bluuebunny/crossref_metadata_2025 huggingface dataset:
In Vivo Ultrasound Study of the Angular Artery Anatomy: Practical Indications for the Treatment of the Deep Pyriform Space
Authors: Franceschelli Antonella , Cazzulani Maria , Urso Simone Ugo , Molinari Paola , Piludu Michela , Zuccaro Martina , Bastiani Luca , Mosti Giovanni
Published: November 2024

Background

The increase in adverse events parallels the increase in aesthetic procedures. Injecting fillers at bone level in the pyriform space has been considered safe, as the angular artery (AA) has been described as crossing this space in a plane closer to the skin than to the bone. However, severe adverse events can occur with this injection modality, even in the pyriform space.

Objectives

Our study aimed to assess the course and depth of AA in the pyriform space using Doppler ultrasound (US).

Methods

The pyriform space was investigated by a US device provided with a 20 MHz probe in healthy volunteers. They were studied in a semi-seated position with the probe positioned vertically with its central pointer at the angle between the lateral nose nostril and the cheek skin. The distances between the AA-skin and AA-bone planes were measured in millimeters.

Results

The AA distance from the bone was <1 mm in 3% of cases and >3 mm in 57% of cases. The AA runs outside the pyriform space in 5% of cases.

Conclusions

The course of AA in pyriform space is highly variable, and sometimes, it can be close to the bone. A US examination of the AA in the pyriform space can identify the AA course, aiding in avoiding complications such as injecting or compressing the AA.

Level of Evidence: 4 (Diagnostic)
Enhanced Deep Learning Based Forecasting of Solar Photovoltaic Generation for Critical Weather Conditions
Authors: Kumar Laveet , Khan Sohrab , Shaikh Faheemullah , Siddiqui Mokhi Maan , Sleiti Ahmad K
Published: November 2024

Solar photovoltaic energy generation due to its high potential is being adopted as one of the main power sources by many countries to mitigate their climate and electrical power issues. Hence the accurate forecasting becomes important to make grid operations smoother, and for this purpose modern day artificial intelligence technologies can make a significant contribution. This study is an endeavor to target accurate forecasting for different weather conditions by using a simple recurrent neural network, long short-term memory and gated recurrent unit based hybrid model, and bi-directional gated recurrent unit. The experimental dataset has been acquired from Quaid-e-Azam Solar Park, Bahawalpur Pakistan. This study observed that the bi-directional gated recurrent unit outperforms the hybrid model, whereas the simple recurrent neural network lags most in accuracy. The results confirm that the bi-directional gated recurrent unit technique can perform accurately in all critical weather types. Whereas the values of root mean square error, mean absolute error and R square values also ensure the precision of the model for all weather conditions and the best of these parameters for bi-directional gated recurrent unit observed are 0.0012, 0.212, and 0.99 respectively for the overcast dataset.
On the bright side of blindsight. Considerations from new observations of awareness in a blindsight patient
Authors: de Gelder Beatrice , Humphrey Nicholas , Pegna Alan J
Published: November 2024

Blindsight refers to the ability to make accurate visual discriminations without conscious awareness of the stimuli. In this study, we present new evidence from naturalistic observations of a patient with bilateral damage to the striate cortex, who surprisingly demonstrated the ability to detect colored objects, particularly red ones. Despite the slow and effortful process, the patient reported full awareness of the color aspect of the stimuli. These observations cannot be explained by traditional concepts of type 1 or type 2 blindsight, raising intriguing questions about the boundaries between objective and subjective blindness, as well as the nature of visual experience and epistemic agency. Moreover, these findings underscore the significant role that blindsight could play in future research, especially in understanding how higher cortical functions are involved in emotions and feelings. This highlights the necessity for further exploration to better understand the visual features that contribute to the phenomenon of affective blindsight.
Kidney hemodynamic effects of sodium-glucose cotransporter 2 inhibitors in diabetes: physiology and clinical implications
Authors: León-Jiménez David , Sridhar Vikas S , López-Mendoza Manuel , Scholtes Rosalie A , Schmieder Roland E , Cherney David Z I , van Raalte Daniël H , Toro-Prieto Francisco J , Miramontes-González José Pablo , van Bommel Erik J M
Published: November 2024

The progressive loss of kidney function in diabetes mellitus is partly attributable to the occurrence of glomerular hyperfiltration. Consequently, therapeutic interventions that lower intra-glomerular pressure are a cornerstone of treatment in diabetic kidney disease. Sodium-glucose cotransporter 2 (SGLT2) inhibitors consistently reduce glomerular filtration rate (GFR) and calculated intraglomerular pressures across studies. However, the net effect on arteriolar tone that leads to acute GFR declines may differ between cohorts. While pre-glomerular vasoconstriction appears to be the dominant mechanism responsible for GFR dipping in patients with type 1 diabetes (T1D) and glomerular hyperfiltration, other factors, including post-glomerular vasodilation, may contribute to the acute GFR decline in normofilterering individuals with T1D and type 2 diabetes. Regardless of the responsible mechanisms, acute changes in GFR are associated with long-term kidney function preservation—a relationship that may reflect an underlying protective decline in glomerular hypertension.
Call variation and calling site preference of three sympatric Boulenophrys frogs
Authors: Qian Tianyu , Shang Yuanlingbo , Zheng Wenbao , Li Pipeng , Yang Daode
Published: November 2024

Animals living in syntopy share acoustic space. Asian horned frogs are well known for their sympatric distribution, but little is known about their strategies to avoid acoustic niche competition. This study focused on three sympatric Boulenophrys frog species from southern China—B. nanlingensis, B. ombrophila, and B. shimentaina, with the former two species call in similar frequencies but breed in different seasons. First, we checked the call variation during the change of individual body size and the ambient air temperature in three species. We have found call frequencies were the most static parameters in each species that were associated with body size and contributed most to species identification. Temporal call parameters shift with temperature but are mostly influenced by low temperatures. Second, we checked the interactions between the environment and call properties. The calling site preferences of each species corresponded well with the prediction of the acoustic adaptation hypothesis (in view of higher frequency better transmission in open habitat), and species with similar call frequencies have some aspects of common calling sites. Third, we checked the species–species interaction by using playback tests with male B. nanlingensis. Results from playback experiments showed species that call at similar frequencies could hardly share the same habitat during the same season. These findings expanded the knowledge of acoustic coexistence in closely related anuran species and provided insights into the vocal behavior of Asian horned frogs.
A rare complication of intracardiac double knotting of temporary pacemaker lead during bedside insertion: a case report
Authors: Dattagupta Aditi , Agrawal Shweta , Adhyapak Srilakshmi , Kramadhari Harshith , Konda Abhilash
Published: November 2024

Background

Temporary pacemaker lead implantation is a common low-risk procedure, but can occasionally get complicated by infections, arrhythmias, thromboembolic events, and perforation of the vessel or the heart. However, intracardiac knotting of the temporary pacemaker lead has been rarely reported. This could lead to vascular or valvular injury, pneumothorax, symptomatic loss of pacing or haemodynamic compromise, and difficult lead removal.

Case summary

We are reporting a case of twice twice-knotted temporary pacemaker lead, which to our knowledge has not been reported before. The two knots in the transjugularly inserted temporary pacemaker lead, via a 6F venous sheath made it difficult to retrieve it.

Discussion

We decided to snare the knotted TPI into the inferior vena cava, and then retrieve it via a large-size femoral sheath, thus avoiding the need for a venotomy or any surgical intervention.
demuxSNP: supervised demultiplexing single-cell RNA sequencing using cell hashing and SNPs
Authors: Lynch Michael P , Wang Yufei , Ho Sui Shannan , Gatto Laurent , Culhane Aedin C
Published: November 2024

Background

Multiplexing single-cell RNA sequencing experiments reduces sequencing cost and facilitates larger-scale studies. However, factors such as cell hashing quality and class size imbalance impact demultiplexing algorithm performance, reducing cost-effectiveness.

Findings

We propose a supervised algorithm, demuxSNP, which leverages both cell hashing and genetic variation between individuals (single-nucletotide polymorphisms [SNPs]). demuxSNP addresses fundamental limitations in demultiplexing methods that use only one data modality. Some cells may be confidently demultiplexed using probabilistic hashing methods. demuxSNP uses these data to infer the genotype of singlet and doublet clusters and predict on cells assigned as negative, uncertain, or doublet using a nearest-neighbor approach adapted for missing data.

We benchmarked demuxSNP against hashing, genotype-free SNP and hybrid methods on simulated and real data from renal cell cancer. demuxSNP outperformed standalone hashing methods on low-quality hashing data benchmark, improved overall classification accuracy, and allowed more high RNA quality cells to be recovered. Through varying simulated doublet rates, we showed that genotype-free SNP and hybrid methods that leverage them were impacted by class size imbalance and doublet rate. demuxSNP’s supervised approach was more robust to doublet rate in experiments with class size imbalance.

Conclusions

demuxSNP uses hashing and SNP data to demultiplex datasets with low hashing quality where biological samples are genetically distinct. Unassigned or negative cells with high RNA quality are recovered, making more cells available for analysis. Data simulation and benchmarking pipelines as well as processed benchmarking data for 5–50% doublets are publicly available. demuxSNP is available as an R/Bioconductor package (https://doi.org/doi:10.18129/B9.bioc.demuxSNP).
Return to work after parenting in thoracic surgery: a call to action
Authors: Pompili Cecilia , Costa Rita , Opitz Isabelle , Tsukazan Maria Teresa , Hugen Niek , Novoa Nuria , Blackmon Shanda , Seguin-Givelet Agathe , Antonoff Mara
Published: November 2024

OBJECTIVES

Women in our modern era are facing considerable challenges in the workplace, particularly in Cardiothoracic Surgery where women are under-represented in leadership and academic roles. Returning to work after parental leave may potentially uncover or exacerbate existing gender biases within the workplace, with important consequences on professional and personal lives. Our goal was to characterize the experiences and the impact of return-to-work after parenting on Thoracic Surgery careers across Europe.

METHODS

All the participants of the European Society of Thoracic Surgeons Annual Meeting in 2023 were invited to complete this 32-item questionnaire. The survey was subsequently distributed through the European Society of Thoracic Surgeons social media platform from November to January 2024. A descriptive and specific group analysis was performed according to the distribution.

RESULTS

There were 152 participants, 92 of whom were female (61.0%) and 66 (43%) were between 31 and 40 years, constituting the most heavily represented age group. More women parents reported their role as the primary care provider of their child (89% vs 34%; P < 0.00001). Moreover, presence of in-hospital childcare facilities was evaluated as more important by women. Approximately half of the parent-respondents reported breastfeeding (42, 52%), but only 26% (11) of this group indicated having any type of flexible hours for breast-feeding. Compared to men, women more often agreed that parenting might affect their career (81% vs 53%; P = 0.040) and felt less supported by their employers when having children (45% vs 68%; P = 0.37).

CONCLUSIONS

This survey study identified main challenges to return to surgical work after parental leaves. Lack of structural or system-level support and limited resources for childcare and breastfeeding were considerably affecting women surgeons. Institutional initiatives for new parents and breast-feeding colleagues are crucial for supporting a diverse workforce, and any kind of discrimination derived from parental leaves should not be tolerated.
AmpC β-lactamases detected in Southeast Asian Escherichia coli and Klebsiella pneumoniae
Authors: Roberts Tamalee , Ling Clare L , Watthanaworawit Wanitda , Cheav Chanvoleak , Sengduangphachanh Amphonesavanh , Silisouk Joy , Hopkins Jill , Phommasone Koukeo , Batty Elizabeth M , Turner Paul , Ashley Elizabeth A
Published: November 2024

Objectives

AmpC β-lactamases are neglected compared with ESBL as a cause of third-generation cephalosporin (3GC) resistance in Enterobacterales in low- and middle-income countries and the burden is unknown. The aim of this study was to investigate the presence of AmpC β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in clinical specimens from three clinical research laboratories in Southeast Asia.

Methods

Stored clinical isolates of E. coli and K. pneumoniae resistant to ceftriaxone or ceftazidime or cefpodoxime and ESBL confirmation test negative were screened using MASTDISCS AmpC, ESBL and Carbapenemase Detection Set—D72C. Short-read WGS was performed to identify ampC genes.

Results

Of 126 isolates collected between 2010 and 2020, 31 (24.6%) and 16 (12.7%) were phenotypically AmpC and inducible AmpC positive by MASTDISCS testing, respectively. All inducible AmpC isolates were ceftriaxone susceptible and 97.7% of AmpC/inducible AmpC isolates tested against cefoxitin were resistant. Through WGS, 17 and eight different STs were detected for the AmpC/inducible AmpC E. coli and K. pneumoniae isolates, respectively. Twelve different β-lactamase resistance genes were detected, with blaCMY-2 most commonly in AmpC-positive isolates (20/31; 64.5%; 15 chromosomal, five plasmid). All inducible AmpC-positive isolates had the blaDHA-1 gene (seven chromosomal, nine plasmid).

Conclusions

Though uncommon, AmpC and inducible AmpC β-lactamases in E. coli and K. pneumoniae are an important cause of infection in Southeast Asia. With current testing methods, these infections may be going undetected, resulting in patients receiving suboptimal treatment.
Trends in central/peripheral ratio of fentanyl in Harris County, TX, and Orange County, CA, from 2009 to 2020
Authors: Behnke Grayce , Mata Dani , Meneses Vanessa , Strickland Erin C , Gray Teresa R
Published: November 2024

Since the opioid epidemic was declared in 2017, postmortem fentanyl cases and the need for interpretation of their results have increased. Postmortem redistribution (PMR) is one of the factors to consider when interpreting cases. There have been several previous studies regarding fentanyl PMR; however, these studies either have small sample sizes or were conducted prior to the declaration of the opioid epidemic, which may cause conflicting results and not be reflective of current trends. This study includes fentanyl central/peripheral (C/P) blood ratios from 748 cases from both Harris County, TX, and Orange County, TX, spanning from January 2009 to June 2022. Because the data set was determined to be non-normally distributed, a Kruskal–Wallis test was used for statistical comparisons. There were statistically significant differences between epidemic cases from the Harris County Institute of Forensic Sciences and the Orange County Crime Laboratory, C/P ratios from pre-epidemic to epidemic years, and in cases where medically related administration of fentanyl was documented when compared to cases where there was no documentation of licit fentanyl use. Various factors that could impact PMR were evaluated (age, gender, polydrug use, etc.), and no clear trend or observation was made from the data. Based on the results of this study, there is still no clear indication as to what caused the increase in C/P ratios, but it may be related to an increase in illicit fentanyl use.
Far from Home: The Impact of Corruption on Tactical Military Effectiveness
Authors: Binetti Marco Nicola
Published: November 2024

This article investigates how regime corruption affects the tactical military effectiveness of armies during clashes against violent non-state actors. It is posited that as armies operate further from their main logistic hub, regime corruption increasingly undermines their battlefield capabilities. In fact, corruption diminishes troops' skills and reduces the quality and quantity of their weapons, while as armies become more reliant on extended and strained supply lines, they become more vulnerable to inadequate equipment. To test this hypothesis, a range of multivariate Tobit, ordinary least squares (OLS), and multilevel regression analyses is employed, using data from engagements between armies and violent non-state actors worldwide between 1989 and 2021.
“It’s My Sciatica.”: Radiating Leg Pain in a 37-Year-Old
Authors: Taylor Riden William , Standaert Christopher J. , Carneiro Kevin A.
Published: November 2024

Lumbar disc herniations are a common clinical problem, most often affecting those in their 30s or 40s. When symptomatic, they are often associated with low back pain (LBP) with radiation down one or both legs, depending on the location of the herniation. The majority of lumbar disc herniations (~95%) occur at the L4/5, L5/S1 levels and can occur with or without an inciting event. In the absence of severe or progressive motor weakness or cauda equina syndrome, this problem is typically managed with nonsurgical treatments geared toward symptom control, patient education, and watchful waiting for improvement over time. For most patients, radicular pain will resolve within 6–12 weeks. Surgery is performed only in about 10% of those sustaining a disc herniation with a radiculopathy. Therefore, this problem is most effectively treated with symptom management, activity modification, reassurance, and patient education about how to recognize progressive or concerning neurologic symptoms.
“I Was Rear-Ended Last Week, and My Back Is Killing Me.”: Pain after a Motor Vehicle Accident
Authors: Holmes Benjamin D. , Atlas Steven J. , Roseen Eric J.
Published: November 2024

Low back pain (LBP) is common after motor vehicle collisions (MVCs). Most LBP following a MVC is localized and not radicular in nature. In the absence of neurologic findings, it can be difficult to identify a specific cause of LBP. Common sources of pain include spinal and surrounding connective tissue injury. Serious pathology, although rare, can occur in MVCs, and the severity of the collision, loss of consciousness, sudden pain, and multiple traumas can alert responders at the scene to individuals who require emergency evaluation. Imaging is unlikely to change initial management of these patients in the absence of radicular symptoms and other red flags. Although most patients with MVC-related LBP recover within 4–10 weeks, pain is reported by 30% at 12 months and 20% at 7 years. Evidence of poor recovery on follow-up, despite active participation in physical treatments, should prompt exploration of contributing psychosocial factors.
“My Injury Was Years Ago, but Something in My Back Is Not Right.”: Low Back Pain on the Way to the Paralympics
Authors: Crane Deborah
Published: November 2024

Individuals with spinal cord injury (SCI) are prone to certain spinal issues over time including neuropathic spinal arthropathy, or Charcot spine. Many individuals with SCI have low back or trunk pain. Muscular weakness, spinal column and spinal cord trauma, surgery, altered biomechanics, and spinal deformity all may contribute to pain in those with SCI. Issues related to prior trauma must be considered when affected individuals present with new, worsening, or progressive pain. Typically affecting the lumbar spine, Charcot spine is associated with bony destruction and may result in instability, audible “clunking,” and/or further neurological injury. Plain X-rays and advanced imaging, typically magnetic resonance imaging (MRI), are required. Affected individuals should see a spine surgeon, as this condition often requires surgical stabilization. Expertise in the medical care, functional optimization, and wheelchair seating specific to individuals with SCI is needed to care for individuals with this condition.
Individual and Catchment Area Factors Associated With Breast and Cervical Cancer Screening Within the Military Health System
Authors: Segel Joel E , Chetlen Alison , Ramos Mark , Zaorsky Nicholas G , Chi Guangqing , Luan Patrick
Published: November 2024

Introduction

Breast and cervical cancer screening is critical to identifying cases at earlier stages in order to begin treatment earlier and improve survival. Screening rates have been shown to vary within the Military Health System (MHS). The goal is to estimate drivers of variation in screening rates within the MHS.

Materials and Methods

We used 2007-2019 MHS Data Repository Data to examine individual-level and catchment area-level factors associated with 1- and 2-year breast and cervical cancer screening rates. Specifically, we estimated univariate and multivariate association between 1- and 2-year probability of breast and cervical cancer screening rates and age group, marital status, rank, service branch, beneficiary type (service member vs. dependent), race/ethnicity of service members, catchment area fraction of overall care through purchased care and average per capita spending. The project was approved by both the Penn State Institutional Review Board (IRB) and the Defense Health Agency’s electronic IRB.

Results

Overall, we observed a 45.6% 1 year and a 65.7% 2-year mammography screening rate and a 30.5% 1 year and a 51.9% 2-year Pap testing rate. For breast cancer screening, we found higher screening rates for older (ages 50-64 years), married, service members, more senior ranked women or those married to more senior ranked members, and non-Hispanic Black women in both unadjusted and multivariate analyses. Conversely, we found higher rates of cervical cancer screening for younger, unmarried, more junior ranked women as well as for non-Hispanic Black women. We also found higher rates for both breast and cervical cancer screening in catchment areas with a greater fraction of care delivered through the private sector.

Conclusion

Our finding of higher screening in catchment areas with higher rates of purchased care warrants additional study to understand what factors may drive this result. The differential findings of the association between individual characteristics and breast and cervical cancer screening suggest important differences in these 2 types of screening with potentially different policies required to encourage and enhance breast vs. cervical cancer screening. Finally, our results showing higher screening among non-Hispanic Black women suggests important features of the MHS, such as universal, low-cost sharing coverage may help to reduce racial and ethnic disparities in breast and cervical cancer screening.
Key Insights for the Ethical and Appropriate Use of Artificial Intelligence by Medical Learners
Authors: Murray Brian Patrick , Thota Darshan S , Baker Carrie , Stierwalt Joshua B
Published: November 2024

Introduction

The rapid advancement and adoption of large language models (LLMs) in various academic domains necessitate an examination of their role in scholarly works by medical learners.

This paper seeks to discern the implications of LLM use by medical learners when preparing works for publication. While LLMs possess great potential to revolutionize the academic writing process, they can detract from the learning process when used by students and residents who are still learning how to research, formulate ideas, and write cohesive arguments.

Materials and Methods

An environmental scan of both traditional evidence-based sources and gray literature was performed to glean best practices of generative AI in medical education. Sources included peer-reviewed journals, open-source websites, and previous publications in this field ranging from 2015 to 2023.

Results

We propose several strategies to detect AI involvement: direct inquiry to the learner, assessing the coherence level of the content in contrast to the learner’s known capabilities, recognizing patterns of shallow insight or depth, utilizing plagiarism and AI-specific detection tools, and monitoring for fabricated citations—a known pitfall of LLMs.

Conclusions

Although LLMs offer potential efficiencies in academic writing, unchecked use can jeopardize the development of essential critical thinking and analytical skills in medical learners. Ultimately, mentors and primary investigators are responsible for ensuring learners are advancing and appropriately utilizing new and emerging technology. This study provides a foundational framework for educators in both responsible use of generative AI and best practices.
Assessing the diagnostic and therapeutic value of submandibular gland elastography in patients with immunoglobulin G4-related sialadenitis
Authors: Shibuki Saki , Saida Tsukasa , Tsuboi Hiroto , Kamimaki Takashi , Ota Maki , Sugaya Yohei , Ichinose Naoya , Yoshida Miki , Matsumoto Isao , Nakajima Takahito
Published: November 2024

Objectives

To investigate the utility of shear wave elastography (SWE) values in differentiating IgG4-related submandibular sialadenitis (IgG4-RSS) from healthy individuals and in monitoring the response to glucocorticoid treatment.

Methods

Patients with IgG4-RSS who underwent ultrasound between 2017 and 2023 were included. Gland size, border, internal echo pattern, vascularity, and SWE were measured. These parameters were compared with those of the healthy controls, and before and after treatment.

Results

Thirty-one glands from 16 patients were analysed. All glands had a nodular shape; the nodular hypoechoic was the most prevalent pattern, followed by the diffuse hypoechoic; the reticular was the least common. Most glands had rich vascularity, whereas two glands had minimal vascularity. The depth (mean 18 mm) and SWE (mean 3.57 m/s) were significantly higher in IgG-RSS (P = .003 and <.001, respectively) than in the healthy controls. Nine glands from five patients were enrolled to evaluate the treatment response. After treatment, the margins became smoother and all glands showed a reduction in size, hypoechoic area, and vascularity. The mean SWE decreased from 3.56 m/s to 2.50 m/s with a significant difference between pre- and post-treatment (P < .001).

Conclusions

The SWE is useful for diagnosing IgG4-RSS and assessing the effectiveness of treatment.
Community-level variability in Bronx COVID-19 hospitalizations associated with differing population immunity during the second year of the pandemic
Authors: Forster Ryan , Griffen Anthony , Daily Johanna P , Kelly Libusha
Published: November 2024

The Bronx, New York, exhibited unique peaks in the number of coronavirus disease 2019 (COVID-19) cases and hospitalizations compared to national trends. To determine which features of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus might underpin this local disease epidemiology, we conducted a comprehensive analysis of the genomic epidemiology of the four dominant strains of SARS-CoV-2 (Alpha, Iota, Delta, and Omicron) responsible for COVID-19 cases in the Bronx between March 2020 and January 2023. Genomic analysis revealed similar viral fitness for Alpha and Iota variants in the Bronx despite nationwide data showing higher cases of Alpha. However, Delta and Omicron variants had increased fitness within the borough. While the transmission dynamics of most variants in the Bronx corresponded with mutational fitness-based predictions of transmissibility, the Delta variant presented as an exception. Epidemiological modeling confirms Delta’s advantages of higher transmissibility in Manhattan and Queens, but not the Bronx; wastewater analysis suggests underdetection of cases in the Bronx. The Alpha variant had slightly faster growth but a lower carrying capacity compared to Iota and Delta in all four boroughs, suggesting stronger limitations on Alpha’s growth in New York City (NYC). The founder effect of Iota varied between higher vaccinated and lower vaccinated boroughs with longer delay, shorter duration, and lower fitness of the Alpha variant in lower vaccinated boroughs. Amino acid changes in T-cell and antibody epitopes revealed Delta and Iota having larger antigenic variability and antigenic profiles distant from local previously circulating lineages compared to Alpha. In concert with transmission modeling, our data suggest that the limited spread of Alpha may be due to a lack of adaptation to immunity in NYC. Overall, our study demonstrates that localized analyses and integration of orthogonal community-level datasets can provide key insights into the mechanisms of transmission and immunity patterns associated with regional COVID-19 incidence and disease severity that may be missed when analyzing broader datasets.
Exploring the management of recurrent angioedema caused by different mechanisms
Authors: Mormile Ilaria , Suffritti Chiara , Bova Maria
Published: November 2024

Purpose of review

We aim to explore the most recent insights into the pathogenesis of recurrent angioedema caused by different mechanisms and then focus on the management and treatment approaches available.

Recent findings

The recently developed DANCE consensus classification identifies five types of angioedema: mast cell-mediated (AE-MC), bradykinin-mediated, because of intrinsic vascular endothelium dysfunction (AE-VE), drug-induced (AE-DI), and due to unknown mechanisms (AE-UNK). These subtypes require different management with treatment choices targeting the main pathogenetic pathways involved in each form. For AE-MC and AE-BK, the therapeutic landscape has been significantly widened in recent years. Conversely, there is a lack of consensus for the hereditary forms because of newly discovered mutations (factor 12, plasminogen, kininogen-1, myoferlin, angiopoietin-1, heparan sulfate 3-O-sulfotransferase 6) and AE-UNK.

Recurrent angioedema can present with or without wheals. Angioedema without wheals may be driven by bradykinin and/or mast cell mediators. The different forms respond to specific drugs and require a different management. For its potentially life-threatening and disfiguring features, angioedema should be promptly recognized and effectively treated. For this reason, enhancing awareness about various angioedema subtypes and their management provide a useful tool for the clinical practice.
Type 2 diabetes: a contemporary view from the Asian lens
Authors: Ratnasingam Jeyakantha , Lim Quan Hziung , Chan Siew Pheng
Published: November 2024

Purpose of review

The aim of this article was to review the up-to-date evidence with regards to the unique features of the Type 2 diabetes (T2D) pathophysiology, complications, response to therapy with the possibility of precision medicine guiding therapeutic decision making in Asia.

Recent findings

Asia is the epicenter of diabetes. There have been marked advances with genotyping and phenotyping of the Asian patient with T2D, particularly with young onset diabetes where early beta cell failure and rapid progression of complications are more frequent. As Asians have lower muscle mass and higher adiposity, sarcopenia is increasingly associated with diabetes. Response to lifestyle and pharmacotherapy are generally similar, but unique features exist with different populations. Across Asia, use of guideline directed medical therapy for cardio-renal protection are recommended, but uptake of these newer agents are suboptimal and barriers exist with regards to standardized care.

Although many similarities have been observed across Asia, due to the heterogeneity of populations within Asia, further research is required to streamline and pave the way towards precision medicine. There is an urgent need for region wide consensus to minimize barriers to diabetes care and stigma in diabetes terminology across Asia.
Preeclampsia and fetal growth restriction: does novel proteomics reveal immunological possible candidate biomarkers?
Authors: Winther Marie , Dziegiel Morten Hanefeld , Thorsen Steffen Ullitz
Published: November 2024

Purpose of review

The aim of this review is to explore a possible link between immunological candidate proteins, identified through modern proteomic techniques, and preeclampsia (PE) and fetal growth restriction (FGR).

Recent findings

Proteomics has become a promising tool in the search for disease pathways, drug targets, and biomarkers. PE and FGR are adverse pregnancy complications with supposed immunological involvement in their pathogenesis, but no circulating immunological biomarkers are currently established for diagnosis and risk stratification. Several proteomic studies have aimed to identify PE and FGR biomarkers - often with varying results across studies. However, proteomics has revealed altered expression of human leukocyte antigen-I in PE cases, which is supported in Genome-wide association study (GWAS) studies. Proteomic results support the heterogeneous nature of PE by identification of molecular subgroups – including subgroups characterized by immune-related proteins e.g. CXCL10. No specific immunological markers are found on FGR, but differences in overall plasma proteomic signature have been suggested.

Proteomics certainly holds great potential. The immunological component in PE and FGR are still unclarified, but improvements in proteomic technologies may provide both definition of disease subgroups and subsequent discovery of biomarkers and targeted analysis within each subgroup.
Chronic rhinosinusitis and asthma: epidemiology, pathophysiology, morbidity, treatment
Authors: Speth Marlene M. , Liu David T. , Besser Gerold , Sedaghat Ahmad R.
Published: November 2024

Purpose of review

Especially with the advent of biologics which have originally been prescribed primarily for pulmonary disease, the interconnections between asthma and chronic rhinosinusitis are becoming even more apparent. Biologics can now also be prescribed for chronic rhinosinusitis in some countries. But what is the epidemiology, pathophysiology and treatment of both diseases?

Recent findings

This review covers the epidemiology, pathophysiology, morbidity and treatment of both diseases. Specifically, this review highlights the interdependencies of both diseases and potential future treatment options.

This review aims to alert physicians to go beyond treating only one of the diseases, but rather to get a broader picture of the diseases and treatment options.
Therapeutic Outcomes in 691 Angiosarcomas of the Head and Neck—A Retrospective SEER Study
Authors: Knoedler Leonard , Hoch Cosima C. , Baecher Helena , Geldner Benedikt , Niederegger Tobias , Knoedler Samuel , Lellouch Alexandre G. , Heiland Max , Koerdt Steffen , Alfertshofer Michael
Published: November 2024

Angiosarcomas (AS) are an aggressive subtype of head and neck tumors. Current outcome research is limited to single-surgeon and/or single-institution data. This study analyzes the Surveillance, Epidemiology, and End Results program (SEER) database data to improve outcomes of head and neck AS. In this study, the authors accessed the SEER database from 2000 to 2020 to identify patients who underwent surgical and/or nonsurgical treatment of head and neck AS. Data included demographics, diagnostic workup, tumor characteristics, treatment pathways, and therapy outcomes. The study included 691 patients (210 females, 481 males) with AS of the head and neck. The median tumor size was 40 mm. Most patients (63%) underwent surgery, with surgery followed by radiation being the most common treatment combination (50%). Median survival was 16 months. Patients treated with surgery showed significantly longer survival (18 mo) compared with nonsurgery cases (12 mo, P<0.001). Neoadjuvant treatment significantly improved survival (28 mo) compared with non-neoadjuvant cases (15 mo, P=0.023). Adjuvant treatment also improved overall survival (19 mo) versus nonadjuvant treatment (14 mo, P<0.001). There was no significant difference between neoadjuvant and adjuvant treatment outcomes (P=0.270). Bottom of Form This study compares the outcomes of multimodal treatments, especially surgery and radiotherapy, for head and neck AS, emphasizing tailored approaches to optimize patient outcomes and extend survival. Future research should refine these strategies.
Current gaps in acute reperfusion therapies
Authors: Nguyen Thanh N. , Xiong Yunyun , Li Shuya , Abdalkader Mohamad , Chen Hui-Sheng
Published: November 2024

Purpose of review

Advances in intravenous thrombolysis and endovascular thrombectomy have significantly reduced disability and improved outcomes associated with acute ischemic stroke.

Recent findings

An expansion of indications for reperfusion therapies in select groups of patients to permit treatment in an extended time window, with large ischemic core, and with simplified imaging protocols have enabled a broader group of patients access to disability-sparing therapy. Cerebroprotection has had renewed development in the era of acute reperfusion.

In this review, we highlight recent developments in stroke reperfusion research and related questions that are under study or remain unanswered.
Machine learning-driven in-hospital mortality prediction in HIV/AIDS patients with Cytomegalovirus infection: a single-centred retrospective study
Authors: Lai Shiyi , Wei Wudi , Yang Shixiong , Wu Yuting , Shi Minjuan , Meng Sirun , Tao Xing , Chen Shanshan , Chen Rongfeng , Su Jinming , Yuan Zongxiang , Ye Li , Liang Hao , Xie Zhiman , Jiang Junjun
Published: November 2024

Introduction.
Cytomegalovirus (CMV) is a widely disseminated betaherpesvirus that typically induces latant infections. In immunocompromised populations, especially transplant and HIV-infected patients, CMV infection increases in-hospital mortality.

Gap statement. Although machine learning models have been widely used in clinical diagnosis and prognosis prediction, reports on machine learning model predictions for the in-hospital mortality of HIV/AIDS patients with CMV infection have not been reported.

Aim. Analyze the general gemographic and clinical characteristics of HIV/AIDS patients with CMV infection and identify the factors affecting the prognosis of this population, which will help to reduce their in-hospital mortality.

Methods. Hospitalized HIV/AIDS patients with CMV infection were recruited from the Fourth People’s Hospital of Nanning, Guangxi, from 2012 to 2019. After dividing them into survival and death groups based on their in-hospital survival status, their general and clinical profiles were described. Following 1 : 3 propensity score matching to equalize baseline characteristics, three machine-learning models (Random Forest, Support Vector Machine and eXtreme Gradient Boosting) were deployed to forecast factors influencing prognosis. The SHapley Additive exPlanations tool explained the models.

Results. A total of 1102 HIV/AIDS patients with CMV infection were analysed. There was no statistical difference in the general condition of the study subjects (P＞0.05). Prevalent complications/coinfections included pneumonia (63.6%), tuberculosis (47.2%) and oral fungal infections (44.6%). There were significant differences between the groups in pneumonia, cryptococcosis and hypoproteinaemia (P<0.05). The differences in laboratory indicators between patients were also statistically significant (P<0.05). The three machine learning models demonstrated good performance, identifying primary predictors of mortality. Pneumonia, urea, indirect bilirubin and platelet distribution width exhibited positive associations with death, with higher levels correlating with an increased mortality risk. Conversely, CD4 T-cell count, CD8 T-cell count and platelet displayed negative correlations with mortality.

Conclusions. HIV/AIDS patients with CMV infection exhibit distinctive clinical features impacting survival outcomes. Machine learning models accurately identify key influencing factors and predict mortality risk in this population, which appears to be essential to reducing in-hospital mortality.
Delivery of Peptide Coacervates to Form Stable Interaction Hubs in Cells
Authors: Tu Wangjie , Theisen Rachel Q. , Jin Pengfei , Chenoweth David M. , Patel Amish J. , Good Matthew C.
Published: November 2024

Cells contain membrane-bound and membraneless organelles that operate as spatially distinct biochemical niches. However, these subcellular reaction centers lose fidelity with aging and as a result of disease. A grand challenge for biomedicine is restoring or augmenting cellular functionalities. Although commonly tackled by gene replacement therapy, an excited new strategy is the delivery of protein-based materials that can directly interact with and alter biological networks inside a cell. In this study we sought to develop long-lasting materials capable of cellular uptake and incorporation, akin to an artificial organelle or intracellular interaction hub. Drawing inspiration from protein-based membranelles organelles, we developed a new delivery method to transplant micron size peptide-based compartments into living cells. We determined conditions to form large stable coacervates that are efficiently taken up by a variety of useful cell types and demonstrate their intracellular stability over time. We developed tools to enhance the extent and spatial organization of cargo loading into these coacervates, including co-assembly of nanobodies that selectively bind to targets of interest. Combining them together, we demonstrate successful targeting of GFP protein inside cells. These results represent an important first step toward the development of deliverable synthetic organelles that can be fabricated in vitro and taken up by cells for applications in cell engineering and regenerative medicine.
Operations strategy at Kaspians Cafe
Authors: Sahu Aditya Kumar
Published: November 2024

Learning outcomes

After completion of the case study, students will be able to learn to conduct the 5Cs (Customers, Collaborators, Capabilities, Competitors, Conditions) and Porter’s five forces analysis for understanding the situation of any company; to understand various demand forecasting techniques with the case example of Kaspians Café; to analyse different factors that influence the demand with the case example of Kaspians Café; and to learn how to choose the best time-series forecasting method based on the available dataset.

Case overview/synopsis

This case study focuses on operations strategy, specifically analysing the issues encountered by the Kaspians Café, a food joint establishment located within the Kaspians Institute of Management. Kaspians Café, due to its large student clientele, encountered operational inefficiencies such as inadequate inventory management, stockouts and wastage. These issues resulted in financial losses and customer dissatisfaction. This case study focuses on forecasting the demand for different food items at different times to get a better understanding of the stock to be maintained at Kaspians Café. Furthermore, Shyam Manral, the owner of Kaspians Café, was confronted with the difficulties arising from the surging popularity of neighbouring Dhabas and the escalating impact of food delivery platforms such as Zomato and Swiggy. The formerly prosperous Kaspians Café establishment, known for its uniform offers, was now encountering strong competition from the quaint ambience and varied menus of the Dhabas situated in close proximity to the campus entrance. These conventional establishments not only accommodated the changing preferences of students but also functioned as convenient centres for social meetings. The emergence of Zomato and Swiggy had revolutionised the eating patterns of students by providing a wide range of choices that were conveniently delivered to their residences, thereby diminishing the attractiveness of Kaspians Café. Manral was struggling to revive his business in light of these shifting circumstances. He pondered how to keep consumers loyal in the middle of changing cuisine preferences and the convenience provided by contemporary food delivery services.

Complexity academic level

This case study can be used in the operations management course at the MBA/postgraduate level.

Supplementary materials

Teaching notes are available for educators only.

Subject code

CSS 9: Operations and logistics.
Reverse innovation for global sustainable development: a conceptualisation
Authors: Corsi Simone , Bianchi Lara
Published: November 2024

Purpose

This study offers a first conceptualisation of sustainable reverse innovation by discussing the contribution of innovation from the Global South towards sustainable development. In so doing, this study aims to recognise an active role played by developing countries in creating viable and innovative solutions that can contribute to the achievement of sustainable development for all.

Design/methodology/approach

This study presents five innovation vignettes and discusses them through an antecedents–enablers–consequences scheme for exploring the concept of sustainable reverse innovation. While discussing the model components, this study develops propositions to drive future research directions.

Findings

This study contributes to both development studies and innovation studies by recognising and highlighting the role played by businesses in addressing global challenges through sustainable innovation sourced from or inspired by developing countries.

Originality/value

To the best of the authors’ knowledge, this is the first study that offers a conceptualisation of sustainable reverse innovation that goes beyond the low-cost and frugality connotation that has characterised the debate surrounding innovation from emerging economies.
Canadian HEIs’ contribution to the SDGs: what do the times higher education impact rankings unveil?
Authors: Ordonez-Ponce Eduardo , Khare Anshuman , Khare Kriti
Published: November 2024

Purpose

This study aims to assess the performance of Canadian higher educational institutions (HEIs) on the sustainable development goals (SDGs) from 2019 to 2023, determine where they have focused on, whether they have improved or not their performance and assess if having larger research income affects their sustainability performance.

Design/methodology/approach

Data were collected from the Times Higher Education Impact Rankings from 2019 to 2023 on 27 Canadian HEIs, and statistical tests were used to assess performance, trends and significant differences.

Findings

Results show that while overall Canadian HEIs are performing better on the SDGs, their minimum and maximum scores have improved and the variance across universities has declined; their performance on social and economic SDGs is significantly positive on some but not all these SDGs. More importantly, their environmental performance is poor, with a constant decline in their score on SDG#13 – climate action, which peaked in 2019 and was significantly higher than that of 2023. Results also show smaller research universities perform better than top institutions.

Originality/value

There is a lot of research on the impact of universities on the SDGs; however, this study makes a deeper and statistical assessment of a quarter of Canadian universities on all the SDGs, with important findings for decision makers to consider as they accept and act according to the role that educational institutions should play in sustainable development.