bluuebunny/crossref_metadata_2025 huggingface dataset:
Antibiotic-derived approaches in cancer therapy: effectiveness of ikarugamycin in hexokinase-2 inhibition, tissue factor modulation, and metabolic regulation in breast cancer
Authors: Akgul Obeidin Serra Vildan , Senol Masite Sehadet , Dogru Koseoglu Zeynep , Bayramoglu Feyza , Disli Sevgi , Yigitbasi Turkan , Emekli Neslin
Published: January 2025

We aimed to explore the role of ikarugamycin (IKA) in breast cancer, its connection with hexokinase-2 (HK-2) repression, and tissue factor (TF). This study sought to extend the role of HK-2 as a TF activator in a comprehensive analysis of these interactions from the enzyme, gene, and protein levels. The investigation was performed with MDA-MB-231 and MCF-7 breast cancer lines. The oxidative stress index (OSI), lactate production, and HK activity were assessed using colorimetric assays. Western blot and quantitative PCR analyses were performed to determine HK-2 and TF expressions. Prothrombin time Tests additionally assessed the effect of IKA therapy on TF activation. Three over four significantly downregulated genes were identified after a specific analysis of the IKA’s effect on HK-2 and TF in breast cancer cell lines. In the IKA treatment group, lactate production was markedly reduced (P < 0.05) and hexokinase activity was found to be reduced in all groups (P < 0.05, <0.01). Paclitaxel cytotoxicity independently causes lower OSI in all IKA-treated groups as compared to controls even though OSI is elevated in IKA groups compared to control. Molecular analysis results demonstrated significantly downregulated HK-2 and TF expressions at the protein level (P < 0.05, P < 0.01). Partial thromboplastin time results also showed that IKA-treated cells had longer TF activation duration. A potential indirect association of HK-2 inhibition and TF regulation in breast cancer cells is put forward in this study by presenting IKA’s bioactivation of breast cancer in all gene, protein, and enzyme levels.
The Representation of Wellness Programs in Plastic Surgery Residency
Authors: Schlidt Kevin , Hricz Nicholas , El-Mallah Jessica , Waldron Olivia , Karwoski Allison , Rasko Yvonne
Published: January 2025

Background:

Plastic surgery residency comprises a significant portion of early adulthood. The difficulties of residency are well documented, particularly with the impact on wellness and risk of burnout. Structured wellness programs, mentorship, social support, and autonomy can decrease residency burnout. This study looked at how plastic surgery program websites and GME websites represent wellness and support programs between both integrated and independent plastic surgery residencies.

Methods:

A cross-sectional analysis of US plastic surgery residency programs was performed during the month of April 2024. The authors conducted a systematic content analysis on the available websites of these residency websites, GME websites, and associated programs’ Instagram and X (formally Twitter) pages. Data points included (1) mention of wellness on the program website, (2) vacation time mentioned on the website, (3) protected time available, (4) spouse support options, (5) day care options, (6) connections with mentors, (7) images of social events on the website, and (8) images of social events on Instagram. Data were compiled and analyzed in JASP (JASP Team [2024]. JASP [version 0.18.3; computer software]) as well as Microsoft Excel. Categorical variables were compared using binomial tests and chi-squared tests. Statistical significance was defined a P value less than or equal to 0.05.

Results:

The majority of plastic surgery residencies did not discuss or describe their wellness programs on their official website, regardless of program size. Similar results were displayed when searching for spousal support and daycare. GME websites were more comprehensive than the program websites but still showed significant discrepancies with vacation policies and day care. Mentorship was mentioned in under half of all plastic surgery residencies. Integrated programs were more likely to display social events on Instagram when compared with independent programs.

Conclusions:

Plastic surgery residencies do not provide evidence of existing wellness programs on their program websites. Although a lack of public information on wellness programs does not mean they do not exist, this could easily be mitigated by providing more comprehensive information on both GME and program websites.
Relating digitalization and quality management in health care organizations: A systematic review
Authors: Rego Kerstin , Petzold Thomas
Published: January 2025

Background

Quality management has been established in health care organizations as an important management function for internal quality measurement and external quality reporting. Digitalization processes have recently gained momentum with uncertain outcomes for health care organizations, quality, and the role of quality management.

Purpose

We conduct a systematic review to answer the questions of how the introduction of digital technologies affects quality management as a management function, how quality management is affecting digitalization, which quality management topics are addressed, and which competencies are needed during digitalization.

Methods

Four databases were searched from 2000 to January 2022. Both empirical and conceptual articles reporting on digital technologies and quality management as a management function, quality reporting, or risk management were included. The studies included were analyzed based on the PICOS and PRISMA approaches.

Results

A total of 20 out of 662 articles met the inclusion criteria. Results show that both quality management as a management function as well as the digitalization of quality managements’ own work processes are barely visible in the existing research. Only parts of the core tasks of quality management are discussed in connection with digitalization. Core competencies relevant for digitalization processes and quality management are identified.

Practice Implications

Quality managers require knowledge of digital technologies in order to develop and implement them to support their own work processes and the work processes of health care organizations in general. Currently, research is not guiding this process, which makes it important for quality managers to be able to access local knowledge. In addition, professional associations should develop skill catalogs for quality management education.
Retained lens fragment causing anterior uveitis four years after successful phacoemulsification
Authors: Shoukry Mira , Lopez-Ruiz Andrea , Patel Dharmendra , Shusko Alexander
Published: January 2025

Introduction:

Existing literature has detailed occurrences of retained cataract lens fragments identified days to weeks after cataract surgery. However, lens fragments in the anterior chamber remaining asymptomatic for several years are extremely rare, thus remaining a diagnostic challenge. A complex case of a retained lens fragment causing anterior uveitis 4 years after phacoemulsification is presented.

Patient and Clinical Findings:

A 76-year-old woman presented with a chief concern of right eye pain, photosensitivity, and blurred vision after head trauma.

Diagnosis, Intervention, and Outcomes:

Diagnostic imaging ruled out the presence of orbital fracture or globe deformity leading to an initial diagnosis of traumatic iritis. Initial management with topical corticosteroids did not improve symptoms. Subsequent slit lamp examination revealed a small cataract lens fragment in the anterior chamber leading to a diagnosis of anterior uveitis secondary to the retained lens. Anterior chamber washout was performed with successful removal of the fragment, and the patient reported resolution of pain and photosensitivity postoperatively.

Conclusions:

Owing to its rarity, diagnostic and treatment standards for retained cataract lens fragments have not yet been sufficiently explored. This case suggests that head trauma may be a precipitating event causing delayed onset of symptoms. Cataract lens retention should be considered in patients presenting with uveitis years after cataract surgery.
Work Disability Prevention and Management
Authors: Kertay Les , Caruso Garson M. , Baker Nancy A. , Christian Jennifer H. , Cook Jerald L. , Das Rajiv , Goertz Michael , McKenzie Judith Green , Martin Douglas W. , Melhorn J. Mark , Mohammad Amir , Pransky Glenn , Warren Pamela A. , Mandel Steven , Harris Jeffrey S. , Hegmann Kurt T. ,   ACOEM Evidence-based Practice Work Disability and Prevention and Management Panel
Published: January 2025

Objective: This abbreviated version of the American College of Occupational and Environmental Medicine’s (ACOEM) Work Disability Prevention and Management Guideline reviews the available evidence and provides recommendations to clinicians regarding interventions to help patients remain at or return to work.

Methods: Systematic literature reviews were conducted. Studies were graded and evidence tables were created, with involvement of a multidisciplinary expert panel that evaluated the evidence and finalized recommendations for all clinical questions. Extensive peer review was performed. Consensus recommendations were formulated when evidence was lacking.

Results: Evidence-based recommendations have been developed to guide work disability prevention and management.

Conclusion: Clinicians should utilize quality evidence in determining treatment methods to prevent and alleviate work disability for workers.
Non-enhanced abbreviated MRI as a periodic surveillance protocol for colorectal liver metastases compared with contrast-enhanced CT: a prospective observational study
Authors: Liu Jingjing , Ye Lechi , Miao Gengyun , Rao Shengxiang , Zeng Mengsu , Liu Liheng
Published: January 2025

Background:

Adopting appropriate noninvasive radiological method is crucial for periodic surveillance of liver metastases in colorectal cancer (CRC) patients after surgery, which is closely related to clinical management and prognosis. This study aimed to prospectively enroll stage II-III CRC patients for the surveillance of liver metastases, and compare the diagnostic performance of contrast-enhanced CT (CE-CT) and non-enhanced abbreviated MRI (NE-AMRI) during this process.

Methods:

587 CRC patients undergoing radical resection of the primary tumor were evaluated by 1 to 3 rounds of surveillance tests, consisting of abdominal CE-CT and contrast-enhanced MRI (CE-MRI) within 7 days at 6-month intervals. Subsequently, images of NE-AMRI were extracted from the CE-MRI examination, paired CE-CT and NE-AMRI analysis were performed. The lesion-based detection rates between two protocols were compared and a subgroup analysis was performed in lesions with the size of ≤ 10 mm. The patient-based sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the areas under the curves (AUCs) of CE-CT and NE-AMRI in each round were evaluated. Finally, the relationship between the diagnostic accuracy of two protocols and characteristics of patients was explored.

Results:

The lesion-based detection rates of NE-AMRI in three rounds were all significantly higher than that of CE-CT (p < 0.001, p < 0.001, p = 0.003, respectively). In the subgroup analysis of lesions ≤ 10 mm, NE-AMRI also performed better than CE-CT (p < 0.001, p = 0.002, p = 0.005, respectively). The patient-based sensitivities, specificities, NPVs, PPVs of NE-AMRI were higher than those of CE-CT in three rounds of surveillance. The AUCs for NE-AMRI were all significantly better than that for CE-CT in each round (p = 0.015, p = 0.045, p = 0.009, respectively). Furthermore, patient BMI and fatty liver disease had impacts on the diagnostic accuracy of CE-CT protocol, but not on NE-AMRI protocol.

Conclusion:

NE-AMRI may be a promising periodic surveillance tool for CRC patients after surgery to increase diagnostic accuracy of liver metastases, developing personalized clinical management and improving prognosis, simultaneously avoiding side-effects associated with ionizing radiation and contrast agents.
The efficacy of diltiazem, glyceryl trinitrate, nifedipine, minoxidil, and lidocaine for the medical management of anal fissure: a systematic review and network meta-analysis of randomized controlled trials
Authors: Wang Cong , Ni Jing , Xiong Yi , Chen Jinlan , Li Binting , Xu Li
Published: January 2025

Purpose:

Anal fissure (AF) is a common anorectal condition causing pain, bleeding, and other perianal discomfort. This study conducts a network meta-analysis to compare the efficacy and side effect profiles of pharmacological treatments for AF, including diltiazem, glyceryl trinitrate, nifedipine, minoxidil, and Lidocaine.

Methods:

Following PRISMA guidelines, a systematic review and network meta-analysis were performed. Randomized controlled trials (RCTs) comparing non-surgical treatments for AF were sourced from PubMed, Cochrane Library, Embase, and Medline. The primary outcome was AF healing, with secondary outcomes including recurrence rates, pain reduction (visual analog scale), and adverse effects. Statistical analysis utilized odds ratios and SUCRA (Surface Under the Cumulative Ranking) values for treatment ranking.

Results:

Twenty-two randomized controlled trials (RCTs) involving a total of 1,770 participants were included in the analysis. Nifedipine demonstrated the highest healing rate, followed by diltiazem and minoxidil. Lidocaine exhibited the lowest healing rate. Diltiazem had the lowest recurrence rate and was the most effective in pain reduction, whereas lidocaine had the highest recurrence rate and was the least effective in alleviating pain. The incidence of adverse effects with minoxidil was relatively low, second only to lidocaine, while glyceryl trinitrate had the highest rate of adverse effects.

Conclusion:

Nifedipine had the highest healing rate and should be considered as a first-line non-surgical treatment for anal fissures. Given the elevated incidence of adverse reactions associated with nitroglycerin, its use should be avoided in order to minimize the risk of significant toxicities and side effects. Additionally, because of its outstanding analgesic properties, diltiazem is recommended as the preferred option for patients with heightened sensitivity to pain, but more studies are needed to evaluate its efficacy.
Construction of an Artificially Intelligent Model for Accurate Detection of HCC by Integrating Clinical, Radiological, and Peripheral Immunological Features
Authors: Wang Yangyang , Chi Shengqiang , Tian Yu , Li Xueyao , Zhang Hang , Xu Yiting , Huang Chao , Gao Yiwei , Jin Gaowei , Fu Qihan , Cao Wanyue , Chen Cao , Ding Haonan , Zhang Yuquan , Hong Yupeng , Li Junjian , Sun Xu , Li Enliang , Zhang Yuhua , Yao Weiyun , Liu Runtian , Hua Yongfei , Huang Haifeng , Xu Minghui , Zhang Bo , Tao Weifeng , Yang Tianxing , Gao Yuming , Wang Xiaoguang , Lin Cheng , Li Jingsong , Zhang Qi , Liang Tingbo
Published: January 2025

Background:

Integrating comprehensive information on hepatocellular carcinoma (HCC) is essential to improve its early detection. We aimed to develop a model with multi-modal features (MMF) using artificial intelligence (AI) approaches to enhance the performance of HCC detection.

Materials and methods:

A total of 1,092 participants were enrolled from 16 centers. These participants were allocated into the training, internal validation, and external validation cohorts. Peripheral blood specimens were collected prospectively and subjected to mass cytometry analysis. Clinical and radiological data were obtained from electrical medical records. Various AI methods were employed to identify pertinent features and construct single-modal models with optimal performance. The XGBoost algorithm was utilized to amalgamate these models, integrating multi-modal information and facilitating the development of a fusion model. Model evaluation and interpretability were demonstrated using the SHapley Additive exPlanations method.

Results:

We constructed the electronic health record, BioScore, RadiomicScore, and DLScore models based on clinical, radiological, and peripheral immunological features, respectively. Subsequently, these single-modal models were amalgamated to develop an all-in-one MMF model. The MMF model exhibited enhanced performance compared to models comprising only single-modal features in detecting HCC. This superiority in performance was confirmed through the internal and external validation cohorts, yielding area under the curve (AUC) values of 0.985 and 0.915, respectively. Additionally, the MMF model improved the detection ability in subpopulations of HCCs that were negative for alpha-fetoprotein and those with small size, with AUC values of 0.974 and 0.996, respectively.

Conclusions:

Integrating multi-modal features improved the performance of the model for HCC detection.
Prevalence of colonoscopy-related adverse events in older adults aged over 65 years: a systematic review and meta-analysis
Authors: Lu Qing , Lv Xiu-He , Tang Li , Yan Hai-Lin , Xia Bi-Han , Wang Zhu , Yang Jin-Lin
Published: January 2025

Background:

This study aims to assess the occurrence of colonoscopy-related adverse events (AEs) in adults aged over 65 years, as there has been a significant increase in the prevalence of colonoscopies among the elderly compared to two decades ago.

Methods:

A comprehensive search was conducted on June 3rd, 2024, using the PubMed, Embase, and Cochrane Library databases. Meta-analyses were performed using the generalized linear mixed model, and the results were presented as pooled rates with relevant 95% confidence intervals (CIs).

Results:

We retrieved a total of 15,417 records and included 13 population-based studies. The overall rates of colonoscopy-related perforation and bleeding in the elderly population were 7.8 (95% CI 5.5-11.2; I2 = 94%) and 23.5 (95% CI 9.0-61.3; I2 = 100%) per 10,000 colonoscopies, respectively. The “ > 80 years” group had a significantly higher risk of perforation (RR 2.55; 95% CI 1.15-5.66; I2 = 79%) and bleeding (RR 1.23; 95% CI 1.02-1.48; I2 = 0%) compared to the “65-80 years” group. For screening colonoscopies, the rates of perforation and bleeding were 8.5 (95% CI 7.1-10.2; I2 = 0%) and 27 (95%CI 9.0-81.0; I2 = 99%) per 10,000 colonoscopies, respectively. For diagnostic colonoscopies, the rates of perforation and bleeding were 18 (95% CI 16.2-20.0; I2 = 1%) and 16 (95% CI 8.1-31.3; I2 = 98%) per 10,000 colonoscopies, respectively. Compared to non-therapeutic colonoscopies, therapeutic procedures exhibited higher rates of both perforation (1.5 vs. 0.4 per 10,000 colonoscopies) and bleeding (7.1 vs. 0.5 per 10,000 colonoscopies). The prevalence of cardiopulmonary AEs in elderly population is relatively high, although the definition used vary across different studies.

Conclusions:

We conducted a comprehensive analysis on the prevalence of AEs related to colonoscopy in older adults. Overall, the AEs rates remain low. However, we emphasize the importance of enhancing safety protocols to further minimize risks, ensuring that the benefits of colonoscopy continue to outweigh the risks, especially for patients over the age of 80.
Incidence and Risk Factors for Orthopedic Device-Related Pressure Injuries: A Systematic Review and Meta-Analysis
Authors: Guan Yaqi , Zheng Lidan , Zhu Yueying
Published: January 2025

BACKGROUND:

As orthopedic trauma increases, the resultant use of orthopedic devices and associated pressure injuries has increased.

OBJECTIVE:

This study aims to systematically evaluate the incidence and risk factors for orthopedic device-related pressure injuries.

METHODS:

A systematic review and meta-analysis was conducted by searching PubMed, Embase, Cochrane Library, Web of Science, ClNAHL, China National Knowledge Infrastructure, Wanfang Database, and Chinese BioMedical Literature Database from their inception until November 30, 2023. The population included adult orthopedic surgery patients aged 18 and older. Studies included case-control, cohort, or cross-sectional designs reporting risk factors, incidence, or predictors of orthopedic device-related pressure injuries published in Chinese or English. Exclusion criteria included unavailable full text, duplicate publications, reviews, animal studies, and conference abstracts. Two researchers independently screened the literature, extracted the data, and assessed the quality of the literature.

RESULTS:

A total of eight papers involving 3,783 patients were included. Meta-analysis showed that the incidence of orthopedic device-related pressure injuries was 12.0%. Significant risk factors included duration of device wear [OR 1.197, 95% Cl (1.025, 1.369), p = .016] and the length of stay [OR 1.144, 95% CI (1.096, 1.199), p < .001].

CONCLUSION:

The duration of device wear and length of stay are key factors contributing to orthopedic device-related pressure injuries. Clinicians should actively monitor and manage these factors to reduce the risk of these injuries.
Impact of Vibrations and Rapid Decelerations on SemontPLUS Maneuver Efficacy: An In Vitro Study
Authors: Morrison Miranda , Bucciarelli Aurelia , Korda Athanasia , Goetz Leonie Sarah , Caversaccio Marco D. , Obrist Dominik , Mantokoudis Georgios
Published: January 2025

Objective

We aimed to investigate the effect of adding “rapid decelerations” and “vibrations” during a SemontPLUS maneuver on the dynamics of the inner ear and the success rate of canalolithiasis repositioning.

Methods

We used a previously described upscaled (5×) in vitro model of the posterior semicircular canal of the inner ear to analyze the trajectory of a single and clumped surrogate otolith particle (metallic sphere) during a SemontPLUS maneuver (−60 degrees below earth horizontal) on a repositioning chair (TRV). We compared the angular displacement of these particles with and without the application of “vibrations” or “rapid decelerations” using TRV. We recorded the success rates of the SemontPLUS maneuver for each condition.

Results

After the first step of the SemontPLUS, the application of “vibrations” increased the angular displacement of single particles from 119.9 to 125.9 degrees and clumps from 106.7 to 122.8 degrees. Clumps traveled shorter distances than single particles. “Rapid decelerations” also increased the angular displacement from 119.9 to 123.4 degrees and from 106.7 to 111.7 degrees for singles and clumps, respectively. “Vibrations” and “rapid decelerations” applied on the in vitro model resulted in enhanced repositioning success rates to 60 and 73%, respectively.

Conclusions

Adding “rapid decelerations” or “vibrations” to the SemontPLUS maneuver increased otolith particle displacement and improved the repositioning success rates in an in vitro model. However, the effect size of these additional modalities on angular displacement is small, and their use in clinics to improve repositioning in the SemontPLUS would have to be supported by further clinical trials.
Co-infection of COVID-19 and pulmonary tuberculosis – impacts of COVID-19 and TB on the lungs and issues related to liver damage: a case report
Authors: Bereda Gudisa
Published: January 2025

Background:

Co-infection with COVID-19 and tuberculosis (TB) frequently results in fever, coughing, hypotension, a changed blood cell count, raised liver enzymes, and decreased hemoglobin. Significant concern is also raised about the lung damage brought on by severe COVID-19 and the associated sensitivity to TB.

Case presentation:

On 19 May 2022, a retired Black African woman in her 50s went to the emergency room with a sore throat, a 12 kg weight loss in the previous month, and a day of shortness of breath. The patient arrived at the emergency room with weak muscles, a fever, a productive cough, a lack of appetite, a headache, and night sweats that had lasted for three days. On chest auscultation, there were reduced breath sounds in the right middle and upper lungs. After 36 hours, a throat swab polymerase chain reaction test produced positive findings, confirming the presence of the COVID-19 infection. The patient required continuous oxygen at a rate of 4 L per minute via a nasal cannula for the first 5 days while in the hospital, and she is still taking her anti-tubercular medications. In order to combat hospital-acquired infections, she was given therapy with a broad-spectrum antibiotic consisting of 1 g of intravenous ceftriaxone administered daily for 5 days.

Clinical discussion:

Patients with active pulmonary TB disease have a worse prognosis and can develop COVID-19. Both TB and COVID-9 are infectious diseases that primarily affect the lungs. COVID-19-related mortality is significantly higher in people with active pulmonary tuberculosis.

Conclusion:

Among the most serious health concerns currently affecting the world are COVID-19 and Mycobacterium TB. An increased risk of severe COVID-19 infection is associated with TB infection.
Novel ABCB4 mutation in a female patient with progressive familial intrahepatic cholestasis type 3: a case report and literature review
Authors: Sharabati Israa , Qafesha Ruaa Mustafa , Mustafa Mohamed M.M. , Hindawi Mahmoud Diaa , Rasras Heba , Bannoura Sami , Abdulrazzak Mohammed , Shamasneh Ibrahim
Published: January 2025

Introduction and importance:

Progressive familial intrahepatic cholestasis (PFIC) is an uncommon disorder inherited in an autosomal recessive manner. PFIC type 3 (PFIC-3) results from mutations in the ABCB4 gene. This type typically advances from chronic cholestasis, which may occur with or without jaundice.

Case presentation:

A 16-year-old female presented with abdominal pain, later developing liver complications. Genetic testing revealed a novel ABCB4 gene mutation linked to cholestasis. Diagnosed with PFIC-3, she was treated with ursodeoxycholic acid (UDCA) and vitamins, leading to improved liver function. Despite uncertain clinical significance of the mutation, predictions suggested it was damaging. Her liver function fully recovered, and she remained in remission during follow-up visits.

Clinical discussion:

PFIC3 is a rare, autosomal recessive disorder causing cholestasis and liver damage. Our study reported a young female with a novel ABCB4 mutation who responded well to UDCA. Diagnosis relies on comprehensive evaluation, and treatment options include UDCA, surgery, and liver transplantation.

Conclusion:

PFIC-3 gene must be considered while evaluating a young female with symptoms of cholestasis.
Oral anticoagulant (OAC) monotherapy vs. dual-antithrombotic therapy (DAT) in patients with atrial fibrillation and coronary artery disease; a meta-analysis of four randomized controlled trials
Authors: Shahid Sufyan , Saeed Humza , Iqbal Minahil , Batool Ayesha , Zehra Mishal , Majeed Uzair , Abdullah Muhammad , Hussain Anum Touseef , Iftikhar Hammad Ahmad , Shah Yusuf Ali , Abid Muhammad Shuaib , Zahidi Muzaffar Ali , Ch Iftikhar Ali , Khalid Salman , Tahirkheli Naeem Khan
Published: January 2025

Background:

Dual-antithrombotic therapy (DAT) is recommended for patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) but carries an increased risk of bleeding. Recent trials suggest oral anticoagulant (OAC) monotherapy as a safer alternative, but data remains limited. We conducted a meta-analysis to compare OAC monotherapy with DAT in this population.

Methods:

A comprehensive literature search was conducted using PubMed, Embase, and Cochrane Central Library to identify randomized controlled trials (RCTs) that compared OAC monotherapy with DAT in patients with AF and stable CAD. A bivariate random-effects model was used to perform meta-analyses. Statistical analyses were conducted using R Software 4.4.1, with a significance level of P < 0.05. Heterogeneity was assessed using I
2 statistics, and the quality of studies was evaluated using the revised Cochrane risk-of-bias tool.

Results:

Four RCTs with a total of 4123 patients (20.2% females) were included. The mean age of the participants was 74 years. The results showed a significant reduction in major or clinically relevant nonmajor bleeding (risk ratio [RR]: 0.52; 95% confidence interval [CI]: 0.34–0.80; P = 0.003) in the OAC monotherapy group compared to the DAT group. However, net adverse clinical events (NACE) (RR: 0.67; 95% CI: 0.45–1.01; P = 0.054), major ischemic events (RR: 0.98; 95% CI: 0.62–1.53; P = 0.91) and all-cause mortality (RR: 0.94; 95% CI: 0.49–1.83; P = 0.87) were comparable between the two groups.

Conclusions:

In patients with AF and stable CAD, OAC monotherapy reduced the risk of major bleeding, with no significant differences in NACE, major ischemic events, or all-cause mortality as compared to DAT.
Traditional Chinese Baduanjin Exercise With Nursing and Peer Group Support in the Care of Patients After Allogeneic Hematopoietic Stem Cell Transplantation
Authors: Guo Jianli , Liu Lingyu , He Cuifen , Ma Xuhong , Liu Huimin , Zheng Zhuanzhen , Zhang Yuanjuan
Published: January 2025

Background

Sleep problems and anxiety are imperative for continuity of care and rehabilitation in patients following an allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Objective

The aim of this study was to investigate the impact on anxiety, sleep quality, and survival of integrating traditional Chinese Baduanjin exercises to track the control of continuous care in patients receiving an allo-HSCT.

Methods

A total of 75 patients discharged after receiving an allo-HSCT were included. The control group received routine continuity of care, whereas the intervention group carried out Baduanjin exercises combined with 3C (company, clinical nurse, community nurse) support. Follow-up data were compared between the 2 groups using the Generalized Anxiety Disorder 7-item scale score for anxiety and the Pittsburgh Sleep Quality Index for sleep quality.

Results

Both the control and intervention groups showed that continuity of care measures were effective for improving sleep quality (P < .05). The continuity of care model and the time effect in the intervention group during the first 6 months of follow-up were associated with patient anxiety (P < .05). The median survival time was 26 months in the control group and 41 months in the intervention group, with this difference being statistically significant (P = .0239).

Conclusion

The 3C support group improved patients’ compliance with continuity of care. Also, integrating Baduanjin exercises with continuous care alleviated anxiety, improved sleep quality, and prolonged median survival time in patients after an allo-HSCT.

Implications for Practice

The results indicate this model of care is potentially suitable for clinical promotion and application of allo-HSCT patients.
Effects of omega-3 polyunsaturated fatty acids on inflammation resolution and angiogenesis in fat grafts in a controlled mouse model
Authors: Li Ming , Li Facheng
Published: January 2025

Background:

The upregulation or delay of acute inflammation at any stage limits fat graft survival. Active endogenous inflammation resolution mechanisms and mediators are novel therapeutic tools for inflammation. This study explored the effects of supplementation of omega-3 polyunsaturated fatty acids (PUFAs) deriving specialized proresolving mediators (SPMs) on postoperative inflammation and graft survival in vivo.

Methods:

Fish oil (FO) (or saline for the control group) was intragastrically administered in the C57BL/6N mouse fat graft model for a week before and after transplantation. The mice were euthanized at 3, 7, 14, 30, or 90 days posttransplantation. Serum C-reactive protein (CRP) concentration was determined via enzyme-linked immunosorbent assay (ELISA); gene expression levels of inflammatory factors, perilipin-1 and vascular endothelial growth factor (VEGF) in the grafts were analyzed via quantitative real-time PCR (QPCR); hematoxylin and eosin (H&E), masson’s trichrome, immunohistochemistry (IHC) and immunofluorescence (IF) staining were performed.

Results:

Omega-3 PUFAs reduced the serum CRP concentration. Additionally, in the grafts of FO group, proinflammatory factors expression was reduced while anti-inflammatory factors expression was increased; the CD11b+ IF intensity at Days 14 and 30 was reduced, the F4/80+/CD11b+ ratio at Days 3 and 7 and the CD206+/F4/80+ ratio at Days 7, 14, and 30 were increased, consistent with the results of IHC control staining (CD11b, F4/80 and CD206); the gene expression of VEGF at Day 14 and perilipin-1 at Days 30 and 90 were increased; the perilipin-1+ %area and CD31+ %area at Day 90 were increased; inflammatory cell infiltration and fibrosis were decreased.

Conclusion:

Omega-3 PUFAs can enhance inflammation resolution and angiogenesis and promotes fat graft survival in a controlled mouse model.
Fatal overdoses among people with HIV experiencing nonfatal overdoses in British Columbia, Canada
Authors: Marziali Megan E. , Kooij Katherine W. , Zhang Wendy , Budu Michael , Martins Silvia S. , Montaner Julio S.G. , Hogg Robert S.
Published: January 2025

The breadth of the overdose crisis is underestimated because of a lack of quantifying nonfatal overdoses. We estimate the proportion of nonfatal overdoses among all people with HIV (PWH) in British Columbia, Canada, and the prevalence of fatal overdoses among people who had a nonfatal overdose, stratified by sex. A small proportion of PWH who experienced a nonfatal overdose subsequently died of a fatal overdose, signaling opportunities for crucial interventions and treatment to prevent overdose death.
Epstein–Barr virus-associated smooth muscle tumor with multiple lesions in a patient with AIDS
Authors: Zhen Xiu-Mei , Liu Zhi-Hong , Zhang Lu , Xiao Fang , Liao Bo-Ming
Published: January 2025

Epstein–Barr virus-associated smooth muscle tumors (EBV-SMTs) represent a rare category of soft tissue tumors that are predominantly seen in individuals with compromised immune systems. Pathologically, EBV-SMT has malignant potential because of its unpredictable nature. These tumors can manifest at various anatomical sites or even multiple lesions in different locations. Among the various forms of EBV-SMT, individuals with HIV infection or AIDS exhibit the poorest survival outcomes. The efficacy of antiretroviral therapy (ART), either as a standalone treatment or in combination with localized tumor interventions remains uncertain. The highlights of this article are the clinical diversity and various treatment possibilities for multisite AIDS-related EBV-SMT.
Aging with HIV and HIV-associated neurocognitive impairment
Authors: Bennett Teresa , Walmsley Sharon , Bendayan Reina
Published: January 2025

Antiretroviral therapy (ART) is the most effective therapeutic intervention for HIV infection. With improved survival, comorbidities, including neuropsychiatric and HIV-associated neurocognitive impairment (NCI) are of increasing concern to aging people with HIV (PWH). The clinical features and the inter-individual variability of the aging process confound the elucidation of the diagnosis and underlying mechanisms of cognitive dysfunction in aging PWH. Herein, we review the clinical aspects of HIV-associated NCI in the aging PWH contrasting to the normative neuro-aging seen in people without HIV (PWoH) and address the growing role of biomarkers to predict the onset of age-related diseases in PWH and their clinical significance. There is an urgent need for further research into the role of specific immune brain biomarkers in predicting the aging process and how these biomarkers may assist in understanding the mechanisms and possible prognosis of age-related neurocognitive comorbidities in aging PWH as an endpoint for interventional studies.
Mpox: emergence following smallpox eradication, ongoing outbreaks and strategies for prevention
Authors: Bryant Amy E. , Shulman Stanford T.
Published: January 2025

Purpose of review

This review focuses on the temporal relationship between the discontinuation of the global smallpox eradication effort with the rise of mpox in Africa and worldwide. It also discusses the global 2022 clade II mpox epidemic and the current 2024 clade I mpox outbreak. Newer findings on viral evolution and pathogenesis, plus current and future strategies for disease prevention, are reviewed.

Recent findings

The temporal association between the incidence of mpox and the World Health Organization's Global Smallpox Eradication Program (GSEP) is presented. The 2022 global mpox epidemic is discussed. Recent data show that clade IIb monkeypox virus (MPXV)-2022 has novel genetic features supporting a greater propensity for mutations that may be responsible for enhanced human-to-human transmissibility, increased disease severity and accelerated viral evolution. In 2023, another outbreak of mpox began in Africa, this time due to the potentially more virulent MPXV clade Ib strains. This outbreak remains ongoing in Africa, and clade Ib mpox cases have recently been reported elsewhere including the United States and Great Britain. The World Health Organization has deemed mpox to be a global public health emergency. Two smallpox vaccines are approved for mpox prevention in the United States; a third smallpox vaccine and an improved diagnostic test have recently received WHO Emergency Use authorization. Newer mRNA-based vaccines for evolving orthopoxvirus infections are discussed.

Vaccination to prevent smallpox provides immunologic cross-protection against infection with other members of genus Orthopoxvirus, including mpox. Discontinuation of the global smallpox eradication program in the 1980s and the subsequent waning of herd immunity contributed to the 2022 multinational epidemic of human clade IIb mpox infections. A second multinational outbreak with clade Ib MPXV is ongoing. Vaccination against smallpox remains the gold standard for mpox prevention, however newer multiepitope mRNA-based vaccines are in development and hold promise for prevention of mpox and other orthopoxvirus outbreaks.
Effect of Saline Sealing After CT-Guided Lung Biopsy on Pneumothorax and Hemoptysis
Authors: Zhang Xiaoxia , An Jianli , Wu Jingpeng , Jing Xiuxiu , Lu Hongzhi , Tian Ye
Published: January 2025

Objective:

To confirm that saline sealing of the needle trace after computed tomography (CT)-guided lung biopsy reduces the incidence of pneumothorax and chest tube insertion, and to observe its effects on pulmonary hemorrhage and hemoptysis.

Materials and Methods:

Patients who underwent CT-guided lung biopsy at our hospital between January 2018 and January 2024 were included in the study. Patients were divided into 2 groups according to whether the needle trace was sealed with saline after tissue sampling. Patient baseline characteristics, lung lesion factors, procedural factors, pneumothorax rates, chest tube insertion rates, pulmonary hemorrhage rates, and hemoptysis rates were recorded.

Results:

The incidence of pneumothorax was 28.9% (38/132) and 15.8% (15/95) in groups A (control) and B (with sealed traces), respectively (P=0.002). The incidence of pneumothorax requiring chest tube insertion was significantly lower in group B than in group A (1.1% vs. 6.8%; P=0.048). The incidence of pulmonary hemorrhage was similar between the 2 groups (38.6% vs. 42.1%; P=0.599). No significant difference was observed in the hemoptysis of patients in groups A and B (6.8% vs. 10.5%; P=0.320). In the binary logistic regression analysis, significant risk factors for pneumothorax included lack of saline sealing, smaller lesion size, multiple passes through the pleura, and the lateral decubitus position. Smaller lesions and longer biopsy trace lengths were independent risk factors for hemoptysis.

Conclusions:

Sealing the needle trace with saline significantly reduced the incidences of pneumothorax and chest tube insertion due to pneumothorax. Moreover, it did not significantly increase the incidence of pulmonary hemorrhage or hemoptysis. This technique is recommended for use in CT-guided lung biopsies.
Refractory Psychosis as a Red Flag for End of Life in Individuals With Dementia With Lewy Bodies
Authors: Armstrong Melissa J. , Galvin James E. , Manning Carol , Boeve Bradley F. , Pontone Gregory M. , Taylor Angela S. , Patel Bhavana , Fleisher Jori E. , Maixner Susan M.
Published: January 2025

Objectives:

Many individuals with dementia with Lewy bodies (DLB) die of disease-related complications, but predicting the end of life can be challenging. We identified a phenotype associated with approaching end of life.

Methods:

We present 4 exemplar cases where individuals with DLB experienced refractory psychosis before death. We reviewed codebooks and quotes from 3 studies regarding end-of-life experiences in DLB to identify experiences that aligned with this phenotype.

Results:

In addition to the 4 cases, family caregivers in prior studies described prominent worsening of psychosis before death in some individuals with DLB. The worsening often occurred several months before death and was sometimes associated with rapid deterioration. Worsening psychosis was the prominent symptom and was not initially accompanied by cognitive or physical decline. In many cases, the refractory psychosis resulted in inpatient psychiatric hospitalization or residential care, but these scenarios were challenging because of the individual’s behavior.

Conclusion:

Refractory psychosis in DLB, particularly out of proportion to other symptoms, may be a signal of approaching the end of life. More research is needed to understand this phenomenon and to develop effective and safe treatments for psychosis in DLB.
Language Mapping With rTMS in Healthy Pediatric Patients
Authors: Vedala Kishore , Kadis Darren S. , Vannest Jennifer , Sino Sara , Horn Paul S. , Maue Ellen , Williamson Brady , Mangano Francesco T. , Leach James L. , Greiner Hansel M.
Published: January 2025

Purpose:

Repetitive transcranial magnetic stimulation (rTMS) is a potentially effective, noninvasive tool for language mapping. However, there is a paucity of data in pediatric patients. In this study, we aimed to map language sites in healthy pediatric participants with navigated rTMS.

Methods:

Children aged 5 to 18 years underwent bilateral language mapping. Stimulation was delivered at 5 Hz during visual-naming and auditory verb-generation tasks in 1 to 2 second bursts. We targeted 33 standardized sites per hemisphere. In total, 34 participants completed the visual-naming task, and 27 participants completed the verb-generation task. Lateralization index (LI) and Wilcoxon signed-rank test were used to assess language lateralization. A difference of least squares means model was developed to determine the prevalence of visual-naming and verb-generation errors within lobar and hemispheric regions.

Results:

Weak left lateralization was observed for visual naming (LI 0.14; p = 0.038), and no lateralization was observed for verb generation (LI 0.08; p = 0.269). Using multiple least squares regression, left hemisphere errors were more likely to occur than right hemisphere errors for visual naming (OR 1.23; 95% CI 1.06–1.44), but no lateralization effect was observed for verb-generation errors (OR 1.11; 95% CI 0.93–1.27).

Conclusions:

rTMS is likely to identify bilateral or weakly left-lateralized language sites in pediatric patients during language tasks. Although rTMS can be a useful noninvasive method for identifying potential language-positive sites, our results in healthy controls suggest that it cannot be used as a singular method for language mapping in the preoperative setting.
Microbial surveillance versus cytokine responsiveness in native and non-native house sparrows
Authors: McCain Kailey M. , Mansilla Gabby , Sheldon Elizabeth L. , Zimmer Cedric , Schrey Aaron W. , Rowe Melissah , Dor Roi , Kohl Kevin D. , Søraker Jørgen S. , Jensen Henrik , Mathot Kimberley J. , Vu Thinh , Phuong Ho Thu , Jimeno Blanca , Buchanan Katherine L. , Thiam Massamba , Briskie James , Martin Lynn B.
Published: January 2025

The success of introduced species often relies on flexible traits, including immune system traits. While theories predict non-natives will have weak defences due to decreased parasite pressure, effective parasite surveillance remains crucial, as infection risk is rarely zero and the evolutionary novelty of infection is elevated in non-native areas. This study examines the relationship between parasite surveillance and cytokine responsiveness in native and non-native house sparrows, hypothesizing that non-natives maintain high pathogen surveillance while avoiding costly inflammation. We made this specific prediction, as this pattern could enable invaders to effectively mitigate pathogen risk in a manner commensurate with the life-history priorities of a colonizing organism (i.e. rapid maturation and high reproductive effort). To test this hypothesis, we measured
TLR
-2 and
TLR
-4 expression, markers of pathogen surveillance and cytokine responses (changes in
IL-1β
and
IL-10
), regulators of inflammation, to a simulated bacterial infection. In non-native sparrows, we found that as
TLR
-4 expression increased,
IL-1β
and
IL-10
responses decreased, a relationship not observed in native sparrows. Additionally, higher body condition predicted larger
IL-1β
and
IL-10
responses in all birds. These findings suggest that high
TLR-4
surveillance may mitigate strong inflammatory responses in non-native sparrows, with pathological and resource-based costs driving immune variation among and within populations.
Time-varying reproduction number estimation: fusing compartmental models with generalized additive models
Authors: Pang Xiaoxi , Han Yang , Tressier Elise , Abdul Aziz Nurin , Pellis Lorenzo , House Thomas , Hall Ian
Published: January 2025

The reproduction number, the mean number of secondary cases infected by each primary case, gives an indication of the effort required to control the disease. Beyond the well-known
basic
reproduction number, there are two natural extensions, namely the
control
and
effective
reproduction numbers. As behaviour, population immunity and viral characteristics can change with time, these reproduction numbers can vary over time. Real-world data can be complex, so in this work we consider a generalized additive model to smooth surveillance data through the explicit incorporation of day-of-the-week effects, to provide a simple measure of the time-varying growth rate associated with the data. Converting the resulting spline into an estimator for both the control and effective reproduction numbers requires assumptions on a model structure, which we here assume to be a compartmental model. The reproduction numbers calculated are based on both simulated and real-world data, and are compared with estimates from an already existing tool. The derived method for estimating the time-varying reproduction number is effective, efficient and comparable with other methods. It provides a useful alternative approach, which can be included as part of a toolbox of models, that is particularly apt at smoothing out day-of-the-week effects in surveillance.
Quantifying the configurational complexity of biological systems in multivariate ‘complexity space’
Authors: Rock Tim , Wills Matthew A.
Published: January 2025

An increasing number of evolutionary studies seek to quantify the morphological complexity of organisms, particularly those comprising serially homologous elements at different hierarchical levels of organization. Numerous operational frameworks have been proposed for doing this, but most focus on one or multiple conflated aspects of what is really a multidimensional concept. Here, we advocate the use of ‘complexity spaces’: multidimensional spaces defined by different vectors of complexity. We explore their application to biological systems composed of homologous parts and identify three axes on which those systems differ: part number, part differentiation and the regularity of that differentiation. Such complexity spaces can be constructed for systems at different hierarchical levels of biological organization. To illustrate this, we explore the complexity spaces for trilobite body plans (comprising body segments of varying number and form), and for ant colonies (comprising differentiated worker polymorphisms of varying number and form within a ‘superorganism’). Many different complexity spaces are possible, but all seek to distinguish different aspects of complexity within an information-theoretic framework, and thereby to clarify patterns of complexity evolution.