bluuebunny/crossref_metadata_2025 huggingface dataset:
The Combatant Activities Exception and the Rule of Law
Authors: Abraham Haim
Published: November 2024

This chapter examines a particular immunity that many common law states enjoy for any losses they inflict during warfare, which prevents individuals from being able to obtain a remedy through tort law for the injuries they sustain. This immunity is referred to as the ‘combatant activities exception’. The analysis in this chapter is based on a substantive rule of law approach, which has played a significant role in limiting the scope of states’ immunity from liability and enabling the pursuit of private law remedies for wrongs committed by states. The chapter establishes that the combatant activities exception deviates from the requirement of substantive rule of law, as its scope is ambiguous, its application is potentially discriminatory, it frustrates access to legal remedies, and it creates a sphere in which public officials’ discretion is unbounded. Moreover, the chapter illustrates that the scope and character of the combatant activities exception are not properly justified to cohere with the requirements of a substantive rule of law approach. The basic starting point for a rule of law–abiding regime is to provide compensation to individuals as a matter of right. Compensation enables individuals to enforce their rights and hold officials accountable. As the combatant activities exception is not properly justified, it should either be interpreted narrowly or abolished.
Unpacking States’ Vicarious and Direct Liabilities
Authors: Abraham Haim
Published: November 2024

This chapter assesses the viability of vicarious and direct impositions of liability on states for wrongful losses inflicted by their combatants, contractors, and citizens. It shows that the relevant relationship between the state and the wrongdoer clearly exists towards its combatants but not necessarily towards its contractors or civilians. Furthermore, and generally, the doctrine’s second limb of acting ‘in the course of employment’ could be met when a belligerent wrong was inflicted negligently. Yet, the applicability of vicarious liability to intentional torts varies between jurisdictions and could only be established on a case-by-case basis.

The chapter also discusses three additional instances in which states could be held directly liable. First, the states’ own failures result in the creation and materialization of the wrongful loss. The chapter shows that this form of liability might be available for losses inflicted by a state’s private military contractor, but is unlikely to be available in relation to wrongs that a state’s civilian population inflicts on enemy non-combatants. Second, the chapter argues that states have non-delegable duties to ensure the health and safety of prisoners of war and occupied populations, and that an argument could be made to support the view that states have a non-delegable private law duty to ensure that civilians do not sustain belligerent wrongs. Third, it demonstrates that in some jurisdictions, direct liability could be imposed on states through the doctrine of ratification when states explicitly or implicitly adopt the wrongful conduct of their combatants or contractors as their own.
‘Power to the Convicted Class’: Re-Assessing Prisoner-Led Movements and Trade Union Organizing
Authors: Behan Cormac , Maycock Matthew
Published: November 2024

This article examines prisoner-led movements that have sought the right to representation and improvements in pay and conditions. We argue that this strand of prison organizing has tended to be subsumed into narratives around prison disturbances, studies of movements for prisoners’ rights and campaigns for penal reform. The article considers the extent to which prisoner-led organizations have adapted to their unique set of circumstances by examining some historical and contemporary examples of labour organizing in prison. We contend that questions of class and class analysis more widely in relation to prisoner labour have not been explicitly analysed within contemporary penology, and consider the need for a new approach to critique worker organizing within prison settings.
Comparing 5-year and 10-year predicted cardiovascular disease risks in Aotearoa New Zealand: national data linkage study of 1.7 million adults
Authors: Liang Jingyuan , Wells Susan , Jackson Rod , Choi Yeunhyang , Mehta Suneela , Chung Claris , Gao Pei , Poppe Katrina
Published: November 2024

Aims

There is no consensus on the optimal time horizon for predicting cardiovascular disease (CVD) risk to inform treatment decisions. New Zealand and Australia recommend 5 years, whereas most countries recommend 10 years. We compared predicted risk and treatment-eligible groups using 5-year and 10-year equations.

Methods and results

Individual-level linked administrative data sets identified 1 746 665 New Zealanders without CVD, aged 30–74 years in 2006, with follow-up to 2018. Participants were randomly allocated to derivation and validation cohorts. Sex-specific 5-year and 10-year risk prediction models were developed in the derivation cohort and applied in the validation cohort. There were 28 116 (3.2%) and 62 027 (7.1%) first CVD events that occurred during 5-year and 10-year follow-ups, respectively (cumulative risk, derivation cohort). Median predicted 10-year CVD risk (3.8%) was approximately 2.5 times 5-year risk (1.6%), and 95% of individuals in the top quintile of 5-year risk were also in the top quintile of 10-year risk, across age/gender groups (validation cohort). Using common guideline-recommended treatment thresholds (5% 5-year and 10% 10-year risk), approximately 14% and 28% of women and men, respectively, were identified as treatment-eligible applying 5-year equations compared with 17% and 32% of women and men applying 10-year equations. Older age was the major contributor to treatment eligibility in both sexes.

Conclusion

Predicted 10-year CVD risk was approximately 2.5 times 5-year risk. Both equations identified mostly the same individuals in the highest risk quintile. Conversely, commonly used treatment thresholds identified more treatment-eligible individuals using 10-year equations, and both equations identified approximately twice as many treatment-eligible men as women. The treatment threshold, rather than the risk horizon, is the main determinant of treatment eligibility.
Liver cyst penetration of antibiotics at the target site of infection: a randomized pharmacokinetic trial
Authors: Bernts Lucas H P , Brüggemann Roger J M , Jansen Anouk M E , Jager Nynke G L , Wertheim Heiman F L , Drenth Joost P H , Lantinga Marten A
Published: November 2024

Background

The EASL cystic liver disease guideline states that drug penetration at the site of infection (liver cyst) is essential for successful treatment, but pharmacokinetic (PK) data on cyst penetration are limited.

Objectives

This study aims to investigate tissue penetration of four antibiotics in non-infected liver cysts and explores influencing factors.

Methods

We performed a prospective, randomized single-dose PK-study. Before percutaneous drainage of a non-infected liver cyst, an intravenous (IV) dose of either ciprofloxacin and piperacillin/tazobactam (group 1); or co-trimoxazole (trimethoprim/sulfamethoxazole) and doxycycline (group 2) was given. Cyst fluid was collected during drainage. Blood samples were obtained before, during and after drainage (within 12 h). Drug concentrations were measured with a validated LC-MS/MS. Primary outcome was liver cyst penetration, defined as the cyst-fluid-to-plasma concentration ratio (%) expressed as median (IQR).

Results

We included 20 patients, and 21 liver cysts were drained (group 1: n = 11, group 2: n = 10). Median drained cyst volume was 700 mL. Median time between infusion and drainage was 139 min (IQR 120–188 min). Median cyst-fluid-to-plasma concentration ratio was 4.2% (IQR 1.6%–8.9%) for ciprofloxacin, 0.3% (IQR 0.0%–1.3%) for piperacillin, 0.2% (IQR 0.0%–1.3%) for tazobactam, 12.2% (IQR 6.3%–16.1%) for trimethoprim, 0.4% (IQR 0.2%–3.8%) for sulfamethoxazole and 1.6% (IQR 0.9%–2.3%) for doxycycline. Time between trimethoprim infusion and cyst drainage was correlated with increased cyst-fluid-to-plasma concentration ratio (P < 0.01).

Conclusions

Trimethoprim and ciprofloxacin have the highest penetration ratios amongst antibiotics tested. We found that liver cyst penetration varies widely between drugs after a single IV dose.

Clinical trial number

NTR8499

The trial was originally registered in the Netherlands Trial Register (ID: NL7290), which was converted to the International Clinical Trials Registry Platform in 2022.
A chromosome-level genome assembly of the mountain lion, Puma concolor
Authors: Supple Megan A , Escalona Merly , Alexandre Nicolas , Buchalski Michael R , Riley Seth P D , Dellinger Justin A , Vickers T Winston , Sahasrabudhe Ruta , Nguyen Oanh , Fairbairn Colin W , Seligmann William E , Wilmers Christopher C , Shapiro Beth
Published: November 2024

Mountain lions, Puma concolor, are widespread and adaptable carnivores. However, due to their large home ranges and long distance dispersals, they are strongly impacted by habitat fragmentation, which results in small and isolated populations. Genomic analyses play an important role in understanding and predicting the impacts of increased isolation of populations, such as decreased genetic diversity and increased levels of inbreeding. Here we report a high-quality, chromosome-level reference genome of P. concolor that was generated as part of the California Conservation Genomics Project. The primary assembly has a total length of 2.5 Gb contained in 258 scaffolds, a contig N50 of 42.3 Mb, a scaffold N50 of 149.8 Mb, and a BUSCO completeness score of 95%. This P. concolor genome assembly will provide an important resource for genomic analyses that aid decision-makers in managing the species in fragmented landscapes.
Transient analysis of multiple arbitrarily oriented cracks under antiplane shear wave
Authors: Chen Shyh-Haur , Luo Man-Wen , Wu Kuang-Chong
Published: November 2024

Most works in the literature on interactions of cracks and stress waves were for collinear or parallel cracks. However, in reality, cracks are usually randomly oriented. In this work, the problem of a homogeneous linear elastic body containing arbitrarily oriented cracks under dynamic antiplane shear loading is considered. Distribution of dynamic dislocations is used to simulate the cracks and the corresponding integral equation is derived. The integral equation is utilized to calculate the dynamic stress intensity factors. Numerical examples are provided to demonstrate the effectiveness of the present method.
Nationwide Epidemiology and Outpatient Healthcare Resource Use of Children with Respiratory Syncytial Virus from 2005 to 2021
Authors: Okubo Yusuke , Uda Kazuhiro , Yoshikawa Yuki , Ogimi Chikara , Nakabayashi Yosuke , Ito Kenta
Published: November 2024

Background

Respiratory syncytial virus (RSV) poses a global health challenge, particularly among younger children. While the disease burden in Japan has been preliminarily quantified in short-term or inpatient settings, a comprehensive understanding of outpatient settings at a national level is still lacking.

Methods

In this retrospective cohort study, we followed 697 802 children until they reached 60 months of age, amounting to 25 680 468 million person-months, using two nationally representative databases from the fiscal years 2005–2021. We analyzed trends in the epidemiology of RSV infections and associated outpatient health resource use.

Results

Incidence rates of RSV and associated hospitalizations among infants showed fluctuations of 50–100 cases and 20–30 hospitalizations per 1000 person-years, respectively, during the 2010s. These rates dropped to 8.7 cases and 2.2 hospitalizations per 1000 person-years in 2020, then returned to the same levels in the 2010s. Similar patterns were noted for RSV testing, outpatient visits, healthcare cost, and the proportion of cases hospitalized (case-hospitalization risk). Whereas antibiotic use decreased from 56.4% in 2005 to 27.8% in 2021, palivizumab use increased from 95.2 to 195.9 days of therapy per 1000 person-years. Applying the calculated incidence rates to national data, annual outpatient healthcare costs for RSV infections were estimated to be 7–9 billion JPY (50–64 million USD) for children aged < 60 months in the late 2010s.

Conclusions

Our study highlights the changes in epidemiology and outpatient health resource utilization for children with RSV infections. These findings are valuable for policymakers and clinicians aiming to develop strategies, including newly developed maternal vaccines and single-dose long-acting monoclonal antibodies.
Adalimumab-induced CNS demyelination in a patient with multiple pre-existing autoimmune diseases: Treatment contemplation
Authors: Khosravi Sepehr , Zamani Babak , Motamed Mohammad Reza , Akhoundi Fahimeh H
Published: November 2024

Anti-tumour necrosis factor (TNF) agents like adalimumab are safe and effective for rheumatologic disorders, but they have been reported to cause demyelinating diseases like multiple sclerosis. A 47-year-old woman with weakness in the left hand was evaluated. She had a previous medical history of intermediate uveitis and rheumatoid arthritis. Anti-TNF-α treatment was initiated with adalimumab 2 years before this visit. Magenetic resonance imaging showed numerous T2-hyperintense lesions in bilateral periventricular, juxtacortical, and subcortical areas, which were absent in her scan before anti-TNF therapy. She was diagnosed with multiple sclerosis, and adalimumab was discontinued. IV glucocorticoids were administered with marked improvement. She was then started on anti-CD20 therapy with rituximab. A year later, she was symptom-free, and her follow-up brain magnetic resonance imaging showed no new lesions. The link between multiple sclerosis and TNF-α inhibitors is poorly understood, but several hypotheses have been proposed. Discontinuing anti-TNF therapy alone may not be enough to prevent further demyelinating disease activity, and it is essential to consider the necessity of starting a disease-modifying treatment. Autoimmunity plays a significant role in rheumatologic and neurological diseases, and as personalised medicine advances, understanding genetic risk is crucial for selecting appropriate therapeutic targets. A thorough evaluation of a patient’s family background is recommended before a therapeutic decision-making, especially in patients with multiple autoimmune disorders, and the question of whether TNF-α is a suitable therapeutic target in patients with multiple autoimmune disorders is raised.
Inherited kidney disease and CAKUT are common causes of kidney failure requiring kidney replacement therapy: an ERA Registry study
Authors: Ortiz Alberto , Kramer Anneke , Ariceta Gema , Rodríguez Arévalo Olga L , Gjerstad Ann C , Santiuste Carmen , Trujillo-Alemán Sara , Ferraro Pietro Manuel , Methven Shona , Santamaría Rafael , Naumovic Radomir , Resic Halima , Hommel Kristine , Segelmark Mårten , Ambühl Patrice M , Sorensen Søren S , Parmentier Cyrielle , Vidal Enrico , Bakkaloglu Sevcan A , Plumb Lucy , Palsson Runolfur , Kerschbaum Julia , ten Dam Marc A G J , Stel Vianda S , Jager Kitty J , Torra Roser
Published: November 2024

Background

Inherited kidney diseases (IKDs) and congenital anomalies of the kidney and urinary tract (CAKUT) are causes of kidney failure requiring kidney replacement therapy (KRT) that major renal registries usually amalgamate into the primary renal disease(PRD) category ‘miscellaneous’ or in the glomerulonephritis or pyelonephritis categories. This makes IKDs invisible (except for polycystic kidney disease) and may negatively influence the use of genetic testing, which may identify a cause for IKDs and some CAKUT.

Methods

We re-examined the aetiology of KRT by composing a separate IKD and CAKUT PRD group using data from the European Renal Association (ERA) Registry.

Results

In 2019, IKD-CAKUT was the fourth most common cause of kidney failure among incident KRT patients, accounting for 8.9% of cases [IKD 7.4% (including 5.0% autosomal dominant polycystic kidney disease), CAKUT 1.5%], behind diabetes (23.0%), hypertension (14.4%) and glomerulonephritis (10.6%). IKD-CAKUT was the most common cause of kidney failure among patients <20 years of age (41.0% of cases), but their incidence rate was highest among those ages 45–74 years (22.5 per million age-related population). Among prevalent KRT patients, IKD-CAKUT (18.5%) and glomerulonephritis (18.7%) were the two most common causes of kidney failure overall, while IKD-CAKUT was the most common cause in women (21.6%) and in patients <45 years of age (29.1%).

Conclusion

IKD and CAKUT are common causes of kidney failure among KRT patients. Distinct categorization of IKD and CAKUT better characterizes the epidemiology of the causes of chronic kidney disease (CKD) and highlights the importance of genetic testing in the diagnostic workup of CKD.
Physical activity and cardiorenal health—from associations to interventional studies
Authors: Billany Roseanne E , Smith Alice C , Graham-Brown Matthew P M
Published: November 2024

Clustering of traditional and kidney-specific risk factors leads to elevated cardiovascular disease (CVD) risk across the trajectory of chronic kidney disease (CKD) and transplantation. As kidney function declines, the prevalence of CVD, cardiovascular events, and mortality increases. This review considers recent evidence for the association between physical activity (PA) and exercise and cardiorenal health, and the effectiveness of interventions for the prevention and management of cardiorenal decline across the CKD spectrum. Evidence supports a beneficial dose–response effect of PA in the prevention of incident CKD, and growing evidence in prevalent CKD patients for the attenuation of kidney function decline, and a reduction in CVD risk, morbidity, and mortality. Broadly speaking, across the trajectory of CKD, the literature supports the efficacy of exercise interventions for improving cardiorespiratory fitness and aspects of cardiorenal health. The mechanisms underlying improvements indicate differential effects on traditional and non-traditional risk factors for CKD progression and CVD. To date, there is limited transfer of these findings into clinical care, although the evaluation of available evidence has led to the development of the first detailed clinical practice guideline for exercise and lifestyle in CKD. There is a lack of large-scale multicentre randomized controlled trials, and trials exploring hard clinical outcomes and long-term effects of exercise on cardiorenal outcomes. However, research should also address the challenges of implementing programmes of exercise and PA as part of routine care in combination with addressing the shortfall in literature to improve cardiorenal outcomes in all patients with CKD.
The potato sugar transporter SWEET1g affects apoplasmic sugar ratio and phloem-mobile tuber- and flower-inducing signals
Authors: Lauschke Angelique , Maibaum Leonie , Engel Mira , Eisengräber Luise , Bayer Sina , Hackel Aleksandra , Kühn Christina
Published: November 2024

The main phloem loader in potato, sucrose transporter StSUT1, is coexpressed with 2 members of the SWEET gene family: StSWEET11b, a clade III member of SWEET carriers assumed to be involved in sucrose efflux, and StSWEET1g, a clade I member involved in glucose efflux into the apoplast, that physically interacts with StSUT1. We investigated the functionality of SWEET carriers via uptake experiments with fluorescent glucose or sucrose analogs. Inhibition or overexpression of StSWEET1g/SlSWEET1e affected tuberization and flowering in transgenic potato plants. Isolation of the apoplasmic fluid by vacuum infiltration centrifugation revealed changes in the apoplasmic hexose composition and mono-to-disaccharide ratio, affecting sink strength. Downregulation of StSWEET1g expression affected the expression of SP6A, a tuberigen, and miR172 under long-day conditions, leading to early flowering and tuberization. A systematic screen for StSWEET1g-interacting protein partners revealed several proteins affecting cell wall integrity and strengthening. StSWEET1g and the main interaction partners were strongly downregulated during tuber development. We discuss whether StSWEET1g activity might be linked to cell wall remodeling during tuber development and the switch from apoplasmic to symplasmic phloem unloading.
The Use of External Beam Radiation Therapy for Heterotopic Ossification Prophylaxis After Surgical Fixation of Acetabular Fractures: A Randomized Controlled Trial
Authors: Boissonneault Adam , O'Hara Nathan N. , Slobogean Gerard P. , Meyer Anna , Maceroli Michael , Sciadini Marcus F. , Nascone Jason W. , Gage Mark J. , Lin Jolinta , Hanasoge Sheela , Shelton Jay , Rana Zaker , Mishra Mark , O'Toole Robert V.
Published: November 2024

OBJECTIVES:

To determine the effect of external beam radiation (XRT) on preventing severe heterotopic ossification (HO) after acetabular surgery.

METHODS:

Design:

Randomized controlled trial.

Setting:

Two level I academic trauma centers.

Patient Selection Criteria:

Patients with an acetabular fracture (OTA/AO type 62) surgically treated through a posterior or combined anterior and posterior approach.

Outcome Measures and Comparisons:

Radiographic HO was determined using Brooker Classification at the last follow-up. The primary outcome was severe HO (Brooker classes III–IV). The secondary outcome was any HO (Brooker classes I–IV). The incidence of radiographic HO was compared between patients who did and did not undergo postoperative XRT. The results were analyzed in both an intention-to-treat (randomized to XRT) and as-treated (received XRT) basis.

RESULTS:

Severe HO occurred in 3 of 54 (6%) patients randomized to XRT and 9 of 50 (18%) patients randomized to no XRT (odds ratio 0.24, 95% confidence interval, 0.05 to 0.94; P = 0.05). Any HO occurred in 10 (19%) patients assigned to XRT and 17 (34%) patients in the no XRT control group (odds ratio 0.39; 95% confidence interval, 0.13 to 1.05; P = 0.07).

CONCLUSIONS:

The findings of this dual-center randomized controlled trial suggest that XRT after acetabular surgery significantly reduced the odds of severe HO compared with patients who did not receive XRT. These results can help guide shared decision making between surgeons and patients regarding the use of XRT for HO prophylaxis.

LEVEL OF EVIDENCE:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Evaluation of Cyanoacrylate Tissue Adhesive Glue Application Outcomes in Corneal Thinning and Perforation
Authors: Sheth Sohum , Khan Shawn , Olson April , Jeang Lauren , Tuli Sonal , Shah Ankit
Published: November 2024

Objectives:

Corneal thinning and perforation are ocular emergencies necessitating urgent intervention to prevent visual impairment or enucleation. Cyanoacrylate tissue adhesive is frequently used to maintain globe integrity in these cases. However, gaps remain in understanding the outcomes of corneal gluing and the factors influencing its efficacy. This case series evaluates the clinical characteristics and outcomes of glue application in corneal thinning and perforation.

Methods:

A retrospective chart review was conducted on patients treated for corneal thinning and perforation at the University of Florida between January 2012 and May 2023. Demographic data, clinical history, glue application details, and posttreatment outcomes were collected and analyzed.

Results:

The study included 128 eyes from 125 subjects. Corneal perforation was found in 71 eyes (55.5%), mostly centrally (49.2%). The leading cause of perforation/thinning was microbial infection (45.3%). The average number of glue applications per eye was 1.66. Within 1 month, 23 patients (18.0%) required only glue reapplication, 37 (28.9%) required surgical intervention (regardless of glue reapplication), and 68 (53.1%) required no further treatment. Factors significantly linked to gluing failure (requiring surgery within 1 month) in univariate analysis included large perforation size, microbial infection, ocular surface disorder, single glue application, and indirect application via sterile drape. Multivariate analysis showed that only large perforation size was significantly associated with gluing failure.

Conclusion:

Corneal glue application is an effective temporizing measure for corneal thinning and perforation, with multiple applications potentially providing added stability to the globe. However, the need for surgical intervention is high.
Stent thrombosis in the setting of ST-segment elevation acute myocardial infarction in the contemporary practice: results from the TOTAL randomized trial
Authors: Moreno Raúl , Džavík Vladimír , Cairns John , Balasubramanian Kumar , Martínez Ricardo , Cantor Warren J. , Kedev Sasko , Stankovic Goran , Bertrand Olivier , Pinilla Natalia , Sibbald Matthew , Akl Elie , Jolly Sanjit S.
Published: November 2024

The aim was to know the risk and predictive factors of stent thrombosis (ST) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) in the contemporary practice. The TOTAL [ThrOmbecTomy with percutaneous coronary intervention (PCI) versus PCI ALone] randomized trial, being the largest trial performed in the setting of STEMI with a general application of the recent recommendations, represents a unique opportunity to know the current real-world incidence of ST as well as its associated factors. A total of 10 064 patients that received ≥1 coronary stent in the TOTAL trial comprise the study population. The risk, predictive factors, and clinical implications of ST was studied. During 1-year follow-up, 155 patients (1.54%) suffered definitive or probable ST (59 acute, 67 subacute, and 29 late). Previous infarction, the number of stents, the previous use of clopidogrel, and the use of diuretics at discharge were independent predictors for ST, whereas the use of upfront glycoprotein IIb/IIIa inhibitors, radial access, and treatment with statins at discharge were independent protective factors. The number of stents, stent diameter, upfront treatment with IIb/IIIa inhibitors, previous treatment with clopidogrel, and treatment with statins at discharge were independently associated with the risk of early ST. Only previous infarction was associated with the risk of late ST. In the contemporary practice, ST still constitutes a frequent complication of primary PCI for STEMI, occurring in 1.5% of patients. Independent predictors are different depending on the time of ST.
Timing of coronary angiography in high-risk non-ST-elevation acute coronary syndrome: results from the Portuguese Registry for Acute Coronary Syndromes (ProACS)
Authors: Ribeiro Carvalho Catarina , Bernardo Marta Catarina , Martins Moreira Isabel , Mateus Pedro , Baptista Ana , Moreira Ilídio ,   on behalf of the Portuguese Registry of Acute Coronary Syndromes
Published: November 2024

Background

Current guidelines recommend an early invasive coronary angiography (ICA) within 24 h of admission for high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Nevertheless, meta-analyses failed to demonstrate a clear advantage of this strategy in reducing hard endpoints such as death or nonfatal myocardial infarction compared to a delayed approach. Thus, the optimal timing of ICA in high-risk NSTE-ACS remains undetermined.

Objective

This study aimed to determine the optimal timing for ICA in high-risk NSTE-ACS, regarding 1-year all-cause mortality and cardiovascular rehospitalizations.

Methods

We conducted a national multicenter retrospective study of high-risk NSTE-ACS patients included in the Portuguese Registry for Acute Coronary Syndromes. Patients were divided into three groups according to the time of ICA: within the first 24 h, between 24 and 48 h, and between 48 and 72 h. The incidence of in-hospital complications and mortality, 1-year mortality, and cardiovascular rehospitalizations were assessed.

Results

Of the 9949 patients included, 46.7% underwent early ICA. This was associated with a lower incidence of acute heart failure (8.5% vs. 11.1% vs. 11.5%, P < 0.001) and shorter length of stay (3 vs. 4 vs. 6 days, P = 0.012). It, however, did not reduce in-hospital complications or mortality (1.2 vs. 0.7 vs. 0.8%, P = 0.066). We also found no significant association with the composite endpoint of 1-year mortality or cardiovascular rehospitalization (15.1 vs. 15.9 vs. 15.7%, P = 0.887).

Conclusions

Early ICA was associated with a lower incidence of acute heart failure and shorter length of stay, without a significant impact on 1-year mortality risk or cardiovascular rehospitalizations.
Association of Resolved Low-Lying Placentation With Risk of Postpartum Hemorrhage
Authors: Ornaghi Sara , Colciago Elisabetta , Montelisciani Laura , Arienti Francesca , Fernicola Federica , Abbamondi Alessandra , Giani Sofia , Fumagalli Simona , Antolini Laura , Vaglio Tessitore Isadora , Zangheri Giulia , Gatti Elena , Vignali Michele , Callegari Clelia , Sala Andrea , Plevani Cristina , Smid Maddalena , Pozzoni Mirko , Castoldi Maria , Benedetti Sara , Meroni Mario G. , Bulfoni Camilla , Catalano Anna , Consonni Sara , Fichera Anna , Fabbri Elisa , Vergani Patrizia , Locatelli Anna ,   for the MODEL-PLACENTA Study Group*
Published: November 2024

OBJECTIVE:

To evaluate whether individuals who have a placenta previa or low-lying placenta that resolves before delivery are at increased risk of postpartum hemorrhage and postpartum hemorrhage–related morbidity.

METHODS:

This was a prospective, multicenter, 1:3 matched cohort study of pregnant individuals with singleton gestations diagnosed with low placentation by transvaginal scan at 19 to 23 weeks of gestation between January 2021 and December 2023 at nine academic maternity centers (exposed participants). Unexposed participants were those with a normally located placenta, matched in a 1:3 ratio according to parity. Resolution of low placentation was diagnosed when placenta was at 20 mm or more from the internal os. Individuals with fetal anomalies, hematologic disorders, therapeutic anticoagulation, placenta accreta spectrum disorder, vasa previa, persistent low placentation at birth, and delivery at a nonenrolling center were excluded. Primary outcome was postpartum hemorrhage of 1,000 mL or more. Secondary outcomes included postpartum hemorrhage of 1,500 mL or more, use of second-line uterotonic drugs, blood transfusions, additional procedures to control bleeding, intensive care unit admission, and hospital stay for more than 7 days. Multivariable logistic regression adjusted for confounders was used to estimate independent associations with outcomes.

RESULTS:

The study population included 182 exposed and 589 unexposed participants. Individuals with resolved low placentation had higher rates of smoking (P=.024), prior dilation and curettage (P=.012), posterior placenta (P<.001), and induction of labor (P=.038). Multivariate logistic regression analysis adjusted for confounders showed that exposed people had higher odds of postpartum hemorrhage of 1,000 mL or more (13.2% vs 4.1%, adjusted odds ratio [aOR] 3.1) compared with unexposed people and of use of second-line uterotonic drugs (28.0% vs 12.4%, aOR 2.69) and tranexamic acid (16.5% vs 7.5%, aOR 2.19), as well as hospital stay longer than 7 days (11.5% vs 3.4%, aOR 2.63).

CONCLUSION:

Individuals with resolved low placentation are at increased risk of postpartum hemorrhage and related complications compared with those who always had a normally located placenta.
Versatility of the Pedicled Buccal Fat Flap
Authors: Pak Kaitlynne Y. , Nadeem Wasiq , Yeshoua Brandon , Lee Jay , Mallen-St. Clair Jon
Published: November 2024

The pedicled buccal fat flap (PBFF) is a versatile and robust regional flap used for a variety of maxillofacial reconstructions. However, recent literature has questioned the popularity of this flap. The goal of this single-instruction, retrospective study is to review the outcomes and complications of the PBFF. Our study included 27 patients and 28 PBFFs with 13 males, 14 females, and an average age of 68. The most common primary pathologies included squamous cell carcinoma and a fistula (oroantral or oronasal). Persistent postoperative complications were experienced in 31.3% of the cohort. The most common subsite was the retromolar trigone, and the higher complication rates per subsite were noted in the hard and soft palate groups (66.7% each). Higher total complication rates were seen in cases of SCC and fistula (33.3% each). Our study demonstrates the low morbidity and high tolerance of the procedure despite a patient having older age, significant comorbidities (67.9%), smoking history (60.7%), preoperative radiation (17.9%), and postoperative radiation (28.6%). The authors conclude the PBFF remains a durable and reliable reconstructive option in a variety of patient cases.
Alloplastic Vascular Grafts for Venous Interposition in Pancreatic Surgery
Authors: Kinny-Köster Benedict , Lambrecht Arnaud , Flossmann Viktoria , Steinle Verena , Putri Aghnia J. , Heckler Max , Kaiser Jörg , Hank Thomas , Roth Susanne , Müller-Stich Beat P. , Strobel Oliver , Diener Markus K. , Schneider Martin , Berchtold Christoph , Al-Saeedi Mohammed , Hackert Thilo , Mehrabi Arianeb , Büchler Markus W. , Loos Martin
Published: November 2024

Objective:

To investigate patency and clinical outcomes of alloplastic and other venous interposition graft materials in pancreatic surgery.

Background:

Vascular pancreatic surgery is increasingly performed for locally advanced pancreatic neoplasms. Different than other centers, we prefer to use alloplastic vascular graft materials for superior mesenteric vein and portal vein interposition in pancreatic surgery. Advantages are off-the-shelf availability at any customizable length, different diameters, and ring-enforcement but proposed concerns are their thrombogenicity and fatal complications.

Methods:

Patients who underwent elective pancreatic resections with mesoportal venous interposition grafts (ISGPS type 4) between 2003-2022 were identified from the institutional pancreatectomy registry. Alloplastic vascular grafts imply synthetic materials, either based on polytetrafluorethylene (PTFE) or polyethylene terephthalate (PET). Surgical details, clinicopathological, and follow-up data were analyzed. The patients were followed for graft patency by cross-sectional imaging.

Results:

In this study, 201 patients with venous interposition grafts were included (23% simultaneous arterial resections). Total pancreatectomy (41%) and pancreatoduodenectomy (35%) were the most frequent procedures. Vascular graft materials were alloplastic in 180 patients (83% PTFE and 17% PET) with a median diameter of 10 mm and a median length of 33 mm (measurement by CT scan). Patency rates among all graft materials at 7-, 30-, and 90-days were 99%, 93%, and 87%. Alloplastic grafts demonstrated superior patency over other materials (hazard ratio 2.7, P=0.009), and PTFE reached a 1-year patency of 78%. The all-cause 90-day mortality rate was 10%. No graft infection occurred.

Conclusion:

Alloplastic venous vascular grafts are safe and readily available tools in pancreatic surgery, especially for long-segmental mesoportal venous reconstructions.
Thoracic irrigation for traumatic hemothorax: A systematic review and meta-analysis
Authors: Lyons Nicole B. , Collie Brianna L. , Cobler-Lichter Michael D. , Delamater Jessica M. , Shagabayeva Larisa , Tito-Bustillos Luciana , Proctor Kenneth G. , Valenzuela Julie Y. , Meizoso Jonathan P. , Namias Nicholas
Published: November 2024

BACKGROUND

Traumatic hemothoraces (HTXs) are common, and tube thoracostomy (TT) insertion is generally the initial management. However, a retained HTX can develop into a fibrothorax or empyema requiring secondary intervention. We hypothesized that irrigation of the thoracic cavity at the time of TT may prevent retained HTX.

METHODS

Pubmed, EMBASE, and Scopus were searched from inception to May 2024. Studies with adult trauma patients with traumatic HTX who received a TT and had patients who underwent thoracic irrigation were included. The primary outcome was failure rate, defined as retained HTX requiring a second intervention. Cumulative analysis was performed with χ2 for dichotomous variables and unpaired t test for continuous variables. A fixed-effects model was applied for meta-analysis.

RESULTS

Six studies were included in the analysis; two retrospective and four prospective observational studies. These studies included 1,319 patients (513 irrigated TT, 837 nonirrigated TT). The mean age of patients was 45 years, 81% were male, mean Injury Severity Score was 21, and 42% had penetrating trauma. Failure rate was significantly lower in the irrigation group on cumulative analysis (10.7% vs. 18.2%, p < 0.001) and meta-analysis (effect size, 0.704; 95% confidence interval, 0.218–1.190; I
2 = 0.4; p < 0.001]. In addition, on meta-analysis, the irrigation group had a shorter TT duration and hospital and ICU length of stay (all p < 0.05). There were no differences in overall infectious complications, readmission, or mortality; however, all the models favored the irrigation group.

CONCLUSION

Patients who undergo simultaneous TT and thoracic irrigation have a lower rate of retained HTX and require fewer secondary interventions. Thoracic irrigation for traumatic HTX should be considered; however, randomized studies are needed prior to development of guidelines.

LEVEL OF EVIDENCE

Systematic Review/Meta-analysis; Level III.
Analysis of Intraoperative Visual Evoked Potentials for Inclusion of Unstable Electroretinograms
Authors: Cochard Eva , Bérard Nadia , Schaller Karl , Boëx Colette
Published: November 2024

Purpose:

The objectives of the study were to evaluate the validity of intraoperative flash visual evoked potentials (VEPs) when electroretinograms (ERGs) were unstable, to compare white versus red light-emitting diodes, and to assess the impact of luminance on ERG variability.

Methods:

Thirty patients were included (Inomed system; pre- and postoperative visual fields). Possible changes in visual fields were assessed with mean defects in perimetry. The receiver operating characteristic (ROC) curves of normalized VEPs and of normalized and corrected VEPs with ERGs were compared.

Results:

Thirty-two eyes could be analyzed in 20 patients (mainly gliomas and meningiomas): 2 had a severe defect in their visual field, and 6 had a mild defect. The receiver operating characteristic curve indicated (1) normalized and corrected VEPs with ERGs were more reliable than normalized VEPs only (P < 0.03) and (2) an alarm threshold of 80% of normalized and corrected VEPs. No significant difference in variability of ERGs was found with white or red light-emitting diodes with this system. Increased luminance improved stability of ERGs (P < 0.05).

Conclusions:

Normalization and correction of VEPs with ERGs improved the validity of VEPs and indicated a 20% decrease as alarm criterion. This normalization and correction with peripheral excitation could be generalized to improve the reliability of neuromonitoring.
Amoxicillin resistance of bacteria isolated from dental implants with peri-implant diseases
Authors: Secundino Ismael , Reséndiz-Jaramillo Cynthia , Palacios-Castañon Yosahandy , Pérez Nailea Zambrano , Santiago-Martínez Mayemi Pamela , Zermeño-Loredo María Teresa , Reyes-Martínez Juana Elizabeth , Nizet Victor
Published: November 2024

Background

Peri-implant mucositis is a reversible inflammatory lesion of the mucosa surrounding a dental implant, caused by the accumulation of bacterial plaque and biofilm formation, without bone loss. If peri-implant mucositis is not addressed, it can progress to peri-implantitis, characterized by significant inflammation of the peri-implant mucosa accompanied by the loss of supporting bone. Clinical evidence suggests that the management of peri-implant infections consist of mechanical debridement of implant, surgical intervention, and the administration of antibiotics. However, limited information is available regarding antibiotic resistance in bacteria causing peri-implant diseases.

Gap statement

Peri-implant bacteria are resistant to amoxicillin, a β-lactam antibiotic, which is the first choice medicine to treat peri-implant infections.

Aim

Evaluate the resistance of bacteria isolated from dental implants with peri-implant diseases, to amoxicillin and clindamycin.

Methodology

Biofilms were recovered from implants with peri-implant mucositis (n=4) and peri-implantitis (n=8). Microorganisms were cultured under aerobic and anaerobic conditions. Antibiotic sensitivity was assessed using the disk diffusion susceptibility assay using amoxicillin at a concentration of 8 μg per disk and clindamycin at a concentration of 30 μg per disk.

Results

Cultivation of microorganisms revealed predominant facultative anaerobic bacteria. Isolates recovered from implants with peri-implant mucosistis showed resistance to amoxicillin (100%; 4/4). In comparison, 75% of bacteria isolated from implants with peri-implantitis were resistant to amoxicillin (6/8). All isolates from implants with peri-implant diseases (n=12) were sensitive to clindamycin.

Conclusion

These findings suggest that bacteria isolated from dental implants with peri-implant infections are resistant to amoxicillin, a β-lactam antibiotic, raising concerns about the potential dissemination of this resistance to other oral bacteria.
Toscana virus – an emerging Mediterranean arbovirus transmitted by sand flies
Authors: Keskek Turk Yonca , Ergunay Koray , Kohl Alain , Hughes Joseph , McKimmie Clive S.
Published: November 2024

Toscana virus (TOSV) is an emerging arthropod-borne virus (arbovirus) of medical importance that is increasing its range across much of the Mediterranean Basin, Europe and the Middle East. Transmitted by Phlebotomus spp. sand flies, it is the most clinically relevant sand fly-borne phlebovirus. Initially isolated in the Tuscany region of Central Italy, it has now been detected in multiple countries that surround this geographical area. Infection of the vertebrate host can cause fever and neurological disease, following the dissemination of the virus to the brain. The prevalence is high in some regions, with a notable percentage of individuals showing seroconversion. TOSV can be a leading cause of acute meningitis and encephalitis (AME) during the summer months. In this comprehensive review, we will focus on several key topics. We discuss how TOSV has spread to establish outbreaks of infection in both humans and animals around the Mediterranean and the wider region. Clinical aspects of TOSV infection in humans are described, along with the best standards in diagnosis. Finally, we focus our discussion on the role of the sand fly vector, describing their biology, vector competency, implications for putative vertebrate reservoirs, the effect of the climate emergency on sand fly distribution and the putative role that sand fly-derived salivary factors may have on modulating host susceptibility to TOSV infection.
Dicer-2 mutations in Aedes aegypti cells lead to a diminished antiviral function against Rift Valley fever virus and Bunyamwera virus infection
Authors: Dornbusch Susann , Reuter Melinda , Parry Rhys H. , Stern Michael , Becker Stefanie C. , Schnettler Esther
Published: November 2024

Mosquitoes are known to transmit different arthropod-borne viruses belonging to various virus families. The exogenous small interfering RNA pathway plays an important role in the mosquito defence against such virus infections, with Dicer-2 (Dcr2) as one of the key proteins that initiates the cleavage of viral dsRNAs into 21 nt long virus-derived small interfering RNAs. Previous data identified the importance of various motifs in Dcr2 for its small interfering RNA (siRNA)-mediated antiviral activity. However, all these data focus on positive-strand RNA viruses, although negative-strand RNA viruses, like Bunyaviricetes, include several important mosquito-borne viruses. Here, we aim to investigate the importance of different domains of Dcr2 for antiviral activity against viruses of the Bunyaviricetes. For this, we used the Aedes aegypti-derived Dcr2 knock-out cell line Aag2-AF319 to study the importance of the helicase, RNase III and PIWI–Argonaute–Zwille domains of Dcr2 on the antiviral activity of two viruses belonging to different families of the Bunyaviricetes: the Rift Valley fever virus (RVFV) vaccine strain MP12 (Phenuiviridae, Phlebovirus) and the Bunyamwera orthobunyavirus (BUNV; Peribunyaviridae, Orthobunyavirus). All three domains were determined to be critical for the antiviral activity against both RVFV and BUNV. Interestingly, one specific mutation in the helicase domain (KN) did not result in a loss of antiviral activity for RVFV, but for BUNV, despite losing the ability to produce 21 nt siRNAs.
Study of excess manganese stress response highlights the central role of manganese exporter Mnx for holding manganese homeostasis in the cyanobacterium Synechocystis sp. PCC 6803
Authors: Reis Mara , Zenker Sanja , Viehöver Prisca , Niehaus Karsten , Bräutigam Andrea , Eisenhut Marion
Published: November 2024

Cellular levels of the essential micronutrient manganese (Mn) need to be carefully balanced within narrow borders. In cyanobacteria, a sufficient Mn supply is critical for ensuring the function of the oxygen-evolving complex as the central part of the photosynthetic machinery. However, Mn accumulation is fatal for the cells. The reason for the observed cytotoxicity is unclear. To understand the causality behind Mn toxicity in cyanobacteria, we investigated the impact of excess Mn on physiology and global gene expression in the model organism Synechocystis sp. PCC 6803. We compared the response of the WT and the knock-out mutant in the Mn exporter (Mnx), ∆mnx, which is disabled in the export of surplus Mn and thus functions as a model for toxic Mn overaccumulation. While growth and pigment accumulation in ∆mnx were severely impaired 24 h after the addition of tenfold Mn, the WT was not affected and thus mounted an adequate transcriptional response. RNA-seq data analysis revealed that the Mn stress transcriptomes partly resembled an iron limitation transcriptome. However, the expression of iron limitation signature genes isiABDC was not affected by the Mn treatment, indicating that Mn excess is not accompanied by iron limitation in Synechocystis. We suggest that the ferric uptake regulator, Fur, gets partially mismetallated under Mn excess conditions and thus interferes with an iron-dependent transcriptional response. To encounter mismetallation and other Mn-dependent problems on a protein level, the cells invest in transcripts of ribosomes, proteases and chaperones. In the case of the ∆mnx mutant, the consequences of the disability to export excess Mn from the cytosol manifest in additionally impaired energy metabolism and oxidative stress transcriptomes with a fatal outcome. This study emphasizes the central importance of Mn homeostasis and the transporter Mnx’s role in restoring and holding it.