bluuebunny/crossref_metadata_2025 huggingface dataset:
Resolving velocity distribution function parameters from observations with significant Poisson statistical uncertainty
Authors: Nicolaou G , Livadiotis G , Sarlis N , Ioannou C
Published: December 2024

Several analyses of particle observations aim to determine the distribution functions of physical parameters that characterize observed systems. Some standard analysis methods determine these distributions by fitting mathematical models to the data. The accuracy of the fitting techniques depends on the treatment of the observations and their uncertainties. Here, we evaluate the performance of three fitting techniques by applying them to simulated electron observations, which are governed by the Poisson distribution. We specifically examine and quantify the accuracy of two standard chi-squared minimization techniques and a maximum-likelihood method. The chi-squared minimization techniques simplify the analysis by treating the measurement uncertainties as Gaussian errors. Although such a simplification reduces the complexity of the calculations in some occasions, it may lead to systematic errors in the determined parameters. On the other hand, the maximum-likelihood method considers the exact Poisson probability for each data-point and returns accurate parameters for all the examples we examine here. We highlight the importance of using the appropriate method when the observations are accompanied by significant statistical uncertainty. Nevertheless, the methods we examine here, converge to the same answer as the statistical uncertainty of the observations reduces.
Bark water vapor conductance varies among temperate forest tree species and is affected by flooding and stem bending
Authors: Zhou Yinuo , Rosseau Grace , Dao Viet , Wolfe Brett T
Published: December 2024

Bark water vapor conductance (gbark) modulates forest transpiration during droughts, when leaf transpiration is highly reduced. If disturbances such as windstorms and floods impact gbark, they could affect tree performance during subsequent droughts. Bark traits, particularly lenticel traits, likely drive variation in gbark and may influence the effects of disturbances on gbark. We assessed variation in gbark and bark traits in tree branches of 15 tree species in a temperate forest in Louisiana, USA, and performed experiments to test whether gbark in tree branches was affected by bending (simulating wind) and whether gbark of tree saplings was affected by soil flooding. Among tree species, mean branch gbark ranged from 2.22 to 12.02 mmol m−2 s−1. Stem bending increased gbark by 23% compared with unbent controls. Although gbark was unaffected by 38 days of flooding, after 69 days post-flood it was reduced by 41% compared with unflooded controls. The relationships between gbark and bark traits, including bark thickness, lenticel density and lenticel size, were inconsistent across the survey and experiments. Together, these results show that gbark is variable among species and mutable. Uncovering the drivers of gbark variation within and among trees, including exposure to extreme weather events, will inform projections of forest dynamics under climate change.
Contrasting the soil–plant hydraulics of beech and spruce by linking root water uptake to transpiration dynamics
Authors: Martinetti Stefano , Molnar Peter , Carminati Andrea , Floriancic Marius G
Published: December 2024

Tree water status is mainly determined by the amount of water taken up from roots and lost through leaves by transpiration. Variations in transpiration and stomatal conductance are often related to atmospheric conditions and leaf water potential. Yet, few experimental datasets exist that enable to relate leaf water potential, transpiration dynamics and temporal variation of root water uptake from different depths during soil drying. Here we explored the soil–plant hydraulic system using field measurements of water potentials and fluxes in soils, roots, stems and leaves of beech (Fagus sylvatica) and spruce (Picea abies) trees. Spruce maintained less negative water potentials than beech during soil drying, reflecting a more stringent stomatal control. While root water uptake depths were similar between species, water potentials in plant tissues of spruce were rather constant and less correlated across roots and the stem, possibly because of large water storage and hydraulic capacitance in these tissues. Root water uptake from deep soil layers increased during dry periods, particularly for beech. Our data suggest that species-specific root hydraulic conductance, capacitance and water uptake strategy are linked and affect transpiration dynamics. Thus, it is important to include such species-specific hydraulics when predicting transpiration rates based on plant water status.
Symbiotic nitrogen fixation in trees: patterns, controls and ecosystem consequences
Authors: Taylor Benton N
Published: December 2024

Symbiotic nitrogen fixation (SNF) represents the largest natural input of bioavailable nitrogen into the biosphere, impacting key processes spanning from local community dynamics to global patterns of nutrient limitation and primary productivity. While research on SNF historically focused largely on herbaceous and agricultural species, the past two decades have seen major advances in our understanding of SNF by tree species in forest and savanna communities. This has included important developments in the mathematical theory of SNF in forest ecosystems, experimental work on the regulators of tree SNF, broad observational analyses of tree N-fixer abundance patterns and increasingly process-based incorporation of tree SNF into ecosystem models. This review synthesizes recent work on the local and global patterns, environmental drivers and community and ecosystem effects of nitrogen-fixing trees in natural ecosystems. By better understanding the drivers and consequences of SNF in forests, this review aims to shed light on the future of this critical process and its role in forest functioning under changing climate, nutrient cycling and land use.
Impact of Masking Academic Metrics on Enrolling a Broadly Diverse and Mission-Aligned Student Body
Authors: Harrison Leila E. , Nandagopal Radha , Garcia David , Tomkowiak John
Published: December 2024

Problem

The June 2023 U.S. Supreme Court decision overturning affirmative action required medical schools to discontinue considering race/ethnicity in admissions decisions. Medical schools must now identify different strategies if they aim to recruit and admit applicants from groups underrepresented in medicine (URiM; race/ethnicity), as enrolling broadly diverse students remains critical for serving the U.S. population.

Approach

Washington State University Elson S. Floyd College of Medicine (established in 2015) has an admissions process that assesses academic metrics using national threshold combinations of undergraduate grade point averages (UGPAs) and Medical College Admission Test (MCAT) scores (published on school’s website), and legal residency in or ties to Washington state, as prescreening criteria for secondary applications. UGPAs and MCAT scores are then masked from further consideration, allowing for decisions to be made with a focus on mission-aligned criteria, such as certain personal attributes and lived experiences and coming from specific environments (i.e., educationally or socioeconomically disadvantaged backgrounds, rural communities, military service, or a member of a federally recognized Tribe).

Outcomes

In the last 5 admissions cycles (enrollment years 2018–2022), cohort data demonstrate that as the admissions funnel narrows and each subsequent pool is smaller than the preceding one, the representation of mission-aligned applicants increases, despite the masking of academic metrics. The most recently enrolled class (enrollment year 2022) of 80 had 14 (17.5%) URiM students, closely mirroring the state’s general population. The overall yield (acceptance/matriculation) has steadily improved with the last 2 cycles to 1.68:1 and 1.65:1, indicating slightly more than 1.5 times the number of offers needed to fill the class are being made.

Next Steps

Next steps include further refining the process by considering more granular data on applicants’ childhood community characteristics and rural background and examining how admissions data may correlate with residency and practice location and communities served.
Intraoperative Hyperspectral Imaging Predicts Early Allograft Dysfunction and Overall Survival in Liver Transplantation
Authors: Lederer Andri , Alina Geisler Antonia , Sucher Robert , Seehofer Daniel , Hau Hans-Michael , Scheuermann Uwe , Rademacher Sebastian
Published: December 2024

Objective:

This study explored the novel application of hyperspectral imaging (HSI) for in vivo allograft perfusion assessment during liver transplantation (LT) and its potential value for predicting early allograft dysfunction (EAD), graft, and overall survival (OS).

Background:

LT is a well-established therapy for acute and chronic liver diseases, with excellent outcomes. However, a significant proportion of recipients experience EAD, which affects graft and OS. EAD is associated with ischemia-reperfusion injury. HSI is a noninvasive imaging modality that provides information on tissue characteristics, such as tissue hemoglobin, water index, oxygenation, and perfusion.

Methods:

We included all patients who underwent orthotopic LT with full-size allografts between 2019 and 2021. HSI was performed 15 minutes after reperfusion of the donor liver and subsequently analyzed. Furthermore, we collected data on postoperative graft function and clinical outcomes.

Results:

A total of 73 LT recipients were included in this study. Around 56.9% had expanded criteria donors (N = 41). The mean model for end-stage liver disease score was 22 (±10). Eighteen patients (25%) had EAD. The statistical analysis demonstrated that recipients with EAD had significantly lower near-infrared (NIR) perfusion values after reperfusion. Recipients with low NIR had more pronounced reperfusion injury in postoperative laboratory studies. OS was significantly lower in recipients with low NIR than in those with high NIR (P = 0.049).

Conclusions:

HSI is a promising, noninvasive tool, offering real-time, detailed graft perfusion assessment during LT. The fusion of spatial and spectral information is unique to HSI, making it an essential imaging technology for the further development of AI applications in surgery.
Through the Pupils’ Lens: Multilingual Effort in First and Second Language Listening
Authors: Bsharat-Maalouf Dana , Schmidtke Jens , Degani Tamar , Karawani Hanin
Published: December 2024

Objectives:

The present study aimed to examine the involvement of listening effort among multilinguals in their first (L1) and second (L2) languages in quiet and noisy listening conditions and investigate how the presence of a constraining context within sentences influences listening effort.

Design:

A group of 46 young adult Arabic (L1)–Hebrew (L2) multilinguals participated in a listening task. This task aimed to assess participants’ perceptual performance and the effort they exert (as measured through pupillometry) while listening to single words and sentences presented in their L1 and L2, in quiet and noisy environments (signal to noise ratio = 0 dB).

Results:

Listening in quiet was easier than in noise, supported by both perceptual and pupillometry results. Perceptually, multilinguals performed similarly and reached ceiling levels in both languages in quiet. However, under noisy conditions, perceptual accuracy was significantly lower in L2, especially when processing sentences. Critically, pupil dilation was larger and more prolonged when listening to L2 than L1 stimuli. This difference was observed even in the quiet condition. Contextual support resulted in better perceptual performance of high-predictability sentences compared with low-predictability sentences, but only in L1 under noisy conditions. In L2, pupillometry showed increased effort when listening to high-predictability sentences compared with low-predictability sentences, but this increased effort did not lead to better understanding. In fact, in noise, speech perception was lower in high-predictability L2 sentences compared with low-predictability ones.

Conclusions:

The findings underscore the importance of examining listening effort in multilingual speech processing and suggest that increased effort may be present in multilingual’s L2 within clinical and educational settings.
Prognostic Factors Associated With Intracranial Hemorrhage and Ischemic Stroke During Venovenous Extracorporeal Membrane Oxygenation: A Systematic Review
Authors: Thiara Sonny , Willms Alexander J. , Tran Alexandre , Mitra Anish R. , Sekhon Mypinder , Hoiland Ryan , Griesdale Donald
Published: December 2024

OBJECTIVES:

Venovenous extracorporeal membrane oxygenation (ECMO) is a life-preserving intervention for patients with respiratory failure refractory to conventional mechanical ventilation. Intracranial hemorrhage (ICH) and ischemic stroke are life-threatening complications associated with venovenous ECMO. Despite this, little is known regarding the prognostic factors associated with these adverse neurologic events. We conducted a systematic review that characterizes these predictors of ICH and ischemic stroke during venovenous ECMO.

DATA SOURCES:

We conducted a comprehensive search of MEDLINE and Embase via the Ovid interface.

STUDY SELECTION:

We developed and performed a literature search to identify articles that evaluated ICH and ischemic stroke in adult patients undergoing venovenous ECMO. We excluded studies based on design, target population, and outcomes.

DATA EXTRACTION:

Data were extracted manually by one reviewer. Risk of bias assessment was completed using the Quality in Prognostic Studies approach for each included study. Prognostic factors associated with ICH and ischemic stroke that were identified in two or more included studies were evaluated through the Grading of Recommendations, Assessment, Development, and Evaluation approach.

DATA SYNTHESIS:

Three hundred thirty-three studies met criteria for screening. Seventeen studies met final inclusion criteria. Seventeen studies addressed predictors of ICH. Five studies demonstrated an increased risk of ICH with lower pH before venovenous ECMO (moderate certainty). Five studies demonstrated an increased risk of ICH with greater decreases in Paco
2 pre- to post-venovenous ECMO cannulation (moderate certainty). Four studies addressed predictors of ischemic stroke; however, there were no predictors of ischemic stroke identified in two or more of the included studies.

CONCLUSIONS:

This systematic review demonstrates that abnormalities and changes in blood gas parameters from pre- to post-venovenous ECMO cannulation are probably associated with increased risk of ICH. Additional high-quality studies dedicated to probable predictors of these adverse neurologic events are crucial to understanding the pathophysiology of ICH and ischemic stroke in this population and informing clinical practice to mitigate the risk of these life-threatening events.
The Efficacy and Safety of Endovascular Treatment on Large Vessel Occlusion of Intracranial Atherosclerosis Versus Embolism: A Meta-Analysis
Authors: Zeng FenFei , Pan QiHong , Wang XuTao , Wang Zhen , Ni JiaYan
Published: December 2024

This study is to assess the efficacy and safety of endovascular treatment for acute ischemic stroke resulting from intracranial atherosclerosis-large vessel occlusion (ICAS-LVO) in comparison to embolic-large vessel occlusion (embolic-LVO). We undertook an extensive search of databases including PubMed, Embase, The Cochrane Library, Wanfang Data, and China National Knowledge Internet using a combination of free-text terms and mesh terms as part of our search strategy. Literature screening and data retrieval were conducted following predefined inclusion/exclusion criteria. The search timeframe was limited to studies published until August 2021. All statistical evaluations were carried out by Review Manager 5.3. This meta-analysis comprised a total of 2748 patients across 14 studies. Our results demonstrate a significantly lower rate of systematic intracranial hemorrhage in ICAS-LVO compared with embolic-LVO following endovascular therapy. Moreover, the rates of rescue therapy and stent implantation were significantly lower in ICAS-LVO versus embolic-LVO. However, the 2 groups had a similar recanalization rate, favorable outcome, and mortality rates at 90 days post endovascular treatment. Patients with ICAS-LVO exhibit a lower incidence of systematic intracranial hemorrhage after treatment compared with those with embolic-LVO. Furthermore, ICAS-LVO patients did not demonstrate a unique risk profile regarding recanalization, favorable outcomes (at 90 days), and mortality (at 90 days), resulting in comparable outcomes to embolic-LVO. However, a higher proportion of stent implantation and rescue therapy was observed in ICAS-LVO patients, highlighting the need for further investigation into the standardization of endovascular management for ICAS-LVO.
The Effects of Metformin on Weight Loss, Cardiovascular Health, and Longevity
Authors: Pillai Ashwin A. , Melo Lara , Frishman William H. , Aronow Wilbert S.
Published: December 2024

Metformin, a biguanide derived from Galega officinalis, was first synthesized by Werner and Bell in 1922. Metformin was approved for the treatment of diabetes by the US Food and Drug Administration in 1994. It has since become the most widely used oral antidiabetic agent. The exact mechanisms by which metformin exerts its clinical effects remain the subject of ongoing research. Metformin interacts with multiple molecular pathways, and the downstream effects of which affect weight, cardiovascular health, and longevity. Metformin reduces hunger by mitigating insulin resistance in the hypothalamic pro-opiomelanocortin neurons. It enhances satiety by stimulating the enteral release of glucagon-like peptide 1. It also induces favorable changes to enteric microbiota, enhancing metabolism. These effects cumulatively contribute to metformin-induced weight loss. Metformin use has shown associations with improved cardiovascular outcomes including reduced all-cause mortality, lower rates of myocardial infarctions, and improved heart failure outcomes. Many of these actions are mediated through the direct activation of adenosine monophosphate-activated kinase (AMPK), which, in turn, enhances cellular energy production and endothelial nitric oxide synthase-mediated vascular relaxation. It antagonizes proinflammatory cytokines, reducing cardiac fibrosis and remodeling. The metformin-AMPK pathway may also explain the potential utility of metformin in mitigating aging. Acting through AMPK, it inhibits the mammalian target of rapamycin, leading to increased autophagy and cell growth. The metformin-AMPK-sirtuin pathway may also contribute to longevity. In this review, we will discuss the use of metformin in weight loss, cardiovascular health, and longevity, highlighting the historic background, molecular mechanisms, and current evidence.
Malignant Phyllodes Tumor of the Breast With Multiple Cutaneous Metastasis Resembling Pleomorphic Rhabdomyosarcoma
Authors: Zieba Denise , Pories Susan , Thota Hima Bindu , Suster David I.
Published: December 2024

Malignant phyllodes tumor (PT) of the breast is a rare fibroepithelial neoplasm that shows variegated histomorphology and an aggressive clinical course. Cutaneous metastases are rare. A 68 year old woman presented with a palpable left breast mass identified on a routine breast exam. Mammogram showed an oval circumscribed heterogeneous mass measuring 3.7 × 3.7 × 2.7 cm. Patient underwent core needle biopsy with subsequent excision and received a diagnosis of malignant phyllodes tumor with rhabdomyosarcomatous elements with negative margins. The patient suffered a local recurrence 5 months later and was scheduled for re- excision; however prior to that procedure the patient represented to clinic with several cutaneous and subcutaneous nodules located on the left flank, left arm, and bilateral buttocks; described as itchy but not painful. Biopsies of the left flank and the left arm were performed and pathologic examination of both biopsies demonstrated a high- grade rhabdomyoblastic neoplasm that closely resembled so-called pleomorphic rhabdomyosarcoma. The tumor cells in both biopsies marked for immunohistochemical markers of rhabdomyoblastic differentiation and re-review of the original resection specimen showed identical areas confirming the skin and subcutaneous nodules as metastatic malignant phyllodes tumor. We report an unusual case of malignant PT with cutaneous metastases that demonstrated a pure rhabdomyosarcoma phenotype with pleomorphic morphology. Awareness that malignant PT may rarely involve cutaneous sites and present with a pure rhabdomyosarcomatous morphology is important for proper recognition and diagnosis of these tumors, as out of context they may be confused with sarcomas.
Differential Expression of p53 in Mycosis Fungoides, Sezary Syndromes, and Their Transformed Forms
Authors: Courtois Anna , Allaume Pierre , Raby Maxime , Pastoret Cédric , Droitcourt Catherine , Le Naourès Cécile , Adamski Henri , Dupuy Alain , Le Gall François , Kammerer-Jacquet Solène-Florence
Published: December 2024

Mycosis fungoides (MF) and Sezary syndrome (SS) are common entities among primary cutaneous lymphomas. Large cell transformation is challenging for diagnosis and therapy. Molecular mechanisms by which these lymphomas undergo this transformation are poorly defined. We studied the immunohistochemical status of p53 in these entities and assessed whether p53 expression could be a useful tool for diagnosis and assessment of transformation. We extracted patients with transformed and untransformed SS or MF from the French Study Group on Cutaneous Lymphoma database between 2014 and 2021, followed in the Rennes University Hospital. An immunohistochemical study of p53 expression was performed on the biopsies sampled as part of routine care. We compared p53 overexpression in the different groups. We included 25 patients with MF, 7 patients with transformed MF (T-MF), 11 patients with SS, and 5 patients with transformed SS (T-SS). Using a cut-off set at 30% expression of neoplastic cells, we noted an overexpression of p53 in T-MF and T-SS compared with nontransformed forms (47% vs. 12%, respectively, P < 0.01) and in MF compared with SS (23% vs. 7%, respectively, P < 0.01). Overexpression of p53 with a cut-off at 30% therefore seems to be a discriminating tool in the differential diagnosis of MF/SS versus their transformed forms as well as the differential diagnosis between MF and SS.
Conjunctival Neuroma After Corneal Neurotization in a Patient With Neurotrophic Keratopathy
Authors: Camacho Alex de O. C. , Alzanki Sara , Al Enazi Mohammed , Cherifi Nora , Cayrol Romain , Rahal Akram , Hardy Isabelle , Brunette Isabelle , Mabon Michèle
Published: December 2024

Purpose:

To report a rare case of conjunctival neuroma after a successful corneal neurotization surgery.

Methods:

The clinical file and histopathology slides of this patient who underwent surgical corneal neurotization for a neurotrophic keratopathy in the right eye were reviewed.

Results:

A 70-year-old man with a history of severe herpetic (varicella zoster) neurotrophic keratopathy and keratouveitis in the right eye developed a corneal perforation, which required tectonic keratoplasty (May 2020). Corneal neurotization was performed 1 year later without complication, using the ipsilateral supraorbital and supratrochlear nerves to reinnervate the right cornea (April 2021), followed by repeat penetrating keratoplasty (September 2021). Three months later, a superonasal conjunctival mass was observed with a contiguous corneal delle and melt at the corneal-host junction. In vivo confocal microscopy showed numerous nerve fibers within the conjunctival mass, suggesting a diagnosis of conjunctival neuroma. The mass was surgically debulked, and the diagnosis was confirmed by histopathology and immunohistochemistry. The delle and corneal melt were successfully treated with an amniotic membrane.

Conclusions:

To the best of our knowledge, this is the first case of confirmed conjunctival neuroma reported after corneal neurotization. Confocal microscopy, histopathology, and immunohistochemistry have proven to be highly useful tools for the prompt recognition and accurate diagnosis necessary for the proper management of this rare complication.
4-Factor prothrombin complex concentrates and factor VIII inhibitor bypass activity use in cardiac surgery
Authors: Budd Ashley N. , Parulkar Suraj D. , Carabini Louanne M. , McCarthy Robert J.
Published: December 2024

Objectives

The objective of this study was to compare total thromboembolic complications between 4-factor prothrombin complex concentrate (4F-PCC) with factor VIII inhibitor bypassing activity (FEIBA) when utilized during cardiac surgery.

Design

A quasi-experimental analysis of retrospective data from consecutive patients.

Setting

A tertiary care university hospital.

Participants

Patients undergoing cardiac surgery with cardiopulmonary bypass.

Interventions

Patients received either 4F-PCC or FEIBA after discontinuation of cardiopulmonary bypass and reversal of heparin with protamine.

Measurements and main results

Medical records were reviewed for thromboembolic events (stroke, arterial or venous thrombosis, pulmonary embolism, myocardial infarction), acute kidney injury, ischemic bowel, death, duration of intensive care unit and hospital stay, clinical and surgical characteristics and blood product utilization. A comparison of the clinical and surgical variables demonstrated a mean effect size of 0.33 imbalance between groups that was reduced to 0.18 after propensity score weighting. The propensity scores weighted analysis found an incidence of composite thromboembolic events of 39% in the 4F-PCC (n = 90) and 47% in the FEIBA (n = 50) group, difference −8 (−24% to 12%), P = 0.13. Individual thromboembolic events, acute kidney injury, ischemic bowel, mortality, and length of intensive care unit or hospital stay was not different among groups. Patients who received FEIBA had greater chest tube drainage and received more cryoprecipitate intraoperatively. Patients who received 4F-PCC received more fresh frozen plasma transfusions postoperatively.

Conclusions

Among cardiac surgery patients, there was no difference in thromboembolic events between patients who received 4F-PCC or FEIBA when used as an adjunct to blood product administration.
Increase in prevalence and costs of cirrhosis in the Netherlands: a nationwide hospital diagnosis data analysis
Authors: de Wit Koos , van Doorn Diederick J. , Masclee Gwen M.C. , Coenraad Minneke J. , van Soest Hanneke , Cuperus Frans J.C. , Kramer Matthijs , Maan Raoel , Takkenberg R. Bart , Lantinga Marten A. ,   the Dutch Portal Hypertension Working Group
Published: December 2024

Introduction

Due to the rising incidence of patients with cirrhosis and its accompanied extensive management, there is an increasing burden of cirrhosis patients on healthcare resources and costs. However, exact data on Dutch cirrhosis epidemiology and associated costs are lacking.

Aims and methods

We aimed to determine the year-prevalence of adults (aged ≥18 years) with cirrhosis registered as active patients in Dutch hospitals (2017–2021) using the Dutch hospital claims database. Next, we assessed average reimbursed annual healthcare costs.

Results

The prevalence of patients with cirrhosis registered as an active patient in Dutch hospitals increased by 54% from 48.7 patients per 100 000 in 2017 to 75.2 per 100 000 in 2021. There were regional differences and prevalence for cirrhosis was at highest of 105.6 patients per 100 000. The yearly incidence of patients for which hospitals requested claims was n = 3725 in 2018, n = 3840 in 2019 (+3%), n = 3749 in 2020 (−2%), and n = 3695 in 2021 (−1%). Total number of hospital admissions increased by 19% from 2443 in 2017 to 2899 in 2021. The annual reported costs for patients with cirrhosis increased by 120% from €35 million in 2017 to €78 million in 2021. Adjusted for inflation this increase was 143% to €85 million.

Conclusion

The prevalence of patients with cirrhosis registered as a patient in Dutch hospitals increased by more than 50 percent from 2017 to 2021, with regional differences. Consequently, total healthcare costs for Dutch patients with cirrhosis more than doubled in less than 5 years.
Assessment of surface contamination of low-dose radioactive iodine (131I) treatment container
Authors: Ryu Chan-Ju
Published: December 2024

With the advancement of radiotherapy technology in the medical field, the amount of radioactive waste has rapidly increased, and the International Atomic Energy Agency (IAEA) has proposed waste deregulation standards based on individual dose, collective dose, and nuclide concentration. The purpose of this study is to define the standard period (1 day) required to measure collected radioactive waste using direct and indirect methods with a radioactivity meter, ensure that the radiation dose remains below the allowable level, and transport the waste safely. In this study, 131I low-dose (30 mCi) radioactive waste discarded after radioiodine treatment at a medical institution was collected, and a measuring container was prepared to measure radioactivity concentration according to IAEA standards. The experiments showed that the minimum number of days required for the contamination levels of the inner and outer parts of containers and therapeutic plastics to fall below the tolerance limit were 6, 1, and 5 days, respectively. Conversely, the contamination levels measured immediately after 131I treatments in the cases of Styrofoam and paper boxes were below the tolerance limit. The study emphasizes the need for a safe disposal process and active radioactive waste management operations by radioactive waste transporters by specifying the scope for safe transportation beyond the permissible limit.
Rectal bleeding due to cavernous hemangioma in Klippel–Trenuany syndrome: a rare presentation and review of management
Authors: Usman Omer , Tariq Maham , Khan Muhammad W. , Shahbaz Muhammad U. , Mujahid Rehaab , Ijaz Osama , Hassan Muhammad A.
Published: December 2024

Introduction and importance:

Klippel–Trenaunay syndrome (KTS) is a rare congenital disorder with an incidence of about 2–5:100 000. It is characterized by the triad of cutaneous hemangiomas, soft tissue or bone hypertrophy, and venous malformations. Gastrointestinal (GI) involvement in KTS, although uncommon, can lead to severe complications such as profuse GI bleeding. Our case highlights the challenges and management strategies of a patient with KTS.

Case presentation:

A 5-year-old child presented with rectal bleeding since birth, accompanied by swelling and bluish discoloration on left flank, and multiple varicose veins on left leg. Examination revealed small hemangiomatous lesions scattered along the torso and trunk. Barium enema showed diffuse mucosal irregularity with polypoidal filling defects in the rectum and sigmoid colon. Doppler ultrasound revealed slow-flow vascular lesions in the left flank and leg without arteriovenous communication. Computed tomography (CT) scan showed diffuse cavernous hemangiomas in the descending colon, sigmoid colon, and rectum. Histopathology demonstrated numerous dilated, irregular vascular channels with calcification and hemosiderin-laden macrophages.

Clinical discussion:

GI tract cavernous hemangiomas can cause chronic bleeding and anemia, necessitating careful evaluation. Imaging modalities like CT and Doppler ultrasound are crucial for assessing vascular lesions. Surgical interventions, including partial proctocolectomy and colorectal anastomosis, effectively control bleeding and improve outcomes. A multidisciplinary approach is essential for managing such cases.

Conclusion:

This case underscores the importance of multidisciplinary management in KTS with GI bleeding. Effective diagnostic imaging and surgical treatment are key to managing severe complications and achieving successful outcomes. Long-term follow-up is crucial to monitor for recurrence and residual lesions.
HLA B*15:02 and carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: first case report from Nepal with genetic analysis
Authors: Joshi Mandeep D. , Acharya Bimarsh , Sapkota Surendra , Khati Karuna , Randuwini Dissanayake Dissanayake M. L. , Shah Sachin , Jawarchan Jayanti
Published: December 2024

Introduction and importance:

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the severe adverse drug reactions following drugs like carbamazepine, allopurinol, and infections. Here we present A 32-year-old woman developed SJS/TEN after 7 days of carbamazepine therapy, highlighting the importance of recognizing this risk, particularly in HLA-B*1502 allele carriers.

Case presentation:

A 32-year-old female developed fever, vomiting, and mucocutaneous blisters 7 days after starting carbamazepine. Lesions spread from the face to the chest, abdomen, and extremities, with throat discomfort and eye discharge. History included prior dizziness episodes.

Examination revealed denuded skin, positive Nikolsky’s sign, and HLA-B*1502 allele positivity. Treatment comprised ceasing carbamazepine, fluid administration, and steroids.

Discussion:

SJS/TEN manifest with distinct symptoms and often emerge within weeks of drug exposure. Carbamazepine, a frequent trigger, poses higher risks for HLA-B1502 allele carriers. Timely identification and intervention are essential to reduce mortality rates (10-40%). Treatment involves corticosteroids and supportive measures, with pre-carbamazepine HLA-B1502 screening advised, despite potential accessibility constraints.

Conclusion:

This case underscores the necessity of recognizing carbamazepine-induced SJS/TEN risk, particularly in HLA-B*1502 carriers. Despite screening challenges, early intervention involving multidisciplinary specialists is essential for favorable outcomes. Increased awareness and proactive measures are vital in preventing and managing these severe reactions.
Acute urinary retention in an adolescent female with Herlyn–Werner–Wunderlich syndrome
Authors: Shrestha Pradeep , Shrestha Bibek , Mishra Amit K. , Katuwal Neeta
Published: December 2024

Introduction and importance:

Herlyn–Werner–Wunderlich syndrome (HWWS) is a rare congenital anomaly characterized by the triad of uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. However, atypical presentations such as acute urinary retention are uncommon and pose diagnostic challenges. Early identification and treatment are crucial to prevent long-term complications like endometriosis and infertility.

Case presentation:

A 12-year-old female presented with the unusual symptom of acute urinary retention, which was likely caused by compression of the bladder neck due to hematocolpos. Imaging via ultrasound and MRI confirmed the presence of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis, consistent with HWWS. Surgical excision of the vaginal septum was performed to relieve the hematocolpos, with the patient experiencing a full recovery.

Clinical discussion:

Congenital abnormalities of Mullerian Duct are rare, and atypical presentations such as acute urinary retention, vaginal discharge, and even pyocolpos or hematosalpinx have been reported. MRI played a crucial role in confirming the diagnosis and guiding treatment. The importance of early detection and long-term monitoring is highlighted, though limitations exist due to the inability to assess future reproductive outcomes.

Conclusion:

This case emphasizes the importance of recognizing atypical presentations of HWWS, such as acute urinary retention. Timely diagnosis and appropriate surgical intervention are critical for preventing complications and restoring normal function. Early recognition of this rare syndrome, especially in patients with unusual symptoms such as urine retention, is essential for ensuring optimal clinical outcomes.
Evaluating high-sensitivity cardiac troponin I for early detection of treatment-related cardiotoxicity in HER2-positive breast cancer patients
Authors: Ahmed Nadeem A. , Redwan Faisal N. , Jahjah Akram S. , Al-Shehabi Zuhair A.
Published: December 2024

Background:

Trastuzumab-related cardiotoxicity is a common adverse effect of HER2-positive breast cancer treatment, especially when combined with anthracyclines. However, to date, no definitive prognostic markers have been found to predict trastuzumab-related cardiotoxicity.

Methods:

Patients diagnosed with HER2-positive breast cancer, scheduled to receive anthracyclines followed by 12 months of trastuzumab or with pertuzumab, were prospectively followed up for 27 months. Measurements of left ventricular ejection fraction LVEF, high-sesitivity troponin I hs-Tn I, and a full cardiac examination were performed at baseline, after anthracycline treatment, and after four cycles of anti-HER2 agents. Subsequently, LVEF measurement and full cardiac examination were conducted every 3 months until the end of the follow-up. Cardiotoxicity was defined as an absolute decrease in LVEF of ≥15%, or a drop in LVEF of ≥10% from the baseline to <50%.

Results:

Among 78 patients, cardiotoxicity occurred in 13 (16.7%). A higher risk of cardiotoxicity was linked to hs-Tn I measured after four cycles of anti-HER2 agents (P < 0.001), with a significant cutoff of >84 ng/L. No short-term effects of the anthracycline agents (doxorubicin or epirubicin), were found. However, there was a slightly higher tendency to develop cardiotoxicity (P = 0.046) in patients treated with trastuzumab plus pertuzumab.

Conclusion:

Hs-Tn I measured after four cycles of trastuzumab in HER2-positive breast cancer patients could be an important predictor of cardiotoxicity induced by chemotherapy followed by anti-HER2 agents, particularly in the first year post-treatment, with a different cutoff value than that used in other cardiac conditions.
Brain tumors and induced pluripotent stem cell technology: a systematic review of the literature
Authors: Shayestehfar Monir , Taherkhani Tina , Jahandideh Pardis , Hamidieh Amir A. , Faramarzpour Mahsa , Memari Amirhossein
Published: December 2024

Background:

Induced pluripotent stem cells (iPSCs) provide a novel approach to studying the pathophysiology of brain tumors and assessing various therapeutic techniques with greater precision. This study aims to systematically review the existing literature to critically analyze and synthesize current research findings. The objective is to evaluate the role of iPSCs in understanding brain tumors and in the development of innovative treatment strategies.

Methods:

We systematically reviewed existing articles that utilized iPSC technology to assess either the pathophysiology of brain tumors or therapeutic techniques, following the standards of Preferred Reporting Items for Systematic review and Meta-Analysis guidelines. Key terms were comprehensively searched in electronic databases, including PubMed, EMBASE, and Scopus. Articles were screened based on specific inclusion and exclusion criteria. Ultimately, 22 relevant articles were chosen, and their data were extracted.

Results:

The summary of findings for each selected article was organized into two general categories: “Methods of Generating iPSCs” and “Applications of iPSCs.” The methods of iPSC generation, including transfection and transduction, as well as the types of viral or non-viral vectors used, were extracted and reported for each study. Additionally, the main aims of the selected studies, whether modeling or therapeutic approaches, were gathered and reported in the results section.

Conclusion:

iPSC technology is a novel vehicle that brings new solutions to overcome difficulties in brain tumor studies. In vivo and in vitro models generated from iPSCs provide suitable platforms to investigate the pathophysiology of brain tumors more precisely. Also, iPSCs have been utilized in various studies to examine how different antitumor agents may affect the target cells.
Crovalimab: a new era in paroxysmal nocturnal hemoglobinuria management
Authors: Waheed Aiman , Gul Muhammad Hamza , Wardak Abdul Baseer , Shabbir Muhammad Usama Bin , Touseef Sabahat , Zafar Fatima , Hussaini Helai
Published: December 2024

Crovalimab, a new promising drug for the treatment of paroxysmal nocturnal hemoglobinuria (PNH) has emerged. This marks a significant advancement in the treatment of PNH and potentially other complement-mediated disorders. PNH is characterized by complement-mediated hemolysis, thrombosis, and bone marrow failure, leading to severe morbidity and mortality in affected individuals. PNH arises from a somatic mutation in the PIGA gene, leading to the loss of glycosylphosphatidylinositol (GPI)-anchored proteins on blood cells, making them vulnerable to complement-mediated destruction. Crovalimab is a new anti-C5 recycling antibody that offers a promising treatment by being administered subcutaneously every 4 weeks at a low volume. Clinical trials such as COMMODORE 3 have shown crovalimab’s effectiveness and high tolerability in PNH patients who have not previously used a C5 inhibitor. Crovalimab has been proven effective in maintaining hemoglobin levels, reducing the need for transfusions, and improving patient outcomes by inhibiting terminal complement activation.
Microsurgical resection of a perimedullary conus medullaris arteriovenous fistula type IVa: a case report
Authors: Makhambetov Yerbol , Aiman Maidan , Okon Inibehe Ime , Kerimbayev Talgat , Kunakbayev Baurzhan , Shah Keyur , Abishev Nurzhan , Uteuova Saule , Chaurasia Bipin
Published: December 2024

Introduction and importance:

Conus medullaris arteriovenous fistulas (AVFs) are rare among spinal vascular malformations. This case report highlights the presentation, diagnostic work-up, and management of a patient with a perimedullary conus medullaris AVF type IVa.

Case presentation:

A 29-year-old male presented with progressive weakness and numbness in the left leg. Thoracic magnetic resonance imaging (MRI) showed increased arterial supply in the dural membrane and large, smoldering, twisting spaces from T8 to L1 with a central point from which many abnormal vessels radiated. Angiographic findings showed an enlarged fistula fed by a radiculomedullary artery around the T10 level and draining through a medullary vein, draining into an aberrantly placed radicular vein at the posterior spinal venous plexus. The vein was mimicking nidus.

Clinical discussion:

The microsurgical resection with intraoperative indocyanine green angiography and neuromonitoring was successful. A follow-up MRI showed postoperative resolution of the malformation, and clinically, the patient experienced gradual improvement of his symptoms confirming the surgical success with complete AVF obliteration on postoperative angiography.

Conclusion:

Accurate detection and precise treatment are essential for managing conus medullaris AVFs. These complex lesions can be effectively addressed through both microsurgical and endovascular techniques. A successful treatment strategy necessitates thorough preoperative planning and a collaborative, multidisciplinary approach.
Hashimoto’s encephalopathy: a rare case report of Hashimoto’s thyroiditis with seizure
Authors: Hidig Mohamed Farah Osman , Bashir Ahmed Muhammad , Hassan Mohamed Sheikh , Adam Bakar Ali , Jeele Mohamed Osman Omar
Published: December 2024

Introduction and importance:

Hashimoto’s thyroiditis (HT) is a common autoimmune condition that causes hypothyroidism. It is characterized by a wide range of symptoms, from conventional ones to rare and severe neurological manifestations. Seizures are a very uncommon symptom of HT, requiring a deep understanding and careful management owing to the challenges involved in diagnosing and the severe implications.

Case presentation:

A 19-year-old female with a medical history of untreated hypothyroidism caused by HT presented with a seizure characterized by generalized tonic-clonic movements. She displayed symptoms of fatigue, confusion, and swelling in the extremities. The laboratory results indicated a significant case of autoimmune hypothyroidism. The results of the brain imaging and EEG tests were within the expected range and did not show any abnormalities. The treatment regimen consisted of levothyroxine, levetiracetam, and methyl-prednisolone, which led to the cessation of seizures and the patient’s recovery from the postictal state.

Clinical discussion:

While managing HT itself is well-defined, tackling the neurologic complexities of Hashimoto’s encephalopathy (HE) takes a multifaceted approach.

Conclusion:

This case highlights the intricate nature of diagnosing and managing neurological symptoms caused by HT, namely seizures. Patients presenting with unexplained seizures and autoimmune thyroid illness should be mindful of the possibility of HE, an uncommon condition. Management includes the attainment of normal thyroid function and the consideration of immunosuppressive therapy for severe instances of HE.
The dynamic role of soluble urokinase plasminogen activator receptor (suPAR) in monitoring coagulation dysfunction during COVID-19 progression: a review
Authors: Obeagu Emmanuel Ifeanyi
Published: December 2024

COVID-19, caused by the severe acute respiratory syndrome coronavirus 2, has led to significant morbidity and mortality worldwide, with severe complications often involving coagulation dysfunction and thromboembolic events. Identifying reliable biomarkers for early detection and monitoring of these complications is crucial for improving patient outcomes. The soluble urokinase plasminogen activator receptor (suPAR) has emerged as a potential biomarker in this context, given its role in inflammation and immune response. Elevated suPAR levels correlate with disease severity and inflammatory markers, making it a valuable indicator of the complex interplay between inflammation and coagulation observed in COVID-19. Elevated suPAR levels have been linked to an increased risk of thromboembolic events, such as deep vein thrombosis and pulmonary embolism. Combining suPAR measurement with other coagulation markers, such as D-dimer, enhances the predictive accuracy for thrombotic complications. Furthermore, higher suPAR levels are associated with increased disease severity, intensive care requirements, and higher mortality rates, underscoring its significance in risk stratification and therapeutic decision-making. The integration of suPAR measurement into routine clinical practice for COVID-19 could significantly aid in early diagnosis, risk assessment, and monitoring of therapeutic interventions. By providing insights into the patient’s inflammatory and coagulation status, suPAR can guide the timely initiation of anticoagulant therapy and other treatments aimed at reducing thromboembolic complications. As research continues to validate suPAR’s utility across diverse populations and clinical settings, it holds promise for becoming an integral component of clinical management strategies to mitigate the morbidity and mortality associated with COVID-19.