bluuebunny/crossref_metadata_2025 huggingface dataset:
Absence of dysregulation in amplitude and phase of circadian rhythm of core body temperature in idiopathic hypersomnia: a case–control study
Authors: Adam Tugdual , Barateau Lucie , Tanty Jérôme , Dauvilliers Yves
Published: October 2024

Study Objectives

To investigate the amplitude and phase of the circadian rhythm of core body temperature (CBT) via the continuous measure of the gastrointestinal temperature in participants with idiopathic hypersomnia (IH), non-specified hypersomnia (NSH) compared to healthy controls (HC) in a constant routine standardized bedrest (BR) protocol.

Methods

Consecutive participants evaluated in a National Reference Center for Rare Hypersomnias benefited from an extensive evaluation with one-night polysomnography, followed by a modified Multiple Sleep Latency Test (mMSLT), and a continuous 32-hour BR recording in standardized conditions. CBT was recorded via a telemetry pill (e-Celsius) during the BR, modeled by a Cosinor, with extraction of MESOR, amplitude, and phase. Participants with IH, diagnosed according to the International Classification of Sleep Disorders-3, were compared with participants with NSH (complaint of hypersomnolence but normal mMSLT and BR), and HC. Participants were divided into four groups based on their mMSLT mean sleep latency (mMSLT+,≤8 minutes) and their BR total sleep time (BR+, ≥19 hours).

Results

A total of 108 participants (80% women, 28.3 ± 7.8 years old) were included in the analyses, 81 IH (83% women), 16 NSH (75% women), and 11 HC (64% women). Cosinor amplitude and phase of CBT did not differ between IH, NSH, and HC, nor in the subgroup analysis (37 BR+/mMSLT+, 35 BR+/mMSLT−, 9 BR-/mMSLT+, 27 BR-/mMSLT−). No difference in chronotypes was observed between groups. Women had a greater MESOR and reduced CBT amplitude compared to men.

Conclusions

The circadian rhythm of CBT showed no difference in amplitude or phase between IH, NSH, and HC, and was not related to prolonged sleep time or objective daytime sleepiness.
Phylogeny and biogeography support ancient vicariance and subsequent dispersal out of Africa in Palpimanidae spiders (Araneae)
Authors: Wood Hannah M , Kulkarni Siddharth , Ramírez Martín J , Scharff Nikolaj
Published: October 2024

The Palpimanidae are one of five extant Palpimanoidea families that occur mainly in South America and Africa, although there are lineages in Madagascar, islands of the Indian Ocean, and parts of Asia. Here we examine the role of plate tectonics in shaping the distribution of Palpimanidae. We perform molecular sequencing via target enrichment, which makes use of fragmented DNA, because most specimens are stored in natural history museum collections and were not properly preserved for molecular sequencing. We perform phylogenetic analysis, divergence dating, and ancestral range reconstructions to assess whether continental vicariance shaped the evolution of Palpimanidae. We also examine evolution of eye loss via ancestral character reconstruction. We report the first Palpimanidae phylogeny based on genomic data that samples the majority of Chediminae genera. Results suggest that Palpimanidae originated in the Triassic, with diversification spanning the Jurassic to the Cretaceous. Vicarance played a role in early diversification, with later range expansion out of Africa. Based on morphology and phylogenetic analysis, Sceliraptor is synonymized with Sarascelis, Sceliscelis is synonymized with Scelidocteus, and the new genus and species Sitamacho tao gen. nov., sp. nov. is described, with three species transferred from Hybosida.
The expression of intestinal Cyp2c55 is regulated by the microbiota and inflammation
Authors: Hilman Adrian , Sato Tetsu , Wijatniko Bambang Dwi , Fujimura So , Nakamura Katsushi , Miura Hiroto , Iwatsuki Ken , Inoue Ryo , Suzuki Takuya
Published: October 2024

Although the mutualistic relationship between the intestinal microbiota and the human host is crucial for maintaining health, the underlying mechanisms of this relationship remain unclear. In the present study, aiming to elucidate the regulatory mechanisms governing the Cyp2c55 expression, which is predominantly observed in colonic tissues, germ‐free, antibiotic‐administered and colitic mice, as well as mouse colonoids, were used as experimental models. RNA sequencing showed comparable decreases in the colonic Cyp2c55 expression in germ‐free and antibiotic‐administered mice, when compared with that in specific pathogen‐free mice. Furthermore, administration of dextran sulfate sodium decreased the Cyp2c55 expression in colitic mice. For these mice, a Pearson correlation analysis also showed a positive correlation between the Cyp2c55 expression and unconjugated bile acids (BAs), including chenodeoxycholic, muricholic, deoxycholic, lithocholic, and ursodeoxycholic acids, as well as taurine (T)‐conjugated secondary BAs, including deoxycholic acid. Moreover, bacterial genera, such as Muribaculaceae and unclassified Lachnospiraceae, also exhibited a positive correlation with these BAs. While administration of an agonist of the pregnane X receptor (PXR) increased the Cyp2c55 expression in mouse colonoids, inflammatory cytokines decreased it. In conclusion, Cyp2c55 was highly expressed in the colonic epithelial cells of mice in a microbiota‐dependent manner. The underlying mechanism seemed to involve a BA‐mediated PXR activation. In addition, the colonic expression of Cyp2c55 was regulated by the inflammatory response. Although the physiological function of Cyp2c55 remains largely unidentified, our findings suggested that Cyp2c55 may play a role in the mutualistic interaction between the intestinal microbiota and the intestinal homeostasis.
Pelvic Binder Radiography Is Safe and Feasible for Quantifying Fracture Instability in LC1 Pelvis Fractures: A Clinical Trial
Authors: Patterson Joseph T. , Duong Andrew M. , Flynn Camille , Kim Annabel , Inaba Kenji , Reddy Sravanthi , Blumenthal Sarah R. , Gary Joshua L.
Published: October 2024

OBJECTIVES:

To demonstrate fracture displacement, patient tolerance, and in-hospital safety quantifying lateral compression type 1 (LC1) pelvis fracture stability with awake stress radiography using a pelvic binder (PBR).

METHODS:

Design:

Prospective clinical trial of PBR diagnostic intervention.

Setting:

Two centers, Level I trauma center and academic hospital.

Patient Selection Criteria:

Alert adults with LC1 (OTA/AO B1.1/2.1) pelvic fractures from blunt mechanism presenting within 3 weeks of injury between February and December 2023 without hypotension or injury precluding pelvic binder application.

Outcome Measures and Comparisons:

The primary outcome was fracture displacement on PBR. Secondary outcomes included feasibility (≥85% patient tolerance) and safety (no major adverse events). Exploratory outcomes included pain during examination, opioid medication consumption within 96 hours, length of hospital stay, discharge destination, and correlation between fracture displacement on PBR and examination under anesthetic.

RESULTS:

One hundred sixty-nine patients with pelvis fractures were screened, 58 were eligible, and 31 were enrolled. The mean age of enrolled patients was 58.7 ± 23 years, 54.8% were female, 22.6% were White, and 67.7% Hispanic. Fracture displacement was 4.3 ± 4.7 mm on PBR at 5 kg and 8.4 ± 9.0 mm at 10 kg. All patients tolerated PBR. Sixteen patients (52%) reported pain during PBR but completed the test. No patient experienced an adverse event. Patients received 40.4 ± 56.4 mg oral morphine equivalents within 96 hours of PBR. Ten patients (32.2%) received internal fixation. The median hospital stay was 6 days (interquartile range 5.5 days) with no inpatient mortality. Fourteen patients (45.2%) discharged home.

CONCLUSIONS:

PBR is feasible and safe as a point-of-care test for LC1 pelvis fracture instability.

LEVEL OF EVIDENCE:

Level II Diagnostic.
Effects of Tranexamic Acid on Human Osteoblasts as Proxy for Fracture Healing
Authors: Abraham Alexander , Meyers D. Nicole , Rieger William D. , Anthony Ryan , Aparicio Humberto , Park Adam Y. , Kellam James F. , Ambrose Catherine G.
Published: October 2024

OBJECTIVES:

To investigate the effect of tranexamic acid (TXA) through in vitro culture of primary human osteoblasts (HOB) and in vivo using an operative rat femur fracture model. It was hypothesized that there would not be any effect on fracture healing in both studies.

METHODS:

Primary HOBs were exposed to varying concentrations of TXA over different time periods. Cells were assessed for viability, metabolism, and mineralization. For the in vivo model, fractures were created in the femora of adult rats, exposed to either TXA or saline, and then assessed for healing at different time points. A modified radiographic union score for tibia was used to evaluate radiographs, callus mineralization was assessed with microcomputed tomography, and biomechanical tests were performed.

RESULTS:

Overall, HOB viability and metabolism decreased as TXA concentration and exposure time increased. However, at concentrations below 56.44 mg/mL, HOB viability was not affected. Similarly, mineralization also decreased as TXA concentration and exposure time increased. In both groups, in vivo results demonstrated increasing radiographic healing, callus mineralization, and biomechanical strength as a function of time. There was a trend for increased healing in the TXA group at 6 weeks after fracture; however, the difference compared with untreated animals was not statistically significant.

CONCLUSIONS:

Although a degradation of HOB viability and metabolism occurred with increased TXA concentrations and exposure times, clinically relevant concentrations do not adversely affect HOB viability, metabolism, or mineralization. In addition, there were no noticeable adverse effects of TXA administration in the in vivo model.
Diabetes Mellitus Is Not a Risk Factor for Difficult Intubation Among Critically Ill Adults: A Secondary Analysis of Multicenter Trials
Authors: Long Micah T. , Krause Bryan M. , de Jong Audrey , Dollerschell John T. , Brewer J. Michael , Casey Jonathan D. , Gaillard John P. , Gandotra Sheetal , Ghamande Shekhar A. , Gibbs Kevin W. , Ginde Adit A. , Hughes Christopher G. , Janz David R. , Khan Akram , Latimer Andrew , Mitchell Steven , Page David B. , Russell Derek W. , Self Wesley H. , Semler Matthew W. , Stempek Susan , Trent Stacy , Vonderhaar Derek J. , West Jason R. , Halliday Stephen J. ,   for the Pragmatic Critical Care Research Group (PCCRG)
Published: October 2024

OBJECTIVES:

Diabetes mellitus has been associated with greater difficulty of tracheal intubation in the operating room. This relationship has not been examined for tracheal intubation of critically ill adults. We examined whether diabetes mellitus was independently associated with the time from induction of anesthesia to intubation of the trachea among critically ill adults.

DESIGN:

A secondary analysis of data from five randomized trials completed by the Pragmatic Critical Care Research Group (PCCRG).

SETTING:

Emergency departments (EDs) or ICUs at 11 centers across the United States that enrolled in randomized trials of a pre-intubation checklist, fluid bolus administration, bag-mask ventilation between induction and laryngoscopy, and intubation using a bougie vs. stylet.

PATIENTS:

Critically ill adults undergoing tracheal intubation with a laryngoscope in an ED or an ICU.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 2654 patients were included in this analysis, of whom 638 (24.0%) had diabetes mellitus. The mean time from induction of anesthesia to intubation of the trachea was 169 seconds (sd, 137s). Complications occurred during intubation in 1007 patients (37.9%). Diabetes mellitus was not associated with the time from induction of anesthesia to intubation of the trachea (–4.4 s compared with nondiabetes; 95% CI, –17.2 to 8.3 s; p = 0.50). Use of a video vs. direct laryngoscope did not modify the association between diabetes mellitus and the time from induction to intubation (p for interaction = 0.064). Diabetes mellitus was not associated with the probability of successful intubation on the first attempt (85.6% vs. 84.3%; p = 0.46) or complications during intubation (39.8% vs. 37.4%; p = 0.52).

CONCLUSIONS:

Among 2654 critically ill patients undergoing tracheal intubation in an ED or an ICU, diabetes mellitus was not independently associated with the time from induction to intubation, the probability of successful intubation on the first attempt, or the rate of complications during intubation.
A Systematic Review of Features Forecasting Patient Arrival Numbers
Authors: Förstel Markus , Haas Oliver , Förstel Stefan , Maier Andreas , Rothgang Eva
Published: October 2024

Adequate nurse staffing is crucial for quality healthcare, necessitating accurate predictions of patient arrival rates. These forecasts can be determined using supervised machine learning methods. Optimization of machine learning methods is largely about minimizing the prediction error. Existing models primarily utilize data such as historical patient visits, seasonal trends, holidays, and calendars. However, it is unclear what other features reduce the prediction error. Our systematic literature review identifies studies that use supervised machine learning to predict patient arrival numbers using nontemporal features, which are features not based on time or dates. We scrutinized 26 284 studies, eventually focusing on 27 relevant ones. These studies highlight three main feature groups: weather data, internet search and usage data, and data on (social) interaction of groups. Internet data and social interaction data appear particularly promising, with some studies reporting reduced errors by up to 33%. Although weather data are frequently used, its utility is less clear. Other potential data sources, including smartphone and social media data, remain largely unexplored. One reason for this might be potential data privacy challenges. In summary, although patient arrival prediction has become more important in recent years, there are still many questions and opportunities for future research on the features used in this area.
Poly (ADP-Ribose) Polymerase 1 Induces Cyclic GMP-AMP Synthase-stimulator of Interferon Genes Pathway Dysregulation to Promote Immune Escape of Colorectal Cancer Cells
Authors: Xia Jianhong , Shen Yue , Jiang Qian , Li Xin , Yan Yan , Xu Zhi , Zhou Liqing
Published: October 2024

Colorectal cancer (CRC) ranks third globally in cancer incidence and mortality, posing a significant human concern. Recent advancements in immunotherapy are noteworthy. This study explores immune modulation for CRC treatment. Initially targeting poly (ADP-ribose) polymerase 1 (PARP-1), a gene overexpressed in CRC tissues per The Cancer Genome Atlas, we examined its correlation with immune cell infiltration using the Tumor Immune Estimation Resource tool. Quantitative reverse transcription polymerase chain reaction assessed PARP-1 mRNA and inflammation-related gene expression in tumor tissues and cells. Assessing CD8+ T-cell proliferation and cytotoxicity towards HCT116 cells involved carboxyfluorescein diacetate succinimidyl ester and lactate dehydrogenase kits. Chemotaxis was gauged using a Transwell system in a CD8+ T-cell coculture setup, with immunofluorescence revealing cyclic GMP-AMP synthase (cGAS) and stimulator of interferon genes (STING) levels in HCT116 cells. Enzyme-linked immunosorbent assay kits measured CD8+ T-cell cytokine secretion. The findings suggested that PARP-1 was overexpressed in CRC tissues and cells and this overexpression was positively correlated with Treg cell infiltration. Overexpression of PARP-1 could significantly reduce the proportion of cGAS and STING-positive cells in HCT116 cells, dampen the proliferation, tumor-killing capacity, and chemotaxis of CD8+ T cells, and inhibit the secretion of related cytokines. The introduction of STING agonists could reverse the effects caused by overexpressed PARP-1. In vivo experiments affirmed the independent anti-tumor effects of PARP-1 inhibitors and STING agonists, synergistically inhibiting tumor growth. Silencing PARP-1 in HCT116 cells potentially boosts CD8+ T-cell activity against these cells through the cGAS-STING pathway.
The Paradise Renal Denervation System: An FDA-approved catheter-based treatment option for resistant hypertension
Authors: Khan Rida S. , Frishman William H.
Published: October 2024

Resistant hypertension is defined as office blood pressure >140/90 mm Hg with a mean 24-hour ambulatory blood pressure of >130/80 mm Hg in patients who are compliant with 3 or more antihypertensive medications. Those who persistently fail pharmaceutical therapy may benefit from interventional treatment, such as renal denervation. Sympathetic nervous activity in the kidney is a known contributor to increased blood pressure because it results in efferent and afferent arteriole vasoconstriction, reduced renal blood flow, increased sodium and water reabsorption, and the release of renin. The Recor Paradise Renal Denervation System is designed to target renal sympathetic nerves via ultrasound ablation. The RADIANCE trials have demonstrated that patients who underwent renal denervation had a significant decrease in systolic blood pressure as compared with those who underwent a sham procedure. Furthermore, the device was found to have a favorable safety profile, with minimal major adverse events. The Food and Drug Administration granted approval to Recor, and the Paradise system is expected to serve as an adjunctive therapy for patients with true-resistant hypertension.
Incidence and influential factors of postoperative pruritus in morphine-based intravenous patient-controlled analgesia
Authors: Liao Chung-Yi , Wu Hsiang-Ling , Wu Yu-Ming , Cata Juan P. , Chen Jui-Tai , Wang Chien-Wun , Cherng Yih-Giun , Tai Ying-Hsuan
Published: October 2024

Background:

Pruritus is a distressing symptom of systemic opioid analgesia that responds poorly to conventional anti-pruritus treatments. This study aimed to determine the incidence and risk factors for postoperative pruritus using intravenous patient-controlled analgesia (IV-PCA).

Methods:

Opioid-naïve patients who underwent morphine-based IV-PCA for postoperative pain at a tertiary center between January 1, 2020 and June 30, 2023, were included retrospectively. The primary outcome was pruritus within 72 hours after surgery. Cumulative morphine consumption and pain numerical rating scores were measured to evaluate the potential impact of pruritus on postoperative pain control.

Results:

A total of 1696 patients were enrolled, of whom 119 (7.0%) developed pruritus during the study period. Five independent factors for pruritus were identified, including intraoperative uses of hydroxyethyl starch solutions (adjusted odds ratio [aOR]: 0.13, 95% CI, 0.04-0.43), lockout interval of IV-PCA (aOR: 0.50, 95% CI, 0.27-0.94, on base-2 logarithmic scale), droperidol addition to morphine solutions (aOR: 0.53, 95% CI, 0.35-0.81), cumulative morphine dose (aOR: 1.76, 95% CI, 1.47-2.12, on base-2 logarithmic scale), and postoperative uses of antihistamines (aOR: 2.90, 95% CI, 1.83-4.60) (c-statistic = 0.745). Patients with pruritus had higher postoperative morphine consumption (median: 67.5 mg, interquartile range: 38.3-94.0 vs 38.0 mg, 21.0-65.4, p < 0.001) but similar pain intensity compared to those without pruritus.

Conclusion:

Increasing the lockout interval and the droperidol regimen may protect patients from morphine-induced pruritus after IV-PCA. Further studies are warranted to clarify the mechanisms underlying the anti-pruritus effects of hydroxyethyl starch.
Small bowel obstruction
Authors: Salinas Irene , Opton Laura , Weaver Christy
Published: October 2024

Small bowel obstruction is a common and serious condition that nurses often encounter, making up 80% of bowel obstructions in the US. It frequently occurs in older adults and those who've had abdominal surgeries, with many cases requiring surgical intervention, especially for complete obstructions.
Colorectal cancer
Authors: Brewer Sharon K. , Seth Shelly L.
Published: October 2024

Colon and rectal cancers affect the large intestine and rectum, the lowest parts of the digestive system. This article covers key facts on the signs, symptoms, diagnosis, and treatment of early-stage colon and rectal cancer.
Inflammatory bowel disease
Authors: Rodriguez Thureiyya
Published: October 2024

Inflammatory bowel diseases, including Crohn disease and ulcerative colitis, have traditionally been diagnosed by performing an endoscopy. This approach is the standard method for diagnostics, but this invasive procedure isn't always the patient's preferred method.
Effectiveness of Educational Interventions to Develop Patient Safety Competencies in Undergraduate Nursing Students
Authors: De Rezende Helena , Morais Alexandre Souza , Vitorio Aline Mirema Ferreira , Quadrado Ellen Regina Sevilla , Garzin Ana Claudia Alcântara , Martins Maristela Santini , Lourenção Daniela Campos de Andrade , Modesto Roberto Chrispim , Nicole Andressa Garcia
Published: October 2024

Background:

Nursing professionals are key to providing safe care that improves patient outcomes. Hence, it is essential to focus on developing nurses’ patient safety competencies and principles.

Purpose:

This review examined the effectiveness of educational interventions in developing patient safety knowledge, skills, behaviors, and attitudes in undergraduate nursing students.

Methods:

The search strategy aimed to identify published and unpublished studies in databases and grey literature. Studies were assessed using the Joanna Briggs Institute critical appraisal tools.

Results:

A total of 36 studies met the inclusion criteria. The teaching methods employed single or combined interventions and the educational interventions suggested either improvements in outcomes or no impact.

Conclusion:

The effectiveness of educational interventions to develop patient safety competencies in undergraduate nursing students, either as a single or combined strategy, was mixed. Further research is needed to provide more robust evidence on which teaching method for patient safety is most effective.
Description of a Nurse Practitioner-Led Orthogeriatric Model of Care
Authors: Vaillancourt Emma , Backman Chantal , Chabot Chantal , Joanisse John
Published: October 2024

Older adults often present with multiple comorbidities and face significant postoperative complications. This study aimed to describe the role of Nurse Practitioner (NP)-led orthogeriatric services in managing hip fracture patients. We conducted a review of health records of older adults with hip and proximal femoral fractures between July 2017 and June 2018, presenting descriptive statistics on patient characteristics, surgical outcomes, and the involvement of orthogeriatric services. A total of 197 participants were included, with a majority being female (n = 132; 67.0%). Most patients (53.8%; n = 106) had between five and nine pre-existing conditions. Among the 192 patients who underwent surgery, 69.8% (n = 134) experienced up to four surgical complications. The Nurse Practitioner provided care to 89.1% (n = 163) of the patients within the orthogeriatric service, with half of the patients (n = 82) requiring at least five NP interventions to manage complex pre- and postoperative needs. Refining the NP-led model could potentially help reduce the burden on physicians and surgeons in treating complex medical conditions, especially in settings where geriatricians may not be readily available.
Undernutrition, Sarcopenia, Sarcopenic Obesity, and Sarcopenic Undernutrition
Authors: Briguglio Matteo , Sirtori Paolo , Mangiavini Laura , Wainwright Thomas W. , Peretti Giuseppe M. , Banfi Giuseppe
Published: October 2024

Diagnostic criteria of malnutrition phenotypes have been recently updated. Uncovering the prevalence of these conditions in patients undergoing hip replacement may be crucial in order to apply the most appropriate diagnostic-therapeutic paths to the right patient at the right time. Sixty patients aged between 60 and 85 undergoing elective hip replacement were recruited. Preoperative measures concerning eating behaviors, anthropometry, physical performance, laboratory parameters, and patient reported measures of pain and function were collected, used to make diagnosis, and explored whether they differed based on malnutrition categorization. Patients undernourished were 18.75%, sarcopenic 13.34%, sarcopenic obesity 4.26%, and 8.88% undernourished and sarcopenic. Well-nourished patients ate more cereals and meat, exhibited lower white blood cells but higher lymphocytes, and reported greater hip-related pain. One in three older patients undergoing elective hip replacement was malnourished. Eating behaviors and leucocytes were the discriminating factors between malnourished and well-nourished. It remains to be established whether malnutrition affects outcome after surgery.
Incentivizing Youth and Family SNAP-Ed Participation With Fruit and Vegetable Rewards
Authors: Moffitt Ariana J. , Thapa Rojina , Uwashimimana Mwiza Aline , Savaiano Dennis
Published: October 2024

Poor diet quality in the United States impacts millions of individuals, particularly in low-income communities. The Federal Government’s primary safety-net program, the Supplemental Nutrition Assistance Program (SNAP), and its associated nutrition education initiative, SNAP-Ed, aim to improve food security and diet quality. A number of Food as Medicine interventions have demonstrated that tying nutrition education to healthy food incentives improves diet quality and metabolic disease markers. There have been recent efforts to provide fruits and vegetables to SNAP participants via GusNIP (Gus Schumacher Nutrition Incentive Program) and related programs. However, these incentives have not been tied to nutrition education opportunities. We argue that SNAP-Ed can have a greater impact on diet quality and food security by increasing its reach to a larger number of SNAP participants with the benefits of food incentives. Thus, we propose pilot studies to assess the efficacy of combining SNAP-Ed and healthy food incentives, targeting both adults and youth for a comprehensive impact.
Application of the IMB Model in the Vision of Zero Harm Caused by Magnetic Resonance Ferromagnetic Projection Accidents
Authors: Gong Meng , Qin Lei , Cai Longbiao
Published: October 2024

Objective:

The aim of the study is to explore the application of safety education based on the IMB model to prevent harm caused by magnetic resonance ferromagnetic projection accidents.

Methods:

One hundred ninety-six patients undergoing magnetic resonance imaging were divided into a control group of 90 cases and an observation group of 106 cases. The control group received routine safety education, while the observation group received safety education based on the IMB model in addition to routine education. The knowledge, attitudes, and behaviors related to the prevention of ferromagnetic projection accidents, as well as fear scores, were compared before and after the intervention.

Results:

A total of 90 cases in the control group and 106 cases in the observation group completed the study. There were statistically significant differences in the scores of knowledges, attitudes, and behaviors related to the prevention of ferromagnetic projection accidents, as well as fear scores between the 2 groups after the intervention (all P < 0.01).

Conclusions:

Safety education based on the IMB model can improve the knowledge, attitudes, and behaviors of magnetic resonance imaging patients and reduce the risk of ferromagnetic projection accidents.
Epidemiology and Outcomes Associated with New Persistent Opioid Use after Transabdominal Surgery
Authors: Ingason Arnar B , Galenkamp Amanda L , Jonsdottir Freyja , An Gary , Sigurdsson Martin I
Published: October 2024

BACKGROUND:

Overall, 3% to 12% of opioid-naive patients develop persistent opioid use after surgery. It is still unclear whether persistent opioid use after transabdominal surgery is associated with adverse surgical outcomes. We aimed to assess if new persistent opioid use after transabdominal surgery is associated with increased long-term mortality and readmission rates.

STUDY DESIGN:

Opioid-naive patients older than 18 years undergoing transabdominal surgery at Landspitali University Hospital, the only tertiary hospital in Iceland, from 2006 to 2018 were included. Persistent opioid use was defined as opioid use more than 3 months postoperatively. Inverse probability weighting was used to yield balanced study groups accounting for baseline characteristics. Long-term mortality (during median follow-up of 5.2 years) was compared using propensity-weighted Cox regression and readmission within 3 to 6 months using propensity-weighted logistic regression.

RESULTS:

Overall, 3,923 patients were included (laparoscopy 2,680 and laparotomy 1,243). Rates of new persistent opioid use were 13%. Rates were higher after laparotomy than laparoscopy in the crude analysis but not in the propensity-weighted analysis. New persistent opioid use was associated with higher long-term mortality (hazard ratio 1.84, 95% CI 1.41 to 2.40) and readmission rates (odds ratio 3.24, 95% CI 2.25 to 4.76). This was consistent for both patients undergoing laparoscopy and laparotomy. There were signs of a dose–response relationship, with patients in higher quartiles of postoperative opioid consumption having higher mortality and readmission rates.

CONCLUSIONS:

New persistent opioid use after transabdominal surgery was associated with higher rates of mortality and readmission rates. This calls for increased postoperative support for at-risk patients and increased support during transitions of care for these patients.
Comparative Analysis of Autologous Skin Cell Suspension Technology and Split-Thickness Skin Grafting for Subacute Wounds in Medically Complex Patients: Propensity-Matched Cohort Study
Authors: Gould Lisa J , Acampora Cheryl , Borrelli Mimi
Published: October 2024

BACKGROUND:

Nonhealing wounds are particularly prevalent in older adults and in patients with multiple comorbidities, and they represent a significant medicoeconomic burden. Autologous split-thickness skin grafts (STSGs) are considered the gold standard for wound closure but suffer from high failure rates and complications. Autologous skin cell suspension (ASCS) technology is an autografting technique able to significantly minimize donor site morbidity. This retrospective, propensity-matched cohort study compared outcomes of wounds treated with ASCS vs STSG.

STUDY DESIGN:

Seven patients treated with ASCS were propensity-matched to 7 control patients who received STSG according to age and sex. The ASCS was prepared using the RECELL System and applied either alone as spray only (“ASCS alone,” off-label) or combined with a widely meshed STSG (“ASCS + STSG,” 3:1). The primary outcome was time to complete wound healing. Secondary outcomes included donor site healing, pain, and total number of visits. Statistical analyses included descriptive statistics, univariate analyses, and mixed-effect regression modeling to assess the impact of treatment on wound healing.

RESULTS:

A total of 14 patients and 17 wounds (10 treatment vs 7 control) were included. Demographics were well-matched between cohorts. The overall mean wound healing time was 85.6 ± 11.2 days. Wounds treated with ASCS (both ASCS groups) healed faster than STSG (75.9 ± 4.5 vs 99.4 ± 26.7 days). Wounds treated with ASCS alone healed in 80.8 ± 5.1 days, whereas those treated with ASCS and STSG healed in 68.5 ± 7.6 days.

CONCLUSIONS:

This study suggests that ASCS may offer clinically significant improvements in wound and donor site healing, with significantly less donor skin requirements, and comparable pain levels, compared with traditional STSG. Further research with a prospective study and larger sample size is needed to validate these findings.
Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation
Authors: Sulzer James , Papageorgiou T. Dorina , Goebel Rainer , Hendler Talma
Published: October 2024

Neurofeedback (NF) is endogenous neuromodulation of circumscribed brain circuitry. While its use of real-time brain activity in a closed-loop system is similar to brain–computer interfaces, instead of controlling an external device like the latter, the goal of NF is to change a targeted brain function. In this special issue on NF, we present current and future methods for extracting and manipulating neural function, how these methods may reveal new insights about brain function, applications, and rarely discussed ethical considerations of guiding and interpreting the brain activity of others. Together, the articles in this issue outline the possibilities of NF use and impact in the real world, poising to influence the development of more effective and personalized NF protocols, improving the understanding of underlying psychological and neurological mechanisms and enhancing treatment precision for various neurological and psychiatric conditions.

This article is part of the theme issue ‘Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation’.
Modulating subjective pain perception with decoded Montreal Neurological Institute-space neurofeedback: a proof-of-concept study
Authors: Berman Taryn , Cushing Cody , Manuel Shawn , Vachon-Presseau Etienne , Cortese Aurelio , Kawato Mitsuo , Woo Choong-Wan , Wager Tor Dessart , Lau Hakwan , Roy Mathieu , Taschereau-Dumouchel Vincent
Published: October 2024

Pain is a complex emotional experience that still remains challenging to manage. Previous functional magnetic resonance imaging (fMRI) studies have associated pain with distributed patterns of brain activity (i.e. brain decoders), but it is still unclear whether these observations reflect causal mechanisms. To address this question, we devised a new neurofeedback approach using real-time decoding of fMRI data to test if modulating pain-related multivoxel fMRI patterns could lead to changes in subjective pain experience. We first showed that subjective pain ratings can indeed be accurately predicted using a real-time decoding approach based on the stimulus intensity independent pain signature (SIIPS) and the neurologic pain signature (NPS). Next, we trained participants (
n
= 16) in a double-blinded decoded fMRI neurofeedback experiment to up- or downregulate the SIIPS. Our results indicate that participants can learn to downregulate the expression of SIIPS independently from NPS expression. Importantly, the success of this neurofeedback training was associated with the perceived intensity of painful stimulation following the intervention. Taken together, these results indicate that closed-loop brain imaging can be efficiently conducted using
a priori
fMRI decoders of pain, potentially opening up a new range of applications for decoded neurofeedback, both for clinical and basic science purposes.

This article is part of the theme issue ‘Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation’.
Semantic fMRI neurofeedback of emotions: from basic principles to clinical applications
Authors: Goebel Rainer , Lührs Michael , Ciarlo Assunta , Esposito Fabrizio , Linden David E.
Published: October 2024

During fMRI neurofeedback participants learn to self-regulate activity in relevant brain areas and networks based on ongoing feedback extracted from measured responses in those regions. This closed-loop approach has been successfully applied to reduce symptoms in mood disorders such as depression by showing participants a thermometer-like display indicating the strength of activity in emotion-related brain areas. The hitherto employed conventional neurofeedback is, however, ‘blind’ with respect to emotional content, i.e. patients instructed to engage in a specific positive emotion could drive the neurofeedback signal by engaging in a different (positive or negative) emotion. In this future perspective, we present a new form of neurofeedback that displays semantic information of emotions to the participant. Semantic information is extracted online using real-time representational similarity analysis of emotion-specific activity patterns. The extracted semantic information can be provided to participants in a two-dimensional semantic map depicting the current mental state as a point reflecting its distance to pre-measured emotional mental states (e.g. ‘happy’, ‘content’, ‘sad’, ‘angry’). This new approach provides transparent feedback during self-regulation training, and it has the potential to enable more specific training effects for future therapeutic applications such as clinical interventions in mood disorders.

This article is part of the theme issue ‘Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation’.
Decoding and modifying dynamic attentional bias in gaming disorder
Authors: Oka Taiki , Kubo Takatomi , Kobayashi Nao , Murakami Misa , Chiba Toshinori , Cortese Aurelio
Published: October 2024

With the spread of smartphones and computer games, concerns have escalated regarding the rising prevalence of gaming disorder. Patients often display attentional biases, unconsciously turning their attention towards gaming-related stimuli. However, attempts to discover and ameliorate these attentional deficits have yielded inconsistent outcomes, potentially due to the dynamic nature of attentional bias. This study investigated neural mechanisms underlying attentional bias state by combining neuroimaging (functional magnetic resonance imaging -fMRI) with an approach-avoidance task tailored to an individual’s gaming preference. We conducted a multivariate pattern analysis of endogenous brain activity in 21 participants with probable gaming disorder. Our analyses revealed that activity patterns in the insula tracked temporal attentional bias states specific to gaming stimuli. A broad network of frontal and parietal regions instead appeared to predict a general temporal attentional bias state. Finally, we conducted a proof-of-concept study for ‘just-in-time’ attentional bias training through fMRI-decoded neurofeedback of insula activity patterns, named decoded attentional bias training (DecABT). Our preliminary results suggest that DecABT may help to decrease the attractiveness of gaming stimuli via a insula- and precuneus-based neural mechanism. This work provides new evidence for the insula as an endogenous regulator of attentional bias states in gaming disorder and a starting point to develop novel, individualized therapeutic approaches to treat addiction.

This article is part of the theme issue ‘Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation’.
Amygdala self-neuromodulation capacity as a window for process-related network recruitment
Authors: Gurevitch Guy , Lubianiker Nitzan , Markovits Taly , Or-Borichev Ayelet , Sharon Haggai , Fine Naomi B. , Fruchtman-Steinbok Tom , Keynan Jacob N. , Shahar Moni , Friedman Alon , Singer Neomi , Hendler Talma
Published: October 2024

Neurofeedback (NF) has emerged as a promising avenue for demonstrating process-related neuroplasticity, enabling self-regulation of brain function. NF targeting the amygdala has drawn attention to therapeutic potential in psychiatry, by potentially harnessing emotion-regulation processes. However, not all individuals respond equally to NF training, possibly owing to varying self-regulation abilities. This underscores the importance of understanding the mechanisms behind successful neuromodulation (i.e. capacity). This study aimed to investigate the establishment and neural correlates of neuromodulation capacity using data from repeated sessions of amygdala electrical fingerprint (Amyg-EFP)-NF and post-training functional magnetic resonance imaging (fMRI)-NF sessions. Results from 97 participants (healthy controls and post-traumatic stress disorder and fibromyalgia patients) revealed increased Amyg-EFP neuromodulation capacity over training, associated with post-training amygdala-fMRI modulation capacity and improvements in alexithymia. Individual differenaces in this capacity were associated with pre-training amygdala reactivity and initial neuromodulation success. Additionally, amygdala downregulation during fMRI-NF co-modulated with other regions such as the posterior insula and parahippocampal gyrus. This combined modulation better explained EFP-modulation capacity and improvement in alexithymia than the amygdala modulation alone, suggesting the relevance of this broader network to gained capacity. These findings support a network-based approach for NF and highlight the need to consider individual differences in brain function and modulation capacity to optimize NF interventions.

This article is part of the theme issue ‘Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation’.
Effects of METTL3-METTL14 on primary microRNA processing by Drosha-DGCR8
Authors: Khadgi Brijesh , Nam Yunsun
Published: October 2024

MicroRNAs modulate most protein-coding genes, and many are regulated during maturation. Chemical modifications of primary transcripts containing microRNAs have been implicated in altering Microprocessor processing efficiency, a key initiating endonucleolytic step performed by Drosha and DGCR8. METTL3-METTL14 produces N6-methyladenosine which is the most common methylation for mRNAs. Genetic experiments suggested that METTL3-METTL14 promotes primary microRNA processing by Microprocessor, but the molecular mechanism still needs to be elucidated. We tested the hypothesis that METTL3-METTL14 or m6A may directly impact Drosha or DGCR8 function during primary microRNA processing. After reconstituting the methyltransferase and processing activities, we show that the presence of METTL3-METTL14 complexes does not affect the processing efficiency of Drosha-DGCR8. We also established a method to prepare m6A-modified primary microRNAs and used them to show that the processing of the transcripts with m6A is similar to those without any modification. Recombinant METTL3-METTL14 and DGCR8 do not form stable complexes, challenging the previous model that depends on enhanced DGCR8 recruitment. Therefore, METTL3-METTL14 or m6A modification does not generally promote Microprocessor-mediated microRNA processing, although they may impact certain cases.
Polygenic modifiers of expressivity in telomere biology disorders
Authors: Poeschla Michael , Arora Uma P. , Walne Amanda , McReynolds Lisa J. , Niewisch Marena R. , Giri Neelam , Zeigler Logan , Gusev Alexander , Machiela Mitchell J. , Tummala Hemanth , Savage Sharon A. , Sankaran Vijay G.
Published: October 2024

Variable expressivity, where individuals carrying identical genetic variants display diverse phenotypes, presents an important challenge in clinical genetics. This is exemplified by the telomere biology disorders (TBDs), which exhibit tremendous clinical heterogeneity despite their presumed monogenic nature, even among individuals harboring the same pathogenic variant. Here, we studied cohorts of patients with TBDs and population biobanks to demonstrate that common genome-wide polymorphisms associated with variation in telomere length in the general population combine with large-effect causal variants to significantly impact TBD expressivity. We go on to show that polygenic variation can contribute to expressivity within a single family with a shared large-effect causal variant, and that common and rare variation converge on a shared set of genes implicated in telomere maintenance. By elucidating the role of common genetic variation in rare disease expressivity in TBDs, these results provide a framework for understanding phenotypic variability in other presumed monogenic disorders.
Multi-ancestry proteome-phenome-wide Mendelian randomization offers a comprehensive protein-disease atlas and potential therapeutic targets
Authors: Su Chen-Yang , van der Graaf Adriaan , Zhang Wenmin , Jang Dong-Keun , Selber-Hnatiw Susannah , Yang Ta-Yu , Butler-Laporte Guillaume , Liang Kevin Y. H. , Matsuda Fumihiko , Costanzo Maria C. , Burtt Noel P. , Flannick Jason , Zhou Sirui , Mooser Vincent , Lu Tianyuan , Yoshiji Satoshi
Published: October 2024

Circulating proteins influence disease risk and are valuable drug targets. To enhance the discovery of protein-phenotype associations and identify potential therapeutic targets across diverse populations, we conducted proteome-phenome-wide Mendelian randomization in three ancestries, followed by comprehensive sensitivity analyses. We tested the potential causal effects of up to 2,265 unique proteins on a curated list of 355 distinct phenotypes, assessing 726,035 protein-phenotype pairs in European, 33,078 in African, and 115,352 in East Asian ancestries. Notably, 119 proteins were instrumentable only in African ancestry and 17 proteins only in East Asian ancestry due to allele frequency differences that are common in these ancestries but rare in European ancestry. We identified 3,949, 56, and 325 unique protein-phenotype pairs in European, African, and East Asian ancestries, respectively, and assessed their druggability using multiple databases. We highlighted the causal role of IL1RL1 in inflammatory bowel diseases, supported by multiple orthogonal lines of evidence. Taken together, this study underscores the importance of multi-ancestry inclusion and offers a comprehensive atlas of protein-phenotype associations across three ancestries, enhancing our understanding of proteins involved in disease etiology and potential therapeutic targets. Results are available at the Common Metabolic Diseases Knowledge Portal (https://broad.io/protein_mr_atlas).
OPTICAL BLUR AFFECTS DIFFERENTLY ON AND OFF VISUAL PATHWAYS
Authors: Pons Carmen , Mazade Reece , Jin Jianzhong , Dul Mitchell , Alonso Jose-Manuel
Published: October 2024

The human eye has a crystalline lens that focuses retinal images at the point of fixation. Outside this fixation region, images are distorted by optical blur, which increases light scatter and reduces the spatial resolution and contrast processed by neuronal pathways. The spectacle lenses that humans use for optical correction also minify or magnify the images, affecting neuronal surround suppression in visual processing. Because light and dark stimuli are processed with ON and OFF pathways that have different spatial resolution, contrast sensitivity and surround suppression, optical blur and image magnification should affect differently the two pathways and the perception of lights and darks. Our results provide support for this prediction in cats and humans. We demonstrate that optical blur expands ON receptive fields while shrinking OFF receptive fields, as expected from the expansion of light stimuli and shrinkage of dark stimuli with light scatter. Spectacle-induced image magnification also shrinks OFF more than ON receptive fields, as expected from the stronger surround suppression in OFF than ON pathways. Optical blur also decreases the population response of OFF more than ON pathways, consistent with the different effects of light scatter on dark and light stimuli and the ON-OFF pathway differences in contrast sensitivity. Based on these results, we conclude that optical blur and image magnification reduce the receptive field sizes and cortical responses of OFF more than ON pathways, making the ON-OFF response balance a reliable signal to optimize the size and quality of the retinal image.

HIGHLIGHTS

Optical blur affects ON and OFF pathways differently.

Blur expands ON but shrinks OFF receptive fields, weakening OFF more than ON signals.

Magnification from positive blur reduces OFF more than ON signal strength and latency.

ON-OFF response balance can signal retinal image quality and guide eye growth.

IN BRIEF

Pons et al. demonstrate that optical blur affects differently the receptive field properties and responses from ON and OFF visual pathways, revealing a new relation between ON/OFF pathway balance and blurred visual perception. The results highlight a new role of ON and OFF pathways in optimizing retinal image quality that can have implications for the regulation of eye growth.

GRAPHICAL ABSTRACT