bluuebunny/crossref_metadata_2025 huggingface dataset:
Energy potential assessment and techno–economic analysis of micro hydro–photovoltaic hybrid system in Goda Warke village, Ethiopia
Authors: Feyissa Ephrem Assefa , Tibba Getachew Shunki , Binchebo Tarekegn Limore , Bekele Endeshaw Alemu , Kole Adem Tibesso
Published: January 2024

Rural Ethiopia has significant untapped potential for hydro and solar energy generation systems. However, challenges arise from seasonal variations and unfavourable topographic positions of flowing rivers, hindering the efficient exploitation of these resources. Despite the country’s abundance in hydro and solar energy resources, >75% of the population still lack access to electricity from the national grid. This work deals with energy resource potential assessment and techno–economic analysis of micro hydro–photovoltaic (PV) hybrid systems, considered in the case study of Goda Warke village, located in the Yaya Gulele district. A novel framework is proposed that utilizes the Natural Resource Soil Conservation Service curve number method to assess the energy potential of micro-hydro energy in ungauged basins, specifically at the exit point of the Girar River basin catchment. The average monthly flow rate in the basin is 0.975 m3/s, while the area exhibits a solar radiation potential of 5.39 kWh/m2/day. Energy policy promotes expanding access to modern energy sources and utilization of indigenous energy resources. Simulation results indicate that the hydro/PV/diesel generator (DG)/battery and hydro/PV/battery systems are the most optimal choices based on net present cost, with the inclusion of a DG for economic comparison. Micro-hydro energy covers most of the electric load in the area, achieving a capacity factor of 47.5%. The cost of energy and net present cost were found to be sensitive to variables such as the price of diesel fuel, pipe head loss, and the growth of the village load. The optimized system demonstrated a hydro energy potential of 1405.37 MWh/year and a PV energy output of 274.04 MWh/year, resulting in a levelized cost of energy of 0.0057 and 0.049 $/kWh for the hydro and PV components, respectively.
Explainable machine learning using echocardiography to improve risk prediction in patients with chronic coronary syndrome
Authors: Molenaar Mitchel A , Bouma Berto J , Asselbergs Folkert W , Verouden Niels J , Selder Jasper L , Chamuleau Steven A J , Schuuring Mark J
Published: January 2024

Aims

The European Society of Cardiology guidelines recommend risk stratification with limited clinical parameters such as left ventricular (LV) function in patients with chronic coronary syndrome (CCS). Machine learning (ML) methods enable an analysis of complex datasets including transthoracic echocardiography (TTE) studies. We aimed to evaluate the accuracy of ML using clinical and TTE data to predict all-cause 5-year mortality in patients with CCS and to compare its performance with traditional risk stratification scores.

Methods and results

Data of consecutive patients with CCS were retrospectively collected if they attended the outpatient clinic of Amsterdam UMC location AMC between 2015 and 2017 and had a TTE assessment of the LV function. An eXtreme Gradient Boosting (XGBoost) model was trained to predict all-cause 5-year mortality. The performance of this ML model was evaluated using data from the Amsterdam UMC location VUmc and compared with the reference standard of traditional risk scores. A total of 1253 patients (775 training set and 478 testing set) were included, of which 176 patients (105 training set and 71 testing set) died during the 5-year follow-up period. The ML model demonstrated a superior performance [area under the receiver operating characteristic curve (AUC) 0.79] compared with traditional risk stratification tools (AUC 0.62–0.76) and showed good external performance. The most important TTE risk predictors included in the ML model were LV dysfunction and significant tricuspid regurgitation.

Conclusion

This study demonstrates that an explainable ML model using TTE and clinical data can accurately identify high-risk CCS patients, with a prognostic value superior to traditional risk scores.
Immunoinformatics assisted design of a multi-epitope kit for detecting Cronobacter sakazakii in powdered infant formula
Authors: Oladipo Elijah K , Obisanya Olukayode I , Owoeye Victoria O , Shittu Oyinlola G , Adamitonde Mautin G , Ikwuka Emmanuel C , Ojewale Solomon O , Tijani Adewale J , Adedokun Feranmi A , Adedokun Amudatu A , Oyedepo Temitope A , Onyeaka Helen
Published: January 2024

Objectives

Cronobacter sakazakii, formerly Enterobacter sakazakii, is an emerging ubiquitous and opportunistic foodborne pathogen with a high mortality rate. It has been implicated in cases of meningitis, septicaemia, and necrotizing enterocolitis among infants worldwide in association with powdered infant formula (PIF). This study was an insilico designed peptide base kit framework, using immunoinformatic techniques for quick detection of C. sakazakii in PIF.

Materials and Methods

In the present study, a peptide-based kit was designed with a bioinformatic technique to rapidly identify C. sakazakii in PIF using flhE, secY, and bcsC, which are genes responsible for its biofilm formation, as target genes. The antigenicity, membrane topology, and the presence of signal peptides of the target genes were analysed using VaxiJen, DeepTMHMM, and SignalP servers. To provide stability and flexibility to the multiple-epitope construct, the linear B cells and helper T cells (IL-4 (interleukin 4) and IL-10 (interleukin 10) inducing epitopes) were linked with a GSGSG linker followed by the addition of protein disulphide bonds. To ascertain specificity, the multi-epitope construct was molecularly docked against genes from sources other than PIF, like alfalfa, and the environment, with PIF being the highest: –328.48. Finally, the codons were modified using the pET28a(+) vector, and the resultant multi-epitope construct was successfully cloned in silico.

Results

The final construct had a length of 486 bp, an instability index of 23.26, a theoretical pI of 9.34, a molecular weight of 16.5 kDa, and a Z-score of –3.41.

Conclusions

The multi-epitope peptide construct could be a conceptual framework for creating a C. sakazakii peptide-based detection kit, which has the potential to provide fast and efficient detection. However, there is a need for additional validation through the in vitro and in vivo techniques.
Association between piperacillin/tazobactam use and acute kidney injury in critically ill patients: a retrospective multicentre cohort study
Authors: Tomazini Bruno Martins , Besen Bruno Adler Maccagnan Pinheiro , Taniguchi Leandro Utino , Zampieri Fernando Godinho , Cavalcanti Alexandre Biasi
Published: January 2024

Background

Piperacillin/tazobactam is one of the most common antibiotics prescribed in the ICU and the combination of piperacillin/tazobactam with vancomycin has been associated with acute kidney injury (AKI) in critically ill patients. However, data on the risk of AKI with piperacillin/tazobactam, despite vancomycin co-exposure, are lacking.

Objectives

To investigate the association of piperacillin/tazobactam with AKI and renal replacement therapy (RRT) among adult ICU patients.

Methods

We analysed data from patients included in two open access databases (MIMIC-IV and eICU). Critically ill patients who received piperacillin/tazobactam or cefepime (a cephalosporin with similar broad-spectrum activity to piperacillin/tazobactam) during their first ICU stay were eligible for the study. Marginal structural Cox models, accounting for time-fixed covariates and time-dependent covariates were performed. The primary outcomes were AKI and need of RRT.

Results

A total of 20 107 patients were included, with 11 213 in the piperacillin/tazobactam group and 8894 in the cefepime group. Exposure to piperacillin/tazobactam was associated with AKI (HR 1.77; 95% CI 1.51–2.07; P < 0.001) and with need of RRT (HR 1.31; 95% CI 1.08–1.57; P = 0.005). Tests for interaction were not statistically significant for occurrence of AKI and RRT in the subgroup of patients exposed to vancomycin or not (P = 0.26 and P = 0.6, respectively).

Conclusions

In critically ill patients, exposure to piperacillin/tazobactam was associated with increased risk of AKI and with increased risk of RRT, regardless of combination therapy with vancomycin.
Association of piperacillin and vancomycin exposure on acute kidney injury during combination therapy
Authors: Venugopalan Veena , Maranchick Nicole , Hanai Devorah , Hernandez Yaima Jimenez , Joseph Yuliya , Gore Amanda , Desear Kathryn , Peloquin Charles , Neely Michael , Felton Timothy , Shoulders Bethany , Alshaer Mohammad
Published: January 2024

Objectives

Acute kidney injury (AKI) is a well-documented adverse effect observed with piperacillin/tazobactam in combination with vancomycin. The pharmacokinetics of these antibiotics when given in combination have not been previously evaluated. The purpose of this study was to compare the exposure of vancomycin + piperacillin/tazobactam in patients with and without AKI.

Methods

Ninety adult patients, who received at least 72 h of vancomycin + piperacillin/tazobactam combination therapy and had available serum concentrations of vancomycin and piperacillin were included in the study. Nephrotoxicity was defined as a 1.5-fold increase in serum creatinine within 7 days from baseline. Median daily AUCs were calculated in those with nephrotoxicity (vancomycin + piperacillin/tazobactam ‘N’) versus those without nephrotoxicity (vancomycin + piperacillin/tazobactam ‘WN’) during the first 7 days of combination therapy.

Results

The overall incidence of AKI in those receiving vancomycin + piperacillin/tazobactam was 20% (18/90). The median daily vancomycin AUCs did not differ between the vancomycin + piperacillin/tazobactam ‘WN’ and vancomycin + piperacillin/tazobactam ‘N’ groups. Although not statistically significant, the median daily vancomycin AUCs in the vancomycin + piperacillin/tazobactam ‘N’ group were numerically greater on Day 5 and trended downwards thereafter. For the piperacillin group, the median daily AUCs did not vary between groups, except on Day 7 where the vancomycin + piperacillin/tazobactam ‘WN’ group had statistically greater median piperacillin AUC than the vancomycin + piperacillin/tazobactam ‘N’ group (P = 0.046).

Conclusions

Utilizing serum creatinine-defined AKI, our study did not find any significant differences in vancomycin and piperacillin/tazobactam exposure between the groups with and without nephrotoxicity. These data indicate that vancomycin + piperacillin/tazobactam should not be avoided due to the risk of overexposure; instead, clinicians should continue to use these therapies cautiously.
Implementing the WHO AWaRe antibiotic book guidance in lower-resource settings: the case of the Lao PDR
Authors: Chansamouth Vilada , Inlorkham Phouthavanh , Keohavong Bounxou , Bellingham Khonsavath , van Doorn H Rogier , Mayxay Mayfong , Newton Paul N , Turner Paul , Day Nicholas P J , Ashley Elizabeth A
Published: January 2024

In 2022, WHO released the WHO AWaRe (Access, Watch, Reserve) antibiotic book to promote the rational use of antibiotics. Here, we review the AWaRe antibiotic book from the perspective of implementation in low-resource settings, using the Lao PDR (Laos) as a case study. Not all recommendations in the AWaRe antibiotic book match the epidemiology of infectious diseases and antimicrobial susceptibility patterns in Laos and other low- and middle-income countries (LMICs), e.g. melioidosis, rickettsial disease and leptospirosis are common causes of sepsis and febrile illness in Laos but do not feature in the AWaRe book. Conversely, some infectious diseases like Clostridioides difficile-associated diarrhoea are in the AWaRe antibiotic book but rarely considered in Laos with no diagnostic tests available. Only 29/39 antibiotics in the AWaRe book are available in Laos, with no Reserve group antimicrobials available. The AWaRe book stimulates countries such as Laos to consider alternative diagnoses and include additional antimicrobials in the national essential medicines list (NEML). However, it should be updated to include regional important pathogens that are not included. Comprehensive antibiotic use guidelines alone might not assure appropriate use or control overuse of antibiotics. Access to antibiotics is challenging in low-resource settings in terms of unavailability in the country (low demand or small market size), patchy access, especially for those living in remote areas, and unaffordability. All these systemic factors can contribute to inappropriate use of antibiotics. Improved access to antibiotics, strengthening diagnostic capacity and promoting antibiotic stewardship should be combined.
A single-institution retrospective exploratory analysis on the effectiveness and safety of lenvatinib plus pembrolizumab for advanced endometrial cancer: insights from ProMisE molecular classification system
Authors: Chiba Yohei , Kagabu Masahiro , Osakabe Mitsumasa , Ito Rikako , Sato Sho , Takatori Eriko , Kaido Yoshitaka , Nagasawa Takayuki , Shoji Tadahiro , Yanagawa Naoki , Baba Tsukasa
Published: January 2024

Background

The Proactive Molecular Risk Classifier for Endometrial Cancer has identified four risk groups for the prognosis of endometrial cancer. Lenvatinib plus pembrolizumab was recently approved as a second-line treatment for unresectable endometrial cancer, but reports in clinical practice are lacking. The relationship between the efficacy of lenvatinib/pembrolizumab and Proactive Molecular Risk Classifier for Endometrial Cancer classification is unclear.

Methods

This single-centre retrospective study included patients who underwent lenvatinib/pembrolizumab therapy at Iwate Medical University Hospital between January 2022 and March 2023. Formalin-fixed paraffin-embedded specimens obtained from patients before treatment were collected and classified into the mismatch repair-deficient, p53 abnormal and no specific molecular profile subtypes using immunohistochemistry. The response rate, progression-free survival and adverse events were evaluated using electronic medical records. The study was approved by the hospital’s ethics committee (approval number: MH2022-093).

Results

This study enrolled 20 patients, who underwent a median follow-up of 17.8 months (95% confidence interval: 16.6–18.9). The best overall response rate was 60.0% (36.1–80.9), and the median progression-free survival was 11.6 months (2.9–20.3). The median progression-free survival in the p53 abnormal group (n = 9) was 3.4 months (3.0–3.8); however, progression-free survival did not reach the median (P < 0.001) in the mismatch repair-deficient/no specific molecular profile group (n = 11). Symptomatic immune-related adverse events (except hypothyroidism) occurred in 4/20 (25.0%) patients, and partial responses were observed in all cases. No treatment-related deaths occurred.

Conclusion

The p53abn group in the Proactive Molecular Risk Classifier for Endometrial Cancer classification has a poor prognosis even after treatment with lenvatinib/pembrolizumab.
Real-world outcomes of nivolumab plus ipilimumab combination therapy for advanced renal cell carcinoma in Japanese patients: data with a minimum of 3 years of follow-up
Authors: Ishihara Hiroki , Yuki Nemoto , Ishiyama Ryo , Ikeda Takashi , Kobari Yuki , Fukuda Hironori , Yoshida Kazuhiko , Shimmura Hiroaki , Hashimoto Yasunobu , Iizuka Junpei , Kondo Tsunenori , Takagi Toshio
Published: January 2024

Background

Long-term follow-up data regarding treatment outcomes of nivolumab plus ipilimumab combination therapy for advanced renal cell carcinoma as a first-line therapy are limited in real-world Japanese populations.

Methods

We retrospectively evaluated data of 56 advanced renal cell carcinoma patients treated with nivolumab plus ipilimumab, with a follow-up of at least 3 years. Survival, tumour response and adverse event profiles were assessed.

Results

A total of 41 patients (73%) were histopathologically diagnosed with clear-cell renal cell carcinoma, and 34 (61%) were categorized into the International Metastatic renal cell carcinoma Database Consortium intermediate-risk group. The median follow-up period was 34.4 months. Regarding an effectiveness profile, median progression-free survival, time to treatment failure and overall survival were 9.01, 12.5 and 49.0 months, respectively. Objective response was observed in 27 patients (48%), including eight patients with complete response (14%), and the median duration of response was 30.8 months. Multivariate analyses showed that clear-cell histology was an independent factor of longer overall survival (hazard ratio: 0.23, P = 0.0013). Regarding safety profiles, adverse events of any grade and those with grade ≥3 developed in 40 (71%) and 25 patients (45%), respectively. Median time to adverse event development was 1.68 months. Treatment was interrupted in 28 patients (50%), and corticosteroid administration was needed in 25 (45%).

Conclusion

The 3-year follow-up data showed that nivolumab plus ipilimumab combination therapy exhibited a feasible effectiveness in real-world Japanese patients with advanced renal cell carcinoma. Accordingly, the high risk of adverse event development, which often requires treatment withdrawal and corticosteroid administration, should be considered.
Invasive cervical cancer incidence following bivalent human papillomavirus vaccination: a population-based observational study of age at immunization, dose, and deprivation
Authors: Palmer Tim J , Kavanagh Kimberley , Cuschieri Kate , Cameron Ross , Graham Catriona , Wilson Allan , Roy Kirsty
Published: January 2024

Background

High-risk human papillomavirus causes cervical cancer. Vaccines have been developed that significantly reduce the incidence of preinvasive and invasive disease. This population-based observational study used linked screening, immunization, and cancer registry data from Scotland to assess the influence of age, number of doses, and deprivation on the incidence of invasive disease following administration of the bivalent vaccine.

Methods

Data for women born between January 1, 1988, and June 5, 1996, were extracted from the Scottish cervical cancer screening system in July 2020 and linked to cancer registry, immunization, and deprivation data. Incidence of invasive cervical cancer per 100 000 person-years and vaccine effectiveness were correlated with vaccination status, age at vaccination, and deprivation; Kaplan Meier curves were calculated.

Results

No cases of invasive cancer were recorded in women immunized at 12 or 13 years of age irrespective of the number of doses. Women vaccinated at 14 to 22 years of age and given 3 doses of the bivalent vaccine showed a significant reduction in incidence compared with all unvaccinated women (3.2/100 000 [95% confidence interval (CI) = 2.1 to 4.6] vs 8.4 [95% CI = 7.2 to 9.6]). Unadjusted incidence was significantly higher in women from most deprived (Scottish Index of Multiple Deprivation 1) than least deprived (Scottish Index of Multiple Deprivation 5) areas (10.1/100 000 [95% CI = 7.8 to 12.8] vs 3.9 [95% CI = 2.6 to 5.7]). Women from the most deprived areas showed a significant reduction in incidence following 3 doses of vaccine (13.1/100 000 [95% CI = 9.95 to 16.9] vs 2.29 [95% CI = 0.62 to 5.86]).

Conclusion

Our findings confirm that the bivalent vaccine prevents the development of invasive cervical cancer and that even 1 or 2 doses 1 month apart confer benefit if given at 12-13 years of age. At older ages, 3 doses are required for statistically significant vaccine effectiveness. Women from more deprived areas benefit more from vaccination than those from less deprived areas.
Prediction for distributional outcomes in high-performance computing input/output variability
Authors: Xu Li , Hong Yili , Morris Max D , Cameron Kirk W
Published: January 2024

Although high-performance computing (HPC) systems have been scaled to meet the exponentially growing demand for scientific computing, HPC performance variability remains a major challenge in computer science. Statistically, performance variability can be characterized by a distribution. Predicting performance variability is a critical step in HPC performance variability management. In this article, we propose a new framework to predict performance distributions. The proposed framework is a modified Gaussian process that can predict the distribution function of the input/output (I/O) throughput under a specific HPC system configuration. We also impose a monotonic constraint so that the predicted function is nondecreasing, which is a property of the cumulative distribution function. Additionally, the proposed model can incorporate both quantitative and qualitative input variables. We predict the HPC I/O distribution using the proposed method for the IOzone variability data. Data analysis results show that our framework can generate accurate predictions, and outperform existing methods. We also show how the predicted functional output can be used to generate predictions for a scalar summary of the performance distribution, such as the mean, standard deviation, and quantiles. Our prediction results can further be used for HPC system variability monitoring and optimization. This article has online supplementary materials.
Examining efforts to predict day-of-surgery cancellation (DOSC): a systematic review protocol
Authors: Sardesai Thomas , Hobbs Laura , Phillips Caroline , Bashford Tom , Kohler Katharina , Stubbs Daniel
Published: January 2024

Day-of-surgery cancellation (DOSC) in elective surgery occurs in roughly 18% of elective surgeries worldwide. This impacts patient physical health, psychological wellbeing and social function. Further impacts include reduced health service efficiency and wider economic productivity. There is a range of contributing variables including patient factors, resource constraints and health service pressures which could be integrated into predictive models. This article describes the protocol for a systematic review to evaluate peer-reviewed original research articles and implementation studies of models to predict DOSC. Such statistical models could, if properly integrated into clinical practice, yield benefits to patients and healthcare providers. The systematic review will provide a comprehensive synthesis of evidence in this area to inform future efforts at gold-standard statistical modelling. Predictor-finding studies, subsequent publications of the same model and publications in which the predictive variables have not been disclosed will be excluded. Searches will be conducted in Medline, Embase, Scopus and Web of science. Risk of bias will be assessed using the prediction model risk of bias assessment tool. Data will be collected on included variables, method of prediction, whether prediction was made at the level of the patient or the system, and training and assessment processes. These data will be subject to qualitative synthesis and used to generate a narrative summary and figures. This systematic review will abide by the 2020 PRISMA guidelines. This review is registered on PROSPERO, registration CRD42023478984.
Evaluation of Gender Disparity in Tactical Combat Casualty Care
Authors: Vaughan Shanna R , Ballard Timothy , Ward-Demo Pamela , Vojta Leslie , Ahmed Anwar E , Costello Amy
Published: January 2024

Introduction

Women comprise nearly 19% of the U.S. military and now serve in almost all operational roles, increasing their risk of combat trauma and injuries.3 Data from the Joint Trauma Registry during Operation Enduring Freedom shows that battle-injured females had a higher case fatality rate at 36% compared to their male counterparts at 17%.1 The Tactical Combat Casualty Care curriculum is used to prepare battlefield medics to provide immediate care to wounded service members, but fails to address differences in the care of female versus male casualties. The students, who are presented with life-threatening injuries in simulated trauma scenarios, may be slower to assess, identify, and treat injuries in female patients as compared with male patients.

Materials and Methods

This observational program analysis was reviewed by the Uniformed Services University Human Research Protections Program and approved for execution as an exempt protocol under the provision of 32 CFR 219.104(d)(1). The study assessed the performance of male and female Mexican military personnel during a Tactical Combat Casualty Care course, using standardized trauma scenarios. Anatomically, correct male and female manikins were used to compare response time for different gender patients presenting with the same injuries.

Results

There was a statistically significant increase in time required to complete an initial blood sweep, identify a gunshot wound to the chest, and call for medical evacuation when treating a female patient compared to a male patient.

Conclusions

A lack of female representation in trauma training may have contributed to the higher case fatality rate of female soldiers compared to male soldiers during Operation Enduring Freedom. Female live actors and Gender Retrofit Kits can augment trauma casualty assessment and treatment training scenarios and better prepare our forces to respond to life-threatening emergencies.
Sex and HIV Differences in Preserved Ratio Impaired Spirometry (PRISm) Among Ugandans Postpneumonia
Authors: Abelman Rebecca A , Fitzpatrick Jessica , Byanova Katerina L , Zawedde Josephine , Sanyu Ingvar , Byanyima Patrick , Musisi Emmanuel , Hsieh Jenny , Zhang Michelle , Branchini Jake , Sessolo Abdul , Hunt Peter W , Lalitha Rejani , Davis J Lucian , Crothers Kristina , Worodria William , Huang Laurence
Published: January 2024

Background

Preserved ratio impaired spirometry (PRISm), defined as a normal ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (≥0.70) with low FEV1 (<80% predicted), has been associated with increased mortality in the general population. Female sex has been associated with increased odds of PRISm in people without HIV. People with HIV (PWH) are at increased risk for lung function abnormalities, but whether HIV modifies the effect of sex on PRISm development is largely unknown.

Methods

Adults with and without HIV underwent baseline followed by serial spirometry after completing therapy for pneumonia, predominantly tuberculosis (TB), in Kampala, Uganda. Using generalized estimating equations adjusted for age, body mass index, smoking, biomass fuel exposure, HIV, and TB status, we compared individuals with PRISm with those with normal spirometry. These models were stratified by HIV status.

Results

Of 339 baseline participants, 153 (45%) were women; 129 (38%) had HIV, of whom 53% were women. Overall, 105/339 participants (31%) had PRISm at baseline. HIV was associated with lower odds of PRISm (adjusted odds ratio [aOR], 0.38; 95% CI, 0.21–0.68; P = .001). Female sex trended toward increased odds of PRISm among all participants (aOR, 1.65; 95% CI, 0.99–2.75; P = .052). The association between female sex and PRISm tended to be stronger among PWH (aOR, 3.16; 95% CI, 1.14–8.76; P = .03) than among those without HIV (aOR, 1.34; 95% CI, 0.73–2.45; P = .34); this study was underpowered to detect an HIV–sex interaction of this magnitude (P = .30).

Conclusions

Among Ugandan adults who recovered from pneumonia, female sex was associated with increased odds and HIV with decreased odds of PRISm, suggesting independent sex and HIV effects on PRISm pathogenesis.
Clinical Characteristics and Outcomes of Endemic Mycoses After Solid Organ Transplantation: A Comprehensive Review
Authors: Abad Cybele Lara R , Razonable Raymund R
Published: January 2024

Background

Geographically endemic fungi can cause significant disease among solid organ transplant (SOT) recipients. We provide an update on the epidemiology, clinical presentation, and outcomes of 5 endemic mycoses in SOT recipients.

Methods

Multiple databases were reviewed from inception through May 2023 using key words for endemic fungi (eg, coccidioidomycosis or Coccidioides, histoplasmosis or Histoplasma, etc). We included adult SOT recipients and publications in English or with English translation.

Results

Among 16 cohort studies that reported on blastomycosis (n = 3), coccidioidomycosis (n = 5), histoplasmosis (n = 4), and various endemic mycoses (n = 4), the incidence rates varied, as follows: coccidioidomycosis, 1.2%–5.8%; blastomycosis, 0.14%–0.99%; and histoplasmosis, 0.4%–1.1%. There were 204 reports describing 268 unique cases of endemic mycoses, including 172 histoplasmosis, 31 blastomycosis, 34 coccidioidomycosis, 6 paracoccidioidomycosis, and 25 talaromycosis cases. The majority of patients were male (176 of 261 [67.4%]). Transplanted allografts were mostly kidney (192 of 268 [71.6%]), followed by liver (n = 39 [14.6%]), heart (n = 18 [6.7%]), lung (n = 13 [4.9%]), and combined kidney-liver and kidney-pancreas (n = 6 [2.7%]). In all 5 endemic mycoses, most patients presented with fever (162 of 232 [69.8%]) and disseminated disease (179 of 268 [66.8%]). Cytopenias were frequently reported for histoplasmosis (71 of 91 [78.0%]), coccidioidomycosis (8 of 11 [72.7%]) and talaromycosis (7 of 8 [87.5%]). Graft loss was reported in 12 of 136 patients (8.8%). Death from all-causes was reported in 71 of 267 (26.6%); half of the deaths (n = 34 [50%]) were related to the underlying mycoses.

Conclusions

Endemic mycoses commonly present with fever, cytopenias and disseminated disease in SOT recipients. There is a relatively high all-cause mortality rate, including many deaths that were attributed to endemic mycoses.
NAMPT promotes the malignant progression of HBV‐associated hepatocellular carcinoma through activation of SREBP1‐mediated lipogenesis
Authors: He Xian‐lu , Guo Hui‐jie , Lei Ya‐ruo , Li Jun , Li Jing‐yi , Li Min‐hui , Li Na , Wang Fei , Mo Chun‐fen
Published: January 2024

Metabolic reprogramming is a hallmark of cancer. The nicotinamide phosphoribosyltransferase (NAMPT)‐mediated salvage pathway maintains sufficient cellular NAD levels and is required for tumorigenesis and development. However, the molecular mechanism by which NAMPT contributes to HBV‐associated hepatocellular carcinoma (HCC) remains not fully understood. In the present study, our results showed that NAMPT protein was obviously upregulated in HBV‐positive HCC tissues compared with HBV‐negative HCC tissues. NAMPT was positively associated with aggressive HCC phenotypes and poor prognosis in HBV‐positive HCC patients. NAMPT overexpression strengthened the proliferative, migratory, and invasive capacities of HBV‐associated HCC cells, while NAMPT‐insufficient HCC cells exhibited decreased growth and mobility. Mechanistically, we demonstrated that NAMPT activated SREBP1 (sterol regulatory element‐binding protein 1) by increasing the expression and nuclear translocation of SREBP1, leading to the transcription of SREBP1 downstream lipogenesis‐related genes and the production of intracellular lipids and cholesterol. Altogether, our data uncovered an important molecular mechanism by which NAMPT promoted HBV‐induced HCC progression through the activation of SREBP1‐triggered lipid metabolism reprogramming and suggested NAMPT as a promising prognostic biomarker and therapeutic target for HBV‐associated HCC patients.
Incidence, Diversity, and Quality of Publications in Orthopaedic Trauma Literature
Authors: Ottofaro Trevor , McGurk Kathy , Horn Ryan , Rivas Gabriella , Hartsock Langdon , Reid Kristoff
Published: January 2024

Introduction:

Modern medicine increasingly relies on evidence-based care, using academic journals as vehicles for information dissemination. Increasing rates of publication have led to an overwhelming volume of literature. This study evaluates the proportion of dedicated orthopaedic trauma literature, the frequency of different topic domains, and the quality of currently published information.

Methods:

Top orthopaedic journals were selected by impact factor and scientific articles published between 2016 –2019 were evaluated. All articles were categorized by subspecialty and pre-defined topic domains and level of evidence was recorded.

Results:

3,697 articles were published in Journal of Orthopaedic Trauma (JOT), Clinical Orthopaedics and Related Research (CORR), the Journal of Bone and Joint Surgery (JBJS), and Bone and Joint Journal (BJJ). 32% of articles were dedicated to orthopaedic trauma topics. Joint Arthroplasty was the most published subspecialty in general journals (35.37%, P<0.002). Hip fractures were the most prevalent trauma topic domain in all four journals (15.5%, P<0.002). Pelvic ring injuries were the second most prevalent topic in orthopaedic trauma journals, versus distal radius fractures in non-trauma journals (P<0.05). 48.4% of published literature was level III evidence, with no differences between trauma and non-trauma publications (P>0.05).

Conclusion:

Orthopaedic trauma is well represented within the orthopaedic literature with a diverse distribution of topics over the four-year period, second only to Joint Arthroplasty which was by far the most common topic in general orthopaedic journals. Level of Evidence in trauma literature parallel other orthopaedic subspecialties, but there is an overall low proportion of level I and II studies in the orthopaedic literature.

Level of Evidence:

Level II
The Road Well Traveled: Making Choices, Ensuring Progress While Heeding the “Clarion Call”
Authors: Reece E. Albert
Published: January 2024

The career path of everyone is quite unique based on the goals and the choices we make, and success can take time to unfold. My career choices have been greatly influenced by remarkable mentors and opportunities. Reciprocally I have had the pleasure, as a faculty member, department chair, and medical school dean to mentor promising young physicians and scientists to launch successful careers. We need to continue to attract physicians and scientists to academic medicine to ensure that our field continues to innovate and improve the lives of our patients. To influence positive change, we must stay relentlessly focused and have faith that success will come.
Continuing Steady Challenges Involved in the Lifting of Evacuation Orders after the Fukushima Daiichi Nuclear Power Plant Accident
Authors: Kobashi Yurie , Hasegawa Arifumi , Yamashita Shunichi
Published: January 2024

Steady efforts for recovery and reconstruction after the accident at the Fukushima Daiichi Nuclear Power Plant have been underway for 12.5 y. The present study reports on the world’s first-ever efforts for a gradual and safe return to areas contaminated with radiation fallout and reconstruction support by providing an overview of the actual situation regarding the strategy for return, especially with the transition after the lifting of the evacuation order by the Japanese government. A stage-by-stage progression of the evacuation order and lifting strategy is summarized chronologically in the following three phases: the Emergency Phase in 2011, the Reconstruction Phase from 2013 to 2020, and the Challenging Phase for Lifting All the Evacuation Zones from 2023. Through the lifting strategy of the government, the number of evacuees decreased significantly, especially during the Reconstruction Phase, from 152,113 in May 2013 to 37,826 in May 2020. It is crucial to strengthen support for reconstruction and convey an unbiased and accurate understanding of Fukushima Prefecture by developing a concrete strategy for community development and increasing the size of the exchange population.
Clinical outcomes and patient-reported outcomes after oncoplastic breast surgery in breast cancer patients: A matched cohort study
Authors: Chou Hsuan-Yu , Tseng Ling-Ming , Ma Hsu , Perng Cherng-Kang , Huang Chi-Cheng , Tsai Yi-Fang , Lin Yen-Shu , Lien Pei-Ju , Feng Chin-Jung
Published: January 2024

Background:

Surgery is the recommended treatment for breast cancer, the most common cancer in women in Taiwan and the leading cause of cancer-related deaths. Although breast-conserving surgery (BCS) has good prognosis, in some cases, BCS may cause more significant deformities and interfere with the patient’s psychosocial well-being. Oncoplastic breast surgery (OBS) is the treatment option in these cases. This study aimed to determine the outcomes of OBS and BCS regardless of clinical and patient-reported esthetic outcomes.

Methods:

Between 2015 and 2020, 50 patients who underwent OBS at our hospital after complete treatment were enrolled. With 1:2 matched ratios, 100 patients were enrolled in the BCS control group. Clinical outcomes were analyzed. The BREAST-Q questionnaire was then assessed 6 months after the completion of treatment for subjective patient-reported outcomes.

Results:

Due to the matching process, no difference was noted between the two groups in terms of demographic data such as age, comorbidities, or tumor characteristics. There were no significant differences in the local recurrence rate, disease-free survival, overall survival, positive margin rate, rewide excision rate, conversion to mastectomy rate, or complication rate (major or minor) between both groups. However, the OBS group showed higher satisfaction with breasts in the BREAST-Q questionnaire (p < 0.001). The mean follow-up time was 38.77 ± 14.70 months in the BCS group and 29.59 ± 14.06 months in the OBS group.

Conclusion:

OBS seems to be a safe and feasible surgery in breast cancer patients because clinical outcomes are compatible with BCS. Moreover, the OBS group had better patient-reported outcomes in terms of satisfaction.
AST to ALT ratio as a prospective risk predictor for liver cirrhosis in patients with chronic HBV infection
Authors: Lai Xiaohuan , Chen Haiyan , Dong Xiaofeng , Zhou Guanlin , Liang Dong , Xu Fei , Liu Hongxia , Luo Yingmin , Liu Hui , Wan Shaogui
Published: January 2024

Background

Serum aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR) is one of the most frequent indicators to discriminate fibrosis and cirrhosis. However, the results remained controversial. The aim of this study was to evaluate the predictive effect of AAR on hepatitis B virus (HBV)-related cirrhosis development.

Method

A retrospective cohort study was conducted based on 1754 chronic HBV-infected patients. Clinical variables at their initial visit and follow-up data were collected. Cox proportional hazards model was constructed to evaluate the predictive value of AAR on cirrhosis risk, and its discrimination accuracy was determined by receiver operating characteristic (ROC). The time-dependent effect was assessed by a Fine and Gray competing risk model.

Results

Compared to patients with lower AAR, those with elevated AAR level had higher risk of cirrhosis development by adjusting for host characteristics (dichotomized analyses: hazard ratio =
2.77, P = 8.25 × 10-4

; tertile analyses: hazard ratio =
2.95, P = 1.61 × 10-3

), with an increasing risk trend (P
trend =
4.56 × 10-4

). The effect remained prominent when ALT or AST was abnormal, while no significant risk was observed when AST and ALT were simultaneously normal. Time-dependent effect analysis demonstrated a persistently higher risk, with the average hazard ratio equivalent to 1.92. AAR level could improve the discrimination efficacy of host variables with area under the curve increased from 0.684 to 0.711 (P = 
0.039
).

Conclusion

Higher AAR was significantly associated with increased risk of HBV-related cirrhosis, and might be a potential predictor of cirrhosis development.
Barthel Index, SPAN-100, and NIHSS Studies on the Predictive Value of Prognosis in Patients With Thrombolysis
Authors: Fu Meng , Fan Yani , Yan Shuangmei , Wang Sujie , Zhang Sai , Chen Feifei , Han Rui , He Xiaohong , Gu Ping , Li Jian , Chen Lili
Published: January 2024

Objective:

We mainly explore the predictive value of Barthel Index (BI), SPAN-100, and National Institute of Health stroke scale (NIHSS) scores on clinical prognosis and functional outcomes in thrombolytic patients and compare the differences in the predictive values of the above 3 scales so as to provide an effective basis to evaluate the prognosis of thrombolytic patients.

Methods:

Data were collected from 212 patients with the first-onset AIS (acute ischemic stroke). The enrolled patients were treated with recombinant tissue plasminogen activator thrombolytic therapy and were divided into 2 groups according to the modified Rankin Scale (mRS) score at discharge: the prognosis group (mRS≤2 points) and the poor prognosis group (mRS≥3 points). Logistic multivariate analysis was used to analyze the predictors of poor prognosis in patients with thrombolysis. MedCalc software was used to plot receiver operating characteristic (ROC) curves, calculate the area under the ROC curve (AUC), and compare the prediction performance of the 3 scales by the Delong and colleagues’ method, and the difference of P<0.05 was statistically significant.

Results:

Logistic binary regression multivariate analysis suggested that BI was a predictor of poor prognosis for thrombolytic therapy in patients with AIS. The lower the BI score, the poorer the prognosis. The AUC for BI score was 0.862, 95% CI (0.808-0.906), NIHSS score AUC was 0.665, 95% CI (0.597-0.728), and SPAN-100 score AUC was 0.640, 95% CI (0.572-0.705). AUC comparison of 3 scoring ROC curves suggested statistically significant differences between BI and NIHSS (P
C=0.0000), BI and SPAN-100 (P
C=0.0000); no significant difference was observed between SPAN-100 and NIHSS (P
C=1.7997).

Conclusions:

Simple BI scores have a high prognostic value for thrombolytic therapy in AIS.
Characteristics of Cerebral Venous Sinus Thrombosis Due to Autoimmune Diseases
Authors: Saridas Furkan , Mesut Gizem , Dinc Yasemin , Koc Emine Rabia , Ozpar Rifat , Hakyemez Bahattin , Turan Omer Faruk
Published: January 2024

Objectives:

Cerebral venous sinus thrombosis (CVST) is a cerebrovascular disease characterized by thrombosis of the cerebral venous or dural sinuses. Autoimmune diseases (AD) are important causes of CVST. This study aims to reveal the differences between CVST associated with autoimmune diseases compared with other causes (OCs) and Behcet’s syndrome (BS) compared with other ADs.

Methods:

This is a single-center retrospective study in which the medical records of 187 patients we followed with a diagnosis of CVST between 2008 and 2023 were collected retrospectively. Four neurologists collected data on initial symptoms, neurological examinations, and laboratory findings. Findings on magnetic resonance imaging and magnetic resonance venography performed on all patients (thrombosis localizations, hemorrhagic or ischemic complications, and collateralization) were re-evaluated by 2 radiologists. The results were compared with AD, other ADs, and OCs groups.

Results:

There were 28 cases of CVST associated with AD. Of these, 18 were BS, and 10 were other AD. Subacute-chronic onset, headache, and transverse sinus involvement were more common in AD-related patients than in OCs. However, collateralization, venous infarction, hemorrhagic transformation, and bleeding were less common. BS-related patients had earlier age, more frequent transverse sinus, less frequent cortical vein thrombosis, and better collateralization than other ADs.

Conclusion:

CVST is one of the rare complications in autoimmune diseases. It has a more subacute-chronic onset. Since headaches are more common, it is essential to make a differential diagnosis of CVST in autoimmune diseases with chronic headaches. Transverse sinus thrombosis is more common. Collateralization, venous infarction, and hemorrhagic transformation are less.
Topographic, cognitive, and neurobiological profiling of the interdependent structural and functional connectome in the human brain
Authors: Wang Xiaoyue , Sun Lianglong , Liang Xinyuan , Zhao Tengda , Xia Mingrui , Liao Xuhong , He Yong
Published: January 2024

The structural connectome (SC) is tightly coupled to the functional connectome (FC) in the human brain. Most previous related studies have modeled and analyzed SC or FC as isolated brain networks. However, challenges remain in modeling the interdependent structural-functional connectome and elucidating its cognitive implications and molecular underpinnings. Here, we present a multilayer connectome model composed of SC and FC components and further characterize their interacting topological properties. We found that the interdependent connectome is topographically heterogeneous, with the transmodal cortex exhibiting greater modular variability across layers. This spatial topography reflects cortical hierarchy and evolution and shows high test-retest reliability, reproducibility, and heritability. The interdependent connectome contributes to high-order cognitive processes and is associated with multiple neurotransmitter systems and transcriptional signatures of synaptic transmission. Our results provide insights into the nontrivial interdependencies of SC and FC, highlighting their cognitive significance and the molecular mechanisms underlying the connectome of connectomes.
Robust Majorana bound states in magnetic topological insulator nanoribbons with fragile chiral edge channels
Authors: Burke Declan , Heffels Dennis , Moors Kristof , Schüffelgen Peter , Grützmacher Detlev , Connolly Malcolm R.
Published: January 2024

Magnetic topological insulators in the quantum anomalous Hall regime host ballistic chiral edge channels. When proximitized by an s-wave superconductor, these edge states offer the potential for realizing topological superconductivity and Majorana bound states without the detrimental effect of large externally applied magnetic fields on superconductivity. Realizing well-separated unpaired Majorana bound states requires magnetic topological insulator ribbons with a width of the order of the transverse extent of the edge state, however, which is expected to bring the required ribbon width down to around 100nm. In this regime, it is known to be extremely difficult to retain the ballistic nature of chiral edge channels and realize a quantized Hall conductance. In this paper, we study the impact of disorder in such magnetic topological insulator nanoribbons and compare the fragility of ballistic chiral edge channels with the stability of Majorana bound states when the ribbon is covered by a superconducting film. We find that the Majorana bound states exhibit greater robustness against disorder than the underlying chiral edge channels.

Published by the American Physical Society
2024
Fifth- and sixth-order net baryon number fluctuations in nuclear matter at low temperature
Authors: Yang Xin-ran , Shao Guo-yun , He Wei-bo
Published: January 2024

We calculate the density fluctuations of net baryon number up to sixth order induced by the interactions of nuclear matter, and explore their relationship with the nuclear liquid-gas phase transition (LGPT), including the stable and metastable phases as well as the region far from the phase transition. The results show that dramatic density fluctuations exist in the vicinity of LGPT, and the higher order density fluctuations are more sensitive than the lower order ones to the interactions and structural properties of nuclear matter. The study also indicates that, even far away from the critical region of LGPT, the hadronic interactions can still lead to larger fifth- and sixth-order density fluctuations. In combination with the chemical freeze-out line fitted from the experimental data, the derived results can be used to investigate the chiral phase transition and nuclear LGPT, as well as to analyze related experimental signals.

Published by the American Physical Society
2024