bluuebunny/crossref_metadata_2025 huggingface dataset:
Modelling CN Zeeman effect observations of the envelopes of a low-mass protostellar disc and a massive protostar
Authors: Mazzei Renato , Li Zhi-Yun , Chen Che-Yu , Tu Yisheng , Fissel Laura , Klein Richard I
Published: December 2023

We use the polaris radiative transfer code to produce simulated circular polarization Zeeman emission maps of the cyanide (CN) J = 1–0 molecular line transition for two types of protostellar envelope magnetohydrodynamic simulations. Our first model is a low-mass disc envelope system (box length L = 200 au), and our second model is the envelope of a massive protostar (L = 104 au) with a protostellar wind and a CN-enhanced outflow shell. We compute the velocity-integrated Stokes I and V, as well as the implied V/I polarization percentage, for each detector pixel location in our simulated emission maps. Our results show that both types of protostellar environments are in principle accessible with current circular polarization instruments, with each containing swaths of envelope area that yield percentage polarizations that exceed the 1.8 per cent nominal sensitivity limit for circular polarization experiments with the Atacama Large Millimeter/submillimeter Array. In both systems, high-polarization (≳1.8 per cent) pixels tend to lie at an intermediate distance away from the central star and where the line-centre opacity of the CN emission is moderately optically thin (τLC ∼ 0.1–1). Furthermore, our computed V/I values scale roughly with the density-weighted mean line-of-sight magnetic field strength, indicating that Zeeman observations can effectively diagnose the strength of envelope-scale magnetic fields. We also find that pixels with large V/I are preferentially co-located where the absolute value of the velocity-integrated V is also large, suggesting that locations with favourable percentage polarization are also favourable in terms of raw signal.
Exploring theex-situcomponents withinGaiaDR3
Authors: Li Zhuohan , Zhao Gang , Zhang Ruizhi , Xue Xiang-Xiang , Chen Yuqin , Amarante João A S
Published: December 2023

The presence of Gaia DR3 provides a large sample of stars with complete 6D information, offering a fertile ground for the exploration of stellar objects that were accreted to the Milky Way through ancient merger events. In this study, we developed a deep learning methodology to identify ex-situ stars within the Gaia DR3 catalogue. After two phases of training, our neural network (NN) model was capable of performing binary classification of stars based on input data consisting of 3D position and velocity, as well as actions. From the target sample of 27 085 748 stars, our NN model managed to identify 160 146 ex-situ stars. The metallicity distribution suggests that this ex-situ sample comprises multiple components but appears to be predominated by the Gaia-Sausage-Enceladus (GSE). We identified member stars of the Magellanic Clouds, Sagittarius, and 20 globular clusters throughout our examination. Furthermore, an extensive group of member stars from GSE, Thamnos, Sequoia, Helmi streams, Wukong, and Pontus were meticulously selected, constituting an ideal sample for the comprehensive study of substructures. Finally, we conducted a preliminary estimation to determine the proportions of ex-situ stars in the thin disc, thick disc, and halo, which resulted in percentages of 0.1 per cent, 1.6 per cent, and 63.2 per cent, respectively. As the vertical height from the Galactic disc and distance from the Galactic centre increased, there was a corresponding upward trend in the ex-situ fraction of the target sample.
The true fraction of repeating fast radio bursts revealed through CHIME source count evolution
Authors: Yamasaki Shotaro , Goto Tomotsugu , Ling Chih-Teng , Hashimoto Tetsuya
Published: December 2023

Fast Radio Bursts (FRBs) are classified into repeaters and non-repeaters, with only a few per cent of the observed FRB population from the Canadian Hydrogen Intensity Mapping Experiment (CHIME) confirmed as repeaters. However, this figure represents only a lower limit due to the observational biases, and the true fraction of repeaters remains unknown. Correcting for these biases uncovers a notable decline in apparently non-repeating FRB detection rate as the CHIME operational time increases. This finding suggests that a significant portion of apparently non-repeating FRBs could in fact exhibit repetition when observed over more extended periods. A simple population model infers that the true repeater fraction likely exceeds 50 per cent with 99 per cent confidence, a figure substantially larger than the observed face value, even consistent with 100 per cent. This greater prevalence of repeaters had previously gone unnoticed due to their very low repetition rates (∼10−3.5 h−1 on average). Hence, theoretical FRB models must incorporate these low-rate repeaters. Furthermore, our results indicate a significantly higher repeater volume number density, potentially exceeding observed values by up to 104 times, which in turn impacts comparisons with potential FRB progenitors.
Visualizing a two-state conformational ensemble in stem–loop 3 of the transcriptional regulator 7SK RNA
Authors: Camara Momodou B , Lange Bret , Yesselman Joseph D , Eichhorn Catherine D
Published: December 2023

Structural plasticity is integral to RNA function; however, there are currently few methods to quantitatively resolve RNAs that have multiple structural states. NMR spectroscopy is a powerful approach for resolving conformational ensembles but is size-limited. Chemical probing is well-suited for large RNAs but provides limited structural and kinetics information. Here, we integrate the two approaches to visualize a two-state conformational ensemble for the central stem–loop 3 (SL3) of 7SK RNA, a critical element for 7SK RNA function in transcription regulation. We find that the SL3 distal end exchanges between two equally populated yet structurally distinct states in both isolated SL3 constructs and full-length 7SK RNA. We rationally designed constructs that lock SL3 into a single state and demonstrate that both chemical probing and NMR data fit to a linear combination of the two states. Comparison of vertebrate 7SK RNA sequences shows either or both states are highly conserved. These results provide new insights into 7SK RNA structural dynamics and demonstrate the utility of integrating chemical probing with NMR spectroscopy to gain quantitative insights into RNA conformational ensembles.
Epigenetic characterization of housekeeping core promoters and their importance in tumor suppression
Authors: Loza Martin , Vandenbon Alexis , Nakai Kenta
Published: December 2023

In this research, we elucidate the presence of around 11,000 housekeeping cis-regulatory elements (HK-CREs) and describe their main characteristics. Besides the trivial promoters of housekeeping genes, most HK-CREs reside in promoter regions and are involved in a broader role beyond housekeeping gene regulation. HK-CREs are conserved regions rich in unmethylated CpG sites. Their distribution highly correlates with that of protein-coding genes, and they interact with many genes over long distances. We observed reduced activity of a subset of HK-CREs in diverse cancer subtypes due to aberrant methylation, particularly those located in chromosome 19 and associated with zinc finger genes. Further analysis of samples from 17 cancer subtypes showed a significantly increased survival probability of patients with higher expression of these genes, suggesting them as housekeeping tumor suppressor genes. Overall, our work unravels the presence of housekeeping CREs indispensable for the maintenance and stability of cells.
Peak-agnostic high-resolution cis-regulatory circuitry mapping using single cell multiome data
Authors: Zhang Zidong , Ruf-Zamojski Frederique , Zamojski Michel , Bernard Daniel J , Chen Xi , Troyanskaya Olga G , Sealfon Stuart C
Published: December 2023

Single same cell RNAseq/ATACseq multiome data provide unparalleled potential to develop high resolution maps of the cell-type specific transcriptional regulatory circuitry underlying gene expression. We present CREMA, a framework that recovers the full cis-regulatory circuitry by modeling gene expression and chromatin activity in individual cells without peak-calling or cell type labeling constraints. We demonstrate that CREMA overcomes the limitations of existing methods that fail to identify about half of functional regulatory elements which are outside the called chromatin ‘peaks’. These circuit sites outside called peaks are shown to be important cell type specific functional regulatory loci, sufficient to distinguish individual cell types. Analysis of mouse pituitary data identifies a Gata2-circuit for the gonadotrope-enriched disease-associated Pcsk1 gene, which is experimentally validated by reduced gonadotrope expression in a gonadotrope conditional Gata2-knockout model. We present a web accessible human immune cell regulatory circuit resource, and provide CREMA as an R package.
The protein phosphatase EYA4 promotes homologous recombination (HR) through dephosphorylation of tyrosine 315 on RAD51
Authors: de la Peña Avalos Bárbara , Paquet Nicolas , Tropée Romain , Coulombe Yan , Palacios Hannah , Leung Justin W , Masson Jean-Yves , Duijf Pascal H G , Dray Eloïse
Published: December 2023

Efficient DNA repair and limitation of genome rearrangements rely on crosstalk between different DNA double-strand break (DSB) repair pathways, and their synchronization with the cell cycle. The selection, timing and efficacy of DSB repair pathways are influenced by post-translational modifications of histones and DNA damage repair (DDR) proteins, such as phosphorylation. While the importance of kinases and serine/threonine phosphatases in DDR have been extensively studied, the role of tyrosine phosphatases in DNA repair remains poorly understood. In this study, we have identified EYA4 as the protein phosphatase that dephosphorylates RAD51 on residue Tyr315. Through its Tyr phosphatase activity, EYA4 regulates RAD51 localization, presynaptic filament formation, foci formation, and activity. Thus, it is essential for homologous recombination (HR) at DSBs. DNA binding stimulates EYA4 phosphatase activity. Depletion of EYA4 decreases single-stranded DNA accumulation following DNA damage and impairs HR, while overexpression of EYA4 in cells promotes dephosphorylation and stabilization of RAD51, and thereby nucleoprotein filament formation. Our data have implications for a pathological version of RAD51 in EYA4-overexpressing cancers.
Enhancer–promoter interactions can form independently of genomic distance and be functional across TAD boundaries
Authors: Balasubramanian Deevitha , Borges Pinto Pedro , Grasso Alexia , Vincent Séverine , Tarayre Hélène , Lajoignie Damien , Ghavi-Helm Yad
Published: December 2023

Topologically Associating Domains (TADs) have been suggested to facilitate and constrain enhancer–promoter interactions. However, the role of TAD boundaries in effectively restricting these interactions remains unclear. Here, we show that a significant proportion of enhancer–promoter interactions are established across TAD boundaries in Drosophila embryos, but that developmental genes are strikingly enriched in intra- but not inter-TAD interactions. We pursued this observation using the twist locus, a master regulator of mesoderm development, and systematically relocated one of its enhancers to various genomic locations. While this developmental gene can establish inter-TAD interactions with its enhancer, the functionality of these interactions remains limited, highlighting the existence of topological constraints. Furthermore, contrary to intra-TAD interactions, the formation of inter-TAD enhancer–promoter interactions is not solely driven by genomic distance, with distal interactions sometimes favored over proximal ones. These observations suggest that other general mechanisms must exist to establish and maintain specific enhancer–promoter interactions across large distances.
Efficacy and toxicity of bimodal radiotherapy in WHO grade 2 meningiomas following subtotal resection with carbon ion boost: Prospective phase 2 MARCIE trial
Authors: Deng Maximilian Y , Maas Sybren L N , Hinz Felix , Karger Christian P , Sievers Philipp , Eichkorn Tanja , Meixner Eva , Hoegen-Sassmannshausen Philipp , Hörner-Rieber Juliane , Lischalk Jonathan W , Seidensaal Katharina , Bernhardt Denise , Jungk Christine , Unterberg Andreas , Wick Antje , Wick Wolfgang , von Deimling Andreas , Sahm Felix , Combs Stephanie , Herfarth Klaus , Debus Jürgen , König Laila
Published: December 2023

Background

Novel radiotherapeutic modalities using carbon ions provide an increased relative biological effectiveness (RBE) compared to photons, delivering a higher biological dose while reducing radiation exposure for adjacent organs. This prospective phase 2 trial investigated bimodal radiotherapy using photons with carbon-ion (C12)-boost in patients with WHO grade 2 meningiomas following subtotal resection (Simpson grade 4 or 5).

Methods

A total of 33 patients were enrolled from July 2012 until July 2020. The study treatment comprised a C12-boost (18 Gy [RBE] in 6 fractions) applied to the macroscopic tumor in combination with photon radiotherapy (50 Gy in 25 fractions). The primary endpoint was the 3-year progression-free survival (PFS), and the secondary endpoints included overall survival, safety and treatment toxicities.

Results

With a median follow-up of 42 months, the 3-year estimates of PFS, local PFS and overall survival were 80.3%, 86.7%, and 89.8%, respectively. Radiation-induced contrast enhancement (RICE) was encountered in 45%, particularly in patients with periventricularly located meningiomas. Patients exhibiting RICE were mostly either asymptomatic (40%) or presented immediate neurological and radiological improvement (47%) after the administration of corticosteroids or bevacizumab in case of radiation necrosis (3/33). Treatment-associated complications occurred in 1 patient with radiation necrosis who died due to postoperative complications after resection of radiation necrosis. The study was prematurely terminated after recruiting 33 of the planned 40 patients.

Conclusions

Our study demonstrates a bimodal approach utilizing photons with C12-boost may achieve a superior local PFS to conventional photon RT, but must be balanced against the potential risks of toxicities.
High-speed flexible near-infrared organic photodiode for optical communication
Authors: Zhu Yu , Chen Hongbin , Han Ruiman , Qin Hao , Yao Zhaoyang , Liu Hang , Ma Yanfeng , Wan Xiangjian , Li Guanghui , Chen Yongsheng
Published: December 2023

Optical communication is a particularly compelling technology for tackling the speed and capacity bottlenecks in data communication in modern society. Currently, the silicon photodetector plays a dominant role in high-speed optical communication across the visible-near-infrared spectrum. However, its intrinsic rigid structure, high working bias and low responsivity essentially limit its application in next-generation flexible optoelectronic devices. Herein, we report a narrow-bandgap non-fullerene acceptor (NFA) with a remarkable π-extension in the direction of both central and end units (CH17) with respect to the Y6 series, which demonstrates a more effective and compact 3D molecular packing, leading to lower trap states and energetic disorders in the photoactive film. Consequently, the optimized solution-processed organic photodetector (OPD) with CH17 exhibits a remarkable response time of 91 ns (λ = 880 nm) due to the high charge mobility and low parasitic capacitance, exceeding the values of most commercial Si photodiodes and all NFA-based OPDs operating in self-powered mode. More significantly, the flexible OPD exhibits negligible performance attenuation (<1%) after bending for 500 cycles, and maintains 96% of its initial performance even after 550 h of indoor exposure. Furthermore, the high-speed OPD demonstrates a high data transmission rate of 80 MHz with a bit error rate of 3.5 $ \times $ 10−4, meaning it has great potential in next-generation high-speed flexible optical communication systems.
Smoking Quit Attempts and Associated Factors Among Rural Adults Who Smoke Daily in the United States
Authors: Bittencourt Lorna , Rubenstein Dana , Noonan Devon , McClernon F Joseph , Carroll Dana Mowls
Published: December 2023

Introduction

Rural American communities are heavily affected by tobacco-related health disparities. This study aims to evaluate the prevalence of quit attempts (QAs) and factors that promote or impede QA among rural adults who smoke daily.

Methods

Data from Wave 5 of the Population Assessment of Tobacco and Health study were analyzed. Multivariable logistic regression was used to identify factors associated with QA. Backward selection was used to identify variables included in the final model with statistical significance set at p < .05.

Results

Among 1610 rural adults who smoked daily, the prevalence of a QA in the past 12 months was 25.6% (95% confidence interval [CI]: 23.2, 28.2). Factors associated with greater QA odds: having greater education (adjusted odds ratio [aOR] = 1.35, 95% CI: 1.03, 1.77), e-cigarette use (aOR = 1.35 95% CI: 1.03, 1.80), disapproval of smoking from friends/family (aOR = 1.46, 95% CI: 1.09–1.94), greater frequency of thinking about the harm of tobacco (aOR = 1.48, 95% CI: 1.28, 1.71), fair/poor physical health (aOR = 1.31, 95% CI: 1.00, 1.70), and being advised to quit by a doctor (aOR = 1.63, 95% CI:1.25, 2.13). Smokeless tobacco use (aOR = 0.67, 95% CI: 0.47, 0.96) and greater cigarettes per day (aOR = 0.67, 95% CI: 0.47, 0.96) were associated with QA lower odds.

Conclusions

Only one in four rural adults who smoke made a past-year QA. Interventions that promote provider advice to quit smoking, tobacco health harms, and normative beliefs may increase QAs in rural communities.

Implications

Along with higher smoking rates and lower QAs, rural communities face limited access to programs, medication, and health care professionals as tools to help them quit smoking. Public Health initiatives should focus on developing cultural sensitivity training targeting health care professionals to advise patients to quit smoking and the role of multiple tobacco product use. Furthermore, given the low rates of smoking QAs, future mixed-methods research is needed to inform policies and interventions targeted at eliminating tobacco-related health disparities.
Health insurance status, lifestyle choices and the presence of non-communicable diseases: a systematic review
Authors: Folayan Adeola , Cheong Mark Wing Loong , Fatt Quek Kia , Su Tin Tin
Published: December 2023

Background

Although health insurance (HI) has effectively mitigated healthcare financial burdens, its contribution to healthy lifestyle choices and the presence of non-communicable diseases (NCDs) is not well established. We aimed to systematically review the existing evidence on the effect of HI on healthy lifestyle choices and NCDs.

Methods

A systematic review was conducted across PubMed, Medline, Embase, Cochrane Library and CINAHLComplet@EBSCOhost from inception until 30 September 2022, capturing studies that reported the effect of HI on healthy lifestyle and NCDs. A narrative synthesis of the studies was done. The review concluded both longitudinal and cross-sectional studies. A critical appraisal checklist for survey-based studies and the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies were used for the quality assessment.

Result

Twenty-four studies met the inclusion criteria. HI was associated with the propensity to engage in physical activities (6/11 studies), consume healthy diets (4/7 studies), not to smoke (5/11 studies) or take alcohol (5/10 studies). Six (of nine) studies showed that HI coverage was associated with a lowered prevalence of NCDs.

Conclusion

This evidence suggests that HI is beneficial. More reports showed that it propitiated a healthy lifestyle and was associated with a reduced prevalence of NCDs.
Unveiling protein corona composition: predicting with resampling embedding and machine learning
Authors: Liao Rong , Zhuang Yan , Li Xiangfeng , Chen Ke , Wang Xingming , Feng Cong , Yin Guangfu , Zhu Xiangdong , Lin Jiangli , Zhang Xingdong
Published: December 2023

Biomaterials with surface nanostructures effectively enhance protein secretion and stimulate tissue regeneration. When nanoparticles (NPs) enter the living system, they quickly interact with proteins in the body fluid, forming the protein corona (PC). The accurate prediction of the PC composition is critical for analyzing the osteoinductivity of biomaterials and guiding the reverse design of NPs. However, achieving accurate predictions remains a significant challenge. Although several machine learning (ML) models like Random Forest (RF) have been used for PC prediction, they often fail to consider the extreme values in the abundance region of PC absorption and struggle to improve accuracy due to the imbalanced data distribution. In this study, resampling embedding was introduced to resolve the issue of imbalanced distribution in PC data. Various ML models were evaluated, and RF model was finally used for prediction, and good correlation coefficient (R2) and root-mean-square deviation (RMSE) values were obtained. Our ablation experiments demonstrated that the proposed method achieved an R2 of 0.68, indicating an improvement of approximately 10%, and an RMSE of 0.90, representing a reduction of approximately 10%. Furthermore, through the verification of label-free quantification of four NPs: hydroxyapatite (HA), titanium dioxide (TiO2), silicon dioxide (SiO2) and silver (Ag), and we achieved a prediction performance with an R2 value >0.70 using Random Oversampling. Additionally, the feature analysis revealed that the composition of the PC is most significantly influenced by the incubation plasma concentration, PDI and surface modification.
The cost-effectiveness of adding an ultrasound corticosteroid and local anaesthetic injection to advice and education for hip osteoarthritis
Authors: Kigozi Jesse , Oppong Raymond , Paskins Zoe , Bromley Kieran , Lewis Martyn , Hughes Gemma , Hughes Emily , Hennings Susie , Cherrington Andrea , Hall Alison , Holden Melanie A , Stevenson Kay , Menon Ajit , Roberts Philip , Peat George , Jinks Clare , Foster Nadine E , Mallen Christian D , Roddy Edward
Published: December 2023

Objectives

Evidence for the comparative cost-effectiveness of intra-articular corticosteroid injection in people with hip osteoarthritis (OA) remains unclear. This study investigated the cost-effectiveness of best current treatment (BCT), comprising advice and education, with BCT plus a single ultrasound-guided intra-articular hip injection of 40 mg triamcinolone acetonide and 4 ml 1% lidocaine hydrochloride (BCT+US-T).

Methods

A trial-based cost–utility analysis of BCT+US-T compared with BCT was undertaken over 6 months. Patient-level cost data were obtained, and effectiveness was measured in terms of quality-adjusted life years (QALYs), allowing the calculation of cost per QALY gained from a UK National Health Service (NHS) perspective.

Results

BCT+US-T was associated with lower mean NHS costs (BCT+US-T minus BCT: −£161.6; 95% CI: −£583.95, £54.18) and small but significantly higher mean QALYs than BCT alone over 6 months (BCT+US-T minus BCT: 0.0487; 95% CI: 0.0091, 0.0886). In the base case, BCT+US-T was the most cost-effective and dominated BCT alone. Differences in total costs were driven by number of visits to NHS consultants, private physiotherapists and chiropractors, and hip surgery, which were more common with BCT alone than BCT+US-T.

Conclusion

Intra-articular corticosteroid injection plus BCT (BCT+US-T) for patients with hip OA results in lower costs and better outcomes, and is highly cost-effective, compared with BCT alone.

Trial registration

EudraCT: 2014-003412-37 (8 August 2015) and registered with Current Controlled Trials: ISRCTN 50550256 (28 July 2015).

Trial protocol

Full details of the trial protocol can be found in the Supplementary Appendix, available with the full text of this article at https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-018-2153-0, doi: doi.org/10.1186/s12891-018-2153-0.
Deep Learning-based Brain Age Prediction in Patients With Schizophrenia Spectrum Disorders
Authors: Kim Woo-Sung , Heo Da-Woon , Maeng Junyeong , Shen Jie , Tsogt Uyanga , Odkhuu Soyolsaikhan , Zhang Xuefeng , Cheraghi Sahar , Kim Sung-Wan , Ham Byung-Joo , Rami Fatima Zahra , Sui Jing , Kang Chae Yeong , Suk Heung-Il , Chung Young-Chul
Published: December 2023

Background and Hypothesis

The brain-predicted age difference (brain-PAD) may serve as a biomarker for neurodegeneration. We investigated the brain-PAD in patients with schizophrenia (SCZ), first-episode schizophrenia spectrum disorders (FE-SSDs), and treatment-resistant schizophrenia (TRS) using structural magnetic resonance imaging (sMRI).

Study Design

We employed a convolutional network-based regression (SFCNR), and compared its performance with models based on three machine learning (ML) algorithms. We pretrained the SFCNR with sMRI data of 7590 healthy controls (HCs) selected from the UK Biobank. The parameters of the pretrained model were transferred to the next training phase with a new set of HCs (n = 541). The brain-PAD was analyzed in independent HCs (n = 209) and patients (n = 233). Correlations between the brain-PAD and clinical measures were investigated.

Study Results

The SFCNR model outperformed three commonly used ML models. Advanced brain aging was observed in patients with SCZ, FE-SSDs, and TRS compared to HCs. A significant difference in brain-PAD was observed between FE-SSDs and TRS with ridge regression but not with the SFCNR model. Chlorpromazine equivalent dose and cognitive function were correlated with the brain-PAD in SCZ and FE-SSDs.

Conclusions

Our findings indicate that there is advanced brain aging in patients with SCZ and higher brain-PAD in SCZ can be used as a surrogate marker for cognitive dysfunction. These findings warrant further investigations on the causes of advanced brain age in SCZ. In addition, possible psychosocial and pharmacological interventions targeting brain health should be considered in early-stage SCZ patients with advanced brain age.
Israel—tax update
Authors: Eyal Lyat
Published: December 2023

A public committee was established in the field of international taxation with the aim of providing recommendations to simplify and provide certainty and efficiency to the Israeli tax system. The report was submitted in November 2021 and dealt with various areas. This article will present relevant recommendations from the report that have not yet passed the relevant legislative procedure.
Antimicrobial resistance and epidemic clustering of late-onset neonatal infections in a Brazilian intensive care unit
Authors: Freitas Felipe Teixeira de Mello , da Costa Marcela Santos Corrêa , da Costa Kaylla Heduarda Rodrigues , Alves Everton Giovanni
Published: December 2023

Nosocomial infections in the neonatal intensive care unit (NICU) tend to cluster and multidrug-resistant (MDR) pathogens are rising in developing countries. We did a retrospective cohort study of neonates admitted to a NICU in Brazil with late-onset neonatal sepsis (LOS) confirmed by blood culture from October 2012 to December 2016 and from July 2018 to December 2021. We defined a cluster of infection when at least two cases of LOS occurred within two different time intervals: 15 and 30 days with the same pathogen in different patients. A random amplified polymorphic DNA (RAPD) was performed from samples from one of these clusters. A logistic regression model was applied having death as the outcome and the infection with an MDR pathogen as the exposure of interest. There were 987 blood cultures from 754 neonates, 621 (63%) were gram-positive cocci, 264 (30%) were gram-negative rods and 72 (7%) fungi. A third of Enterobacterales were resistant to cefepime and a third of non-fermenting glucose rods were resistant to carbapenems. There were 100 or 104 clusters of infection in the 15- or 30-day interval, respectively. A RAPD analysis from an outbreak of MDR Acinetobacter baumannii showed that all five samples belonged to a single clone. An infection with an MDR pathogen was associated with death (OR 1.82, 95% CI 1.03–3.21). In conclusion, clusters of infections in a Brazilian NICU are a frequent phenomenon as seen elsewhere. They suggest cross-transmission of pathogens with increasing antimicrobial resistance and should prompt intensified surveillance and infection control measures.
Identification and Characterization of Pythium deliense Causing Sugar Beet (Beta vulgaris) Root Rot in Grand Forks, North Dakota
Authors: Bhuiyan M. Z. R. , Lakhsman Dilip K. , del Rio Mendoza Luis E. , Ismaiel Adnan , Khan M. F. R.
Published: December 2023

Damping-off disease caused by multiple species of soilborne pathogens causes severe economic losses to sugar beet production. Thus, identifying the causal agent is important to formulating effective disease management. During a July 2021 disease survey in a sugar beet field at Grand Forks, North Dakota, we observed that approximately 15% of plants located in low areas of a commercial field showed wilting leaves that were pale green and slightly blighted in color, and the roots were dark brown to black, along with irregular necrotic lesions. The isolated pathogen had the characteristic morphology of Pythium deliense. The sequences of the internal transcribed spacer (ITS) region and the cytochrome c oxidase subunit 1 mitochondrial ( cox1) genes were 100% homologous to corresponding sequences in the NCBI database, which confirmed its P. deliense identity. Moreover, the ITS phylogeny confirmed its identity as P. deliense and its close relationship with P. aphanidermatum. A disease screening trial with four sugar beet varieties was done. Growers and breeders could benefit from accurate information about the sugar beet pathogen in a given field to formulate effective disease management practices.
Acute Compartment Syndrome in Pediatric Patients on Extracorporeal Membrane Oxygenation Support
Authors: Bridges Callie S. , Taylor Tristen N. , Bini Thomas , Ontaneda Andrea M. , Coleman Ryan D. , Hill Jaclyn F. , Montgomery Nicole I. , Shenava Vinitha R. , Gerow Frank T.
Published: December 2023

Background:

When acute compartment syndrome (ACS) occurs in pediatric patients requiring venoarterial extracorporeal membrane oxygen (VA ECMO) support, there is little data to guide surgeons on appropriate management. The purpose of this study is to characterize the presentation, diagnosis, timeline, and outcomes of patients who developed this complication.

Methods:

This is a single-center retrospective case series of children below 19 years old on VA ECMO support who subsequently developed extremity ACS between January 2016 and December 2022. Outcomes included fasciotomy findings, amputation, mortality, and documented function at the last follow-up.

Results:

Of 343 patients on VA ECMO support, 18 (5.2%) were diagnosed with ACS a median 29 hours after starting ECMO. Initial cannulation sites included 8 femoral, 6 neck, and 4 central. Femoral artery cannulation was associated with an increased risk of ACS [odds ratio=6.0 (CI: 2.2 to 15), P<0.0001]. In the hospital, the mortality rate was 56% (10/18). Fourteen (78%) patients received fasciotomies a median of 1.2 hours after ACS diagnosis. Only 4 (29%) patients had all healthy muscles at initial fasciotomy, while 9 (64%) had poor muscular findings in at least 1 compartment. Patients with worse findings at fasciotomy had a significantly longer duration between ischemia onset and ACS diagnosis. Patients required a median of 1.5 additional procedures after fasciotomy, and only 1 (7%) developed a surgical site infection. Of the 7 surviving fasciotomy patients, 2 required amputations, 3 developed an equinus contracture, 1 developed foot drop, and 3 had no ACS-related deficits. Four patients did not receive fasciotomies: 3 were deemed too ill and later died, and 1 was diagnosed too late to benefit. The only surviving nonfasciotomy patient required bilateral amputations.

Conclusions:

Pediatric ECMO-associated ACS is not exclusive to patients with femoral artery cannulation. The majority of fasciotomy patients were diagnosed with ACS after muscle necrosis had already started. We were unable to definitively conclude whether fasciotomies provide better outcomes. There is a need for increased awareness and earlier recognition of this rare yet potentially devastating complication.

Level of Evidence:

Level IV—retrospective case series
Primary Repair of Achilles Tendon Rupture Using a Mini-incision: A Novel Technique
Authors: Bordignon Glaucia , Klavas Derek M. , Benevides Pedro C. , Rosemberg Dov L. , Lin Johnny L. , Lee Simon , Bohl Daniel D.
Published: December 2023

The use of minimally invasive techniques in the treatment of primary Achilles rupture has become more popular in the past few decades as they have been associated with a lower wound complication rate. Most of the techniques demand the use of procedure-specific instruments and are designed mainly for midsubstance lesions. This article aims to present a novel technique for Achilles tendon repair that can be used for both insertional and midsubstance ruptures, using a mini-incision and with no special instruments required.

Level of Evidence: Diagnostic Level V.
Single Incision Broström-Gould Surgery With Peroneal Debridement and Calcaneal Osteotomy
Authors: Scheinberg Mila , McCrosson Matthew , Fortin Travis , Singh Swapnil , Shah Ashish
Published: December 2023

Objective:

Chronic lateral ankle instability (CLAI) with hindfoot varus is a common condition that can be treated with various surgical approaches. The Broström-Gould procedure is the gold-standard surgery for CLAI, and a sliding lateralizing calcaneal osteotomy (SLCO) is a common procedure for CLAI with hindfoot varus. The purpose of this paper is to describe a single-incision approach for the Broström-Gould repair with concomitant peroneal tendon debridement and an SLCO.

Patients and Methods:

The study retrospectively reviewed 189 cases of lateral ankle ligamentous repair with peroneal tendon debridement and an SLCO between 2011 and 2020. Of these, 53 patients had a single-incision approach, meeting the major inclusion criteria. The remaining patients had 2 incisions. Inclusion criteria for this study required patients to be at least 18 years of age, have a preoperative diagnosis of CLAI with hindfoot varus, and receive an isolated one-incision approach for a Broström-Gould procedure with concomitant peroneal tendon debridement and an SLCO.

Results:

The single-incision technique has shown to be equally effective with potential for decreased wound and neurovascular complications in comparison to a traditional multi-incisional approach.

Conclusions:

The single-incision technique for the Broström-Gould repair with concomitant peroneal tendon debridement and an SLCO is a safe and effective approach for treating CLAI with hindfoot varus. This technique offers adequate visualization of the lateral ankle ligaments, peroneal tendons, and lateral calcaneus while still achieving excellent postoperative cosmesis.
Unifying Fluid Responsiveness and Tolerance With Physiology: A Dynamic Interpretation of the Diamond–Forrester Classification
Authors: Kenny Jon-Émile S. , Prager Ross , Rola Philippe , Haycock Korbin , Basmaji John , Hernández Glenn
Published: December 2023

Point of care ultrasound (POCUS) is a first-line tool to assess hemodynamically unstable patients, however, there is confusion surrounding intertwined concepts such as: “flow,” “congestion,” “fluid responsiveness (FR),” and “fluid tolerance.” We argue that the Frank–Starling relationship is clarifying because it describes the interplay between “congestion” and “flow” on the x-axis and y-axis, respectively. Nevertheless, a single, simultaneous assessment of congestion and flow via POCUS remains a static approach. To expand this, we propose a two-step process. The first step is to place the patient on an ultrasonographic Diamond–Forrester plot. The second step is a dynamic assessment for FR (e.g., passive leg raise), which individualizes therapy across the arc of critical illness.
Discriminative-stimulus effects of cannabidiol oil in Sprague-Dawley rats
Authors: Chalmé Rebecca L. , Frankot Michelle A. , Anderson Karen G.
Published: December 2023

Cannabidiol (CBD) is one of the major centrally active phytocannabinoid components of cannabis, and has been approved by the FDA only for the treatment of seizures associated with three rare disorders. It has also been touted as a potential treatment for anxiety in place of more traditional treatments like benzodiazepines. Although there is some evidence of anxiolytic effects of CBD, its suitability as a substitute for benzodiazepines is unknown. This experiment was designed to assess the extent to which CBD shares interoceptive discriminative-stimulus properties with the anxiolytic drug chlordiazepoxide (CDP), a benzodiazepine. In the present experiment, a range of doses (0-1569 mg/kg) of over-the-counter CBD oil was administered (i.g.) in male Sprague–Dawley rats trained to discriminate 5.6 mg/kg CDP from saline. Due to the long time-course effects of CBD, generalization tests were conducted at 90 and 120 min post-CBD administration. The two highest doses of CBD tested (1064 and 1569 mg/kg) were found to partially substitute for 5.6 mg/kg CDP, with mean percent responding on the CDP-associated lever reaching above 20% at time 2 (120 min post-CBD administration), suggesting that high doses of the over-the-counter CBD oils used in this experiment share interoceptive discriminative-stimulus properties to some degree with CDP. These results are novel in comparison to existing research into stimulus effects of CBD, in which substitution for benzodiazepines has not previously been observed.
Association of glucagon-like peptide-1 receptor agonists with serious liver events among patients with type 2 diabetes: A Scandinavian cohort study
Authors: Engström Arvid , Wintzell Viktor , Melbye Mads , Svanström Henrik , Eliasson Björn , Gudbjörnsdottir Soffia , Hveem Kristian , Jonasson Christian , Hviid Anders , Ueda Peter , Pasternak Björn
Published: December 2023

Background and Aims:

Clinical trials suggest that glucagon-like peptide-1 (GLP-1) receptor agonists may have beneficial effects on NAFLD, but the impact on hard hepatic end points is unknown. We assessed the association between the use of GLP-1 receptor agonists and the risk of serious liver events in routine clinical practice.

Approach and Results:

Cohort study using data from nationwide registers in Sweden, Denmark, and Norway, 2007–2020, including 91,479 initiators of GLP-1 receptor agonists and 244,004 initiators of the active comparator, dipeptidyl peptidase-4 inhibitors, without a history of chronic liver disease other than NAFLD/NASH. The primary outcome was serious liver events: a composite of incident compensated and decompensated cirrhosis and HCC. Secondary outcomes were the individual components of the primary outcome. Cox regression was used to estimate HRs, using propensity score weighting to control for confounding. Users of GLP-1 receptor agonists had 608 serious liver events (adjusted incidence rate: 16.9 events per 10,000 person-years), compared with 1770 events among users of dipeptidyl peptidase-4 inhibitors (19.2 events per 10,000 person-years). The adjusted HR was 0.85 (95% CI: 0.75 to 0.97), and the rate difference was −2.1 (−4.4 to 0.1) events per 10,000 person-years. In secondary outcome analyses, the adjusted HR was 0.85 (0.75 to 0.97) for compensated and decompensated cirrhosis and 1.05 (0.80 to 1.39) for HCC.

Conclusions:

The use of GLP-1 receptor agonists was associated with a significantly reduced risk of serious liver events, driven by a reduction of compensated and decompensated cirrhosis.
Comparison of the effect of capsular bend on the rotational stability between 2 toric intraocular lenses
Authors: Wang Yiyi , Lou Xicong , Qian Shuyi , Li Yuanyuan , Wu Xueer , Li Siyan , Wang Yalan , Zhao Yune , Chang Pingjun
Published: December 2023

Purpose:

To compare the effect of capsular bend on the rotational stability between 2 toric intraocular lenses (IOLs).

Setting:

Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China.

Design:

Prospective study.

Methods:

Patients with preexisting astigmatism received AcrySof IQ (SN6AT) or TECNIS (ZCT/ZMT) toric IOL during cataract surgery. CASIA2 was used to record the toric IOL axial orientation and capsular bend index (CBI) at the 1-day, 1-week, 1-month, and 3-month interval postoperatively. The postoperative rotational stability and CBI of both models were compared.

Results:

A total of 58 eyes from 58 patients were enrolled in this study. The total misalignment of the TECNIS (ZCT/ZMT) group (6.96 ± 5.10 degrees, 7.41 ± 5.19 degrees, 6.93 ± 5.29 degrees, and 6.86 ± 5. 27 degrees) was significantly higher than that of the AcrySof IQ (SN6AT) group (3.55 ± 2.21 degrees, 4.00 ± 2.74 degrees, 3.72 ± 2.72 degrees, and 3.52 ± 2.50 degrees) at all follow-up intervals (P < .05). The mean rotation of the TECNIS (ZCT/ZMT) group (2.66 ± 2.18 degrees) was significantly greater than that of the AcrySof IQ (SN6AT) group (1.65 ± 1.47 degrees) from 1 day to 1 week postoperatively (P < .05). The capsular bend formation in the TECNIS (ZCT/ZMT) group was delayed compared with the AcrySof IQ (SN6AT) group (P < .05, at the 1-week, 1-month, and 3-month interval). The TECNIS (ZCT/ZMT) group showed fibrosis in the peripheral anterior capsule, leading to its stretching away from the IOL surface, while the AcrySof IQ (SN6AT) group exhibited gentle adherence of the anterior capsule to the IOL surface.

Conclusions:

The AcrySof IQ toric IOL (SN6AT) exhibited greater rotational stability than the TECNIS toric IOL (ZCT/ZMT), which may partially result from the delay in capsular bend formation of TECNIS at the 1-day to 1-week follow-up postoperatively.
Experiences With Work-Family Conflict, Breastfeeding, and Perinatal Mental Health Among Women Returning to Work After Giving Birth
Authors: McCardel Rachel , Callands Tamora , Rajbhandari-Thapa Janani , Swartzendruber Andrea , Padilla Heather
Published: December 2023

Objective

This study aimed to examine working mothers’ experiences with returning to work after giving birth, work-family conflict, breastfeeding, and mental health.

Methods

A sequential, mixed methods design was used to administer an online survey to capture job characteristics and perceptions of work-family conflict among first-time mothers in Georgia who gave birth within the previous year (N = 26). Then, interviews were conducted to understand their experiences with returning to work, work-family conflict, breastfeeding, and mental health.

Results

Many participants worked in educational settings and returned to full-time work after giving birth. Qualitative themes from 12 interviews captured the context of participants’ work environments, types of work-family conflict, and factors that alleviated work-family conflict.

Conclusions

Employers need to incorporate support for work-family conflict and perinatal mental health into workplace breastfeeding programs and maternity leave policies.
The impact of COVID-19 and the COVID-19 pandemic on hospitalized patients with STEMI in the United States: insights from the National Inpatient Sample
Authors: Kwok Chun Shing , Qureshi Adnan I. , Will Maximillian , Schwartz Konstatin , Borovac Josip A. , Waters David , Potluri Rahul , Lip Gregory Y.H.
Published: December 2023

Background

It is unclear how COVID-19 pandemic affected care and outcomes among patients who are diagnosed with ST-elevation myocardial infarction (STEMI) in the USA.

Methods

We analyzed the data from National Inpatient Sample from 2016 to 2020 and assessed the impact of COVID-19 infection and the COVID-19 pandemic (year 2020) on in-hospital mortality, length of stay (LOS) and hospitalization costs.P

Results

There were 1 050 905 hospitalizations with STEMI, and there was an 8.2% reduction in admissions in 2020. Patients with COVID-19 versus those without had significantly greater in-hospital mortality (45.2% vs. 10.7%; P < 0.001). In 2020, 3.0% of hospitalizations had a diagnosis of COVID-19, and the mortality was 11.5% compared to 10.7% for patients admitted in 2016–2019 period. There was a significantly increased mortality (OR 6.25, 95% CI 5.42–7.21, P < 0.001), LOS (coefficient 3.47, 95% CI 3.10–3.84, P < 0.001) and cost (coefficient 10.69, 95% CI 8.4–12.55, P < 0.001) with COVID-19 infection compared with no infection. There was a borderline difference in mortality (OR 1.04, 95% CI 1.00– 1.09, P = 0.050) but LOS (coefficient −0.21, 95% CI−0.28 to −0.14, P < 0.001) and costs (3.14, 95% CI 2.79 to 3.49, P < 0.001) were reduced in 2020 compared to 2016–2019 period.

Conclusions

In conclusion, in patients hospitalized with STEMI, COVID-19 infection was associated with increased mortality, LOS, and cost but during the pandemic year of 2020 there was a small trend for increased mortality for patients with a diagnosis of STEMI.
Setting positive end-expiratory pressure by using electrical impedance tomography
Authors: Frerichs Inéz , Schädler Dirk , Becher Tobias
Published: December 2023

Purpose of review

This review presents the principles and possibilities of setting positive end-expiratory pressure (PEEP) using electrical impedance tomography (EIT). It summarizes the major findings of recent studies where EIT was applied to monitor the effects of PEEP on regional lung function and to guide the selection of individualized PEEP setting.

Recent findings

The most frequent approach of utilizing EIT for the assessment of PEEP effects and the PEEP setting during the time period from January 2022 till June 2023 was based on the analysis of pixel tidal impedance variation, typically acquired during stepwise incremental and/or decremental PEEP variation. The most common EIT parameters were the fraction of ventilation in various regions of interest, global inhomogeneity index, center of ventilation, silent spaces, and regional compliance of the respiratory system. The studies focused mainly on the spatial and less on the temporal distribution of ventilation. Contrast-enhanced EIT was applied in a few studies for the estimation of ventilation/perfusion matching.

The availability of commercial EIT devices resulted in an increase in clinical studies using this bedside imaging technology in neonatal, pediatric and adult critically ill patients. The clinical interest in EIT became evident but the potential of this method in clinical decision-making still needs to be fully exploited.
Setting positive end-expiratory pressure: lung and diaphragm ultrasound
Authors: Mousa Amne , Klompmaker Peter , Tuinman Pieter R.
Published: December 2023

Purpose of review

The purpose of this review is to summarize the role of lung ultrasound and diaphragm ultrasound in guiding ventilator settings with an emphasis on positive end-expiratory pressure (PEEP). Recent advances for using ultrasound to assess the effects of PEEP on the lungs and diaphragm are discussed.

Recent findings

Lung ultrasound can accurately diagnose the cause of acute respiratory failure, including acute respiratory distress syndrome and can identify focal and nonfocal lung morphology in these patients. This is essential in determining optimal ventilator strategy and PEEP level. Assessment of the effect of PEEP on lung recruitment using lung ultrasound is promising, especially in the perioperative setting. Diaphragm ultrasound can monitor the effects of PEEP on the diaphragm, but this needs further validation. In patients with an acute exacerbation of chronic obstructive pulmonary disease, diaphragm ultrasound can be used to predict noninvasive ventilation failure. Lung and diaphragm ultrasound can be used to predict weaning outcome and accurately diagnose the cause of weaning failure.

Lung and diaphragm ultrasound are useful for diagnosing the cause of respiratory failure and subsequently setting the ventilator including PEEP. Effects of PEEP on lung and diaphragm can be monitored using ultrasound.