Rocío , García-Bello Laura B. , Sequeira-Villar Orlando R. , Montiel-Gómez Carmen R. , Candia-Irala José C. , Galeano Erdulfo J.
Published: February 2025

Background:

Atrial fibrillation (AF) is the most frequently recorded arrhythmia in clinical practice, and its appearance conditions high risk of morbidity and mortality. The role of interatrial block (IAB) as predictor pathway of the development of AF in the postoperative period of patients undergoing cardiac surgery has been studied scantly.

Methods:

Partial IAB was defined as the P wave >120 ms, and advanced IAB as the P wave >120 ms with biphasic morphology in inferior leads. The pre-surgical ECG was analyzed and the frequency of AF onset in the postoperative period was determined. A comparative analysis was performed between the patients who presented AF, and those who did not.

Results:

A total of 94 patients were included, with a mean age of 61±16 years. Of the total number of patients, 42 (45%) presented some degree of IAB (partial 42.8%, advanced 57.1%). There was a significant relationship between patients with IAB and those who develop AF post-cardiac surgery (21.3% p<0.01). The presence of interatrial block had an [area under the curve, 0.75; 95% confidence intervals (CI), 0.66–0.85] and demonstrated a specificity of 69%, a sensitivity of 83%, and negative predictive value of 92% for predicting AF development.

Conclusion:

IAB has a relatively frequent incidence in patients undergoing cardiac surgery. There was a significant association between the presence of IAB and the development of AF in the postoperative period. Our findings establish for the first time that IAB has high specificity, sensitivity, and negative predictive value for predicting AF development post-cardiac surgery.
A Smart Computational Tool for Personalized Coronary Blood Flow Settings During Normothermic Ex Situ Heart Perfusion
Authors: Amesz Jorik H. , Lupgens Niki L. , Duncker Dirk J. , Sluijter-Rozendaal Lisa E. , Dumay Dwight , Manintveld Olivier C. , Taverne Yannick J. H. J.
Published: February 2025

Myocardial edema significantly develops during current subnormothermic ex situ heart perfusion (ESHP) procedures, resulting in myocardial function decline during prolonged perfusion. A relatively high coronary blood flow (CBF) during ESHP is thought to be responsible for this high degree of myocardial edema formation. In this study, we present a novel tool to calculate CBF based on individual donor (sex and body weight) and perfusate (hemoglobin concentration, oxygen saturation, partial pressure of oxygen [PO2]) characteristics. The tool continuously evaluates the balance between myocardial oxygen consumption (MVO2) and delivery to facilitate adequate and preventing excess perfusion. Taking this personalized approach, the CBF can potentially be lowered while still providing sufficient oxygen to the donor heart. Furthermore, the tool automatically calculates MVO2, ΔPO2, and coronary vascular resistance during ESHP, which aids in the qualitative assessment of the heart before transplantation.
Rotational thromboelastometry predicts transplant-free survival in patients with liver cirrhosis
Authors: Janko Natasha , Majeed Ammar , Commins Isabella , Gow Paul , Kemp William , Roberts Stuart K.
Published: February 2025

Background and aims

Emerging evidence suggests that rotational thromboelastometry (ROTEM) is superior to conventional haemostatic tests in the assessment and management of bleeding risk in patients with cirrhosis. Whether ROTEM may also be useful for assessing the prognosis of these patients is unknown. We aimed to explore the role of ROTEM in predicting the transplant-free survival of patients with cirrhosis.

Methods

We conducted a prospective cohort study of patients with cirrhosis at two hospitals. All patients underwent ROTEM analysis at baseline and were followed up until death, liver transplantation or the end of follow-up (28 February 2023). Univariate and multivariate Cox regression analyses were performed to explore the association between transplant-free survivals.

Results

Between April 2018 and October 2021, 162 patients with cirrhosis were recruited and followed-up for a median of 42 months. During follow-up, 36 patients died and 7 underwent liver transplantation. On univariate analysis, maximum clot firmness (MCF) using both EXTEM and INTEM tests was significantly reduced in the death/liver transplant group compared to the survivor group (52 vs. 57, P = 0.02; and 51 vs. 55, P = 0.01, respectively). After adjusting for age, sex, presence of clinically significant portal hypertension, hepatocellular carcinoma, care setting, bilirubin, sodium and creatinine, only albumin (hazard ratio: 0.92, 95% CI: 0.85–0.99, P = 0.018) and MCFEXT (hazard ratio: 0.96, 95% CI: 0.92–0.99, P = 0.032) remained significant predictors of transplant-free survival.

Conclusion

ROTEM may be useful in assessing the survival of patients with cirrhosis. Further research is needed to determine the clinical utility of ROTEM parameters as prognostic markers in cirrhosis.
The use of pre-endoscopic metoclopramide in patients with upper gastrointestinal bleeding: a systematic review and meta-analysis
Authors: Zaidi Syed Muhammad Mehdi , Alvi Mustafa Hassan , Irfan Qunoot , Abbasi Laraib , Zohair Muhammad , Abbas Zainab , Qyoum Ahsan , Danish Rabee
Published: February 2025

Introduction

Upper gastrointestinal bleeding (UGIB) is a critical condition with an incidence of 80–150 cases per 100 000 annually and a mortality rate of 2–15%. Endoscopy is crucial for diagnosis and treatment. Prokinetic agents like metoclopramide are studied for their potential to improve visualization by promoting gastric motility. This meta-analysis evaluates the efficacy of intravenous metoclopramide in enhancing endoscopic visualization and clinical outcomes in UGIB patients.

Materials and methods

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review and meta-analysis using PubMed, Embase, Cochrane Library, and Scopus up to July 2024. We included randomized controlled trials involving UGIB patients who received intravenous metoclopramide vs placebo. Primary outcome was endoscopy visualization score (EMV). Meta-analysis was conducted using RevMan 5.4. This review was registered in PROSPERO RD42024552979.

Results

Five studies with 515 patients were included. The pooled analysis for overall EMV scores indicated significant improvement in metoclopramide group [standardized mean difference 0.47 (95% confidence interval, CI: 0.12–0.82)]. Repeat endoscopy showed no significant difference 0.70 (95% CI: 0.38–1.29). The mean difference for hospital stay was minimal and not significant [mean difference −0.06 (95% CI: −0.24 to 0.12)]. The mean number of red blood cell transfusions was slightly higher but not significant [mean difference 0.04 (95% CI: −0.14 to 0.22)].

Conclusion

Intravenous metoclopramide before endoscopy in UGIB patients improved EMV scores, while the other clinical outcomes were not significant. These findings suggest potential benefits of metoclopramide in UGIB, highlighting the need for further research with larger studies to confirm its effectiveness.
Is type 2 diabetes a link between lung function and metabolic dysfunction–associated steatotic liver disease? Insights from population studies and Mendelian randomization
Authors: Cao Runmin , Zhang Yurun , Cao Ling , Jiang Honghe
Published: February 2025

Aim:

This study aimed to investigate the relationship between lung function and metabolic dysfunction–associated steatotic liver disease (MASLD), and the potential mediating role of type 2 diabetes.

Methods

Data from the 2007 to 2012 National Health and Nutrition Examination Survey were used. Logistic regression analysis was employed to assess the association between lung function parameters [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC] and MASLD prevalence while exploring type 2 diabetes mediation. Further analyses included linkage disequilibrium score regression, Mendelian randomization, and meta-analysis to examine the causal relationship between lung function and MASLD, considering type 2 diabetes mediation.

Results

The results showed that higher FVC and FEV1 levels were associated with decreased MASLD risk, with type 2 diabetes partially mediating this relationship. Genetic analyses supported a causal link between lung function and MASLD, with type 2 diabetes acting as an intermediary. However, no significant association was found between FEV1/FVC and MASLD.

Conclusion

The study identified a causal relationship between lung function and MASLD, with type 2 diabetes playing a partial mediating role.
The mediating role of BMI in alcohol-linked liver enzyme elevation among adults at a tertiary care hospital in South India
Authors: Barathi Arivarasan , Krishnamoorthy Yuvaraj , Kannan Suthanthira , Govindhan Dhanajayan , Elangovan Venmathi , Subbiah Padmavathi , Kuberan Deivasigamani
Published: February 2025

Background

Excessive alcohol consumption is a major risk factor for liver disease, with significant variations in its impact across populations. BMI has been identified as a potential mediator in alcohol-related liver damage. This study aimed to examine the association between alcohol consumption and liver function and to explore the mediating role of BMI in a population from India, where both are rising public health concerns.

Materials and methods

A cross-sectional study was conducted using data from adult participants. Liver function was assessed using serum levels of gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP). Alcohol consumption was self-reported, and BMI was calculated AST from height and weight measurements. Multiple linear regression models were used to evaluate the relationship between alcohol consumption and liver enzymes while adjusting for BMI as a mediator. Statistical significance was set at P < 0.05.

Results

The results indicated that higher alcohol consumption was significantly associated with elevated levels of GGT, ALT, and AST. BMI was found to mediate this relationship, with individuals having higher BMI showing a greater increase in liver enzyme levels in response to alcohol consumption. However, no significant association was observed for ALP. BMI also independently correlated with higher levels of GGT, ALT, and AST.

Conclusion

This study highlights the mediating role of BMI in alcohol-induced liver dysfunction in the Indian population. Public health interventions focusing on both reducing alcohol intake and managing obesity may help mitigate the risk of liver disease in this high-risk population.
Treatment of Gonorrhea in setting of Ceftriaxone allergy
Authors: Morton Erin E. , Winters Shannon E. , Cannon Chase A. , Ramchandani Meena S. , Soge Olusegun O. , Altman Matthew C.
Published: February 2025

Treating Neisseria gonorrhoeae infection in patients with cephalosporin allergy represents a significant challenge and highlights urgent need for alternative therapies. This patient case details use of alternative antimicrobials to cure urogenital and pharyngeal gonorrhea in a patient with a severe ceftriaxone allergy in the outpatient clinical setting.
Rare Liver Diseases With Near-Normal Histology: A Review Focusing on Metabolic, Storage, and Inclusion Disorders
Authors: Du Xiaotang , Wang Hanlin L.
Published: February 2025

Despite the growing availability of noninvasive and faster diagnostic modalities, biopsy remains an important tool in the diagnosis and management of liver diseases. However, it is not uncommon that liver biopsies reveal normal or near normal histologic findings in patients with abnormal liver biochemistries, elevated autoantibodies, clinical findings suggestive of portal hypertension, systemic autoimmune or inflammatory diseases, hepatomegaly, cirrhosis by imaging, or other indications. These scenarios present significant diagnostic challenges and are rarely discussed in detail in the literature or textbooks. This article aims to provide a comprehensive review of a group of selected rare liver diseases, with a focus on metabolic, storage and inclusion disorders, that may exhibit a near-normal histology on biopsy. By recognizing subtle histologic features and correlating with clinical history, laboratory results and imaging findings, it is often possible to narrow down the differential diagnosis. In many cases, this integrative approach can yield a definitive diagnosis, allowing for tailored treatment and better patient outcomes.
Preferences for monthly oral PrEP over other PrEP modalities among a national sample of gay, bisexual, and other men who have sex with men in the United States
Authors: Gravett Ronnie M. , Long Dustin M. , Biello Katie B. , Mayer Kenneth H. , Krakower Douglas S. , Hill-Rorie Jonathan , Lillis Rebecca A. , Whiteside Yohance , Elopre Latesha
Published: February 2025

Introduction:

Pre-exposure prophylaxis (PrEP) cannot meaningfully impact the HIV epidemic in the United States without improving access to PrEP and reducing PrEP disparities among gay, bisexual, and other men who have sex with men (GBM), especially GBM of color. A patient-centered approach to increase PrEP options will offer better PrEP solutions to GBM. We sought to understand how GBM prefer current and emerging PrEP modalities.

Methods:

We conducted a national online survey among adult GBM to determine preferences for current and emerging PrEP modalities (daily, on-demand, and monthly oral, subcutaneous and intramuscular injectable, implantable, and rectal douche) and perceived barriers, based on their lived experiences. We determined PrEP modality preferences and associations using multivariable exploded logit regression model.

Results:

723 GBM completed the survey. The largest proportion preferred monthly oral PrEP (n=207, 28.6%), and over half preferred some form of oral PrEP. Race was significantly associated with PrEP modality preference, and Black GBM preferred daily oral PrEP most. Side effects, healthcare visits, administration route and frequency influenced PrEP preferences. PrEP and HIV knowledge, and HIV risk were associated with PrEP modality choice. GBM considered out-of-pocket cost and side effects as the significant barriers to PrEP care.

Conclusions:

Monthly oral PrEP was most preferred with oral options preferred more than other modalities. Black GBM most preferred daily oral PrEP, which could be due to lack of familiarity with the emerging products. Future PrEP provision must include patient-centered prevention plans that include enhanced education and counseling to promote use of newer agents.
Exosomes obtained from human adipose-derived stem cells alleviate epileptogenesis in the pentylenetetrazol model of epilepsy
Authors: Derisfard Fateme , Jafarinezhad Zahra , Azarpira Negar , Namavar Mohammad Reza , Aligholi Hadi
Published: February 2025

As exosome therapy is a promising treatment in neurological disorders including epilepsy, the present study aimed to evaluate the effects of exosomes obtained from human adipose-derived stem cells (ADSCs) on pentylenetetrazol (PTZ) model of epilepsy in mice. Thirty adult mice were divided into PTZ, diazepam + PTZ, and exosome (5, 10, and 15 µg) + PTZ groups. The exosomes were administered intranasally 30 min before PTZ injection. The seizure latency, tonic-clonic onset, seizure duration, and mortality protection rate were monitored. Also, the level of hippocampal malondialdehyde (MDA), the oxidative stress marker, was evaluated. Exosomes in 5 and 15 µg concentration significantly increased seizure latency. Only 15 µg of exosomes induced a considerable delay in tonic-clonic onset. Seizure duration was significantly attenuated in the 5 µg exosome group. In addition, the 5-µg exosome indicated the highest mortality protection rate. Furthermore, the MDA level was significantly reduced in all animals treated by exosomes. Exosomes obtained from human ADSCs could alleviate epileptogenesis induced by PTZ maybe through reducing hippocampal oxidative stress.
The effect of referential and emotional information on novel word learning: an fNIRS study
Authors: Li Shan , Sui Xue , Hu Yanbo , Li Yutong
Published: February 2025

The current study utilized functional near-infrared spectroscopy to examine the neural mechanisms underlying the effect of referential and emotional information on novel word learning. After learning the meaning of novel words in different sentences, participants were asked to complete a semantic consistency judgment task and a source judgment task. The behavioral data and neural data were recorded simultaneously. The results showed that: (1) referential information affected the novel word learning; (2) the interaction between referential and emotional information was significant; (3) these effects were associated with neural activities in the frontal and temporal lobe, mainly in the activation of the dorsolateral prefrontal cortex, the inferior frontal gyrus, the middle temporal gyrus, the superior temporal gyrus, and the premotor and supplementary motor cortex. The findings suggested that self-referential information could promote the novel word learning. Notably, referential and emotional information jointly affected the novel word learning in the frontal and temporal lobe, indicating the integrative contributions of both referential and emotional information to novel word learning.
State-dependent neural signatures of autistic traits: evidence from fNIRS-based fractional amplitude of low-frequency fluctuation analysis during natural social interaction
Authors: Feng Shuyuan , Yuan Yuqing , Wang Mingliang , Zhang Jianing , Ding Lin , Zhang Peng , Bai Xuejun
Published: February 2025

Autistic traits exist on a continuum within the general population, yet how these traits influence regional neural activity during real-world social interactions remains unclear. Using functional near-infrared spectroscopy (fNIRS), we investigated how autistic traits relate to the fractional amplitude of low-frequency fluctuations (fALFF) during both resting-state and real-time conversations in 62 high autistic trait and 58 low autistic trait neurotypical adults. While resting-state differences were minimal, significant group differences emerged during conversation. Specifically, individuals with high autistic traits showed lower ΔfALFF in the right superior temporal gyrus, with the largest differences observed during emotionally positive topics. Interestingly, although fALFF strongly correlated with functional connectivity across both states, only ΔfALFF demonstrated sensitivity to autistic traits. These findings reveal state-dependent neural differences linked to autistic traits, emphasizing the importance of studying brain activity during naturalistic social interactions. Our results provide new insights into how autistic traits modulate neural processing during dynamic social contexts and suggest fALFF change as a sensitive marker for studying social processing differences.
Text understanding in GPT-4 versus humans
Authors: Shultz Thomas R. , Wise Jamie M. , Nobandegani Ardavan S.
Published: February 2025

We examine whether a leading AI system, GPT-4, understands text as well as humans do, first using a well-established standardized test of discourse comprehension. On this test, GPT-4 performs slightly, but not statistically significantly, better than humans given the very high level of human performance. Both GPT-4 and humans make correct inferences about information that is not explicitly stated in the text, a critical test of understanding. Next, we use more difficult passages to determine whether that could allow larger differences between GPT-4 and humans. GPT-4 does considerably better on this more difficult text than do the high school and university students for whom these the text passages are designed, as admission tests of student reading comprehension. Deeper exploration of GPT-4’s performance on material from one of these admission tests reveals generally accepted signatures of genuine understanding, namely generalization and inference.
Disseminated tuberculosis with rare coccygeal involvement: a case report
Authors: Baziaa Sarra , Zegmout Adil , beaouiss Mohamed , el fathi soufiane , Rafik Aniss , souhi hicham , Rhorfi Ismail , El Ouazzani Hanane
Published: February 2025

Introduction : Tuberculosis (TB) is a preventable and usually curable disease but remains a major health problem worldwide, particularly in developing countries. TB of the lumbosacral junction is rare and occurs in only 1% to 2% of all cases of spinal TB. Moreover, isolated sacrococcygeal TB is extremely rare.
Case report : We present a case of a 64-year-old patient with a history of diabetes who presented with chronic back pain and cough. Physical examinations revealed a peri-anal fistula and left elbow joint arthritis. the patient is diagnosed with disseminated tuberculosis with coccygeal involvement. Diagnosis was achieved non-invasively using Xpert MTB/RIF confirming Mycobacterium tuberculosis infection. The patient experienced complete resolution of symptoms following the commencement of anti-tuberculosis therapy.
Conclusion : We highlight the importance of this case due to the rare coccygeal localization of tuberculosis in an immunocompetent patient, diagnosed through non-invasive means.