bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal image sandwiches enable link between functional data analysis and deep learning for single-plant cotton senescence
Authors: DeSalvio Aaron J , Adak Alper , Arik Mustafa A , Shepard Nicholas R , DeSalvio Serina M , Murray Seth C , García-Ramos Oriana , Badavath Himabindhu , Stelly David M
Published: November 2024

Abstract. Senescence is a highly ordered biological process involving resource redistribution away from ageing tissues that affects yield and quality in annuals and perennials. Images from 14 unmanned/unoccupied/uncrewed aerial system/vehicle (UAS, UAV and drone) flights captured the senescence window across two experiments while functional principal component analysis effectively reduced the dimensionality of temporal visual senescence ratings (VSRs) and two vegetation indices: the red chromatic coordinate (RCC) index and the transformed normalized difference green and red (TNDGR) index. Convolutional neural networks trained on temporally concatenated, or ‘sandwiched’, UAS images of individual cotton plants (Gossypium hirsutum L.), allowed single-plant analysis. The first functional principal component scores (FPC1) served as the regression target across six CNN models (M1–M6). Model performance was strongest for FPC1 scores from VSRs (R2 = 0.857 and 0.886 for M1 and M4), strong for TNDGR (R2 = 0.743 and 0.745 for M3 and M6), and strong-to-moderate for RCC index (R2 = 0.619 and 0.435 for M2 and M5), with deep learning attention of each model confirmed by activation of plant pixels within saliency maps. Single-plant UAS image analysis across time enabled translatable implementations of high-throughput phenotyping by linking deep learning with functional data analysis. This has applications for fundamental plant biology, monitoring orchards or other spaced plantings, plant breeding, and genetic research.
Embracing Universality: Toward the Future of United Nations Development Work
Authors: Baumann Max-Otto , Haug Sebastian
Published: November 2024

United Nations (UN) development work has long followed the binary logic of “developed” countries providing funding so that UN entities support “developing” countries with their national development efforts. This rigid North–South template, however, is unfit for responding to current sustainability challenges that cut across borders and implicate both “developed” and “developing” member states. Against this backdrop, we suggest that the principle of universality promoted by the 2030 Agenda for Sustainable Development holds untapped potential for rethinking how the UN development pillar operates. We first make the general case for universalizing UN development work, i.e., adapt UN support functions to enable engagement with all member states. We then examine the status quo of UN development work in more detail. Building on the strong North–South bias and the limited examples of UN engagement with “developed” countries we identify, we outline the contours of what a more universal future of UN development work could look like and discuss the political economy of our proposal. Overall, we argue that the principle of differentiated universality provides a helpful heuristic for rethinking the roles and functions of the UN development system in light of sustainable development concerns and persisting inter-state inequalities.
Pretreatment and acquired HIV drug resistance in Belize—results of nationally representative surveys, 2021–22
Authors: Morey Francis , Girón-Callejas Amalia , Manzanero Russell , Urbina Aspiro , García-Morales Claudia , Joseph Job , Bolastig Edwin , Jones Sandra , Wu Stephanie M , Tapia-Trejo Daniela , Monreal-Flores Jessica , Ortega Veronica , Manzanero Marvin , Sosa Aldo , Ravasi Giovanni , Jordan Michael R , Sued Omar , Ávila-Ríos Santiago
Published: November 2024

Background

The rising prevalence of pretreatment drug resistance (PDR) to non-nucleoside reverse-transcriptase inhibitors threatens the effectiveness of ART. In response, the WHO recommends dolutegravir-based ART regimens due to their high genetic barrier to resistance and better treatment outcomes. This is expected to contribute to achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) target of 95% viral suppression in people on ART.

Objectives

To estimate the prevalence of PDR among adults initiating ART and assess viral suppression and acquired HIV drug resistance (ADR) among individuals receiving ART in Belize.

Patients and methods

Nationally representative cross-sectional PDR and ADR surveys were conducted between 2021 and 2022. Sixty-seven adults were included in the PDR survey, and 43 children and adolescents and 331 adults were included in the ADR survey. Demographic and clinic data and blood specimens were collected. HIV drug resistance (HIVDR) was predicted using the Stanford HIVdb tool.

Results

The prevalence of PDR to efavirenz or nevirapine in adults was 49.3% (95% CI 42.2%–56.4%) and was significantly higher in those with previous antiretroviral exposure (OR: 7.16; 95% CI 2.71–18.95; P = 0.002). Among children and adolescents receiving ART, 50.0% had viral suppression, with better rates for those receiving dolutegravir-based ART (OR: 5.31; 95% CI 3.02–9.34; P < 0.001). In adults, 79.6% achieved viral suppression. No resistance to integrase inhibitors was observed in those on dolutegravir-based ART.

Conclusions

Prioritizing dolutegravir-based ART is critical for achieving HIV epidemic control in Belize. Efforts should focus on retention in care and adherence support to prevent HIVDR.
Plumage polymorphism in the black sparrowhawk (Accipiter melanoleucus) is strongly associated with the expression level of agouti signaling protein
Authors: Rodseth Edmund , Amar Arjun , Sumasgutner Petra , Ingle Robert A
Published: November 2024

Melanin-based plumage polymorphisms in birds are often associated with mutations in the melanogenesis genes, notably the melanocortin-1 receptor (MC1R), but may also arise through changes in the expression of these genes. Here we investigate the molecular basis of plumage polymorphism in both adult and juvenile black sparrowhawks (Accipiter melanoleucus), an African raptor that occurs in two adult color morphs, light and dark, and also exhibits variation in juvenile plumage coloration. Our results confirmed that plumage differences in adult morphs were a result of differential deposition of eumelanin in their ventral contour feathers. No polymorphisms in the coding regions of the MC1R or the agouti signaling protein (ASIP) genes associated with adult color morph were identified. However, lack of pigmentation in the developing breast feathers of light morph birds was strongly associated with elevated ASIP expression, and concomitant downregulation of the downstream melanogenesis genes microphthalmia-associated transcription factor (MITF), tyrosinase (TYR), and tyrosinase-related protein 1 (TYRP1). Variation in the rufous colored plumage of juveniles was found to be due to covariation in eumelanin and pheomelanin levels in dorsal and ventral contour feathers. As in adult birds, an inverse relationship between melanin pigmentation and ASIP expression was observed. This covariation between eumelanin and pheomelanin levels is not consistent with the pigment type-switching model of melanogenesis, where increased ASIP expression results in a switch from eumelanin to pheomelanin production. This highlights the need for caution when extrapolating results from model systems to other animals and the value of conducting research in wild species.
Asymmetric effects of planting pattern and density on leaf-height traits of Glycine max and Amaranthus retroflexus
Authors: Lu Ping , Pang Yan , Wang Huai-Jing , Zhang Zi-Han , Dai Xin , Bing Xue-Wei , Yuan Qiu-Yu
Published: November 2024

Environmentally sustainable weed management is crucial to meet the increasing demand for food. Previous studies have demonstrated that improving spatial uniformity and planting density can effectively suppress weeds. However, research on how planting patterns (PPs) affect the functional traits of crops and weeds is limited. In 2019 and 2021, we conducted a field experiment to compare the functional traits and biomass of Glycine max and Amaranthus retroflexus in two PPs—row (R) and equidistant (E)—with varying combinations of G. max and A. retroflexus densities. We found that the equidistant planting pattern (EPP) amplified the competitive ability of G. max in size-asymmetric competition with A. retroflexus, and this advantage increased alongside higher G. max density, primarily due to functional traits related to light acquisition. In the EPP, G. max established a closed canopy during the early growth stage, reducing light availability to A. retroflexus. This advantage was reflected in higher leaf area index (LAI) and leaf dry weight for G. max in the EPP than in the row planting pattern (RPP), while A. retroflexus experienced reduced LAI and plant height due to increased shading in the EPP. Consequently, the EPP enhanced the total biomass and yield of G. max by an average of 40.8% and 37.7%, respectively, while the biomass of A. retroflexus decreased by an average of 34.5% compared with the RPP. These results suggest that adopting an EPP with a high density of G. max, could be an effective strategy for suppressing A. retroflexus and improving crop yield.
Abducens nerve palsy secondary to allergic fungal sinusitis
Authors: Alsaleh Majd A , Almomen Ali A
Published: November 2024

Allergic fungal rhinosinusitis (AFRS) stands out as the predominant form of fungal sinusitis, primarily attributable to a hypersensitive response to fungal invasion. AFRS Characterized by symptoms of rhinosinusitis. The expanding mass in the disease leads to bony restructuring and implicating adjacent anatomical structures. AFRS may extend beyond the sinus cavities, leading to compression of nearby structures like the orbit, optic and abducens nerves which leads to many complications such as nerve palsies and proptosis. Diagnosis of AFRS typically necessitates radiographic assessment initially, with histopathological examination serving as the confirmatory modality. The management of AFRS typically entails a multifaceted approach integrating surgical intervention alongside medical therapy. This case report illustrates a distinctive manifestation of abducens nerve palsy secondary to allergic fungal sinusitis which had dramatic improvement and resolution of the diplopia after the Endoscopic sinus surgery. Steroids and nasal saline irrigation have been prescribed post operatively to prevent the recurrence.
A rare case of hepatocellular carcinoma and colorectal liver metastasis
Authors: Alwabel Wed K , Aljesh Saud M , Alsamaani Ibrahim S , Alrasheed Ayman S , Alzahrani Nayef A
Published: November 2024

Hepatocellular carcinoma is the third leading cause of cancer deaths worldwide, with a 5-year survival rate of 20.3%, while colorectal cancer is a major cause of morbidity and mortality worldwide, being the third most common cancer in men and the second in women. In addition, multiple primary tumors, involving cancers at different sites and histologies, occur in 2.4% to 17% of cases. We report a case of a 74-year-old man with colon cancer presented at the Emergency Department with asymptomatic anemia post chemotherapy and surgical intervention two years ago. He reported experiencing paleness, dizziness, exertional dyspnea, and fatiguability for the past month. Therefore, chest computed tomography was performed to rule out pulmonary embolism; however, the image revealed an incidental finding of two hepatic lesions in segment II. After further investigations, the decision was to perform hepatic segmentectomy. Postoperative pathology revealed residual Hepatocellular carcinoma and metastatic colonic-type adenocarcinoma with mucinous differentiation.
Stanford A aortic dissection 40 years after aortic valve replacement with a Starr–Edwards caged-ball prosthesis: a case report
Authors: Tokic Tomislav , Hasnas Lea , Mikulic Lovro , Markovic Pavel , Gustek Stella , Kucina Anamarija , Jurca Ivana , Sipus Dubravka , Mihaljevic Martina Zrno , Gasparovic Hrvoje , Burcar Ivan
Published: November 2024

Stanford A aortic dissection is one of the most devastating acute medical conditions due to its high morbidity and mortality. We describe a 77-year-old male patient with a medical history of surgical aortic valve replacement with a still functioning Starr–Edwards caged-ball valve 40 years prior. The patient was promptly diagnosed with an ascending aortic aneurysm and dissection, and an emergency Bentall procedure in deep hypothermic circulatory arrest was performed. This is, to the best of our knowledge, the first Stanford A dissection case described in the literature in a patient with Starr–Edwards valve, and the longest still functioning caged-ball valve to have been replaced with the Bentall procedure. We also discuss the caged-ball valve’s unfavorable hemodynamics as a potential predisposing factor of the dissection, as well as the patient’s supposed initial bicuspid aortic valve disease which could also predispose to aortic aneurysm formation and dissection.
Idiopathic pneumoperitoneum after gynecological surgery: a report of two clinical cases
Authors: Boligo Sofia , Santos Cláudia , Contente Helena
Published: November 2024

Pneumoperitoneum, characterized by the presence of air in the peritoneal cavity, is usually associated with severe clinical conditions, such as perforations of hollow viscera, often requiring urgent surgical intervention. However, in rare cases, pneumoperitoneum occurs without an identifiable cause, thus classified as idiopathic pneumoperitoneum. We present two clinical cases of women who developed pneumoperitoneum after extensive gynecological surgeries. In the first case, a 63-year-old woman underwent elective hysterectomy and bilateral adnexectomy due to a large adnexal mass. In the second case, a 55-year-old woman had a similar surgical history. Both patients were treated conservatively, with a positive outcome. Idiopathic pneumoperitoneum is a diagnostic and therapeutic challenge, especially in the postoperative context. The cases presented underscore the importance of rigorous diagnostic evaluation and a cautious therapeutic approach, suggesting that idiopathic pneumoperitoneum may represent a benign and self-limiting phenomenon rather than a surgical emergency.
European Banks and Substantial EU Financial Law Frameworks
Authors: Lo Schiavo Gianni
Published: November 2024

This chapter evaluates other EU financial frameworks that have an impact on the conduct of the business of credit institutions in Europe. Although the prudential framework is undoubtedly the most complex and relevant regulatory framework for banks, the key to ensuring the good functioning of banks and appropriate risk assessments is that credit institutions need to comply with a number of provisions deriving from other areas of EU financial law. Among others, the chapter considers the financial conglomerate framework for banking groups (the FICOD regime); the EU rules on markets in financial instruments and activities; rules on market abuse; the anti-money laundering/counterterrorist financing framework; the deposit insurance rules; payments regulation; and retail financial services rules. Other frameworks not relating to substantive rules applicable to banks but having an impact on financial markets broadly are not examined in this chapter. Among others, these are EU rules on prospectuses, covered bonds, transparency of consolidated accounts, credit rating agencies, and trading venues.
EU Banking Resolution, Insolvency Framework, and Public Interventions
Authors: Lo Schiavo Gianni
Published: November 2024

This chapter investigates the complex legal framework of EU banking resolution, insolvency, and public interventions under EU law. It begins with a brief overview of banking resolution and insolvency theories. The chapter then looks at the EU framework for banking resolution in the Bank Recovery and Resolution Directive by examining the preparatory aspects for resolution, the core resolution tools, and the powers of resolution authorities. It then moves to the rules of the Single Resolution Mechanism as the supranational framework for resolution where the Single Resolution Board is the EU agency in charge of orderly resolutions in Europe together with the national resolution authorities, and the Single Resolution Fund is the fund established to ensure sufficient financial resources in case private sources are insufficient. A section looks at the application or non-application of the resolution framework in case studies. Finally, the chapter considers state interventions under the EU state aid framework and discusses the (lack of) an orderly EU insolvency framework for banks.
Added prognostic value of DCE blood volume imaging in patients with suspected recurrent or residual glioblastoma—A hybrid [18F]FET PET/MRI study
Authors: Henriksen Otto Mølby , Muhic Aida , Lundemann Michael Juncker , Larsson Henrik Bo Wiberg , Lindberg Ulrich , Andersen Thomas Lund , Hasselbalch Benedikte , Møller Søren , Marner Lisbeth , Madsen Karine , Larsen Vibeke Andrée , Poulsen Hans Skovgaard , Hansen Adam Espe , Law Ian
Published: November 2024

Background

Magnetic resonance imaging (MRI) cerebral blood volume (CBV) measurements improve the diagnosis of recurrent gliomas. The study investigated the prognostic value of dynamic contrast-enhanced (DCE) CBV imaging in treated IDH wildtype glioblastoma when added to MRI or amino acid positron emission tomography (PET).

Methods

Hybrid [18F]FET PET/MRI with 2CXM (2-compartment exchange model) DCE from 86 adult patients with suspected recurrent or residual glioblastoma were retrospectively analyzed. High CBV tumor volume (VOLCBV), and contrast-enhancing (VOLCE) and [18F]FET active tumor (VOLFET) volumes were delineated. Absolute and fractional high CBV subvolumes within VOLCE and VOLFET were determined. Associations with overall survival (OS) were assessed by Cox analysis.

Results

Adjusted for methyltransferase gene status and steroid use all total tumor volumes were individually associated with shorter OS. Adding VOLCBV to VOLCE or VOLFET only the effect of VOLCBV was prognostic of OS (hazard ratio [HR] 1.327, P = .042 and 1.352, P = .011, respectively). High CBV subvolumes within both VOLCE and VOLFET were associated with shorter survival (HR 1.448, P = .042 and 1.416, P = .011, respectively), and the low CBV subvolumes with longer survival (HR 0.504, P = .002 and .365, P = .001, respectively). The fraction of VOLCE and VOLFET with high CBV was a strong predictor of OS with shorter median OS in upper versus lower tertiles (8.3 vs 14.5 months and 7.1 vs 15.6 months, respectively, both P < .001).

Conclusions

The high CBV tumor volume was a strong prognosticator of survival and allowed for the separation of high- and low-risk subvolumes underlining the heterogeneous physiological environment represented in the contrast-enhancing or metabolically active tumor volumes of treated glioblastoma.
Awakening of Maunaloa Linked to Melt Shared from Kīlauea’s Mantle Source
Authors: Pietruszka Aaron J , Heaton Daniel E , Marske Jared P , Norman Marc D , Robbins Mahinaokalani G , Mershon Reed B , Lynn Kendra J , Downs Drew T , Steiner Arron R , Rhodes J Michael , Garcia Michael O
Published: November 2024

Maunaloa—the largest active volcano on Earth—erupted in 2022 after its longest known repose period (~38 years) and two decades of volcanic unrest. This eruptive hiatus at Maunaloa encompasses most of the ~35-year-long Puʻuʻōʻō eruption of neighboring Kīlauea, which ended in 2018 with a collapse of the summit caldera and an unusually voluminous (~1 km3) rift eruption. A long-term pattern of such anticorrelated eruptive behavior suggests that a magmatic connection exists between these volcanoes within the asthenospheric mantle source and melting region, the lithospheric mantle, and/or the volcanic edifice. The exact nature of this connection is enigmatic. In the past, the distinct compositions of lavas from Kīlauea and Maunaloa were thought to require completely separate magma pathways from the mantle source of each volcano to the surface. Here, we use a nearly 200-yr record of lava chemistry from both volcanoes to demonstrate that melt from a shared mantle source within the Hawaiian plume may be transported alternately to Kīlauea or Maunaloa on a timescale of decades. This process led to a correlated temporal variation in 206Pb/204Pb and 87Sr/86Sr at these volcanoes since the early 19th century with each becoming more active when it received melt from the shared source. Ratios of highly over moderately incompatible trace elements (e.g. Nb/Y) at Kīlauea reached a minimum from ~2000 to 2010, which coincides with an increase in seismicity and inflation at the summit of Maunaloa. Thereafter, a reversal in Nb/Y at Kīlauea signals a decline in the degree of mantle partial melting at this volcano and suggests that melt from the shared source is now being diverted from Kīlauea to Maunaloa for the first time since the early to mid-20th century. These observations link a mantle-related shift in melt generation and transport at Kīlauea to the awakening of Maunaloa in 2002 and its eruption in 2022. Monitoring of lava chemistry is a potential tool that may be used to forecast the behavior (e.g. eruption rate and frequency) of these adjacent volcanoes on a timescale of decades. A future increase in eruptive activity at Maunaloa is likely if the temporal increase in Nb/Y continues at Kīlauea.
The wheat CC-NBS-LRR protein TaRGA3 confers resistance to stripe rust by suppressing ascorbate peroxidase 6 activity
Authors: Fang Nannan , Jia Conghui , Chen Ruolin , An Jiarui , Kang Zhensheng , Liu Jie
Published: November 2024

Nucleotide-binding leucine-rich repeat (NLR) proteins are intracellular immune receptors that activate innate immune responses upon sensing pathogen attack. However, the molecular mechanisms by which NLR proteins initiate downstream signal transduction pathways to counteract pathogen invasion remain poorly understood. In this study, we identified the wheat (Triticum aestivum) NLR protein Resistance Gene Analogs3 (TaRGA3), which was significantly upregulated during Puccinia striiformis f. sp. tritici (Pst) infection. TaRGA3 and its coiled-coil (CC) domain, localized to the cytoplasm and nucleus, can induce cell death in Nicotiana benthamiana. Virus-induced gene silencing and overexpression suggested that TaRGA3 contributed to wheat resistance to stripe rust by facilitating reactive oxygen species (ROS) accumulation. Yeast 2-hybrid, luciferase complementation imaging, and co-immunoprecipitation assays revealed that TaRGA3 interacted with wheat protein Ascorbate Peroxidase 6 (TaAPX6). Further analysis showed that TaAPX6 specifically targeted the CC domain of TaRGA3. The TaRGA3–TaAPX6 interplay led to reduced enzyme activity of TaAPX6. Notably, TaAPX6 negatively regulated wheat resistance to Pst by removing excessive ROS accompanying Pst-induced hypersensitive responses. Our findings reveal that TaRGA3 responding to Pst infection confers enhanced wheat resistance to stripe rust, possibly by suppressing TaAPX6-modulated ROS scavenging, and demonstrate that TaRGA3 can be used to engineer stripe rust resistance in wheat.
Women are awarded more team than solo grants and lead more gender-balanced teams than men
Authors: Kingsley Isabelle , Slavich Eve , Harvey-Smith Lisa , Johnston Emma L , Williams Lisa A
Published: November 2024

We modelled patterns of collaboration, team gender composition, and funding amounts across awarded Australian government-funded competitive team research grants from 2000 to 2020. The percentage of grants awarded to women at mid- and senior-career levels was higher for team grants than sole investigator grants compared to men at those levels. Teams led by women tended to have a greater percentage of women coinvestigators than teams led by men, but this was below gender parity regardless of team leader gender. Funding amounts per grant did not differ by the principal investigator’s gender and reached parity in 2020 across teams with both high and low representation of women. Since teams tend to be more gender-balanced when led by women, women’s grant leadership may be an important mechanism for shifting overall representation of women in research. We offer public policy measures to address gender inequities in the research sector.
Human umbilical cord mesenchymal stem cells small extracellular vesicles-derived miR-370-3p inhibits cervical precancerous lesions by targeting DHCR24
Authors: Li Weizhao , Zhang Chi , Gao Tianshun , Sun Yazhou , Yang Huan , Liu Lixiang , Shi Ming , Ding Lu , Zhang Changlin , Deng David Y B , Li Tian
Published: November 2024

Background

Cervical cancer is often caused by persistent high-risk human papillomavirus (HPV) infection, causing precancerous lesions. Human umbilical cord mesenchymal stem cells-derived small extracellular vesicles (hucMSC-sEV) exhibit diverse effects on tumors. This study investigates hucMSC-sEV, the impact and mechanisms on HPV-positive cervical precancerous lesion cells to provide new treatment insights.

Materials and Methods

We previously obtained hucMSC and hucMSC-sEV. In vitro experiments evaluated hucMSC-sEV effects on the proliferation and migration of S12 cells (derived from cervical precancerous lesions). Bioinformatics identified key microRNA components, and their impact on S12 cell proliferation and migration was investigated. The target gene of the microRNA component was predicted and confirmed via bioinformatics and dual-luciferase reporter assays. Lentiviral systems overexpressed target gene in S12 cells to examine the effects on microRNA impacts. SH-42 inhibitor was used to investigate target gene treatment potential. Immunohistochemistry assessed target gene expression in cervical precancerous lesions tissue.

Results

hucMSC-sEV significantly inhibited S12 cell proliferation and migration. Bioinformatics identified miR-370-3p as an effective cargo, which also suppressed S12 cell proliferation and migration. miR-370-3p was confirmed targeting DHCR24 (24-Dehydrocholesterol Reductase). DHCR24 overexpression reversed miR-370-3p’s inhibitory effects, while SH-42 counteracted DHCR24 overexpression’s promoting effects. Clinical specimen analysis supported these findings, demonstrating a positive correlation between DHCR24 protein expression and cervical precancerous lesions’ progression.

Conclusions

hucMSC-sEV inhibits S12 cell proliferation and migration, mediated by miR-370-3p targeting DHCR24 to regulate cellular cholesterol content. DHCR24 inhibition reduces the cholesterol level and cell functions, suggesting its potential as a therapeutic target in cervical precancerous lesions.
Tunnel sign in patients with melioidosis: a case series from South India
Authors: Gupta Nitin , Malla Sundeep , Kumar Tirlangi Praveen , Singh Sonali , Varma Muralidhar , Mukhopadhyay Chiranjay
Published: November 2024

Introduction

The tunnel sign (linear contrast enhancement along the corticospinal tract) can aid in the early diagnosis of neuromelioidosis, a potentially fatal condition requiring urgent diagnosis.

Methodology

We retrospectively analyzed the hospital data of all patients with culture-confirmed melioidosis between 2018 and 2023 in a tertiary care hospital in South India. MRI scans of patients with neuromelioidosis were reviewed for the presence of the tunnel sign.

Results

Of the 177 patients with melioidosis, 21 had possible neurological involvement. Seven had confirmed neuromelioidosis. Of the six patients with neuromelioidosis, where an MRI scan was available, a tunnel sign was noted in four.

Conclusion

We report this study to create awareness amongst physicians to look for this sign in patients with suspected neuromelioidosis.
Integrative analysis of non12‐hydroxylated bile acid revealed the suppressed molecular map of alternative pathway in nonalcoholic steatohepatitis mice
Authors: Feng Yanruyu , Liu Chang‐Hai , Yang Jingtao , Zhang He , Li Lian , Yang Qian , Gan Wei , Yang Zi , Gong Puyang , Fu Chunmei , Qian Guangsheng , Li Dapeng
Published: November 2024

Bile acids (BAs) are significantly altered in the liver and serum of patients with nonalcoholic steatohepatitis (NASH). However, the underlying mechanisms of these changes, particularly BA alternative pathways (BAP) responsible for non12‐OH BAs, remain unclear. RNA‐seq data were initially analyzed to reveal the changes of gene expression in NASH patients. Targeted metabolomics were conducted on plasma from NASH mice induced by high‐fat or western diet with CCl4 for 10–24 weeks. Liver tissues were examined using proteomics, RT‐qPCR, and western blotting. An integrated approach was then employed to analyze protein interactions and network correlations. Analysis of RNA‐seq data revealed the inhibition of CYP7B1 in NASH patients, indicating the dysregulation of BAP. In NASH mouse models, dysregulation of BA circulation was observed by increased plasma total BA (TBA) levels and decreased liver TBA, with liver swelling and histopathological changes. Targeted metabolomics revealed suppressed levels of non12‐OH BAs, which inversely correlated with increased liver injury markers. The reduced mRNA and protein expression of Fxr and upregulation of Lxr signaling in livers suggested the suppressed BAP was modulated by Fxr‐Lxr signaling. Moreover, BAP interactions predominantly implicated multiple metabolism disruptions, involving 7 hub proteins (Hk1, Acadsb, Pklr, Insr, Ldlr, Cyp27a1, and Cyp7b1), offering promising therapeutic targets for NASH. We presented the metabolic and proteomic map of BAP and its regulatory network in NASH progression. Therapeutic targeting of BAP or its co‐regulatory proteins holds promise for NASH treatment and metabolic syndrome management.
CXCL13 promote angiogenesis by recruiting M2 macrophages and endothelial progenitor cells in beige adipose grafts
Authors: Zhang Xining , Chen Xinyao , Li Jiapeng , Liu Ying , Luo Sai
Published: November 2024

Fat grafting is an emerging clinical technique to address soft tissue deficiencies. This study investigates whether the secretory function of beige adipose tissue(BeigeAT) grafts is involved in promoting soft tissue regeneration in fat grafting. In this study, mice were randomly divided into white adipose tissue (WAT) and BeigeAT groups. Each type of adipose tissue (0.3 mL) was transplanted into the respective groups, and samples were harvested at 2, 4, and 12 week. Subsequently, mice were further divided into three groups, BeigeAT group, BeigeAT with CXCL13 treatment group, and BeigeAT with TAK‐779 treatment group, to investigate the role of CXCL13 in BeigeAT transplants. Graft retention rate, vascularization, and fibrosis levels were compared among the groups. Compared to WAT transplants, BeigeAT transplants exhibited moderate inflammation, enhanced revascularization, reduced fibrosis, and increased infiltration of M2 macrophages and endothelial progenitor cells in the early stages following fat grafting. CXCL13 expression was significantly higher in BeigeAT transplants at 2, 4, and 12 week post‐grafting. Additionally, modulation of CXCL13 expression affected the infiltration of M2 macrophages and endothelial progenitor cells. However, BeigeAT transplants exhibited superior retention rates compared to BeigeAT CXCL13 groups and BeigeAT TAK‐779 groups after 12 weeks of fat grafting. BeigeAT transplants achieve improved retention rates through CXCL13‐induced infiltration of M2 macrophages and endothelial progenitor cells.
Static Versus Expandable Cages in Minimally Invasive Lateral Lumbar Interbody Fusion
Authors: Beyer Ryan S. , Shooshani Tara , Batista Bianca , Fraipont Genevieve M. , Pooladzandi Omead , Brown Nolan J. , Pennington Zach , Pham Martin H.
Published: November 2024

Study Design:

A meta-analysis approach to a systematic review.

Objective:

Perform a systematic review to identify all reports directly comparing outcomes of lateral lumbar interbody fusion (LLIF) using static versus expandable interbody cages. Specifically focusing on periprocedural complications, intraoperative morbidity, and fusion outcomes.

Summary of Background Data:

Minimally invasive surgical techniques, particularly LLIF, have gained popularity for their potential to reduce muscle and soft tissue dissection, leading to faster postoperative recovery. LLIF has been associated with fewer complications compared with open posterior approaches. The introduction of expandable lumbar interbody devices aims to further reduce surgical difficulty and potential complications. However, concerns include a small graft window due to the expansion mechanism and higher costs.

Methods:

The Web of Science, Scopus, and PubMed databases were systematically queried in accordance with PRISMA guidelines to identify articles comparing outcomes following LLIF using static and expandable interbodies. The Newcastle-Ottawa Scale (NOS) was employed to assess the risk of bias (ROB) in the selected studies. Extracted data underwent effect-size meta-analysis with the PyMARE library, using P<0.05 to define statistical significance.

Results:

Of the 77 identified articles, 4 studies comprising 283 patients (mean age: 67.1 y, 55.8% female) met the inclusion and exclusion criteria. A total of 150 patients (53%) were treated with static interbodies compared with 133 (47%) receiving expandable interbodies. The groups did not differ significantly with respect to operative time (P=0.59), blood loss (P=0.89), length of stay (P=0.78), subsidence (P=0.49), 24-month mean disc height (P=0.11), 24-month mean ODI (P=0.58), or 24-month mean visual analog scale (VAS) back pain (P=0.81). The expandable group saw a trend toward improved fusion rates (97% vs. 92%, P=0.06).

Conclusions:

The present meta-analysis suggests the use of expandable (vs. static) interbodies in LLIF surgery may result in similar surgical morbidity, subsidence, and decompression. Further prospective comparative studies are merited to validate these results.
A Comparative Study of Direct Immunofluorescence Patterns in Linear IgA Bullous Dermatosis Versus Dermatitis Herpetiformis
Authors: Sagut Pelin , Lyles Elliott , Vroman Jenna , Barker Catherine S. , Juratli Hazem A. , Bruner Evelyn , Self Sally , Elston Dirk M.
Published: November 2024

Background:

Dermatitis herpetiformis (DH) is typically characterized by granular IgA deposition in the papillary dermis on direct immunofluorescence (DIF), and linear IgA bullous dermatosis (LABD) is characterized by linear deposition of IgA along the basement membrane. Other DIF findings in both conditions may include IgG, IgM, and C3 deposition in various patterns. In cases where immunofluorescence findings are unclear, such as continuous but somewhat granular IgA deposition along the dermal–epidermal junction, additional DIF patterns may be helpful in the diagnostic process.

Methods:

Forty-five cases of digitized images of LABD and 48 digitized images of DH cases were analyzed. The data regarding the positivity and patterns of immunoglobulins were documented and analyzed.

Results:

None of the LABD cases had a picket fence pattern, while 47.9% (n = 23) of the DH cases had the pattern. Elevated levels of IgG and IgM were found in LABD compared with DH. In DH, higher IgM and kappa light chain levels were observed in the deposited particles compared with those in LABD.

Conclusions:

The “picket fence pattern” is highly specific for DH (Specificity 100%) but less sensitive (Sensitivity 47.9%). It may be helpful to differentiate between DH and LABD for a more accurate diagnosis.
Single-session Preoperative Embolization and Surgical Resection of Vascular Anomalies: A Case Series
Authors: Rajagopalan Aravind , Shah Nikhil , Reddy Narainsai K. , Aronson Sofia , Yamada Akira , Rajeswaran Shankar
Published: November 2024

Vascular anomalies encompass 2 broad classifications including vascular tumors and vascular malformations. The management of vascular anomalies is best approached by a multidisciplinary team. Surgical treatment can offer definitive treatment, but carries several risks such as intraoperative hemorrhage, recurrence, and collateral vascular formations from incomplete resections. Here, we present a case report of 3 patients with different vascular anomalies who were all treated by a multidisciplinary team including interventional radiology and plastic surgery. All underwent preoperative embolization before surgical excision, accomplished under a single anesthetic. Here, we discuss the surgical planning and overall approach to patients presenting with localized vascular anomalies and support the use of preoperative embolization with surgical excision under a single anesthetic as a treatment approach.
Clinicopathological relevance of SMAD4 and RUNX3 in patients with resected pancreatic cancer
Authors: Hirose Katsuya , Omori Yuko , Higuchi Ryota , Yamamoto Masakazu , Furukawa Toru
Published: November 2024

Objectives

Treating pancreatic ductal adenocarcinoma (PDAC) is a major clinical challenge, owing to its poor prognosis. Understanding the underlying molecular interactions may be crucial in determining PDAC intractability. We elucidated the combinatory role of SMAD family member 4 (SMAD4) and Runt-related transcription factor 3 (RUNX3) in PDAC.

Methods

Formalin-fixed and paraffin-embedded tissues were obtained from 101 patients who underwent surgical resection of PDAC. SMAD4 and RUNX3 expression in the tissues was evaluated using immunohistochemistry. SMAD4 and KRAS mutations were evaluated using Sanger sequencing. SMAD4 copy number variations were evaluated using quantitative real-time PCR. These molecular characteristics were compared with clinicopathological features of patients.

Results

Retained SMAD4 expression in PDAC tissues was associated with higher tumor, node, metastasis (TNM) stage, and metastatic recurrence. Defective RUNX3 expression was associated with higher TNM stages. Further analysis to determine significance of retained SMAD4 indicated that all these cases had defective RUNX3 expression; therefore, the combined expression status of retained SMAD4 and defective RUNX3 expression in tissues was determined to be associated with higher TNM stage and metastatic recurrence than defective SMAD4 expression with defective or retained RUNX3 expression. Survival analysis showed that patients with tumors with retained SMAD4 and defective RUNX3 expression had relatively worse overall survival (OS) rates. KRAS mutations were not associated with SMAD4/RUNX3 expression or OS.

Conclusions

Despite inherent limitations of this retrospective study and small sample size, our findings highlight the potential combined role of SMAD4 and RUNX3 in node metastasis and metastatic recurrence in patients with resected pancreatic cancer.
The Effects of Thermal and Pulsed Ultrasound on Pain and Function in Patients with Carpal Tunnel Syndrome: A Randomized Controlled Trial
Authors: ElMeligie Mohamed M. , Ismail Mahmoud M. , Yehia Amr M. , Sakr Hend R. , Amin Doaa I.
Published: November 2024

Objective

While ultrasound therapy is common for carpal tunnel syndrome, the relative merits of thermal versus pulsed ultrasound remain unclear. This study compares their therapeutic effects.

Design

Randomized, double-blinded, placebo-controlled trial. Ninety-two adults aged 30-60 years with mild-moderate carpal tunnel syndrome (characteristic symptoms, positive clinical tests, abnormal electrophysiology) were randomized into 4 groups receiving 4 weeks night splinting plus 12 ultrasound sessions: Group A: 1 MHz, 1.0 W/cm2 continuous ultrasound for 5 minutes; Group B: 1 MHz, 25% duty cycle, 1.0 W/cm2 pulsed ultrasound for 15 minutes; Group C: 5 minutes thermal plus 15 minutes pulsed ultrasound; Group D: sham ultrasound for 15 minutes. Pain (VAS), function (DASH-Arabic), nerve conduction, and grip strength were measured at baseline, 4, and 8 weeks.

Results

Thermal and pulsed ultrasound groups improved in all outcomes versus placebo over 8 weeks (p < 0.05). Pulsed ultrasound decreased pain and distal motor latency more than placebo (p < 0.05). Thermal ultrasound increased sensory nerve action potentials versus placebo (p < 0.05).

Conclusion

Thermal and pulsed ultrasound with splinting improved pain, disability, grip strength, and nerve conduction in carpal tunnel syndrome. Pulsed ultrasound was optimal for pain and motor function, while thermal ultrasound enhanced sensory nerve function.
Ultrasound assessment of muscle and fascia properties and the effects of spasticity and botulinum toxin injections on spastic muscles in chronic stroke survivors
Authors: Magat Elaine , Horstmann Kelly , Francisco Gerard E. , Li Sheng
Published: November 2024

Objective

To objectively quantify changes in muscle properties in chronic stroke survivors and the effects of spasticity and botulinum toxin injections (BoNTi) on muscle properties using ultrasonography.

Design

In this cross-sectional observational study, 24 stroke subjects with history of BoNTi to biceps brachii muscles (BB) but without BoNTi to the triceps (TRI) were included.

Results

12 subjects had spastic TRI, the other half did not. 20 subjects had spasticity in wrist flexors, and 11 subjects received BoNTi to the flexor carpii ulnaris (FCU). On average, a significant decrease in muscle thickness (16.5% loss in TRI), a thicker fascia with higher echo intensity were noted on muscles in the paretic limb. Percent muscle loss (PML) was significantly less (11.0%) in spastic TRI than in non-spastic TRI (22.1%). There was no statistically significant difference in muscle and fascia properties in spastic FCU with and without BoNTi. Spasticity did not correlate significantly with muscle loss, fascia thickness or echo intensity.

Conclusion

Our results provided evidence that muscles on the spastic-paretic side had less muscle mass, thicker fascia and greater echo intensity. Our results showed that spasticity helped maintain muscle mass, but failed to reveal additional muscle loss after botulinum toxin injection.
A Different View of the Issue: Seeing Disability Through the Lens of Diversity and Inclusivity in Healthcare in the United States
Authors: Brose Steven W. , Suarez Kevin O. , Cenberoglu Mine A. , Weber Robert , Turk Margaret A.
Published: November 2024

Advocacy for diversity, inclusion and equity within healthcare continues to be an issue of importance and attention nationally. However, definitions of diversity often do not include people with disability. This commentary describes barriers to healthcare utilization experienced by people with disabilities in the United States (U.S.) and presents a rationale to refocus disability through this lens of diversity, equity, and inclusion within the U.S. systems of care. Bringing light to the ongoing challenges and inequities faced by our patients with disability is an essential first step toward improved inclusivity, leading to improved welfare of persons with disability as a whole.
A Novel Technique for Top Surgery in Small-Breasted Individuals Who Experience Gender Dysphoria – Concentric Periareolar Mastectomy, Interlocking Suture and Waterjet-Assisted-Liposuction
Authors: Wolter Andreas , Fertsch Sonia M , Daniels Marc , Munder Beatrix , Hagouan Mazen , Janku Dirk , Musmann Robert J , Oramary Alan , Andree Christoph , Hammond Dennis
Published: November 2024

Background:

In small-breasted individuals, who experience gender dysphoria, the concentric periareolar approach is typically the preferred method for mastectomy. However, this method carries a notable risk of hypertrophic scars and changes in the areolar dimensions. This study introduces the periareolar interlocking suture (PIS) as a new scar-minimizing procedure, with a low complication rate and high patient satisfaction.

Patients and Methods:

We performed a concentric periareolar mastectomy (CPM) combined with PIS and waterjet-assisted liposuction (WAL) in patients with small breasts (A to B-Cup) and good skin quality/elasticity. Outcome measures included complication rates, patient satisfaction (assessed via the BODY-Q Chest and Nipples Scale and scar appearance), nipple sensitivity, and the rate of surgical corrections.

Results:

Between April 2017 and December 2023, we conducted 2312 mastectomies in 1156 people who experience gender dysphoria, with 410 breasts treated using CPM combined with PIS and WAL. The mean patient age was 23 years, mean hospital stay was 4 days, and mean operation time was 96.1 minutes. The overall complication rate was 7.8%, with acute hematomas occurring in 4.6% of the cases. Secondary revisions were necessary in only 2.2% of cases. Patient satisfaction, measured using the BODY-Q scale, was statistically significant and very high.

Conclusion:

Individuals with gender dysphoria are well-informed and increasingly demand aesthetic outcomes. Whenever feasible, procedures with minimal scarring are preferred. The technique presented here resulted in very high patient satisfaction, preserved nipple sensitivity, and a low rate of complications and secondary aesthetic corrections in a carefully selected cohort of patients with small breasts.
Detecting Early-Stage Pressure Injury in Patients With Dark Skin Tones Using an Enhanced Physical Assessment Technique and Halogen Lighting
Authors: Waidley Monica , Taylor Nikki , Shever-Doletzky Leah L.
Published: November 2024

PURPOSE:

The purpose of this quality improvement project was to identify stage 1 pressure injuries (PIs) in patients with darker skin tones using an enhanced skin assessment (Skin Assessment for Dark Skin, SADS) and halogen lighting.

PARTICIPANTS AND SETTING:

This quality improvement project was conducted on 3 units at a large university teaching hospital in Southeast Michigan. The project was originally designed so that participating patients were identified by bedside nurses as having sufficient melanin to obscure blanching on the hand/forearm using regular lighting, but this goal was not met. Data analysis is based on patients who self-identified as African American or Black, Native Hawaiian or Pacific Islander, Asian, American Indian, and Native Alaskan. Bedside nurses participating in this project were also asked to complete a questionnaire describing their knowledge and experiences with this project and assessment of early-stage PI in patients with darker skin tones.

APPROACH:

The Iowa Model of Evidence-Based Practice was used to guide this quality improvement initiative. Following a trigger event, we reviewed pertinent literature and developed an enhanced technique for assessing patients with darker skin tones that involved use of halogen lighting (SADS) and documentation of findings. We selected units from our facility and taught nurses to apply the SADS approach. Data from the electronic medical record and a survey of participating nurses were used to compare findings before and after project implementation. Comparisons were based on descriptive data analysis.

OUTCOMES:

Following implementation of the enhanced physical assessment, the participating units experienced a 6% decrease in the total number of facility-acquired PIs during the implementation period.

IMPLICATIONS FOR PRACTICE:

The enhanced physical assessment, when paired with halogen lighting, enhanced identification of stage 1 PI in persons with dark skin. The assessment method was easy to teach, learn, and can be performed at the bedside as part of a shift assessment which routinely includes inspection of skin.