bluuebunny/crossref_metadata_2025 huggingface dataset:
Near-universal prevalence of central adiposity in heart failure with preserved ejection fraction: the PARAGON-HF trial
Authors: Peikert Alexander , Vaduganathan Muthiah , Claggett Brian L , Kulac Ian J , Litwin Sheldon , Zile Michael , Desai Akshay S , Jhund Pardeep S , Butt Jawad H , Lam Carolyn S P , Martinez Felipe , Van Veldhuisen Dirk J , Zannad Faiez , Rouleau Jean , Lefkowitz Martin , McMurray John J V , Solomon Scott D , Packer Milton
Published: January 2025

Background and Aims

An expansion of fat mass is an integral feature of patients with heart failure and preserved ejection fraction (HFpEF). While body mass index (BMI) is the most common anthropometric measure, a measure of central adiposity—the waist-to-height ratio (WHtR)—focuses on body fat content and distribution; is not distorted by bone or muscle mass, sex, or ethnicity; and may be particularly relevant in HFpEF.

Methods

The PARAGON-HF trial randomized 4796 patients with heart failure and ejection fraction ≥45% to valsartan or sacubitril/valsartan. The current work characterizes the association of BMI and WHtR with clinical features, outcomes, and the response to neprilysin inhibition.

Results

About half (49%) of the participants were considered obese by BMI (≥30 kg/m2), but nearly every patient (96%) had central adiposity (WHtR ≥0.5). Among patients who were not obese (BMI <30 kg/m2), 860 (37%) had marked central adiposity (WHtR ≥0.6). Higher BMI and WHtR were both associated with higher risk of total heart failure hospitalizations, but as compared with BMI, WHtR was linearly associated with heart failure outcomes and identified a higher proportion of patients who had a particularly elevated risk (i.e., 30% or greater). An obesity-survival paradox (i.e., improved outcomes in those with greater adiposity) was apparent with BMI in unadjusted analyses, but it was not observed with WHtR. Although neprilysin inhibition appeared to have greater effects on heart failure outcomes in patients with higher BMI and WHtR, analyses of interaction with obesity metrics did not show significant heterogeneity across the range of values for adiposity.

Conclusions

In PARAGON-HF, in contrast with BMI, nearly every patient with HFpEF had central adiposity (as assessed by WHtR), and the risks of adverse heart failure events were more robustly related to WHtR. These data challenge the current reliance on BMI as an appropriate metric of adiposity, and they suggest that—rather than obesity-related HFpEF being regarded as a select HFpEF subgroup—central adiposity is a ubiquitous feature of HFpEF.
Signatures of natural selection may indicate a genetic basis for the beneficial effects of oily fish intake in indigenous people from coastal Ecuador
Authors: Brandt Débora Y C , Del Brutto Oscar H , Nielsen Rasmus
Published: January 2025

Atahualpa is a rural village located in coastal Ecuador, a region that has been inhabited by people as early as 10,000 years ago. The traditional diet of their indigenous inhabitants is rich in oily fish and they have, therefore, served as a model for investigating the beneficial effects of such a diet. However, the genetic background of this population has not been studied. In this study, we sequenced the genomes of Atahualpa residents to look for variants under natural selection, which could mediate the effects of oily fish intake. DNA was extracted from 50 blood samples from randomly selected individuals recruited in the Atahualpa Project Cohort. After applying various filters, we calculated genome-wide genotype likelihoods from 33 samples, and combined data from those samples with data from other populations to investigate how the Atahualpa population is genetically related to these populations. Using selection scans, we identified signals of natural selection that may explain the above-mentioned dietary effects. The genetic ancestry in Atahualpa residents is 94.1% of indigenous American origin, but is substantially diverged from other indigenous populations in neighboring countries. Significant signatures of natural selection were found in the Atahualpa population, including a broad selection signal around the SUFU gene, which is a repressor of Hedgehog pathway signaling and associated with lipid metabolism, and another signal in the upstream region of LRP1B which encodes low-density lipoprotein (LDL) receptor related protein 1B. Our selection study reveals genes under selection in the Atahualpa population, which could mediate the beneficial effects of oily fish intake in this population.
Care Recipients’ Cognitive Trajectories and Caregivers’ Depressive Symptoms: The Mediating Role of Caregiving Burden
Authors: Lou Yifan , Gong Jiaowei , Zang Emma
Published: January 2025

Background and Objectives

The heterogeneity of population-based trajectories of care recipients’ (CRs) cognitive functioning and how they are associated with their caregivers’ mental health is less studied in the United States. Informed by the stress process model, this study examines the relationship between care recipients’ cognitive trajectories and caregivers’ depressive symptoms, and the mediating role of caregiving burden.

Research Design and Methods

Data were from the National Health and Aging Trends Study (2011-2020) for 1,086 care recipients and their 1,675 caregivers from the 2021 National Study of Caregiving. We applied Bayesian group-based trajectory modeling to identify distinct cognitive trajectory groups among care recipients. Hierarchical linear models were then used to examine the associations between these trajectory group memberships and caregivers’ depressive symptoms. Finally, Gelbach decomposition analysis was conducted to investigate the mediating role of physical, emotional, and financial caregiving burden.

Results

Five cognitive trajectories were identified among care recipients: “high start, stable” (11.81%), “medium-high start, slight decline” (31.83%), “medium start, slight decline” (27.72%), “medium-low start, sharp decline” (20.60%), and “low start, sharp decline” (8.04%). Worse cognitive trajectories (e.g., lower baselines and steeper slopes) were associated with increasing caregivers’ depressive symptoms; financial, emotional, and physical caregiving burdens jointly explained 63.5% of this association. Emotional caregiving difficulty is the most important contributing caregiving burden, explaining 49.6% of the observed association.

Discussion and Implications

When understanding caregiving experiences, it is critical to consider longitudinal cognitive course among care recipients. Interventions targeting multiple aspects of caregiving burden, especially emotional burden, should be prioritized.
What explains the growth in hospital assets from 2000 through 2019? A decomposition analysis
Authors: Teeple Stephanie , Andy Caroline , Schpero William L , Chatterjee Paula
Published: January 2025

Understanding disparities in hospital finances is essential for ensuring equitable systems of care. One understudied element is total assets, which include both financial and capital resources that hospitals acquire. We evaluated changes and drivers of variation in US hospital assets from 2000 through 2019 using data from the Centers for Medicare and Medicaid Services and American Hospital Association Annual Survey. We decomposed overall variation in total assets to determine the level (hospital, health system, or health care market) that contributed most to variation, and examined the extent to which asset growth was associated with changes in common inputs to hospital wealth vs changing relationships with these inputs or other unmeasured factors. Total assets held by US hospitals increased from $750 billion in 2000 to $1.6 trillion in 2019. Most variation occurred between hospitals, such that high-asset hospitals tended to remain high-asset and low-asset hospitals remained low-asset. Most of the increase in assets was due to unmeasured factors (ie, not patient revenue). We conclude that hospital wealth in the form of assets has grown substantially over time and accrued primarily to wealthy hospitals. Policymakers should consider broader measures of hospital wealth when targeting financial resources and efforts to strengthen data on hospital financing.
4. International Society
Authors: Sørensen Georg , Møller Jørgen
Published: January 2025

This chapter examines the International Society tradition of international relations (IR). International Society, also known as the ‘English School’, is an approach to world politics that places emphasis on international history, ideas, structures, institutions, and values. After providing an overview of International Society’s basic assumptions and claims, the chapter considers the three traditions associated with the leading ideas of the most outstanding classical theorists of IR, namely Niccolò Machiavelli (realism), Hugo Grotius (rationalism), and Immanuel Kant (revolutionism). It then explores International Society’s views regarding order and justice, world society, statecraft and responsibility, and humanitarian responsibility and war. It also examines how International Society scholars have used a historical approach to understand earlier international systems and the development of international society. It also discusses several major criticisms against the International Society approach to IR and concludes with an overview of the research agenda of International Society after the Cold War.
6. Social Constructivism
Authors: Sørensen Georg , Møller Jørgen
Published: January 2025

This chapter examines the social constructivist theory of IR. It first discusses the rise of social constructivism and why it has established itself as an important approach in IR. It then considers constructivism as social theory, and more specifically as both a meta-theory about the nature of the social world and as a set of substantial theories of IR. Several examples of constructivist IR theory are presented, followed by reflections on the strengths and weaknesses of the constructivist approach. The chapter proceeds by exploring constructivist theories of international relations, focusing on cultures of anarchy, norms of international society, the power of international organizations, a constructivist approach to European cooperation, and domestic formation of identity and norms. The chapter concludes with an analysis of some of the major criticisms of constructivism and by reviewing internal debates among constructivists.
7. Post-structuralism
Authors: Sørensen Georg , Møller Jørgen
Published: January 2025

This chapter examines post-structuralism. It sets the stage by introducing global politics (GP) approaches in the study of world politics. The aim of these approaches is to understand and represent the world from a large variety of political, social, cultural, economic, ethnic, and gendered perspectives. Post-structuralism stresses the subjectivity of human inquiry and rejects any claim of an established truth valid for all. It is above all concerned with language and discourse; it highlights the biased ways in which conventional IR theories represent and discuss the world. It is especially critical of neo-realism and its claim to study the world in an objective way valid across time and space. The chapter concludes with an overview of criticisms against post-structuralist approaches to the study of world politics.
9. Feminism and Queer Theory
Authors: Sørensen Georg , Møller Jørgen
Published: January 2025

This chapter examines feminism and queer theory (QT), two approaches that entered the study of world politics in the 1980s and 1990s. Feminism argues that women are a disadvantaged group in the world, in both material terms and in terms of a value system which favours men over women. It dissects the gendered nature of conventional IR theories. The chapter introduces three separate bodies of feminist theory: feminist liberalism, feminist post-structuralism, and feminist postcolonialism. It also introduces and discusses queer theory and its claim that world politics is infused with sexual logics. The chapter concludes with an overview of criticisms against feminist theories and queer theory.
13. Issue: What Is Economic Globalization and Who Benefits?
Authors: Sørensen Georg , Møller Jørgen
Published: January 2025

This chapter examines a third major issues in IPE: The nature and extent of economic globalization. For liberals, globalization is a market-driven process with great potential to bring benefits to all. For realists, states are basically in charge of globalization and heavily influence who gets what from the process. Marxists see globalization as an uneven, hierarchical process where the advanced industrialized countries benefit the most. GP theorists emphasize that the prevalent view of globalization has been much too Eurocentric. This debate currently takes places in a context of increasing inequality between and inside countries. It is also informed by the serious financial crisis that broke out in 2008, the Covid-19 pandemic, and the state-led capitalism of China and several other countries.
Use of wireless geographic locating system to improve medical equipment utilization and medical quality
Authors: Huang Tien-Lin , Lei Yi-Fang , Wang Pa-Chun
Published: January 2025

Hospitals require continuous process optimization to ensure uninterrupted care. This study investigates the integration of Real-Time Locating Systems (RTLS) with logistics and dispatch management in a metropolitan hospital. The system, which tracks circulating beds and medical equipment, improves resource allocation, reduces inefficiencies, and enhances task distribution using wearable devices and big data analytics. Results showed a 20.9% reduction in delivery time, 86.8% faster equipment search, and 91.2% staff satisfaction with zero adverse event recurrence. The findings underscore RTLS’s potential to enhance medical quality, efficiency, and patient safety through digital technology adoption.
Correlation between rrs gene mutations and amikacin resistance in Mycobacterium abscessus: implications for fitness cost and clinical prevalence
Authors: Ding Jie , Hameed H M Adnan , Long Lihua , Zhang Jingran , Fang Cuiting , Tian Xirong , Zhang Han , Li Lijie , Li Chunyu , Yang Ruhao , Gao Yamin , Wang Shuai , Zhang Tianyu
Published: January 2025

Objectives

Amikacin is crucial for treating Mycobacterium abscessus (Mab) infections, with resistance primarily attributed to rrs gene mutations. The correlation between specific mutations and amikacin susceptibility, along with the associated fitness cost, requires further investigation.

Methods

We isolated spontaneous amikacin-resistant mutants in vitro and identified their mutation sites in the rrs gene via Sanger sequencing, which were then compared with existing reports. Using CRISPR/Cas12a-assisted recombineering, we engineered Mab strains with specific rrs mutations. The growth rate and fitness costs in vitro were evaluated, in conjunction with drug susceptibility testing to determine the relationship between rrs mutations and amikacin resistance.

Results

The mutation frequency of Mab for amikacin resistance ranged from 4.68 × 10⁻⁷ to 9.38 × 10⁻⁹. Three rrs mutation sites (A1375G, C1376T, G1458T) were identified, with A1375G being the most prevalent. Two additional sites, T1373A and T1465A, have been reported previously but not detected in this study. The five gene-edited strains demonstrated resistance to amikacin and cross-resistance to other aminoglycosides, and all exhibited slower in vitro growth rates than the wild-type Mab. Competitive experiments revealed that T1373A and T1465A have high fitness costs, while C1376T and G1458T have weak fitness costs and A1375G shows no fitness costs.

Conclusions

Our findings confirm that rrs mutations confer high-level amikacin resistance, with the limited mutation spectrum in clinical isolates possibly linked to higher spontaneous mutation frequency and lower fitness costs.
Sulfate-reducing bacteria block cadmium and lead uptake in rice by regulating sulfur metabolism
Authors: Fang Li-Rong , Ren Jing-Yu , Sun Kai , Zhang Wei , He Wei , Dai Chuan-Chao
Published: January 2025

Aim

This study was dedicated to investigating the role of sulfur metabolic processes in sulfate-reducing bacteria in plant resistance to heavy metal contamination.

Methods and results

We constructed sulfate-reducing bacterial communities based on the functional properties of sulfate-reducing strains and then screened out the most effective sulfate-reducing bacterial community SYN1, that prevented Cd and Pb uptake in rice through a hydroponic experiment. This community lowered Cd levels in the roots and upper roots by 36.60% and 39.88%, respectively, and Pb levels by 35.96% and 51.54%. We also compared two treatment groups, inoculated with SYN1 and exogenously added GSH, and found that both enhanced the antioxidant response of the plants, increased the lignin and GSH contents and the expression of genes related to the phenylpropane biosynthesis pathway (OsCAD, Os4CL, OsCOMT, OsPOD, OsC3H, and OsPAL), and decreased the expression of heavy metal transporter genes (OsHMA2, OsIRT1) expression. There were no significant differences between the two treatments.

Conclusions

Sulfate-reducing bacteria produce GSH through the sulfur assimilation pathway, and GSH can directly chelate heavy metals or enhance plant antioxidant enzyme activities and regulate processes such as the uptake and translocation of heavy metals, thus enhancing plant resistance to heavy metal toxicity.
Assessing sign language comprehension in adults with intellectual disability and deafness
Authors: Weber Chantal , Weber Christoph , Holzinger Daniel
Published: January 2025

Language comprehension is an essential component of human development that is associated not only with expressive language development and knowledge acquisition, but also with social inclusion, mental health, and quality of life. For deaf and hard-of-hearing adults with intellectual disability, there is a paucity of measures of receptive sign language skills, although these are a prerequisite for individualized planning and evaluation of intervention. Assessments require materials and procedures that are accurate, feasible, and suitable for low levels of functioning. We adapted measures of English-language comprehension in young children—a direct assessment and a caregiver questionnaire—into Austrian Sign Language and to the target group of adults with intellectual disability and used them with a non-preselected sample of 67 deaf and hard-of-hearing adults with intellectual disability living in therapeutic communities specifically for deaf and hard-of-hearing people with multiple disabilities in Austria. Findings for both assessments demonstrate their construct validity, excellent internal consistency, and a large symmetrical distribution over the referential age range. Acceptance by the deaf and hard-of-hearing individuals and the caregivers and time-efficient administration suggest high practicability. We recommend further implementation in clinical practice, albeit with cautious interpretation of the results, and the inclusion of the instruments in research on intellectual disability and deafness.
QTL mapping and identification of candidate genes for anthocyanidin accumulation in Salvia miltiorrhiza flowers
Authors: Yu Yan , Li Ziying , Wu Yichao , Xie Gang , Guo Yuhuan , Yang Zaijun
Published: January 2025

Salvia miltiorrhiza Bunge is an ornamental plant known for its diverse flower colors, ranging from white to dark violet. To elucidate the regulatory mechanisms underlying flower color, we conducted QTL mapping and identified candidate genes involved in anthocyanidin accumulation. Total anthocyanidin content and six anthocyanidins in the corollas of S. miltiorrhiza were quantified using the pH differential method and HPLC, respectively. Composite interval mapping was employed to identify QTLs, followed by the identification of candidate genes based on stable QTL intervals across at least two different planting environments. These candidate genes were further validated through gene cloning and expression analysis. Anthocyanidin analysis in the F2 population revealed a positive correlation between total anthocyanidin content and flower color intensity. Notably, three major anthocyanidins of delphinidin (Dp), cyanidin (Cy), and petunidin (Pt) were detected in varying degrees of purple flowers, while no anthocyanidins were found in white flowers. In total, 33 QTLs associated with anthocyanidin content were identified, with two major QTLs located on linkage groups LG4 and LG5. Two candidate genes, CHS1 (a chalcone synthase) and TCP15 (a transcription factor), were identified in the genetic intervals of two major QTL sites, respectively. Preliminary verification experiments suggest that CHS1 may play a positive role in anthocyanidin biosynthesis, whereas TCP15 appears to potentially act as a negative regulator. This study provides a foundation for cloning genes controlling flower color and advances our understanding of the molecular mechanisms regulating flower color in S. miltiorrhiza.
‘I knew about political asylum, but not about asylum for gay people’: How queer exiles come to apply (or not) for SOGI asylum in France
Authors: Chossière Florent
Published: January 2025

SOGI asylum has received increasing political and academic attention. Focusing on refugee status determination, academics have emphasized how normative representations of sexual and gender minorities in Northern asylum institutions lead to the exclusion of many SOGI asylum applicants. To broaden the understanding of queer people’s experiences of forced migration and asylum, this paper shifts attention to what happens just before the asylum examination, namely the fact of applying for SOGI asylum itself. Based on 3 years’ ethnographic fieldwork, this research investigates how queer exiles come to apply for SOGI asylum in France. By emphasizing the variety of factors, besides their experiences of persecution, leading them to apply for SOGI asylum, this paper decompartmentalizes asylum from below, denaturalizing the category of LGBT+ refugees by reinserting the asylum application into more general and diversified individual experiences of migration. Doing so, it also counters liberationist and humanitarian narratives associated with SOGI asylum seekers.
Developmental and environmental effects on VTC2-dependent leaf ascorbate accumulation and functions
Authors: Kappel Sandrine , Frieboes Maureen J , Yokoyama Ryo , Kappel Christian , Tóth Szilvia Z , Fernie Alisdair R , Jahns Peter , Smirnoff Nicholas , Aarabi Fayezeh , Armbruster Ute
Published: January 2025

In nature, environmental conditions strongly fluctuate, frequently subjecting plants to periods of immediate photo-oxidative stress. The small molecule ascorbate allows plants to cope with such stress conditions. Ascorbate scavenges reactive oxygen species and enables the rapid and full induction of photoprotective non-photochemical quenching (NPQ). NPQ is dependent on zeaxanthin (Zx), which requires ascorbate as the electron donor during its synthesis by the violaxanthin de-epoxidase. The VTC2 gene encodes for one of two isoforms of GDP-L-galactose phosphorylase, the rate-controlling enzyme of ascorbate biosynthesis. In the current study, by including a newly identified vtc2 allele, we found that loss of VTC2 depleted ascorbate mainly from the mature leaves and thereby limited NPQ specifically in this tissue. Growth in fluctuating light and controlled climate suppressed the slow NPQ induction phenotype of vtc2 mature leaves to some degree. This was concurrent with a constitutively higher accumulation of zeaxanthin under this condition. When plants were shifted to natural conditions, with strongly fluctuating light and temperature, the ascorbate deficient mature leaves of vtc2 bleached. Together, our results reveal developmental and environmental effects on VTC2-dependent ascorbate accumulation and function.
The outer structure of old star clusters in the Small Magellanic Cloud
Authors: Piatti Andrés E
Published: January 2025

We report results on the internal dynamical evolution of old star clusters located in the outer regions of the Small Magellanic Cloud (SMC). Because the SMC has been imprinted with evidence of tidal interaction with the Large Magellanic Cloud (LMC), we investigated at what extend such an interaction has produced extra-tidal structures or excess of stars beyond the clusters’ tidal radii. For that purpose, we used the Survey of the Magellanic Stellar History DR2 data sets to build number density radial profiles of suitable star clusters, and derived their structural and internal dynamics parameters. The analysed stellar density profiles do not show any evidence of tidal effects caused by the LMC. On the contrary, the Jacobi volume of the selected SMC star clusters would seem underfilled, with a clear trend toward a smaller percentage of underfilled volume as their deprojected distance to the SMC centre increases. Moreover, the internal dynamical evolution of SMC star clusters would seem to be influenced by the SMC gravitational field, being star clusters located closer to the SMC centre in a more advanced evolutionary stage. We compared the internal dynamical evolution of SMC old star clusters with those of LMC and Milky Way globular clusters, and found that Milky Way globular clusters have dynamical evolutionary paths similar to LMC/SMC old star clusters located closer to their respective galaxy’s centres. Finally, we speculate with the possibility that globular clusters belonging to Magellanic Clouds like-mass galaxies have lived a couple of times their median relaxation times.
The human genome encodes a multitude of novel miRNAs
Authors: Gao Fan , Wang Fang , Chen Yue , Deng Bolin , Yang Fujian , Cao Huifen , Chen Junjie , Chen Huiling , Qi Fei , Kapranov Philipp
Published: January 2025

Human cells generate a vast complexity of noncoding RNAs, the “RNA dark matter,” which includes a vast small RNA (sRNA) transcriptome. The biogenesis, biological relevance, and mechanisms of action of most of these transcripts remain unknown, and they are widely assumed to represent degradation products. Here, we aimed to functionally characterize human sRNA transcriptome by attempting to answer the following question—can a significant number of novel sRNAs correspond to novel members of known classes, specifically, microRNAs (miRNAs)? By developing and validating a miRNA discovery pipeline, we show that at least 2726 novel canonical miRNAs, majority of which represent novel miRNA families, exist in just one human cell line compared to just 1914 known miRNA loci. Moreover, potentially tens of thousands of miRNAs remain to be discovered. Strikingly, many novel miRNAs map to exons of protein-coding genes emphasizing a complex and interleaved architecture of the genome. The existence of so many novel members of a functional class of sRNAs suggest that the human sRNA transcriptome harbors a multitude of novel regulatory molecules. Overall, these results suggest that we are at the very beginning of understanding the true functional complexity of the sRNA component of the “RNA dark matter.”
Magnetic exchange interaction between unpaired π- and d-electrons in nanographene-metal coordination complexes
Authors: Li Deng-Yuan , Zheng Yuqiang , Ortiz Ricardo , Wang Bing-Xin , Jiang Yashi , Yuan Bingkai , Zhang Xin-Yu , Li Can , Liu Liang , Liu Xiaoxue , Guan Dandan , Li Yaoyi , Zheng Hao , Liu Canhua , Jia Jinfeng , Frederiksen Thomas , Liu Pei-Nian , Wang Shiyong
Published: January 2025

The combination of open-shell nanographenes (NGs) and magnetic transition metals holds great promise for generating various new quantum phases applicable in spintronics and quantum information technologies. However, a crucial aspect in accomplishing this is to comprehend the magnetic exchange interactions between unpaired π- and d-electrons, a topic that has been seldom addressed. In this study, we focus on magnetic π-d exchange interactions between open-shell NGs and a magnetic coordination center of Fe or Co by employing scanning tunneling microscopy and spectroscopy. We synthesize two sets of NG-metal coordination complexes on a Au(111) substrate, secured by coordination bonds of carboxyl acid-Fe (Co). Through analysis of the excitation spectra, we observe a characteristic exchange coupling of 9 meV (5 meV) between the unpaired π-electron and the Fe (Co) d-shell electrons. Our experimental findings are qualitatively in agreement with multiconfigurational quantum chemistry calculations. This work evidences that a substantial magnetic exchange coupling can be achieved and engineered in metal-organic coordination systems, paving the way for designing and customizing extended radical metal-organic frameworks with precisely tailored magnetic properties.
Effectiveness of text message reminder and motivational interview on adherence to methadone treatment in Vietnam: a randomized controlled trial
Authors: Le Uyen Thanh Nu , Tran Thuan Thien , Le Giang Truong , Huynh Ha Khanh Mai , Bui Han Hy Thi , Pham Phuong Thu Thi , Nguyen Mai Ngoc Thi , Thai Truc Thanh
Published: January 2025

Background

Methadone maintenance treatment (MMT) is effective for treating opioid dependence. However, nonadherence can increase the risk of withdrawal syndrome, relapse, and overdose.

Methods

A community-based randomized controlled trial was conducted on 450 opioid-dependent patients undergoing MMT at three clinics in Ho Chi Minh City, Vietnam. Patients were randomly allocated into three groups including control, text message reminder (TMR), and motivational interview (MI). Treatment adherence was assessed every 3 months, including complete adherence, consecutive adherence, and weekend adherence.

Results

After 6 months, the MI group had significantly higher complete adherence than the control group (RR = 1.36, 95% CI: 1.09–1.69). The TMR group showed higher complete adherence at 3 months (RR = 1.27, 95% CI: 1.02–1.58) and 6 months (RR = 1.28, 95% CI: 1.06–1.56) compared to the control group. Weekend adherence in the TMR group was higher than the control group after 6 months (RR = 1.19, 95% CI: 1.07–1.31).

Conclusion

MI and TMR effectively improved treatment adherence, particularly complete adherence. Therefore, this study suggests the potential of these two methods in enhancing adherence among MMT patients in Vietnam.
Do modern orthopaedic trainees have sufficient exposure to open shoulder stabilization procedures?
Authors: Duvall Grant T. , Chopra Aman , Wright Melissa A. , Murthi Anand M.
Published: January 2025

Background:

Arthroscopic stabilization and bone augmentation procedures have become common treatment options for anterior shoulder instability, while the use of open soft tissue stabilization procedures has declined. This study aimed to determine current trends in utilization of open soft tissue stabilization among shoulder surgeons and the relationship between procedure volume in practice and exposure as trainees.

Methods:

Out of the 1,115 American Shoulder and Elbow Surgeon members surveyed, 212 surgeons completed a questionnaire about exposure to open soft tissue stabilization techniques during training, practice patterns for shoulder instability, perceived skill with open soft tissue stabilization procedures, and opinions on the importance of these procedures. Statistical analyses correlated practice numbers, training exposure, and self-perceived facileness.

Results:

Out of the 212 surgeons who completed the survey, 71% (n=153/212) of respondents performed less than 25% of their stabilization procedures in an open manner. Sixty-seven percent (n=143/212) of respondents reported that less than 10% of their open procedures involved only soft tissue. The number of open soft tissue stabilization procedures performed in practice correlated with the number performed during residency (r=0.42; P<0.001) and fellowship (r=0.46; P<0.001). Eighty percent of respondents reported self-perceived facileness with open soft tissue stabilization which correlated with the number of procedures performed in practice (P<0.001), residency (P<0.001), and fellowship (P<0.001). Half of respondents (51%; n=109/212) believed that procedure exposure was necessary for residents.

Conclusion:

Shoulder specialists perform a low volume of open soft tissue stabilization procedures currently. Exposure throughout training correlates with using these procedures in practice, and with surgeon confidence.

Level of evidence:

V
Thickness of Subcutaneous Fat as a Proxy for BMI in Non-ambulatory Patients With Neuromuscular Scoliosis Undergoing Posterior Spinal Fusion
Authors: Sukkarieh Hamdi , Akalonu Chibuzo , Liles Steele , Gillon William Hunter , Melancon Drew , Spears Isaac , Nehete Priyanka , Brooks Jaysson
Published: January 2025

Background:

Posterior spinal fusion in neuromuscular scoliosis patients carries a significant risk of postoperative surgical site infection (SSI). Body mass index has been associated with increased risk of surgical site infections, but it is difficult to obtain an accurate height of non-ambulatory children with severe neuromuscular scoliosis. Subcutaneous fat thickness has been associated with increased rates of surgical site infections in other surgeries; however, current literature has not elucidated a relationship between subcutaneous fat thickness and surgical site infections in this patient population.

Methods:

A retrospective chart review analyzed non-ambulatory patients with neuromuscular scoliosis who underwent posterior spinal fusion. Patients were stratified into 3 groups (underweight, normal weight, and overweight/obese) based on BMI-for-age percentiles. Subcutaneous fat thickness was measured in both the sagittal and coronal planes at 24 landmarks. Comparisons of categorical data were analyzed using χ2 tests. Logistic regression analysis was used to isolate independent factors associated with surgical site infections.

Results:

A total of 109 patients were analyzed. Thirty-four patients were underweight, 55 patients were normal weight, and 20 were overweight/obese. Twelve patients developed surgical site infections, with only 1 of them requiring an unplanned return to the operating room. Patients in the overweight/obese category had an increased risk of surgical site infection when compared with those in the normal weight and underweight categories (P=0.027). Of the 24 measurements taken, subcutaneous fat thickness to total distance from skin ratios at L2 spinous process (P=0.031), L3 spinous process (P=0.42), and averages of L2, L3, and L4 ratios (P=0.028) were all found to be associated with increased risk of surgical site infection.

Conclusion:

In this study population of patients with neuromuscular scoliosis who underwent posterior spinal fusion, increased BMI was associated with increased risk of SSI. Furthermore, 3 radiographic measurements of subcutaneous fat thickness associated with a higher risk of surgical site infections were identified. This knowledge could contribute to devising preoperative strategies to mitigate surgical risk and postoperative complications.

Level of Evidence:

Level III—a retrospective study
Predictive Models of Visual Decline after Successful Half-dose Photodynamic Therapy in Chronic Central Serous Chorioretinopathy
Authors: Huang Yu-Te , Chou Hsuan-Chung , Lu Jhih-Yi , Huang Yu-Chuen , Kuo Hou-Ting , Yang Chi-Lan , Chen San-Ni
Published: January 2025

Purpose:

To identify baseline characteristics that predict vision decline (VD) in patients with chronic central serous chorioretinopathy(cCSC) who have anatomically responded to half-dose photodynamic therapy(PDT).

Methods:

Patients with cCSC who underwent half-dose PDT once and achieved subretinal fluid resolution were retrospectively reviewed. They were categorized into the VD group and the vision maintenance/improvement(VMI) group based on visual acuity 6 months post-treatment. Baseline optical coherence tomography(OCT), OCT angiography, fundus autofluorescence(FAF), and choroidal vascular hyperpermeability(CVH) patterns were analyzed to identify predictive factors for the VD group. Predictive models were evaluated using the area under the curve (AUC) from receiver operating characteristic curves to estimate the likelihood of VD.

Results:

A total of 63 patients were reviewed, with 14 in VD group and 49 in VMI group. OCT measurements revealed that VD group had significantly thinner layers from internal limiting membrane(ILM) to external limiting membrane(IE) and from ILM to ellipsoid zone(IEZ)(IE: 79.3 ± 22.2 µm vs. 100.1 ± 20.1 µm, P = .001; IEZ: 93.9 ± 23.7 µm vs. 114.5 ± 19.8 µm, P = .002). The IE and IEZ cutoff values were 84 µm and 95.5 µm(P = .006 and .008), respectively. The predictive model's AUC was 0.743 for IE alone. The best model, which included IE, age, sex, spherical equivalent, FAF, and CVH patterns, achieved an AUC of 0.860.

Conclusions:

Baseline IE and IEZ are significant predictors of VD in cCSC patients after half-dose PDT, making them useful for identifying high-risk patients and discussing these potential outcomes in advance.
A clinical-radiomics nomogram to predict early neurological deterioration in patients with stroke undergoing intravenous thrombolysis
Authors: Zhang Xiao-Guang , Jiang Shan-Shan , Zhang Dong , Chen Shu-Hua , Kong Yu-Ming , Bai Yue-Ying , Gu Zhi-Chun , Yue Yun-Hua
Published: January 2025

Background:

Anticipating early neurological deterioration in patients with ischemic stroke undergoing intravenous thrombolysis poses a considerable challenge in clinical practice. This study aimed to develop and validate a diffusion-weighted imaging (DWI)-based clinical-radiomics nomogram for predicting early neurological deterioration in patients with ischemic stroke without large vessel occlusion or hemorrhagic transformation undergoing intravenous thrombolysis.

Methods:

A total of 273 patients with stroke were randomly divided into training (n = 192) and validation (n = 81) cohorts at a ratio of 7:3. DWI images taken within 24 h post-intravenous thrombolysis were used to extract radiological features. The t-test, least absolute shrinkage, and selection operator algorithm were used for feature selection. These features were used to create a radiomics score (radscore) for each patient. Combined with the clinical features, a logistic regression model was used to select independent risk factors that were used to construct a clinical-radiomics nomogram. The performance of the nomogram was evaluated using the area under the curve (AUC), calibration, discrimination, and decision curve analysis.

Results:

A total of 1,307 radiomics features were extracted from each patient’s data. A total of 310 radiomics features were found to be stable after being screened by intraclass correlation coefficients. Seven features were included in the construction of the radscore. The AUC of the clinical-radiomics nomogram was 0.89 (95% confidence interval (CI) 0.83–0.95) in the training cohort and 0.95 (95% CI 0.90–0.99) in the validation cohort. The calibration curve and decision curve analysis indicated favorable calibration and net clinical benefits of the nomogram.

Conclusion:

A DWI-based clinical-radiomics nomogram can effectively predict early neurological deterioration in patients with ischemic stroke in the early phase after intravenous thrombolysis.
Can exercise reduce fatigue in people living with kidney disease?
Authors: Wilkinson Thomas J. , Ancliffe Lisa , Macdonald Jamie H.
Published: January 2025

Purpose of review

In people living with kidney disease (KD) Fatigue is a whole-body tiredness that is not related to activity or exertion. Often self-reported, fatigue is a common and highly burdensome symptom, yet poorly defined and understood. While its mechanisms are complex, many fatigue-related factors may be altered by exercise and physical activity intervention. Thus, this review aims to review the latest research on exercise in reducing fatigue in people living with KD.

Recent findings

The benefits of exercise in KD are well known, yet recent data from clinical trials on fatigue are scarce. Favourable effects on fatigue were found through a myriad of physical activity and exercise-based interventions, including using exercise-based video games, exercise during dialysis, nurse-led exercise programs, and home-based exercise delivered by a novel digital health intervention. Yet, whilst the handful of recent trials show positive efficacy on fatigue across the spectrum of KD, contemporary exercise-based research was impacted critically by COVID-19, and the field is limited by underpowered trials and heterogeneity of assessment tools.

Fatigue remains, at best, a secondary outcome measure in trials despite it being the most commonly reported symptom in KD. Given its importance to the people it impacts most, better quality evidence is needed to fully understand and optimize the impact of exercise in this group.
The Effectiveness of Nonpharmacological Interventions to Reduce Procedural Pain of Pediatric Oncology Patients
Authors: Gürcan Meltem , Karataş Nimet , Turan Sevcan Atay , Özer Zeynep
Published: January 2025

Background

Relieving procedural pain in pediatric oncology is an important facilitator of the cancer treatment process.

Objective

To synthesize the effect of nonpharmacological interventions on reducing the procedural pain of pediatric oncology patients in randomized controlled trials.

Methods

A meta-analysis and systematic review for randomized controlled trials. The PROSPERO has registered the meta-analytic approach used in this review. For studies published in English from the earliest record to May 2023, comprehensive and systematic literature searches were carried out using PubMed, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Science Direct, Springer Link, Scopus, EMBASE, Ovid, ELSEVIER, ProQuest and the CENTRAL, and Taylor & Francis. Two researchers used the Cochrane Collaboration method to assess the risk of bias in the included studies.

Results

Four hundred ninety-four participants in 7 trials met the eligibility requirements. The primary findings showed no evidence of a significant publishing bias. This study revealed that nonpharmacological therapies significantly reduced procedural pain. Virtual reality techniques outperform nondigital distraction techniques in subgroup analysis of intervention types when it comes to lowering procedural pain in pediatric oncology patients.

Conclusion

In pediatric oncology, nonpharmacological therapies significantly and positively reduce procedural pain. No adverse events were reported in the included studies. Nonpharmacological therapies can be utilized by pediatric oncology nurses to mitigate procedural pain associated with needles.

Implications for Practice

The findings of this study will contribute to the application of effective nonpharmacological interventions by clinical nurses and will provide guidance for the planning of further research.
Expanded Approaches for Mastopexy in Aesthetic and Reconstructive Breast Surgery
Authors: Keane Alexandra M. , Tandon Damini , Tenenbaum Marissa M. , Myckatyn Terence M.
Published: January 2025

Learning Objectives:

After studying this article, the participant should be able to: (1) Understand the unique differences between mastopexy in aesthetic and reconstructive breast surgery. (2) Describe the approach to performing mastopexy with autoaugmentation or after explantation. (3) Have insight into the approach and decision-making process for performing mastopexy with nipple-sparing mastectomy. (4) Apply the mastopexy skin reduction techniques to ptotic women undergoing postmastectomy breast reconstruction.

Techniques and indications for mastopexy are expanding. In aesthetic surgery, access to supportive meshes and higher rates of breast implant explantation without replacement contribute to this. In breast reconstruction, higher rates of nipple-sparing mastectomy and higher expectations for cosmetically favorable outcomes with ptotic breasts are key drivers. A keen understanding of the available blood supply and how it may change over time with a staged approach, thoughtful use of otherwise-discarded tissues, and judicious application of mesh support are important new considerations for plastic surgeons to apply to traditional mastopexy. This evidence-based article focuses on specific aesthetic and reconstructive mastopexy techniques associated with autoaugmentation, explantation, and nipple-sparing mastectomy.
Minimally Invasive Puncture and Drainage Surgery for the Treatment of Thalamic Hemorrhage Guided by a 3D-printed Guide Plate
Authors: Zhao Chengle , Chen Yihuan , Qi Xinyao , Fan Yifeng
Published: January 2025

Thalamic hemorrhage is a type of intracerebral hemorrhage with high disability and mortality rates. Because of its deep bleeding location, irregular shape of the hematoma, and compression of the third ventricle, it is not suitable for craniotomy. This paper reports a case of a 63-year-old male patient who sought medical attention for left-sided basal ganglia and thalamus hemorrhage that broke into the ventricles. Upon admission, the patient exhibited impaired consciousness and was diagnosed with thalamic hemorrhage accompanied by ventricular hemorrhage through the head CT and CTA scan. To address the patient’s unique circumstances, a 3D-printed guide plate was utilized to guide the puncture and drainage surgery, thereby ensuring a relatively smooth and less traumatic process. After the surgery, the patient’s consciousness recovered well, and there was significant improvement in clinical indicators. This case demonstrates that a 3D-printed guide plate has the advantage of precise localization and minimal trauma in guiding thalamic hemorrhage surgery, showing promising clinical application prospects and being worthy of promotion in future clinical practice.
Serial Transverse Enteroplasty and The Re-establishment of Enteral Autonomy Among The Adult Population
Authors: Fujiki Masato , Armanyous Sherif R. , ElSherif Ayat , Parekh Neha , Costa Guilherme , Hawthorne Amanda , Osman Mohammed , Abu-Elmagd Kareem M.
Published: January 2025

Objective(S):

To define the evolving role of serial transverse enteroplasty(STEP) in the surgical management of intestinal failure(IF) in patients with short bowel syndrome(SBS) especially among the adult population.

Background:

The current literature is lacking the rationale and long-term efficacy of STEP as a part of the multidisciplinary management of SBS-IF adult population.

Methods:

The study included a total of 64 total parenteral nutrition (TPN) dependent patients. The causes of SBS were wide-ranging with residual bowel length of 79+47 cm and plasma citrulline level of 22+12 umol/L. Partial or full colon was preserved in 56(88%) patients. STEP was primary in 32 patients and integrated with autologous gut reconstruction(AGR) in the remaining 32. Integrated STEP was technically feasible in 44% of the preoperative candidates. To assess the therapeutic benefits of integrated STEP, 32 of the contemporaneous AGR-only patients were statistically identified by propensity-score matching as control group.

Results:

With a mean follow-up of 35+24 months, the 64 study patients received a total of 81 STEP procedures. The 5-year disease-specific survival was 91% with a respective restored enteral autonomy (EA) rate of 80%. Compared to the matched control, integrated STEP significantly(P=0.02) enhanced the cumulative restoration of EA. The ASA comorbidity class IV was the only significant(P=0.05) survival risk factor. Preoperative TPN caloric requirements and total increment in bowel length were independent predictors of STEP-associated EA. Consequently, STEP was a significant predictor of restored EA among the overall SBS-IF patients.

Conclusions:

This study underscores the wide-applicability and long-term therapeutic efficacy of STEP among the SBS-patients including adults. Accordingly, the procedure should be increasingly utilized for all ages and promptly considered as an integral part of the SBS-IF management armamentarium.