bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction
Authors: Hartmann Catherine
Published: February 2025

The book’s introduction accomplishes three primary goals that prepare the reader for the focused argument made in the body chapters. First, the introduction frames the entire argument with an episode from the Vimalakīrtinirdeśa Sūtra in which the Buddha temporarily reveals that the ordinary world of pain and suffering is actually a perfect world. The Buddha argues that ordinary people’s deluded perception prevents them from seeing the world as it truly is. Second, the chapter briefly introduces practices of pilgrimage in Tibet, as well as the goal of transforming perception on pilgrimage so that pilgrims can see the mountain’s ordinarily invisible wonders. Finally, the chapter introduces the range of pilgrimage texts that will be examined in the coming chapters, and it lays out the theoretical and methodological approaches to these texts that will inform the book’s central arguments. This includes the framework of “making the invisible real” as developed by Tanya Luhrmann.
How Pilgrimage Guides Use Language and Landscape to Cultivate Co-Seeing
Authors: Hartmann Catherine
Published: February 2025

This chapter explores the genre of pilgrimage guides (gnas yig), which provide practical instructions for how to see the pilgrimage place. It identifies the literary strategies by which pilgrimage guides direct the reader’s attention. It then develops an account of how the language of these guide texts facilitates co-seeing by functioning as a kind of extended metaphor. In other words, language creates for pilgrims a fantastic vision of the hidden worlds of the pilgrimage place. Meanwhile, the guides constantly draw pilgrims’ attention to their ordinary perception of the physical world in front of them. The effect is to juxtapose that fantastic vision of the site with the pilgrims’ ordinary perception of it. In so doing, the texts themselves interweave the ordinary and fantastic worlds in the pilgrim’s experience, thus creating the conditions for pilgrims to experience the mountain as the divine palace that such guides say it truly is.
Plasma biomarkers for diagnosis and differentiation and their cognitive correlations in patients with Alzheimer’s disease
Authors: Sun Wenhao , Ye Shuwei , Wang Yu , Chen Huifeng , Che Ping , Chen Jingshan , Zhang Nan
Published: February 2025

Increasing evidence has shown the potential value of plasma biomarkers in Alzheimer’s disease (AD) diagnosis. This study aimed to determine the diagnostic and differential values of emerging plasma biomarkers for different types of dementia in a Chinese population and to explore their cognitive correlations. One hundred twenty patients with dementia, including 51 AD patients, 54 subcortical ischemic vascular dementia (SIVD) patients, and 15 frontotemporal lobar degeneration (FTLD) patients were recruited alongside 27 cognitively unimpaired (CU) control subjects. Global and domain-specific cognition was assessed in all participants by a battery of neuropsychological tests. Plasma amyloid beta (Αβ)42, Aβ40, and total tau (T-tau) (in CU controls and AD patients) and phosphorylated tau at threonine-181 (P-tau181), neurofilament light (NfL) and glial fibrillar acidic protein (GFAP) levels (in all participants) were measured using the single-molecule array (Simoa) platform. The levels of all biomarkers differed between AD patients and CU controls, with P-tau181 and GFAP levels and the Aβ42/P-tau181 ratio best differentiating the two groups (AUC=0.966, 0.932, and 0.927, respectively). P-tau181 and GFAP levels were greater in the AD group than in the other two patient groups and showed the best performance in distinguishing AD patients from SIVD (AUC= 0.922) and FTLD patients (AUC= 0.894), respectively. Moreover, compared with that in the CU group, the GFAP level was elevated in the SIVD group, and the NfL level was elevated in all patient groups. Compared with other single biomarkers, the plasma Aβ42/P-tau181 ratio correlated with broader cognitive domains, including global cognition (Mini-Mental Status Examination [MMSE], r = 0.314, P = 0.027; Montreal Cognitive Assessment [MoCA], r = 0.313, P = 0.043), memory (r = 0.339, P = 0.016), language (r = 0.333, P = 0.020), attention and information processing speed (r =0.369, P = 0.008), executive function (r = 0.305, P = 0.031), and visuospatial function memory (r = 0.453, P = 0.001). P-tau181 was an optimal plasma biomarker for identifying AD patients and differentiating AD patients from SIVD and FTLD patients. Moreover, the GFAP level and the Aβ42/P-tau181 ratio showed potential diagnostic and progression monitoring value, respectively, for AD patients.
Can conspiracy theories ever be plausible? The role of narrative rationality in the assessment of online conspiracy theories
Authors: Turner Hossein
Published: February 2025

Conspiracy theories (CTs) represent a persistent challenge in evaluating major events, as they often employ fallacious forms of narrative reasoning and persuasion to posit conspiratorial agency and motives. While many CT narratives conflict with logic and reason, a minority may possess a degree of plausibility. But by what standards can plausibility of a CT be measured? This article introduces concepts from legal storytelling, rhetoric and cognitive linguistics to expand Walter Fisher’s narrative paradigm framework, enabling auditors to critically engage with the rhetorical dynamics of CT narratives. Through an analysis of official and alternative narratives surrounding the death of a Russian spy, this article demonstrates how, in a similar way to the role of jurors in criminal trials, auditors may either join the rhetor in co-creating a coherent and plausible narrative, or end up challenging the rhetor by identifying problems and thus planting the potential seeds of rival accounts.
Sudden cardiac arrest prediction via deep learning electrocardiogram analysis
Authors: Oberdier Matt T , Neri Luca , Orro Alessandro , Carrick Richard T , Nobile Marco S , Jaipalli Sujai , Khan Mariam , Diciotti Stefano , Borghi Claudio , Halperin Henry R
Published: February 2025

Aims

Sudden cardiac arrest (SCA) is a commonly fatal event that often occurs without prior indications. To improve outcomes and enable preventative strategies, the electrocardiogram (ECG) in conjunction with deep learning was explored as a potential screening tool.

Methods and results

A publicly available data set containing 10 s of 12-lead ECGs from individuals who did and did not have an SCA, information about time from ECG to arrest, and age and sex was utilized for analysis to individually predict SCA or not using deep convolution neural network models. The base model that included age and sex, ECGs within 1 day prior to arrest, and data sampled from windows of 720 ms around the R-waves from 221 individuals with SCA and 1046 controls had an area under the receiver operating characteristic curve of 0.77. With sensitivity set at 95%, base model specificity was 31%, which is not clinically applicable. Gradient-weighted class activation mapping showed that the model mostly relied on the QRS complex to make predictions. However, models with ECGs recorded between 1 day to 1 month and 1 month to 1 year prior to arrest demonstrated predictive capabilities.

Conclusion

Deep learning models processing ECG data are a promising means of screening for SCA, and this method explains differences in SCAs due to age and sex. Model performance improved when ECGs were nearer in time to SCAs, although ECG data up to a year prior had predictive value. Sudden cardiac arrest prediction was more dependent upon QRS complex data compared to other ECG segments.
Global Englishes teaching in secondary schools in Italy
Authors: Andreani Claudia , McKinley Jim
Published: February 2025

English Language Teaching (ELT) materials often assign prominence to British English and General American English to the detriment of other varieties, thus promoting native-like competence as a goal for English language learners. Scholars have called for a reconceptualisation of ELT by correlating English varieties with globalisation within the Global Englishes (GE) paradigm. The present mixed-methods study, which engaged ninety-six EFL senior secondary school students in Italy who prepared a presentation of a variety of English of their choice, examined how this task influenced their attitudes to the diversity of English. Data were collected through pre- and post-tests and solicited journals and showed the participants’ preference for a GE-oriented pedagogy, despite the persistence of a more conventional attitude towards British and American English, which may derive from their exam-oriented culture. Results indicate that a GE-oriented pedagogy is likely to foster learners’ critical understanding of language variation and challenge cultural stereotypes.
Receptor modeling, ecological risks, and human health impacts of mercury in some Ghanaian topsoils due to mining and commercial activities
Authors: Asamoah Benjamin Darko , Yevugah Lily Lisa , Borquaye Lawrence Sheringham , Dodd Matt , Darko Godfred
Published: February 2025

Globally, elevated environmental mercury levels have been linked to artisanal and small-scale gold mining; however, investigations into mining communities often overlook other potential sources and their contributions to soil mercury accumulation. This study explored the positive matrix factorization receptor model to identify other possible sources of mercury contamination in two major mining communities (Kenyasi and Obuasi) and a commercial city (Sunyani) in Ghana. The mercury concentrations across the three study areas showed no significant differences (p = 0.257 at the 95% confidence level). The positive matrix factorization model identified mining as the major contributor to mercury accumulation in Obuasi and Kenyasi, with other activities, such as farming, also contributing substantially. The generation and burning of hazardous waste in the Sunyani municipality due to increased commercial activities have contributed significantly to mercury contamination. Although the hazard quotient indicated no adverse health effects in the study areas (HQ < 1), the pollution and ecological risk indices showed that Obuasi was significantly enriched with mercury, with considerable levels found in Kenyasi and Sunyani. The results from this study will serve as a good database for environmental studies on mercury particularly in Kenyasi and Sunyani, where there has not been any extensive research on mercury contamination.
May Measurement Month 2022: an analsyis of blood pressure screening results from China
Authors: Wang Xin-Yu , Hu Zhe , Liu Chang-Yuan , Lei Cheng-Bao , Zheng Qi-Dong , Zheng Mei-Sheng , Chen Xiao-Rui , Ge Li-Bin , Beaney Thomas , Kerr Gabriele , Poulter Neil R , Li Yan , Chen Xin , Wang Ji-Guang
Published: February 2025

The May Measurement Month (MMM) campaign was carried out in China in 2022 with the aim of raising awareness of raised blood pressure (BP). Here, we report the findings of the campaign.

Adults aged ≥ 18 years were recruited opportunistically at 30 China provinces. Three seated BP readings were taken for each participant, along with completion of a questionnaire on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or being on antihypertensive medication. Controlled BP was defined as being on antihypertensive medication with a BP <140/90 mmHg. Multiple imputation was used to estimate any missing BP readings. In total, 188 975 were screened, with a mean age of 46.0 years, and 49.6% of whom were female. Of all participants, 49 788 (26.3%) had hypertension, of whom 11 268 (22.6%) were aware, and 10 945 (22.0%) were on antihypertensive medication. Of those on antihypertensive medication, 6362 (58.1%) had controlled BP, and of all participants with hypertension, 12.8% had controlled BP. After adjustment for age, sex, and use of antihypertensive medication, both systolic and diastolic BP were significantly (p≤0.01) higher in those drinking alcohol 1-3 times per month (n=24322, +0.7/+0.4 mmHg) and higher still BPs in those drinking 1-6 times per week (n=10691, +2.9/+1.0 mmHg) compared to those who never or rarely drank alcohol. In total, 43 426 (23.0%) were found to have either untreated or inadequately treated hypertension.

The MMM campaign in China identified particularly high rates of untreated hypertension and also inadequately treated hypertension which should inform strategies to improve the detection and management of hypertension in China.
Comparison of Self-Reported Physical Activity between Survivors of Out-of-Hospital Cardiac Arrest and Patients with Myocardial Infarction without cardiac arrest: a case-control study
Authors: Heimburg Katarina , Nordström Erik Blennow , Friberg Hans , Oestergaard Lisa G , Grejs Anders M , Keeble Thomas R , Kirkegaard Hans , Mion Marco , Nielsen Niklas , Rylander Christian , Segerström Magnus , Tornberg Åsa B , Ullén Susann , Undén Johan , Wise Matt P , Cronberg Tobias , Lilja Gisela
Published: February 2025

Aims

To investigate whether out-of-hospital cardiac arrest (OHCA) survivors had lower levels of self-reported physical activity compared to a non-cardiac arrest control group with myocardial infarction (MI), and to explore if symptoms of anxiety, depression, kinesiophobia (fear of movement) and fatigue were associated with a low level of physical activity.

Methods

Predefined case–control sub-study within the international Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. OHCA survivors at 8 of 61 TTM2 sites in Sweden, Denmark and the United Kingdom were invited. Participants were matched 1:1 to MI controls. Both OHCA survivors and MI controls answered two questions on self-reported physical activity, categorized as a low, moderate, or high level of physical activity, and questionnaires on anxiety and depression symptoms, kinesiophobia, and fatigue 7 months after the cardiac event.

Results

Overall, 106 of 184 (58%) eligible OHCA survivors were included and matched to 91 MI controls. In total, 25% of OHCA survivors and 20% of MI controls reported a low level of physical activity, with no significant difference (p=0.13). Symptoms of kinesiophobia and fatigue were significantly associated with a low level of physical activity in both groups. OHCA survivors had significantly more kinesiophobia compared to MI controls (18% versus 9%, p=0.04), while levels of anxiety and depression symptoms and fatigue were similar.

Conclusion

OHCA survivors had similar levels of physical activity compared to matched MI controls. High level of kinesiophobia and fatigue were associated with a low level of physical activity in both groups.
Mental health status and quality-of-life after an acute myocardial infarction with non-obstructive coronary arteries or takotsubo syndrome: A systematic review
Authors: Leissner Philip , Olsson Erik M G , Rondung Elisabet , Sundelin Runa , Spaak Jonas , Ulvenstam Anders , Nordenskjöld Anna , Kövamees Lena , Lyngå Patrik , Held Claes , Tornvall Per , Humphries Sophia
Published: February 2025

Background

Myocardial infarction with non-obstructive coronary arteries (MINOCA) and takotsubo syndrome (TS) are both characterised by lack of significant coronary artery stenoses and a higher prevalence of mental health disorders preceding the event. Currently, little is known about their pathological aetiologies and subsequent treatment plans, giving cause for concern among those affected. The objective of this review is to provide a comprehensive overview of mental health status and quality of life (QoL) in MINOCA- and TS-patients after the acute event, compared to both cardiac and non-cardiac populations, and over time.

Methods

A systematic search was conducted via Cochrane Library, CINAHL, PyschINFO, PubMed, ASSIA, Web of Science, Scopus and Embase from inception to May 2024. The review was registered in PROSPERO and methods, and results were reported in accordance with the PRISMA guidelines. Quality assessment and risk of bias were evaluated using the Newcastle-Ottawa Scale for cross-sectional and cohort studies.

Results

Sample sizes ranged from 13 to 5,322 participants. The risk of bias was high in 18/28, medium in 7/28, and low in 3/28 studies. Across the symptoms assessed, MINOCA- and TS-patients reported worse mental health status or QoL than non-cardiac groups in 10/13 studies, and cardiac groups in 10/20 studies. Investigating change over time, 1/5 studies found deteriorating mental health status, 3/5 reported improved mental health status or QoL and 1/5 reported no change in MINOCA- and TS-patients.

Conclusions

Patients with MINOCA or TS seem to have worse mental health status and QoL after the acute event than non-cardiac individuals, but it is yet difficult to conclude whether mental distress and QoL are equal or worse compared to CHD-patients. There is no convincing evidence that mental health status or QoL of MINOCA- and TS- patients naturally improve over time after the acute event. Among the studies evaluated, risk of bias was high. More high-quality studies are needed, investigating mental health status and QoL among MINOCA- and TS-patients.
Rhizosphere Microbiome Influence on Tomato Growth under Low-Nutrient Settings
Authors: Mejia Gerardo , Jara-Servin Angélica , Hernández-Álvarez Cristóbal , Romero-Chora Luis , Peimbert Mariana , Cruz-Ortega Rocío , Alcaraz Luis D
Published: February 2025

Studies have suggested that reduced nutrient availability enhances microbial diversity around plant roots, positively impacting plant productivity. However, the specific contributions of rhizosphere microbiomes in nutrient-poor environments still need to be better understood. This study investigates tomato (Solanum lycopersicum L.) root microbiome under low-nutrient conditions. Plants were grown in hydroponics with soil-derived microbial community inoculations. We hypothesised that nutrient limitation would increase the selection of beneficial bacterial communities, compensating for nutrient deficiencies. We identified 12 294 OTUs across treatments and controls using 16S rRNA gene sequencing. Increased plant biomass was observed in treatments compared to controls, suggesting a role for the microbiome in mitigating nutrient limitations. The relative abundance of genera such as Luteolibacter and Sphingopyxis relative abundance correlated with plant phenotypic traits (p ≤ 0.05), and their presence was further validated using shotgun metagenomics. We annotated 722 677 protein families and calculated a core set of 48 116 protein families shared across all treatments and assigned them into Bacteria (93.7%) and Eukaryota (6.2%). Within the core bacterial metagenome, we identified protein families associated with pathways involved in positive plant interactions like the nitrogen fixation. Limited nutrient availability enhanced plant productivity under controlled conditions, offering a path to reduce fertiliser use in agriculture.
Developmental landscape and asymmetric gene expression in the leaf vasculature of Brassica rapa revealed by single-cell transcriptome
Authors: Guo Xinlei , Yuan Jingping , Zhang Yuanyuan , Wu Jian , Wang Xiaowu
Published: February 2025

Leaf vasculature not only acts as a channel for nutrients and signaling information but also influences leaf morphology. It consists of several distinct cell types with specialized functions. Cell type-specific characterizations based on single-cell RNA sequencing technology could aid in understanding the identities of vascular tissues and their roles in leaf morphogenesis in Brassica rapa. Here, we generated a single-cell transcriptome landscape of the Chinese cabbage leaf vasculature. A total of 12 cell clusters covering 7 known cell types were identified. Different vascular cell types were characterized by distinct identities. The xylem parenchyma and companion cells exhibited an active expression pattern of amino acid metabolism genes. Tracheary elements and sieve elements were enriched in many genes related to cell wall biosynthesis, and the phloem parenchyma was enriched in many sugar transporter-encoding genes. Pseudo-time analyses revealed the developmental trajectories of the xylem and phloem and the potential roles of auxin and ethylene in xylem development. Furthermore, we identified key candidate regulators along the differentiation trajectory of the sieve elements and companion cells. Most of the homoeologous genes in the syntenic triads from the three subgenomes showed asymmetric gene expression patterns in different vascular cell types. Collectively, our study revealed that Chinese cabbage leaf vasculature cells had highly heterogeneous transcriptomes, providing new insights into the complex processes of leaf vasculature development in B. rapa leafy vegetables and other Brasscia crops.
Ethylene Modulates the Phenylpropanoid Pathway by Enhancing VvMYB14 Expression via the ERF5-Melatonin-ERF104 Pathway in Grape Seeds
Authors: Gao Shiwei , Wang Fei , Wang Shengnan , Diao Jiapeng , Lan Shuxia , Xu Yujiao , Lyu Xinning , Kang Hui , Yao Yuxin
Published: February 2025

The interaction between ethylene and melatonin in the regulation of polyphenol metabolism and the underlying mechanism remain largely unclear. This work demonstrated that ethylene treatment increased melatonin biosynthesis by inducing the VvASMT expression in grape seeds. Ethylene-induced VvERF5 transactivated VvASMT via binding to the ERE element in its promoter. VvERF5 overexpression led to an increase in melatonin biosynthesis while its suppression generated the opposite results in grape seeds, calli and/or Arabidopsis seeds. A melatonin responsive element (MTRE) was identified, and melatonin-induced VvERF104 was found to bind to the MTRE of the VvMYB14 promoter and activate its expression. VvMYB14 overexpression widely modified the expression of genes in phenylpropanoid pathway and phenolic compound content in grape seeds. DAP-seq revealed that the MEME-1 motif was the most likely binding sites of VvMYB14. VvPAL, VvC4H and VvCHS were verified to be the target genes of VvMYB14. Additionally, the overexpression of VvERF5 or VvERF104 increased the expression of VvPAL, VvC4H and VvCHS, as well as the levels of the corresponding metabolites. Moreover, the roles of VvERF5, VvASMT and VvERF104 in mediating ethylene-induced changes in phenylpropanoid pathway were elucidated using their suppressing seeds. Collectively, ethylene increased the VvMYB14 expression via the pathway of ERF5-melatonin-ERF104 and thereby modified phenylpropanoid pathway.
Stable isotope labelling and gene expression analysis reveal dynamic nitrogen-supply mechanisms for rapid growth of Moso bamboo
Authors: Zhang Junbo , Shi Man , Zhu Chenglei , Yang Kebin , Li Quan , Song Xiaoming , Gao Zhimin , Cao Tingting , Zhu Dezheng , Song Xinzhang
Published: February 2025

Rapid growth of Moso bamboo (Phyllostachys edulis) shoots (offspring ramet) is primarily fuelled by nitrogen (N) derived from parent ramet and absorbed by rhizome roots. However, the extent to which each N source supports the growth of offspring ramet and the underlying molecular mechanisms of N transport remain unclear. Here, clonal fragments consisting of a parent ramet, an offspring ramet, and an interconnected rhizome were established in a Moso bamboo forest. Additionally, 15N isotope tracing and transcriptome profiling were conducted concurrently to quantify the N contribution from the parent ramet and rhizome roots to the offspring ramet, and to reveal the molecular mechanisms underlying N transport during rapid growth (i.e., early, peak, branching, and leafing stages). The N acquisition strategy of offspring ramet shifted from being primarily provided by the parent ramet (72.53%) during early stage to being predominantly absorbed by rhizome roots (69.85%) during the leafing stage. Approximately equal N contributions (45.82–54.18%) from the parent ramet and rhizome roots were observed during peak and branching stages. PeAAP29123 was identified as a key gene for N transport, being most closely correlated with 15N content. Biomolecular assays demonstrated that PeHDZ23987 could activate the expression of PeAAP29123 via two types of HD-motifs. Overexpression of PeHDZ23987 and PeAAP29123 significantly enhanced N starvation tolerance in transgenic rice with significantly improved N uptake efficiency. Our findings clarify the pattern and mechanisms of N supply for the rapid growth of Moso bamboo offspring ramet and provide transcriptomic evidence for long-distance N transport between clonal ramets.
The ethical considerations of integrating Artificial Intelligence into surgery: a review
Authors: Arjomandi Rad Arian , Vardanyan Robert , Athanasiou Thanos , Maessen Jos , Nia Peyman Sardari
Published: February 2025

OBJECTIVES

The integration of AI into surgery raises significant ethical concerns, including the impact on autonomy, human authority, and the patient-doctor relationship. This study underscores the need for a multidisciplinary approach to navigate these ethical dilemmas, involving stakeholders from various fields.

METHODS

A comprehensive literature review up to March 2024 was conducted to assess the ethical implications of AI applications in surgery. This included an examination of data privacy, informed consent, algorithmic bias, the role of advanced robotics, and the impact on surgeons’ decision-making. The study also considered the development of autonomous surgical robots and their ethical implications.

RESULTS

The review highlights that while AI can enhance surgical precision and improve clinical decision-making, it also poses several ethical challenges. AI's ability to support decision-making risks undermining surgeons' autonomy and judgement, raising concerns about over-reliance on technology. Issues such as data privacy, algorithmic bias, and equitable access to AI-driven tools were identified as key ethical concerns. Autonomous surgical robots, while promising, introduce complex questions about accountability and liability, particularly when unexpected outcomes occur.

CONCLUSIONS

Effective integration of AI into surgical practices demands the development of ethical frameworks that respect both the capabilities of AI and the irreplaceable value of human judgement. Balancing technological advancement with ethical integrity is essential to safeguard patient-centered care and ensure equitable access to AI benefits in healthcare.
Minimally invasive mitral valve surgery for mitral valve prolapse: A comparison between fibro-elastic deficiency and barlow’s disease
Authors: Huyghe Simon , Colpaert Bodine , Czapla Jens , Philipsen Tine , Timmermans Frank , Bové Thierry
Published: February 2025

OBJECTIVES

Within the spectrum of degenerative mitral valve(MV) prolapse, Barlow disease remains a risk factor for suboptimal long-term outcome after MV repair. This study reports on the results of MV repair(MVr) through minimally invasive surgery(MICS) benchmarking patients with Barlow disease to Fibro-Elastic Deficiency(FED).

METHODS

Between July 2008 and December 2021, 246 patients underwent MVr for degenerative MV prolapse via MICS, including 180 FED and 66 Barlow patients. Study end-points focused on 10-year survival, MV reoperation and recurrence of MV regurgitation ≥ grade 2.

RESULTS

Barlow patients were significantly younger(Barlow: 58 y(IQR 47–67) – FED: 68 y(IQR 60–76), p < 0.001), showing more complex MV prolapse than FED patients. The overall 30 day-mortality was 0.4%. Survival at 10 years was 78.8 ± 11.3% and 64.5 ± 7.4%(p = 0.161) in Barlow and FED patients respectively. The cumulative incidence of MV reoperation at 10 years was comparable between Barlow and FED patients(FED: 9.7 ± 3.1% – Barlow: 8.0 ± 4.7%, p = 0.645). The cumulative incidence of MR recurrence ≥ grade 2 was 3.0 ± 1.4% and 6.8 ± 3.1% at 5 and 10 years overall. MR recurrence rate at 10 years was higher in Barlow patients, but the difference was not significant(FED: 3.3 ± 1.7% at 10 y—Barlow: 11.1 ± 8.7% at 10 y, p = 0.765)

CONCLUSIONS

Despite more extensive MV prolapse in Barlow patients, MVr through minimally surgical access can be achieved with a mid-term outcome comparable to patients with fibro-elastic deficiency. Concentrating the expertise to increase the individual surgeon’s experience for surgical approach as the mitral valve procedure itself, allowed to achieve outcome results concurrent with those reported by high volume centers.
Transforming appeal decisions: machine learning triage for hospital admission denials
Authors: Owolabi Timothy
Published: February 2025

Objective

To develop and validate a machine learning model that helps physician advisors efficiently identify hospital admission denials likely to be overturned on appeal.

Materials

Analysis of 2473 appealed hospital admission denials with known outcomes, split 90:10 for training and testing.

Methods

Six binary classifier models were trained and evaluated using accuracy, precision, recall, and F1 score metrics.

Results

An elastic net logistic regression model was selected based on computational efficiency and optimal performance with 84% accuracy, 84% precision, 98% recall, and an F1 score of 0.9.

Discussion

The predictive model addresses the risk of physician advisors accepting inappropriate denials due to biased perceptions of appeal success. Model implementation improved denial screening efficiency and was a key feature of a more successful appeal strategy.

Conclusions

By addressing data quality problems inherent to electronic health data, and expanding the feature space, machine learning can be an effective tool in the healthcare provider space.
Enhanced Siglec-8 and HLA-DR and Reduced CRTH2 Surface Expression, Highlight a Distinct Phenotypic Signature of Circulating Eosinophils in Atopic Dermatitis
Authors: Dezoteux Frédéric , Marcant Pierre , Dendooven Arnaud , Delaunay Émeline , Esnault Stéphane , Trauet Jacques , Lefevre Guillaume , Staumont-Salle Delphine
Published: February 2025

Atopic dermatitis (AD) as well as other type 2 immune response (T2) diseases are often linked to elevated eosinophil (Eos) levels in the blood. Although the role of Eos in AD pathophysiology is suspected, it remains unclear. The development of new treatments targeting the T2 response, particularly cytokines involved in Eos activation and chemotaxis, makes it necessary to identify potential Eos profiles in AD that may respond to these treatments. A prospective study was conducted comparing blood Eos phenotypes in moderate-to-severe AD patients (n=19) without recent systemic treatment to healthy individuals (HI, n=19). The primary outcome was the membranous phenotypic signature of Eos, assessed by flow cytometry. Most AD patients (84%) had early onset in childhood, a severe disease (mean SCORAD of 57.5), and elevated blood Eos counts (310 per µl in AD vs 120 in HI, p<0.0001). AD patients exhibited lower CRTH2 on Eos but higher levels of HLA-DR and Siglec-8 compared to HI. Other surface proteins showed no significant differences. Clustering analysis confirmed increased Siglec-8 in AD patients. Additionally, AD patients had higher serum levels of T2 immune response-markers as eotaxin-2, IL-5, IL-3, and TARC. Circulating Eos in AD patients show a distinct phenotypic profile, suggesting a role in AD pathophysiology and potential involvement in differential treatment responses.
Single exposure to scopolamine highlighted by hair analysis following a drug-facilitated crime in a tourist in Indonesia
Authors: Caré Weniko , Bellouard Marie , Langrand Jérôme , Alvarez Jean-Claude , Dufayet Laurène , Larabi Islam-Amine
Published: February 2025

Documented cases of Datura use as an incapacitating agent remain rare due to the short plasma half-life of the tropane alkaloids. Hair analysis can offer a wide detection window of several months and is an effective way of documenting drug-facilitated robbery, even in the case of a single exposure.
Ionosphere of Ganymede: Galileo observations versus test particle simulation
Authors: Beth A , Galand M , Modolo R , Jia X , Leblanc F , Huybrighs H L F
Published: February 2025

In this paper, we model the plasma environment of Ganymede by means of a collisionless test particle simulation. By coupling the outputs from a DSMC simulation of Ganymede’s exosphere (i.e. number density profiles of neutral species such as H, H2, O, HO, H2O, O2 for which we provide parametrisation) with those of a MagnetoHydroDynamic simulation of the interaction between Ganymede and the Jovian plasma (i.e. electric and magnetic fields), we perform a comparison between simulated ion plasma densities and ion energy spectra with those observed in-situ during 6 close flybys of Ganymede by the Galileo spacecraft. We find that not only our test particle simulation sometimes can well reproduce the in-situ ion number density measurement, but also the dominant ion species during these flybys are $\mathrm{H_2^+}$, $\mathrm{O_2^+}$, and occasionally H2O+. Although the observed ion energy spectra cannot be reproduced exactly, the simulated ion energy spectra exhibit similar trends to those observed near the closest approach and near the magnetopause crossings but at lower energies. We show that the neutral exosphere plays an important role in supplying plasma to Ganymede’s magnetised environment and that additional mechanisms may be at play to energise/accelerate newborn ions from the neutral exosphere.
3D hydrodynamic simulations of white dwarf-main-sequence star collisions - II. Off-centre collisions
Authors: van der Merwe C J T , Mohamed S S , José J , Shara M M , Kamiński T
Published: February 2025

Stellar collisions have garnered renewed attention for their role in the formation of peculiar objects, such as blue stragglers, and their potential to explain transients with atypical observational and spectroscopic signatures. Among these, white dwarf-main sequence (WD-MS) collisions are particularly intriguing due to the diverse evolutionary pathways they can produce—such as peculiar red giants, novae, or sub-Chandrasekhar supernovae. We present 3D smoothed particle hydrodynamics (SPH) simulations of WD-MS collisions, exploring a range of mass ratios and impact parameters. We analyze the dynamics, energetics, gas morphology, and mass loss from these interactions. Using a 34-isotope nuclear network, we further predict the nucleosynthesis products generated during these collisions. Our models suggest that at early times the ejecta have a bipolar structure and, along with the stellar remnant, may be enriched in isotopes such as 13C, 15N, and 17O. In the case of near head-on collisions, the ejecta may also show an overabundance of 7Li relative to solar values.
An aberrant protamine ratio is associated with decreased H4ac levels in murine and human sperm
Authors: Kruse Alexander , Schneider Simon , Merges Gina Esther , Fröbius Andreas Christian , Forné Ignasi , Imhof Axel , Schorle Hubert , Steger Klaus
Published: February 2025

Protamine 2 (Prm2/PRM2), together with Protamine 1 (Prm1/PRM1), constitute the two protamines found in both murine and human sperm. During spermiogenesis in haploid male germ cells, chromatin undergoes significant condensation, a phase in which most histones are replaced by a species-specific ratio of these two protamines. Altered PRM1/PRM2 ratios are associated with subfertility and infertility in both male mice and men. Notably, during histone-to-protamine exchange a small fraction of histones remains (ranging from 1% to 15%) bound to DNA. The regulatory roles of these residual histones, governed by post-translational modifications (PTMs), play a pivotal role in spermatogenesis, particularly in chromatin remodeling and epigenetic regulation of genes during sperm differentiation or even in early embryogenesis.

In this study, utilizing a Prm2-deficient mouse model and conducting an analysis of sperm samples from men exhibiting either normozoospermia or atypical spermiograms, we observed alterations in the methylation and acetylation profiles of histones H3 and H4. Subsequent in- depth analysis revealed that discrepancies in protamine ratios do not significantly influence the post-translational modifications (PTMs) of histones in testicular sperm. In murine epididymal sperm, altered protamine ratios are associated with reduced acetylation of histone H4 (H4ac), a phenomenon similarly observed in ejaculated sperm from men. In particular, H4K5ac and H4K12ac were identified as the two modifications that appear to decrease as a result of reduced Prm2/PRM2 levels. Our findings reveal that Protamine 2 is necessary for the maintenance of specific histone PTMs, such as acetylation, which is essential for proper spermatogenesis and particularly for chromatin remodeling.
Effects of Craniectomy Defect on Tumor Treating Fields
Authors: Lok Edwin , Chang Bryant , Vega Rafael , Haack Monica , Wong Eric T
Published: February 2025

Purpose

Tumor Treating Fields (TTFields) are alternating electric fields approved for the treatment of glioblastoma. They must penetrate through the skull to reach the gross tumor volume (GTV) in the brain. Since skull is an attenuator of electric fields, removal of a section of cortical bone by craniectomy may facilitate the delivery of TTFields into the GTV.

Materials and Methods

We identified a glioblastoma patient who underwent a craniectomy for evacuation of a subdural empyema. The patient subsequently received standard adjuvant treatment with TTFields plus temozolomide without replacement of the skull defect. Post-acquisition magnetic resonance imaging datasets were obtained from this index patient and two others for virtual craniectomy analysis. After anatomic delineation, a 3-dimensional finite element mesh was generated and then solved for the distribution of applied electric fields, rate of energy deposition, and current density at the GTV.

Results

The geometry of craniectomy defect alone, with or without burr holes, did not alter TTFields delivery to GTV. Biomaterials filling the defect could significantly influence electric field penetration, particularly when they are highly conductive at 10 S/m or 7.76 x 106 S/m as in tantalum. The ratio of GTV relative to defect size also enhanced or attenuated TTFields coverage when the GTV was expanded or eroded, respectively.

Conclusions

Craniectomy, biomaterials filling the defect, and the ratio of GTV relative to defect size may interact in a combinatorial fashion in modulating TTFields penetration into the brain. These findings are clinically relevant for personalized TTFields treatment.
Prevalence and clinical significance of anti-neutrophil cytoplasmic antibodies in interstitial lung disease: A retrospective cohort study
Authors: Wu Tingting , Cao Chao , Cen Zekai , Zhou Haijun , Lv Dan , Zhang Yun , Ding Qunli
Published: February 2025

Objectives

Antineutrophil cytoplasmic antibodies (ANCAs) are occasionally positive in patients with interstitial lung disease (ILD). The positivity rates of ANCAs in various types of ILD and the role of ANCAs in ILD are still unclear. The purpose of this study was to estimate the prevalence of ANCAs in Chinese people diagnosed with ILD (including idiopathic pulmonary fibrosis) and identify differences in clinical features, radiographic features, and survival between patients with ANCA-positive and ANCA-negative ILD.

Methods

We retrospectively reviewed the data of 706 ILD patients with available ANCA results from March 2010 to October 2023 at the First Affiliated Hospital of Ningbo University. Patient demographics, symptoms, laboratory parameters, chest CT, and pulmonary function testing results were collected and analysed at each patient’s initial diagnosis. The prevalence and associations of ANCAs with clinical characteristics and survival were evaluated.

Results

ANCAs were positive in 158 of the 706 (22.4%) ILD patients. Compared with ANCA-negative ILD patients, ANCA-positive ILD patients tended to be older, had higher CRP and ESR levels, and had a significantly greater proportion of rheumatoid factor positivity. In total, 58.2% (92/158) of patients were ANCA-positive on average (41.6 ± 31.4) months after ILD diagnosis. Patients with ANCA-positive ILD had higher all-cause mortality than did those with ANCA-negative ILD (33.5% vs 25.0%, p = 0.033). The usual interstitial pneumonia (UIP) pattern (56.3%) was the most common chest HRCT pattern. The proportions of patients with honeycombing (p < 0.001) and oddly shaped cysts (p < 0.001) were significantly greater in the ANCA-positive ILD group than in the ANCA-negative ILD group. Acute exacerbation (AE) of ILD (HR 2.40, 95% CI 1.37–4.22, p = 0.002) was independently associated with shorter survival, and receiving glucocorticoids combined with immunosuppressants (HR 0.30, 95% CI 0.16–0.57, p < 0.001) was independently associated with longer survival in ANCA-positive ILD patients.

Conclusions

The prevalence of ANCAs in patients with ILD is not rare, and ANCA testing in ILD patients is necessary. Oddly shaped cysts with or without a UIP pattern may be a characteristic chest imaging manifestation of ANCA-positive ILDs. The frequency of AEs in ANCA-positive ILD patients is high, and more attention should be given to ANCA-positive ILD patients who have AEs.
Field efficacy of 1,3-dichloropropene and chloropicrin on disinfestation of strawberry crown tissue infected with Fusarium oxysporum f. sp. fragariae or Macrophomina phaseolina
Authors: Henry Peter , Hewavitharana Shashika , Holmes Gerald , Miller David B. , Gillis Matt , Stanghellini Mike , Bolda Mark
Published: February 2025

Past research demonstrated that soilborne pathogens can survive on buried strawberry crowns through fumigation. Devising methods to improve treatment of these tissues could help with disease control. The objectives of this work were to: 1) investigate the extent to which fragmenting pathogen-infested crowns could improve fumigant disinfestation efficacy, 2) evaluate the efficacy of fumigation with chloropicrin alone (Tri-Clor) versus a mixture of chloropicrin and 1,3-dichloropropene (Pic-Clor 60), and 3) characterize the soil concentration and efficacy of fumigants at multiple depths. Fragmenting crowns did not result in improved disinfestation efficacy by any treatment. Neither fumigant achieved adequate Fusarium wilt disease control in the first trial, despite both treatments having high crown disinfestation efficacy. In the second trial, Pic-Clor 60 was significantly more effective than Tri-Clor at disinfesting Fusarium oxysporum f.sp. fragariae (Fof) from strawberry crowns and suppressing Fusarium wilt disease. Broadcast-applied Pic-Clor 60 was significantly more effective than Tri-Clor at controlling Macrophomina phaseolina on crowns and soil across both trials. However, drip-applied Pic-Clor 60 EC was not significantly better than Tri-Clor EC at disinfesting crowns, soil, or suppressing subsequent crown rot disease caused by M. phaseolina. Fumigant gas concentrations tended to be highest at the depth of injection (25 cm), and lowest at the 50 cm depth. Overall, these results indicate there is a consistent advantage to using broadcast Pic-Clor 60 when M. phaseolina is present, but the advantages were not consistent for Fof or when drip applications were made.
Acute hip fractures and the fascia iliaca compartment block
Authors: Robinson Devin
Published: February 2025

Acute hip fractures are common injuries evaluated in the ED. Emergency medicine clinicians are tasked with managing patients' severe pain while also trying to reduce harm caused by overuse of opioids. Multimodal analgesics, including peripheral nerve blocks, are crucial to pain management. This article reviews the fascia iliaca compartment block and the benefits of its early use.
Predictive Value of a Novel Frailty Index for Cardiovascular Outcomes After Major Noncardiac Surgery: A Prospective Cohort Study
Authors: Xie Yi-Shan , Lei Shao-Hui , Wen Shi-Kun , Wang Jia-Qi , Zhang Ya , Liu Jia-Ming , Luo Wen-Chi , Li Zhen-Lue , Peng Huan-Chuan , Liu Ke-Xuan , Zhao Bing-Cheng ,   for the PREVENGE-CB collaborators*
Published: February 2025

Background:

Older patients undergoing noncardiac surgery are at risk of postoperative cardiovascular events. Accurate cardiovascular risk assessment is important for informed decision-making.

Methods:

This prospective cohort study enrolled older patients undergoing elective major noncardiac surgery. A frailty index based on preoperative geriatric assessments (FI-PGA) was constructed using 32 health-related parameters. The primary outcome was the occurrence of any cardiovascular events within 30 days after surgery. The associations between the FI-PGA and outcomes were assessed using logistic regression models. The added predictive value was evaluated by comparing nested models using improvement in model fit, fraction of new predictive information, net reclassification improvement, and decision curve analysis. The predictive performance of the Clinical Frailty Scale was also evaluated.

Results:

A total of 1808 patients were included, with 316 (17.5%) patients experiencing the primary outcome. The FI-PGA was associated with increased odds of the primary outcome after adjustment for clinical predictors (odds ratio 1.56, 95% CI 1.33-1.82 per 0.1-point increment), and clinical predictors plus preoperative N-terminal pro–B-type natriuretic peptide (odds ratio 1.37, 95% CI 1.16-1.61 per 0.1-point increment). Integration of the FI-PGA in prediction models significantly improved model fit and provided new predictive information. Net reclassification improvement analysis showed that adding the FI-PGA to risk models improved risk estimation for patients who did not develop postoperative cardiovascular events, but did not improve risk estimation for those who experienced events. Decision curves showed the models containing the FI-PGA achieved higher net benefit. Improved model performance was also observed when the Clinical Frailty Scale was used for frailty assessment, although the added predictive values appeared lower.

Conclusions:

A frailty index derived from preoperative multidimensional geriatric assessment can improve cardiovascular risk prediction before noncardiac surgery, primarily by improving risk estimation for patients who will not develop postoperative cardiovascular events.
Construction and validation of a nomogram for predicting fatigue in climacteric women
Authors: Wu Huan , Gao Danfeng , Duan Xin , Zhang Haiyue , Ren Yali , Dai Zizhen , Song Liwen
Published: February 2025

Objective

The aim was to develop and validate a nomogram for evaluating the risk of fatigue in climacteric women and to assess its clinical application value.

Methods

Clinical information was collected from 402 climacteric women who visited a tertiary hospital in Shanghai between November 2023 and April 2024. Network analysis methods were utilized to analyze the core symptom (fatigue). The study participants were then randomly divided into training and validation cohorts in a 7:3 ratio. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for fatigue in climacteric women. A nomogram prediction model was established based on these independent risk factors. The predictive performance of the model was evaluated using the concordance index, area under the curve, receiver operating characteristic curve, Hosmer-Lemeshow test, and calibration curve analysis. Additionally, decision curve analysis was performed to assess the model's performance in clinical applications.

Results

Fatigue is identified as the core symptom in climacteric women. Educational level, chronic diseases, and depression status are independent influencing factors for fatigue in menopausal women. The area under the curve for the training cohort and validation cohort are 0.813 (95% CI, 0.743-0.884) and 0.759 (95% CI, 0.637-0.879), respectively, indicating that the model possesses good discriminative ability. The calibration curve shows good consistency between the predicted probabilities and actual probabilities in both the training and validation cohorts. Additionally, the P values for the Hosmer-Lemeshow test in the training and validation sets are 0.233 and 0.197, respectively, indicating good model calibration. Finally, the decision curve analysis curve demonstrates that the model has good clinical utility.

Conclusions

A simple nomogram based on three independent factors (educational level, chronic diseases, and depression status) can aid in clinically predicting the risk of fatigue in climacteric women.