bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptive disturbance observer-based fixed-time prescribed performance sliding-mode control of uncertain robot manipulators
Authors: Xu Shoulin , He Bin
Published: December 2024

This paper studies the fixed-time prescribed performance trajectory tracking issue of robot manipulators under uncertainties, actuator faults, and external disturbances. First, an adaptive disturbance observer (ADO) is developed, which does not need the exact upper bound information of unknown lumped disturbance and its derivative to effectively estimate the unknown lumped disturbance. Then, a novel fixed-time prescribed performance function (FTPPF) that can converge to a small region in a fixed time is proposed as the preset bound of tracking errors. Furthermore, a sliding surface that uses the prescribed performance tracking error is designed. Afterward, a nonsingular fixed-time prescribed performance terminal sliding-mode control (FTPPTSMC) combined with ADO is developed, to assure the transient and steady-state performance of the robot manipulator. The proposed FTPPTSMC can guarantee that the position tracking errors always keep within the prescribed performance bound and converge to a preset small region in a fixed time by the proposed FTPPF, asymptotically converging to the origin. Finally, the effectiveness of the proposed FTPPTSMC scheme for the robot manipulator is verified by simulations and experiments.
Reconstruction of the Amputated Auricle with Retro Auricular Flap in the Three Acts After a Human Bite
Authors: Buja Zejnë , Deliu Besnik
Published: December 2024

Amputations of the earlobe after a human bite are rare. But when they appear, they present a challenge for the plastic surgeon, due to its reconstruction since the earlobe is anatomically built only from skin and cartilage. In these cases, the retro auricular flap represents a perfect solution for reconstruction. We will present a 25-year-old man with amputation of the lower half of the earlobe, caused after a human bite injury. We have decided to reconstruct the amputated part of the auricle in 3 (acts) with a retro auricular flap. The skin is removed from the amputated part of the auricle and the (cartilage part) is implanted in the pocket created in the retro auricular region. Then in the second act, the retro auricular flap is raised with the previously implanted cartilage graft. By contrast, in the third act, the retro auricular flap is separated and the auricle defect is closed. The second defect is covered with a full skin graft. The reconstruction in 3 acts, delay procedure, of the auricle defects with retro auricular flap represents a satisfactory and very acceptable solution for the patient, not only from the reconstructive aspect but also from the aesthetic aspect.
Bringing #LinaBell to life online: A case study in the creative and collaborative dynamics of Chinese online fandom
Authors: Saiyinjiya Ariel , Gu Yuejie , Lei Yuruo , Meng Xingyuan , Literat Ioana
Published: December 2024

This article delves into the dynamics of online fandom in China through the lens of LinaBell, a pink fox character introduced as a mascot by Shanghai Disneyland in September 2021. Unlike traditional Disney characters, LinaBell lacks an official backstory or media presence. Yet she has rapidly gained immense popularity among Chinese Disney fans, largely through social media platforms like Weibo. Our study centers on the LinaBell Super Topic Community on Weibo, consisting of over 543,000 members known as “LinaBell’s moms.” Employing qualitative content analysis of posts and comments, this research examines fans’ creative work, including videos, fanfiction, and memes around LinaBell, in order to understand the collective dynamics of Chinese online fandom. Our findings revealed two main themes: the collective personification of LinaBell through fan work, and the formation of a parakin bond with the character. The findings highlight the transformative role of social media in contemporary Chinese fandom as well as unveil a diverse landscape of participation, creativity, and community in Chinese culture through the prism of platforms like Weibo.
Targeting Na,K-ATPase-Src signaling to normalize cerebral blood flow in a murine model of familial hemiplegic migraine
Authors: Staehr Christian , Guldbrandsen Halvor Østerby , Homilius Casper , Johnsen Laura Øllegaard , Postnov Dmitry , Pedersen Tina M , Pierre Sandrine , Sandow Shaun L , Matchkov Vladimir V
Published: December 2024

Familial hemiplegic migraine type 2 (FHM2) is linked to Na,K-ATPase α2 isoform mutations, including that of G301R. Mice heterozygous for this mutation ([Formula: see text]) show cerebrovascular hypercontractility associated with amplified Src kinase signaling, and exaggerated neurovascular coupling. This study hypothesized that targeting Na,K-ATPase-dependent Src phosphorylation with pNaKtide would normalize cerebral perfusion and neurovascular coupling in [Formula: see text] mice. The effect of pNaKtide on cerebral blood flow and neurovascular coupling was assessed using laser speckle contrast imaging in awake, head-fixed mice with cranial windows in a longitudinal study design. At baseline, compared to wild type, [Formula: see text] mice exhibited increased middle cerebral artery tone; with whisker stimulation leading to an exaggerated increase in sensory cortex blood flow. No difference between genotypes in telemetrically assessed blood pressure occurred. The exaggerated neurovascular coupling in [Formula: see text] mice was associated with increased Kir2.1 channel expression in cerebrovascular endothelium. Two weeks pNaKtide treatment normalized cerebral artery tone, endothelial Kir2.1 expression, and neurovascular coupling in [Formula: see text] mice. Inhibition of the Na,K-ATPase-dependent Src kinase signaling with pNaKtide prevented excessive vasoconstriction and disturbances in neurovascular coupling in [Formula: see text] mice. pNaKtide had only minor hypotensive effect similar in both genotypes. These results demonstrate a novel treatment target to normalize cerebral perfusion in FHM2.
The uncounted and unseen challenges of refugee foster families in Kampala, Uganda
Authors: Oriel Kagan Manya , Shanee Noga
Published: December 2024

Uganda is known for its open-door policies towards refugees, currently hosting over 1.5 million refugees, 60–65% of whom are children. National self-reliance strategies grant refugees who live in urban settings freedom of movement and employment and expect them to be mostly self-sufficient in exchange. Families within the refugee community are fostering unaccompanied refugee children, as this is considered the best solution for them by the Ugandan state and international organisations. We used ethnographic and quantitative methods, including in-depth interviews, questionnaires and participant observation, to assess the living situation of refugee foster families in Kampala. Our sample included 52 foster families who were caring for a total of 289 children. The findings raised four overarching themes: (1) Circumstances and reasoning for fostering unaccompanied children; (2) Formalisation of explicit foster registration; (3) Differences in care and living conditions; and (4) Ambiguous organisational support. Fostering was either direct by family members or friends, or indirect through the intervention of a church or the United Nations High Commissioner for Refugees’ (UNHCR) implementing non-governmental organisations (NGOs) but has never followed national processes to formalise fostering or adoption. Based on the self-reliance policies, refugee foster families in Kampala do not receive adequate support or supervision from any institution, and fostered children remain acutely vulnerable, especially since the economic crises related to Covid-19 and the war in Ukraine. We argue that the lack of recognition and financial and emotional support for foster families hinders community-based solutions. These conditions, coupled with the lack of proper supervision and control, encourage less altruistic fostering and more abusive and exploitative treatment of unaccompanied children.
Predictors of attachment in early- and late-placed adoptees
Authors: Hillman Saul , Lajmi Nahed , Hodges Jill , Kaniuk Jeanne , Steele Miriam
Published: December 2024

Although early experiences with primary caregivers have been recognised to play a significant role in individuals’ attachment relationships, little is known about adoptees’ attachment trajectories once placed within their respective adoptive families. This study aims to address this by investigating how attachment representations might be explained by early predictors including childhood attachment representations and other pertinent pre-placement variables. In early childhood, the Story Stem Assessment Profile (SSAP) is used to capture these representations, whilst in adolescence, an attachment-orientated interview (Friends and Family Interview; FFI) is employed. The sample here consisted of 35 early adoptees, placed before 12 months of age, and 35 maltreated, late-adoptees, placed between four and nine years old. Regression models were statistically significant for three out of four FFI constructs ( Security, Disorganisation, Coherence), though most of these effects were driven by IQ. When exploring the late adoptees alone, all regression models were significant in explaining variance in adolescent attachment, with SSAP Defensive Avoidance and Abuse as the strongest predictors. When examining the early adoptees alone, only two models were statistically significant, with most of these effects from IQ. These findings add to current knowledge on the role of childhood variables in predicting attachment and suggest potential areas to improve adoptees’ outcomes.
Influence of scaffold geometry on the degradation rate of 3D printed polylactic acid bone scaffold
Authors: Khaki Nazanin , Sharifi Emad , Solati-hashjin Mehran , Abolfathi Nabiolah
Published: December 2024

Fabricating scaffolds using three-dimensional (3D) printing is an emerging approach in tissue engineering (TE), where filaments with a controlled arrangement are printed. Using fused deposition modeling in bone replacement enables the simulation of bone structure. However, the microenvironment created by the scaffold must meet specific requirements. These requirements aim to create an environment that promotes adhesion, proliferation, differentiation, and cell migration. One of the challenges in creating polylactic acid scaffolds is controlling the degradation rate to match the target tissue. This study investigates the degradation of scaffolds with different geometries and the relationship between scaffolds’ geometry and degradation rate. These scaffolds are made of polylactic acid and prepared using 3D printing. The lattice geometry was exposed to acidic media with varying pH levels for 1 month, and pH2 was selected for all geometries for further investigation. The five selected geometries were then immersed in the desired acid for 2 months, and measurements were taken for wet weight, dry weight, morphology, molecular weight, and crystallinity during degradation. The results showed that the hexagonal sample had a 1.5% increase in wet weight, and the gyroid sample had a 1.2% increase, indicating that the wavy shapes had a higher fluid-holding capacity. The degradation analysis indicated that the hexagonal geometry had accelerated degradation compared to the other geometries. Based on these findings, it can be concluded that filament separation not only results in rapid cooling and prevents the recovery of the crystalline arrangement but also increases the surface area to volume ratio, allowing for more acid penetration and faster degradation. Finally, mechanical properties and in vitro evaluation were assessed for three selected geometries. On the 60th day, the hexagonal scaffold had the highest elastic modulus value of 105 ± 0.45 MPa, while the gyroid scaffold had the lowest value of 58.8 ± 0.40 MPa. The lattice scaffold had the highest amount of cell attachment, with 210.88 ± 0.35 cells surviving after 24 hours and 94.01 ± 0.18 cells surviving after 72 hours. These high viability rates indicate that the three scaffolds with the selected geometries are suitable for promoting cell growth.
Chronic Concealment and Awareness in the Affective Worlds of Young People Living With Chronic Illness
Authors: Harper Imogen , Broom Alex , Kenny Katherine
Published: December 2024

From the onset of chronic illness, a variety of challenges emerge—challenges that both persist and evolve as life progresses. For young adults living with chronic illness, the age-specific difficulties of becoming ill while young form a foundation that shapes their experience of illness in enduring ways. This paper draws on a series of in-depth qualitative interviews with 33 young adults (aged 19–29 years old) living with a range of chronic illnesses, including fatigue syndromes, auto-immune diseases, and neurological conditions. Participants demonstrated an emergent chronic consciousness of how others perceived their health, which created a series of fraught affective tussles centered on relational recognition and feared judgment. This article explores the difficulties and concerns participants had when communicating the nature and realities of illness; the emotional toll of attempting to avoid attention and judgment from others regarding their conditions; and the ways in which others could productively and sensitively acknowledge participants’ illness experiences. We demonstrate that the process of learning how to navigate these issues was one important way that participants began to integrate their illness (and its implications) into their emerging sense of self and adult life.
Investigation into the time-dependent mechanical behavior of pre-stressed anchor bolts and fractured rock specimens under synchronized tensile loads
Authors: Yang Wendong , Liu Chuntian , Li Yiwe , Wang Bingqi , Zhang Xiang
Published: December 2024

Pre-stressed anchor bolts serve as an effective means to reinforce fractured rock masses. The long-term efficacy of their anchoring function significantly impacts the safety throughout the entire lifecycle of rock engineering projects. Over time, fractured rock masses undergo creep deformation, which interacts synergistically with the time-dependent changes in the pre-stress of anchor bolts. In this work, we conduct uniaxial tensile tests and tensile creep tests on fractured rock specimens anchored by pre-stressed bolts, analyzing the coordinated deformation between the pre-stressed anchor bolts and the fractured specimens. Firstly, conventional uniaxial tensile tests were conducted on the pre-stressed anchorage specimen. The study found that the tensile strength of the anchored specimens was significantly higher than that of the unanchored specimens. Additionally, the ability of the specimens to withstand tensile stresses and deformation improved as pre-stress increased. Secondly, uniaxial tensile creep tests were conducted on the prestressed anchored specimens. The results indicate that, as the stress level increases, the creep strain continues to increase. The application of prestress can effectively limit the tensile deformation of the specimen and delay its damage time. The greater the pre-stress, the smaller the instantaneous strain and creep strain rate during the graded loading test. Finally, based on the synergistic deformation of pre-stressed anchor bolts and the creeping rock mass, we establish a constitutive model reflecting the creep properties of fractured rock mass and derive a theoretical viscoelastic creep formula for anchored rock mass under uniaxial tension. Comparing the creep model with the test results shows that this model is highly applicable and accurate in verifying the tensile creep deformation of prestressed anchorage specimens.
Exploring the Role of Preoperative Systemic Therapy and Primary Resection in NSCLC With Extrathoracic Metastases: Identifying the Optimal Candidates
Authors: Jin Xuanhong , Zhu Xinyu , Shen Hangchen , Zhai Chongya , Pan Hongming , You Liangkun
Published: December 2024

Background

In non-small cell lung cancer (NSCLC), patients with extrathoracic metastases typically have a poor prognosis, with systemic chemotherapy being the standard care. The full potential of primary resection therapy (PRT) in these patients, especially during the immunotherapy era, is not fully established. Additionally, the effectiveness of systemic preoperative therapy in this context is unclear.

Methods

This retrospective study identified NSCLC patients with extrathoracic metastases from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2019. We compared the survival rates of those treated with just chemotherapy vs those receiving both chemotherapy and PRT.

Results

In a study of 41 909 patients with extrathoracic metastatic NSCLC receiving chemotherapy, we found that adding PRT significantly increased overall survival (median OS post-PSM: 18 months vs 11 months, P < 0.001). However, in the immunotherapy era, its effectiveness was less pronounced (HR: 0.56 vs 0.7, P for interaction = 0.011). For patients who have metastases to multiple distant organs, combined distant organ and distant lymph node metastases, or lung metastases, no additional survival benefit from PRT was observed (all P > 0.05). Patients receiving systemic preoperative therapy before PRT had significantly better outcomes than those who did not (HR = 0.69, P < 0.001). A predictive nomogram was developed and validated, showing AUCs of 0.751 and 0.766 in the training and test sets.

Conclusion

In both pre- and post-immunotherapy eras, patients with extrathoracic metastatic NSCLC benefit more from adding primary tumor resection to chemotherapy, especially those with preoperative systemic therapy. We created a precise nomogram to identify the best candidates for PRT among patients with extrathoracic NSCLC metastases.
Understanding student teachers’ learning from negative experiences of feedback during teaching practicum: A feedback literacy perspective
Authors: Yuan Kaihao , Yu Shulin , Liu Simin
Published: December 2024

Although the majority of studies have examined student teachers’ perceptions, emotional experiences, and responses during their teaching practicum (TP), there is a scarcity of research focusing on English as a foreign language (EFL) student teachers’ internal and behavioural responses to negative feedback from mentors or supervisors. Feedback literacy, as a comprehensive concept encompassing internal factors, offers an innovative perspective to explore the characteristics and interplay among learners’ cognitive, affective, and behavioural capacities when dealing with feedback. Therefore, from the perspective of feedback literacy, this study investigated how student teachers cope with negative feedback experiences during TP. This study involved 16 student teachers from five teacher education programmes at the four selected Chinese universities in Sichuan, Fujian, Guangdong, and Macau contexts in China. Multiple data sources were collected, including participants’ narrative reports, semi-structured interviews, and teaching documents. The results revealed participants’ various situations of feedback literacy to cope with negative feedback experiences from their university supervisors and school mentors during TP. Student teachers’ feedback literacy is crucial in mediating their responses to negative feedback experiences, which started with their appreciation of feedback by understanding its meaning, conflicts, and difficulties. Following that, they did not necessarily generate negative external and internal judgements towards negative feedback. Meanwhile, it enabled participants to regulate their emotions with diverse external or internal strategies to respond to such feedback. The findings of this study also provided pedagogical implications for student teachers and teacher educators, respectively.
Välkky’s voyage on to a hospital ward: Expectations, explorations and emergent robocentric nursing care
Authors: Nettleton Sarah , Brown Nik , Atkin Karl , Dolezal Luna , Metsäketo Sanna , Robins Daniel
Published: December 2024

Drawing on ethnographic fieldwork in Finland, we report on the trial of a teleoperated care robot named Välkky introduced onto a fully operational hospital neurological ward. Our data revealed a narrative arc where participants’ early expectations of the hospital-based trial altered as the project unfolded. Greeted with techno-excitement and experimental enthusiasm about the place of robotics in reshaping roles within clinical care, Välkky became the focus for collaborative in situ learning, adaptation and redesign amongst the roboticists, designers, nurses, patients, and managers. Välkky acted as an ‘attractor’ provoking thinking about, and a reimagining of, future arrangements of care. Our empirically informed insights seek to pave the way for real-world nuanced thinking that pushes beyond human/non-human and success/failure binaries. Building on debates in STS and feminist posthumanism, we propose a robocentric approach, which encourages us to ‘queer’ health care robots, and to understand them as fluid, hybrid, distributed and relational figures, rather than purely as inert, mechanical, non-human objects that might replace humans. Nursing care practices by and with robots will generate new meanings and practices of care that will emerge iteratively, as caring relations, relationships and practices develop within the context of operational ward environments. Robots may or may not be able support care, but they will invariably challenge what care is.
A novel non-pneumatic compression device results in reduced foot and ankle swelling in patients with venous and lymphatic edema
Authors: Rao Abhishek , Berland Todd , Mullick Amir , Maldonado Thomas S , Blumberg Sheila N
Published: December 2024

Objectives

Non-pneumatic compression devices (NPCDs) rely on shape-memory alloy technology that allows patients to ambulate and remain active during lymphedema treatment. This study examines the effect of the NPCD on foot and ankle swelling.

Methods

This was a prospective, non-randomized study of patients with phlebolymphedema (venous insufficiency-related lymphedema) treated with a novel NPCD for 4 weeks. Ankle and foot circumference (cm), and volume measurements (ml water displacement using immersion) of the foot and ankle were obtained at enrollment, 2-weeks, and 4-weeks, and ambulation was tracked with a wearable exercise monitoring device.

Results

This study included 13 patients (21 limbs). A significant reduction in circumference (ankle (−0.84 ± 0.22 cm, p < .01) and metatarsal bed (−0.55 ± 0.95, p < .01)) and volume (foot/ankle (−52 ± 22 mL, p = .032)) was observed. Patients reported a mean of 8100 steps per day (±6100).

Conclusions

NPCD results in significant reduction in edema in the foot and ankle despite garments lacking a foot piece. Patients remained mobile while adhering to therapy.
Expanding healthcare access in rural sub-Saharan Africa
Authors: Anand S , Ayodele V , Ashraf A , Shilleh MA , Rahim FO , Mmbaga BT , Rugakingira A
Published: December 2024

While healthcare delivery in sub-Saharan Africa (SSA) has made notable strides, the benefits of improved access predominantly favour urban areas, leaving rural communities largely underserved. A multitude of barriers contribute to this disparity, including inadequate funding, a shortage of trained medical professionals, insufficient transportation, underdeveloped infrastructure, and entrenched educational and cultural beliefs. As rural SSA populations grapple with escalating burdens in infectious diseases such as HIV, malaria, tuberculosis, and heightened risks during childbirth and pregnancy, it becomes imperative to confront these obstacles in healthcare delivery and enhance healthcare provision in these regions.
Unveiling the global sleep divide: how social disparities worsen chronic disease risk
Authors: Sunkersing J , Sunkersing D
Published: December 2024

This article argues that despite significant advancements in the prevention of cardiovascular diseases, efforts to address sleep-related illnesses have lagged, particularly on a global scale. The COVID-19 pandemic has highlighted numerous health disparities, and as we move towards recovery, there is a critical opportunity to enhance public health initiatives by incorporating robust sleep medicine practices.
Myeloid leukemia cutis in the absence of systemic leukemia: A case report
Authors: Taha Mohamad R , Tyring Stephen K
Published: December 2024

Leukemia cutis (LC) is an uncommon cutaneous manifestation of leukemia that involves the leukocytic infiltration of the skin. LC typically presents after a diagnosis of leukemia has been made but may rarely appear before confirmation of the disease. In this report, we describe the case of an 86-year-old male presenting with LC prior to a clear diagnosis of leukemia in the blood. This case highlights the importance of early recognition of LC lesions, to ensure earlier detection of the neoplasm, particularly when they present as the first sign of disease.
Genetic Analysis of Vanishing Twin Syndrome Using Next-Generation Sequencing and Short Tandem Repeat Analysis: A Case Report and Literature Review
Authors: Honda Hidemine , Handa Mika , Takiuchi Tsuyoshi , Tsuji Saori , Goto Takeshi , Miyake Tatsuya , Kimura Tadashi
Published: December 2024

Vanishing twin syndrome (VTS) refers to the spontaneous reduction of a fetus during multiple pregnancies, resulting in its invisibility during gestation. Vanishing twin syndrome is commonly identified through ultrasonographic examination in early pregnancy; nonetheless, the genetic causes of VTS are rarely detected. This report aimed to investigate the feasibility of genetic testing for VTS using low-coverage whole-genome sequencing and short tandem repeat (STR) analysis. We report a 39-year-old woman who underwent in vitro fertilization and conceived dichorionic diamniotic twins. The heartbeat of 1 fetus ceased at 11 weeks, leading to a diagnosis of VTS, whereas the surviving fetus developed normally and was delivered at full term. Placental examination revealed a rudimentary gestational sac adjacent to the placenta that correlated with the vanished fetus. Chorionic tissues were collected from the placenta of the live-born infant and the rudimentary gestational sac that was considered to have originated from the vanished fetus. Genetic testing of chorionic tissues from the gestational sac and placenta showed that both fetuses were monozygotic twins with a normal 46, XY male karyotype. However, a triallelic pattern at the Penta E locus was identified in the vanished fetus on STR analysis, which was a unique genetic characteristic. This report highlights the feasibility of genetic testing for VTS, despite the unclear relationship between the identified genetic pattern and the vanished fetus.
Three-dimensional embodied visibility graph analysis: Investigating and analyzing values along an outdoor path
Authors: Omrani Azizabad Sara , Mahdavinejad Mohammadjavad , Hadighi Mahyar
Published: December 2024

In visibility analysis, a major focus is the relationship between people and the environment, and one of the most important spatial concepts is Isovist. Although typically represented in two dimensions in architecture, this concept has recently been computed in a three-dimensional environment. However, embodied 3D isovist Theory as developed to date does not account for locomotion. In this paper, therefore, we combine that theory with 3D visibility graph theory to develop and propose the Three-Dimensional Embodied Visibility Graph (3D E-VGA). To present and evaluate the proposed model in an architectural environment, we analyze the three-dimensional scene of a pedestrian moving along a path in an outdoor environment, specifically that of a container housing design project in Cairo known as “Sheltainer.” Further, we investigate the relationships between the t-d ratio, the v-h ratio, vertical jaggedness, connectivity, and integration values and conclude that of these the last three-vertical jaggedness, connectivity, and integration- are significantly correlated with each other. However, the relationship between v-h, t-d, and connectivity and integration values has not been determined. Therefore, analyzing both values related to embodied 3D isovist and 3D visibility graph provides us with a more comprehensive and effective analysis of pedestrians’ visual perceptions along a path.
Heuristics for Better Project Leadership: Teasing Out Tacit Knowledge
Authors: Flyvbjerg Bent
Published: December 2024

Heuristics are fast-and-frugal rules of thumb, used to simplify complex decisions. This article explores how heuristics may help improve project leadership. First, it identifies two schools of thought in scholarship about heuristics. Second, it explains why heuristics work, based on Occam’s razor. Third, it outlines five steps for teasing out project leaders’ tacit heuristics, with examples of how the steps were employed in leadership training at Oxford University. The five steps emphasize the role of Aristotelian phronesis in developing effective heuristics. Fourth, the article discusses heuristics that drove success at Pixar and how we may learn from these. Finally, areas for further research are identified. Readers, whether practitioners or scholars, are encouraged to develop and improve their own leadership heuristics and guidance is given for how to do this.
Changing profile of bacterial infection and microbiome in cystic fibrosis: when to use antibiotics in the era of CFTR-modulator therapy
Authors: Milczewska Justyna , Syunyaeva Zulfiya , Żabińska-Jaroń Aleksandra , Sands Dorota , Thee Stephanie
Published: December 2024

The advent of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy, especially the triple therapy combining the drugs elexacaftor, tezacaftor, ivacaftor (ETI), has significantly changed the course of the disease in people with cystic fibrosis (pwCF). ETI, which is approved for the majority (80–90%) of pwCF, partially restores CFTR channel function, resulting in improved mucociliary clearance and, consequently, improved lung function, respiratory symptoms and pulmonary exacerbations. The bacterial burden of classical CF pathogens such asPseudomonas aeruginosaandStaphylococcus aureusis reduced without reaching eradication in the majority of infected patients. Limited data is available on less common or emerging bacterial pathogens. ETI has a positive effect on the lung microbiome but does not fully restore it to a healthy state. Due to the significant reduction in sputum production under ETI, respiratory samples such as deep-throat swabs are commonly taken, despite their inadequate representation of lower respiratory tract pathogens. Currently, there are still unanswered questions related to this new therapy, such as the clinical impact of infection with cystic fibrosis (CF) pathogens, the value of molecular diagnostic tests, the durability of the effects on respiratory infection and the role of fungal and viral infections. This article reviews the changes in bacterial lung infections and the microbiome in CF to provide evidence for the use of antibiotics in the era of ETI.
Impact of COVID-19 pandemic on sex-disparities in asthma healthcare utilization and outcomes: a population study
Authors: Lam Grace Y. , Wen Chuan , Ronksley Paul E. , Bakal Jeffrey A. , Bhutani Mohit , Soril Lesley J.J. , Stickland Michael K. , Gross Douglas P. , Sharpe Heather , Weatherald Jason
Published: December 2024

Background

Sex-disparities in healthcare access were exacerbated during the COVID-19 pandemic. For respiratory conditions like asthma where females have poorer disease outcomes, it is unclear if the pandemic further worsened this sex-disparity. Thus, theobjectiveof this study is to compare the impact of the pandemic on healthcare utilization, exacerbations, and mortality rates in males and females with asthma.

Methods

A retrospective population-based provincial-level analysis was conducted using linked administrative datasets from Alberta, Canada. We measured hospitalization, emergency department and outpatient visits, and asthma outpatient exacerbations in female and males with asthma 18 months before and after March 12, 2020. Mortality data were compared pre-versuspost-pandemic, taking into account confirmed COVID-19 infection within 30 days. Subgroup analysis was undertaken to determine if healthcare utilization differed in those with severe asthma.

Results

Acute care and outpatient encounters for patients with asthma declined for both females and males. Those with severe asthma of either sex experienced a reduction in hospitalizations during the pandemic. Total number of outpatient asthma visits, including both virtual and in-person, increased during the pandemic for both sexes but significantly more in females. Mortality rate was unchanged after adjusting for COVID-19-associated deaths pre-versuspost-pandemic.

Conclusion

All patients with asthma accessed acute care resources less but outpatient visits increased during the pandemic. There was no increase in non-COVID-related mortality, regardless of sex, suggesting that the previously established sex-disparity in asthma outcomes was not seen during the pandemic.
Disseminated histoplasmosis and presumptive CNS toxoplasmosis-associated immune reconstitution inflammatory syndrome in a patient with HIV/AIDS: a case report
Authors: Laverde-Sudupe Nicolás , Carr Erin R. , Velit-Rios Bruno , Morel-Almonte Maria , Castro Jose Guillermo
Published: December 2024

Background

Co-infections associated with Immune Reconstitution Inflammatory Syndrome (IRIS) have been described in literature, however they constitute an uncommon finding in the medical community.

Case presentation

Here we report a rare case of a 55-year-old woman from Cuba with prior medical history of HIV/AIDS adherent to her antiretroviral therapy (ART) regimen, who was hospitalized in Miami, Florida because of fluid dysphagia, odynophagia and right-sided cervical lymphadenopathy. A prior biopsy of the right cervical lymph node performed in an outside hospital found evidence of non-caseating granulomas with budding yeast, which was later confirmed to be disseminated histoplasmosis by a positive (1-3) -β-glucan assay and histoplasmosis urine antigen in this admission. Furthermore, after multiple imaging testing due to her clinical condition, a brain MRI demonstrated findings concerning for cerebral toxoplasmosis, which was supported by serology findings. Treatment with liposomal amphotericin B and TMP-SMX led to clinical and radiological improvement of this patient’s conditions, and she was discharged with an appointment for follow-up in the clinic.

Conclusion

This case highlights the complexities and challenges in managing opportunistic infections (OIs) during immune recovery in HIV/AIDS patients on ART, and emphasizes the necessity of continuous, vigilant monitoring and having a broad differential diagnosis in this group of patients.
Risk factors and nomogram for the prediction of intracranial hemorrhage in very preterm infants
Authors: Wang Yan , Yang Yong , Wen Lijun , Li Minxu
Published: December 2024

Aims

This study aims to identify important risk factors for intracranial hemorrhage (ICH) in very preterm infants at our institution and develop a predictive nomogram for early detection of ICH.

Methods

We retrospectively analyzed neonates with a gestational age (GA) under 32 weeks, admitted to the neonatal intensive care unit from March 2022 to July 2023. Infants were categorized into two groups based on ultrasound findings and assessed for thirteen variables including gender, GA, birth weight (BW), acidosis, among others. We used multivariate logistic regression analysis to build a prediction model and identify independent risk factors for ICH. We build a prediction model by assigning 241 cases to the training set and 103 to the validation set (ratio 7:3).

Results

Among 344 very preterm infants, the incidence of ICH was 36.9% (89 cases) in training set. Significant differences were observed in gestational age, birth weight, antenatal corticosteroids, mechanical ventilation days, and acidosis between cases and controls. Logistic regression analysis identified gestational age (OR = 0.674), antenatal corticosteroids (OR = 0.257), acidosis (OR = 2.556), and mechanical ventilation mechanical ventilation days(OR = 0.257) as independent risk factors for ICH. The C-index of the training and validation sets was 0.814 (95% CI: 0.762–0.869) and 0.784 (95% CI: 0.693–0.875), respectively. According to decision curve analysis, our model outperformed the “None” and “All” baseline lines over a wide range of risk thresholds (0.12–0.92).

Conclusion

Acidosis and mechanical ventilation are independent risk factors for ICH in very preterm neonates, while higher gestational age and antenatal corticosteroid use are protective. The nomogram developed from these four factors demonstrates strong predictive accuracy and calibration, which can aid clinicians in identifying preterm infants at high risk for ICH and facilitate early diagnosis and management.
Evaluation of response to a cholera outbreak in January 2024 using the 7–1–7 timeliness metrics: a case study of Elegu Point of Entry, Uganda
Authors: Ssemanda Innocent , Kibwika Brian , Namusoosa Ritah , Kwesiga Benon , Bulage Lilian , Migisha Richard , Ario Alex Riolexus
Published: December 2024

Background

Cholera is a major public health threat in Uganda, especially in border districts prone to outbreaks from cross-border movement. We investigated and evaluated the initial response to a January 2024 cholera outbreak in Elegu Town, on the Uganda-South Sudan border, using the 7–1–7 timeliness metrics to assess detection, notification, and response capacities, highlighting Uganda's preparedness and challenges in managing cross-border outbreaks.

Methods

We defined a suspected case as the onset of acute watery diarrhea in an asylum seeker at the Elegu border point from January to February 2024. A confirmed case was a suspected case in which Vibrio cholerae was isolated in the stool by culture or PCR. We actively searched for cases and collected data on person characteristics, symptoms, and outbreak timeliness. We used semi-structured interviews to elicit insights from district health officials on the enabling factors and bottlenecks during the response. We used the 7–1–7 metric to assess detection, notification, and response capacities of the point of entry.

Results

Thirteen members of a refugee family from South Sudan were diagnosed with cholera within 6 h of arrival at the Elegu border, with 4 (31%) confirmed cases. No death occurred. The authorities detected, notified, and responded to the outbreak within the 7–1–7 timelines, with no major bottlenecks identified. The outbreak was detected and notified within one day and by the fifth day, a full response was mounted. The prompt response was attributed to the availability of a functional emergency operations center and the presence of trained surveillance frontline health workers.

Conclusion

Response to an imported cholera outbreak at Elegu border point demonstrated Uganda's preparedness in managing cross-border disease outbreaks. Achieving the 7–1–7 targets highlighted the country’s-built capacity to detect, notify, and respond to such events. Continued investment in local-level disease detection, communication, and national-level resource mobilization will be crucial to sustaining future effective cross-border outbreak prevention and control strategies.
Exploring mitogenomic data to enhance the understanding of Seirinae (Collembola: Entomobryidae) evolution, distribution and taxonomy
Authors: Bellini Bruno Cavalcante , Cipola Nikolas Gioia , Jantarit Sopark , da Cunha Santos Nathália Michelly , Nilsai Areeruk , Cheng Hsin-Ju , Godeiro Nerivânia Nunes
Published: December 2024

The subfamily Seirinae (Collembola: Entomobryidae) is among the most diverse suprageneric taxa of epedaphic springtails and is particularly abundant and species-rich in tropical and subtropical regions. Numerous studies have investigated its internal and external phylogenetic relationships, enhancing our understanding on Seirinae systematics. Recent taxonomic efforts have also advanced our knowledge on the subfamily morphology and diversity. In this study, we reevaluate the phylogeny of Seirinae using the mitogenomes of 26 samples from different continents, aiming to discuss recent findings regarding the group systematics, to identify cases of alien species introduced in China and Thailand, and propose new synonyms for Seira spp. Additionally, we describe a new species from Thailand and provide a redescription of Seira brasiliana (Arlé) based on the study of Brazilian and Chinese specimens. Through these efforts, we provide further ground for understanding the evolution, systematics, distribution and taxonomy of the group, contributing to future studies on Seirinae and Entomobryidae.
Biofilm and the effect of sonication in a chronic Staphylococcus epidermidis orthopedic in vivo implant infection model
Authors: Sandbakken Erik Thorvaldsen , Høyer Erling , Witsø Eivind , Søgaard Caroline Krogh , Díez-Sánchez Alberto , Hoang Linh , Wik Tina Strømdal , Bergh Kåre
Published: December 2024

Background

In diagnosing chronic orthopedic implant infections culture of sonicate represents a supplement to tissue cultures. However, the extent to which biofilm forms on implant surfaces and the degree of dislodgement of bacteria by sonication remains unclear. In this in vivo study using a low bacterial inoculum, we aimed to determine whether a variable effect of sonication could be observed in a standardized in vivo model.

Materials and Methods

Seven Wistar rats underwent surgery with intramuscular implantation of two bone xenograft implants, each containing two steel plates. The grafts were inoculated with approximately 500 colony forming units (CFU) of Staphylococcus epidermidis ATCC 35984. After 20 days the rats were sacrificed, and the steel plates were removed from the bone grafts. Epifluorescence microscopy and scanning electron microscopy (SEM) were used to visualize biofilm formation and dislodgement on the plate surfaces. In addition to cultures of sonicate, a quantitative S. epidermidis specific PCR was developed for enumeration of bacteria.

Results

A chronic, low-grade implant infection was successfully established, with all animals remaining in good health. All infected bone graft implants yielded abundant growth of S. epidermidis, with a median of 3.25 (1.6–4.6) × 10⁷ CFU per/graft. We were unable to distinguish infected plates from negative controls using epifluorescence microscopy. On infected plates small colonies of staphylococci were identified by SEM. The number of bacteria detected in the sonicate was low with 500 (100–2400) CFU/plate and 475 (140–1821) copies/plate by qPCR. The difference in area covered by fluorescent material before and after sonication was 10.1 (5.7–12.3) %, p = 0.018.

Conclusion

Despite the pronounced infection in the surrounding tissue, only few bacteria were detected on the surface of the steel implants. This is evident from the minimal findings by SEM before sonication, as well as the very low CFU counts and DNA copies in the sonicate. Sonication did not show variable effectiveness, indicating it is a valuable addition to, but not a replacement for biopsy cultures in cases of implant-associated infections with low-virulence microorganisms.
A latent profile analysis of cognitive emotion regulation strategies in relation to negative emotions and NSSI among Chinese junior high school students
Authors: Zhang Peiyu , Xiong Yuanqi , Shi Jingyu
Published: December 2024

Background

Little is known about the latent profiles of cognitive emotion regulation strategy (CERS) and its relationship with negative emotions and Non-Suicidal Self-Injury (NSSI) in Chinese junior high school students, although CERS is thought to be strongly associated with emotional-behavioral problems in adolescents.

Methods

A total of 2807 junior high school students in Yunnan Province, China, were selected for the study. They were measured with the Cognitive Emotion Regulation Questionnaire (CERQ), the Non-Suicidal Self-Injury Questionnaire, and the Depression-Anxiety-Stress Scale. Latent profile analysis was used to explore latent profiles of CERS among students, and the one-way ANOVA or c2 test was used to explore the relationship between the profiles and depression, anxiety, stress or NSSI.

Results

(1) Latent profile analysis revealed five CERS types: ‘Maladaptive group’ (32.25%), ‘Moderate adaptive-low maladaptive group’ (24.68%), ‘Rigid group’ (19.73%), ‘High adaptive-moderate maladaptive group’ (14.42%), and ‘Sensitive group’ (8.82%). (2) The multivariable logistic regression analyses showed that with increasing age (OR = 0.812, 95% CI = 0.66–0.99, p < 0.05), junior high school students were less likely to be in the ‘Moderate adaptive-low maladaptive group’, and males (OR = 0. 698, 95% CI = 0.52–0.94, p < 0.05) were less likely to be classified as ‘Moderate adaptive-low maladaptive group’; (3) ANOVA and c2 test results showed that the differences between the different latent profiles of junior high school students on anxiety, depression, stress and NSSI indicators were statistically significant (p < 0.05). The ‘Sensitive group’ had the highest risk of emotional-behavioral problems and the ‘Moderate adaptive-low maladaptive group’ had the lowest risk of emotional-behavioral problems.

Conclusion

Negative emotions and NSSI in junior high school students are closely related to their CERS profiles, and it is important to use targeted strategies to prevent and intervene in emotional-behavioral problems for individuals with different CERS subtypes.
The development and application of chimeric antigen receptor natural killer (CAR-NK) cells for cancer therapy: current state, challenges and emerging therapeutic advances
Authors: Yao Pin , Liu Ya-Guang , Huang Gang , Hao Liangchun , Wang Runan
Published: December 2024

Immunotherapy has transformed the landscape of cancer treatment, with chimeric antigen receptor (CAR)-engineered T (CAR-T) cell therapy emerging as a front runner in addressing some hematological malignancies. Despite its considerable efficacy, the occurrence of severe adverse effects associated with CAR-T cell therapy has limited their scope and prompted the exploration of alternative therapeutic strategies. Natural killer (NK) cells, characterized by both their innate cytotoxicity and ability to lyse target cells without the constraint of peptide specificity conferred by a major histocompatibility complex (MHC), have similarly garnered attention as a viable immunotherapy. As such, another therapeutic approach has recently emerged that seeks to combine the continued success of CAR-T cell therapy with the flexibility of NK cells. Clinical trials involving CAR-engineered NK (CAR-NK) cell therapy have exhibited promising efficacy with fewer deleterious side effects. This review aims to provide a concise overview of the cellular and molecular basis of NK cell biology, facilitating a better understanding of advancements in CAR design and manufacturing. The focus is on current approaches and strategies employed in CAR-NK cell development, exploring at both preclinical and clinical settings. We will reflect upon the achievements, advantages, and challenges intrinsic to CAR-NK cell therapy. Anticipating the maturation of CAR-NK cell therapy technology, we foresee its encouraging prospects for a broader range of cancer patients and other conditions. It is our belief that this CAR-NK progress will bring us closer to making significant strides in the treatment of refractory and recurrent cancers, as well as other immune-mediated disorders.