bluuebunny/crossref_metadata_2025 huggingface dataset:
Towards A Participatory Democracy—A Case For Inclusive Public Participation In Law-Making
Authors: Bagchi Sayantani , Raghuvanshi Prakhar
Published: June 2024

Any society is governed by a set of laws. In modern democratic nations, especially nations governed by post-war constitutions, such laws are enacted by an elected legislature. The legislature is bound by the constitution itself, both in procedure and in substance. In India, such protection exists in the forms of legislative competence, fundamental rights, and other provisions of the constitution. However, India lacks a direct say of the people in the law-making process which governs the citizenry. The recent controversy in India, including the farm laws reform undertaken in 2020, highlights the need for the participation of stakeholders, experts, and the public in general in the law-making process. The Supreme Court of India has interpreted the right to participation in a limited sense and majorly in cases relating to environmental pollution. There exists a lacuna in the rights-based framework with respect to the right to participate in law-making. India has had a Pre-Legislative Consultation Policy in place since 2014 that mandates publishing the bill thirty days prior to introduction in the parliament for public comments. However, data reflects disregard of the policy by the Government. Furthermore, there is a downward trend in the number of bills being referred to parliamentary committees for scrutiny. This impacts negatively in two ways—first, leading to a lacuna in legislative drafting, and second, depriving the stakeholder and public of the opportunity to submit their comments on a bill under consideration. The extra-parliamentary avenues like the Law Commission of India, which have a significant impact on the legal framework in the country, are under a shadow. The authors argue that there is a need to incorporate a binding consultation policy ensuring public consultation in the process of law-making. This will have both an intrinsic as well as instrumental value.
Temperature and microbe mediated impacts of the San Diego Bay ostreid herpesvirus (OsHV-1) microvariant on juvenile Pacific oysters
Authors: Kunselman Emily , Manrique Daysi , Burge Colleen A , Allard Sarah , Daniel Zachary , Mitta Guillaume , Petton Bruno , Gilbert Jack A
Published: June 2024

The ostreid herpesvirus (OsHV-1) was recently detected in San Diego Bay for the first time in farmed juvenile Pacific oysters (Crassostrea gigas). Due to the virus’ ability to cause mass mortality (50%–100%), it is important to determine the factors that promote infection as well as the consequences of infection. Here, we assess the role of temperature in controlling OsHV-1 induced mortality. Pacific oysters were exposed to the San Diego Bay microvariant of OsHV-1 at four different temperatures (15°C, 18°C, 21°C, and 24°C). While OsHV-1 was able to replicate in oyster tissues at all temperatures, it did not induce mortality at 15°C, only at the higher temperatures. Additionally, we examined oyster tissue-associated bacterial response to OsHV-1 infection. As shown previously, bacterial richness increased following OsHV-1 exposure and then decreased as the oysters became sick and died. Four bacterial taxa linked to the San Diego Bay microvariant infection, including Arcobacter, Vibrio, Amphritea, and Pseudoalteromonas, were the same as those shown for other microvariant infections in other studies from globally distributed oysters, suggesting a similar spectrum of co-infection irrespective of geography and microvariant type. The significant shift in the bacterial community following exposure suggests a weakening of the host defenses as a result of OsHV-1 infection, which potentially leads to adverse opportunistic bacterial infection.
Pathogenicity and induced resistance in Larix kaempferi and Larix olgensis inoculated with Endoconidiophora fujiensis
Authors: Liu Ya , Zhou Qinzheng , Wu Di , Liu Caixia , Wu Xiaolin , Wang Zheng , Wang Huimin , Lu Quan
Published: June 2024

With climate warming and economic globalization, insect–microbe assemblages are becoming increasingly responsible for various devastating forest diseases worldwide. Japanese larch (Larix kaempferi) is extensively cultivated in China because of its high survival rate, rapid maturation and robust mechanical properties. Endoconidiophora fujiensis, an ophiostomatoid fungus associated with Ips subelongatus, has been identified as a lethal pathogen of L. kaempferi in Japan. However, there is a dearth of research on the pathogenicity of E. fujiensis in larches in China. Therefore, we investigated the pathogenicity of E. fujiensis in introduced L. kaempferi and indigenous larch (Larix olgensis) trees and compared the induced resistance responses to the pathogen in both tree species in terms of physiology and gene expression. Five-year-old saplings and 25-year-old adult trees of L. olgensis and L. kaempferi were inoculated in parallel during the same growing season. Endoconidiophora fujiensis exhibited high pathogenicity in both larch species, but particularly in L. kaempferi compared with L. olgensis adult trees; adult L. olgensis was more resistant to E. fujiensis than adult L. kaempferi, which was reflected in higher accumulation of defensive monoterpenes, such as myrcene, 3-carene and limonene and the earlier induction of defense genes catalase (CAT) and pathogenesis-related protein 1 (PR1). This study contributes to our understanding of the interactions between bark beetle-associated ophiostomatoid fungi and host larches, from phenotypic responses to alterations in secondary metabolites via defense- and metabolism-related gene activation, providing a valuable foundation for the management of larch diseases and pests in the future.
Balance between carbon gain and loss in warmer environments: impacts on photosynthesis and leaf respiration in four temperate tree species
Authors: Wang Zhaoguo , Wang Xiaochun , Han Bingxin , Liu Di , Wang Chuankuan
Published: June 2024

The temperature sensitivities of photosynthesis and respiration remain a key uncertainty in predicting how forests will respond to climate warming. We grew seedlings of four temperate tree species, including Betula platyphylla, Fraxinus mandshurica, Juglans mandshurica and Tilia amurensis, at three temperature regimes (ambient, +2 °C, and +4 °C in daytime air temperature). We investigated net photosynthesis (Anet25), maximum rate of RuBP-carboxylation (Vcmax25) and RuBP-regeneration (Jmax25), stomatal conductance (gs25), mesophyll conductance (gm25), and leaf respiration (Rleaf) in dark (Rdark25) and in light (Rlight25) at 25 °C in all species. Additionally, we examined the temperature sensitivities of Anet, Vcmax, Jmax, Rdark and Rlight in F. mandshurica. Our findings showed that the warming-induced decreases in Anet25, Vcmax25 and Jmax25 were more prevalent in the late-successional species T. amurensis. Warming had negative impacts on gs25 in all species. Overall, Anet25 was positively correlated with Vcmax25 and Jmax25 across all growth temperatures. However, a positive correlation between Anet25 and gs25 was observed only under warming conditions, and gs25 was negatively associated with vapor pressure deficit. This implies that the vapor pressure deficit-induced decrease in gs25 was responsible for the decline in Anet25 at higher temperatures. The optimum temperature of Anet in F. mandshurica increased by 0.59 °C per 1.0 °C rise in growth temperature. While +2 °C elevated the thermal optima of Jmax, it did not affect the other temperature sensitivity parameters of Vcmax and Jmax. Rdark25 was not affected by warming in any species, and Rlight25 was stimulated in T. amurensis. The temperature response curves of Rdark and Rlight in F. mandshurica were not altered by warming, implying a lack of thermal acclimation. The ratios of Rdark25 and Rlight25 to Anet25 and Vcmax25 in T. amurensis increased with warming. These results suggest that Anet and Rleaf did not acclimate to warming synchronously in these temperate tree species.
Evolutionary divergence of CXE gene family in green plants unveils that PtoCXEs overexpression reduces fungal colonization in transgenic Populus
Authors: Wang Dan , Jin Yuting , Guan Chaonan , Yang Qi , He Gang , Xu Nan , Han Xuemin
Published: June 2024

Plant enzymes significantly contribute to the rapidly diversified metabolic repertoire since the colonization of land by plants. Carboxylesterase is just one of the ubiquitous, multifunctional and ancient enzymes that has particularly diversified during plant evolution. This study provided a status on the carboxylesterase landscape within Viridiplantae. A total of 784 carboxylesterases were identified from the genome of 31 plant species representing nine major lineages of sequenced Viridiplantae and divided into five clades based on phylogenetic analysis. Clade I carboxylesterase genes may be of bacterial origin and then expanded and diversified during plant evolution. Clade II was first gained in the ancestor of bryophytes after colonization of land by plants, Clade III and Clade IV in ferns which were considered the most advanced seedless vascular plants, while Clade V was gained in seed plants. To date, the functions of carboxylesterase genes in woody plants remain unclear. In this study, 51 carboxylesterase genes were identified from the genome of Populus trichocarpa and further divided into eight classes. Tandem and segmental duplication events both contributed to the expansion of carboxylesterase genes in Populus. Although carboxylesterase genes were proven to enhance resistance to pathogens in many herbaceous species, relevant researches on forest trees are still needed. In this study, pathogen incubation assays showed that overexpressing of six Class VI carboxylesterases in Populus tomentosa, to a greater or lesser degree, reduced colonization of detached leaves by fungus Cytospora chrysosperma. A significant difference was also found in functional divergence patterns for genes derived from different gene duplication events. Functional differentiation of duplicated carboxylesterase genes in Populus was proved for the first time by in vivo physiological analysis. The identification of the potentially anti-fungal PtoCXE06 gene also laid a theoretical foundation for promoting the genetic improvement of disease-resistance traits in forest trees.
Comparative analysis of multiple consensus genomes of the same strain of Marek’s disease virus reveals intrastrain variation
Authors: Ortigas-Vasquez Alejandro , Pandey Utsav , Renner Daniel W , Bowen Chris D , Baigent Susan J , Dunn John , Cheng Hans , Yao Yongxiu , Read Andrew F , Nair Venugopal , Kennedy Dave A , Szpara Moriah L
Published: June 2024

Current strategies to understand the molecular basis of Marek’s disease virus (MDV) virulence primarily consist of cataloging divergent nucleotides between strains with different phenotypes. However, most comparative genomic studies of MDV rely on previously published consensus genomes despite the confirmed existence of MDV strains as mixed viral populations. To assess the reliability of interstrain genomic comparisons relying on published consensus genomes of MDV, we obtained two additional consensus genomes of vaccine strain CVI988 (Rispens) and two additional consensus genomes of the very virulent strain Md5 by sequencing viral stocks and cultured field isolates. In conjunction with the published genomes of CVI988 and Md5, this allowed us to perform three-way comparisons between multiple consensus genomes of the same strain. We found that consensus genomes of CVI988 can vary in as many as 236 positions involving 13 open reading frames (ORFs). By contrast, we found that Md5 genomes varied only in 11 positions involving a single ORF. Notably, we were able to identify 3 single-nucleotide polymorphisms (SNPs) in the unique long region and 16 SNPs in the unique short (US) region of CVI988GenBank.BAC that were not present in either CVI988Pirbright.lab or CVI988USDA.PA.field. Recombination analyses of field strains previously described as natural recombinants of CVI988 yielded no evidence of crossover events in the US region when either CVI988Pirbright.lab or CVI988USDA.PA.field were used to represent CVI988 instead of CVI988GenBank.BAC. We were also able to confirm that both CVI988 and Md5 populations were mixed, exhibiting a total of 29 and 27 high-confidence minor variant positions, respectively. However, we did not find any evidence of minor variants in the positions corresponding to the 19 SNPs in the unique regions of CVI988GenBank.BAC. Taken together, our findings suggest that continued reliance on the same published consensus genome of CVI988 may have led to an overestimation of genomic divergence between CVI988 and virulent strains and that multiple consensus genomes per strain may be necessary to ensure the accuracy of interstrain genomic comparisons.
Effect of Chair Placement on Physicians’ Behavior and Patients’ Satisfaction: Randomized Deception Trial
Authors: Iyer Ruchita , Park Do , Kim Jenny , Newman Courtney , Young Avery , Sumarsono Andrew
Published: June 2024

(Abstracted from BMJ 2023;383:e076309)

Etiquette-based medicine, which emphasizes good behavior and manners, has been shown to benefit the patient-physician relationship. For example, sitting at the patient’s bedside is associated with improved patient-physician communication, patient satisfaction, and trust.
Learning Plan Use in Undergraduate Medical Education: A Scoping Review
Authors: Romanova Anna , Touchie Claire , Ruller Sydney , Kaka Shaima , Moschella Alexa , Zucker Marc , Cole Victoria , Humphrey-Murto Susan
Published: June 2024

Purpose

How to best support self-regulated learning (SRL) skills development and track trainees’ progress along their competency-based medical education learning trajectory is unclear. Learning plans (LPs) may be the answer; however, information on their use in undergraduate medical education (UME) is limited. This study summarizes the literature regarding LP use in UME, explores the student’s role in LP development and implementation, and identifies additional research areas.

Method

MEDLINE, Embase, PsycInfo, Education Source, and Web of Science databases were searched for articles published from database inception to March 6, 2024, and relevant reference lists were manually searched. The review included studies of undergraduate medical students, studies of LP use, and studies of the UME stage in any geographic setting. Data were analyzed using quantitative and qualitative content analyses.

Results

The database search found 7,871 titles and abstracts with an additional 25 found from the manual search for a total of 7,896 articles, of which 39 met inclusion criteria. Many LPs lacked a guiding framework. LPs were associated with self-reported improved SRL skill development, learning structure, and learning outcomes. Barriers to their use for students and faculty were time to create and implement LPs, lack of training on LP development and implementation, and lack of engagement. Facilitators included SRL skill development, LP cocreation, and guidance by a trained mentor. Identified research gaps include objective outcome measures, longitudinal impact beyond UME, standardized framework for LP development and quality assessment, and training on SRL skills and LPs.

Conclusions

This review demonstrates variability of LP use in UME. LPs appear to have potential to support medical student education and facilitate translation of SRL skills into residency training. Successful use requires training and an experienced mentor. However, more research is required to determine whether benefits of LPs outweigh the resources required for their use.
Description of lymphocyte and cytokine profiles in individuals with acute myeloid leukemia associated with FLT3-ITD and NPM1 mutation status
Authors: Reis Rogério , Müller Gabriel S. , Santos Mariane M. , Santos Allan S. , Santos Herbert , Santos Lorene S. , Lopes Bruno A. , Trindade Soraya C. , Meyer Roberto J. , Freire Songelí M.
Published: June 2024

The pathogenesis of acute myeloid leukemia (AML) involves mutations in genes such as FLT3 and NPM1, which are also associated with the prognosis of the disease. The immune system influences disease progression, but the mechanisms underlying the interaction between the immune system and AML are not clear. In this study, the profiles of lymphocytes and cytokines were described in individuals with AML stratified by molecular changes associated with prognosis. The participants included in this study were newly diagnosed AML patients (n = 43) who were about to undergo chemotherapy. Subtypes of lymphocytes in peripheral blood, including B cells, T cells, and natural killer cells, and serum concentrations of cytokines, including Th1, Th2, and Th17, were studied by flow cytometry assays (BD FACSCanto II). The correlations between lymphocyte subsets, cytokines, and genetic/prognostic risk stratification (based on the FLT3 and NPM1 genes) were analyzed. The differences in B lymphocytes (%), T lymphocytes (%), plasmablasts (%), leukocytes (cells/µl), and tumor necrosis factor (pg/ml) were determined between groups with FLT3-ITD+ and FLT3-ITD− mutations. The presence of mutations in NPM1 and FLT3-ITD and age suggested changes in the lymphocyte and cytokine profile in individuals with AML.
Perceptions of Individuals with Autism Spectrum Disorder on How Health Care Providers Address Sexual Health
Authors: Sharma Aanchal , Pantalone David W. , Kohn Brooke , Pereida Erin T. , Nadwodny Nicole , Faja Susan
Published: June 2024

Objective:

Medical providers report barriers that prevent them from discussing sexual health with patients with autism spectrum disorder (ASD). No investigations have examined the perspectives of adults with ASD about their sexual health care experiences.

Methods:

Twenty-five verbal young adults diagnosed with ASD and 40 young adults without ASD participated. An 8-item self-report survey assessed frequency of health care visits, age when sexual health was first discussed, and frequency/content of discussions with providers.

Results:

The likelihood of discussing sexual health topics did not differ by group, χ2s < 3.25; ps > 0.07, except sexual victimization, which the ASD group reported having discussed less than the non-ASD group (32% vs 9%), χ2 (1, N = 57) = 4.36, p = 0.04. Groups did not differ in their reported comfort level discussing sex/sexual health, having a primary care provider, or frequency of visits. The non-ASD group was significantly more likely to have received sexual health counseling (81%) than ASD group (52%), χ2 (1, N = 58) = 5.33, p = 0.02. Participants in both groups reported having received sexual health information from similar sources except the ASD group was more likely to receive information from parents than the non-ASD group (68% vs 30%), χ2 (1, N = 65) = 8.99, p = 0.003.

Conclusion:

Participants in the ASD and non-ASD groups reported similar comfort levels with sexual health discussions and access to health providers. Yet, the ASD group received less counseling related to sexual health—particularly sexual victimization screening—suggesting that critical information may be missing. Future studies should determine how to help providers overcome barriers to providing young adults with ASD sexual health aligned with their needs.
Anti-Thrombotic Effect of Protoparaxotriol Saponins From Panax notoginseng Using Zebrafish Model
Authors: Liu Xin , Fan Wei , Lin Shenghua , Chen Jiayu , Zhang Shanshan , Li Xiaobin , Jin Meng , He Qiuxia
Published: June 2024

Panax notoginseng has the effect of stimulating circulation to end stasis. Our study was designed to evaluate the anti-thrombotic effect of protoparaxotriol saponins (PTS) from P. notoginseng and the involved mechanisms. A thrombosis model was constructed, and the anti-thrombotic activity of PTS was determined by erythrocyte staining, heart rate, and blood flow velocity. In addition, quantitative real-time polymerase chain reaction was used to identify changes in the expression of genes related to coagulation, inflammation, and apoptosis. PTS alleviated arachidonic acid–induced caudal vein thrombosis, restored blood flow, and increased the area of cardiac erythrocyte staining, heart rate, and blood flow velocity. It reduced the ponatinib-induced cerebral thrombus area and decreased the intensity of erythrocyte staining. The quantitative polymerase chain reaction data showed that the anti-thrombotic effect of PTS was mediated by suppression of genes related to coagulation, inflammation, and apoptosis and also involved inhibition of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathways.
Utility of methylated DNA markers for the diagnosis of malignant biliary strictures
Authors: Cooley Matthew A. , Schneider Amber R. , Barr Fritcher Emily G. , Milosevic Dragana , Levy Michael J. , Bridgeman Amber R. , Martin John A. , Petersen Bret T. , Abu Dayyeh Barham K. , Storm Andrew C. , Law Ryan J. , Vargas Eric J. , Garimella Vishal , Zemla Tyler , Jenkins Sarah M. , Yin Jun , Gores Gregory J. , Roberts Lewis R. , Kipp Benjamin R. , Chandrasekhara Vinay
Published: June 2024

Background and Aims:

Early identification of malignant biliary strictures (MBSs) is challenging, with up to 20% classified as indeterminants after preliminary testing and tissue sampling with endoscopic retrograde cholangiopancreatography. We aimed to evaluate the use of methylated DNA markers (MDMs) from biliary brushings to enhance MBS detection in a prospective cohort.

Approach:

Candidate MDMs were evaluated for their utility in MBS diagnosis through a series of discovery and validation phases. DNA was extracted from biliary brushing samples, quantified, bisulfite-converted, and then subjected to methylation-specific droplet digital polymerase chain reaction.  Patients were considered to have no malignancy if the sampling was negative and there was no evidence of malignancy after 1 year or definitive negative surgical histopathology.

Results:

Fourteen candidate MDMs were evaluated in the discovery phase, with top-performing and new markers evaluated in the technical validation phase. The top 4 MDMs were TWIST1, HOXA1, VSTM2B, and CLEC11A, which individually achieved AUC values of 0.82, 0.81, 0.83, and 0.78, respectively, with sensitivities of 59.4%, 53.1%, 62.5%, and 50.0%, respectively, at high specificities for malignancy of 95.2%–95.3% for the final biologic validation phase. When combined as a panel, the AUC was 0.86, achieving 73.4% sensitivity and 92.9% specificity, which outperformed cytology and fluorescence in situ hybridization (FISH).

Conclusions:

The selected MDMs demonstrated improved performance characteristics for the detection of MBS compared to cytology and FISH. Therefore, MDMs should be considered viable candidates for inclusion in diagnostic testing algorithms.
A Novel Surgical Technique for Macular Manipulation in Highly Myopic Eyes With Long Axial Length
Authors: Baba Takayuki , Nizawa Tomohiro , Iwase Takehito , Shimizu Daisuke
Published: June 2024

Purpose:

The authors developed a novel surgical technique tailored for highly myopic eyes characterized by extended axial lengths. Myopic eyes are prone to macular complications including macular schisis, full-thickness macular holes, and retinal detachment, which can cause severe vision loss. A pars plana vitrectomy is necessary in these cases. However, because of the considerable distance between the posterior pole and the cannula, regular forceps cannot reach the macula in some cases. To overcome this, the authors inserted a trocar more posteriorly after localizing the ora serrata.

Methods:

First, the authors placed two ports and performed partial vitrectomy without the infusion of balanced salt solution to reduce the intraocular pressure. Subsequently, the authors observed the peripheral retina localized to the ora serrata by scleral indentation using forceps. After the precise marking of the area, a third trocar was inserted and its position and placement confirmed intraoperatively.

Results:

Surgical maneuvers including a removal of the internal limiting membrane were safely performed using regular forceps through the posteriorly located cannula.

Conclusion:

The described technique offers a solution to the challenges posed by the extended axial lengths of highly myopic eyes during vitreoretinal surgery. By inserting the trocar more posteriorly, surgeons can enhance accessibility to the macula without requiring specialized equipment or extensive maneuvers.
RETINAL MIGRATION AND SURGICAL OUTCOME AFTER HEMI-TEMPORAL INTERNAL LIMITING MEMBRANE PEELING VERSUS CONVENTIONAL PEELING FOR MACULAR HOLE
Authors: Jujo Tatsuya , Shiono Akira , Sato Keiji , Sekine Reio , Uchiyama Naoto , Kakehashi Kota , Endo Akiko , Arakawa Akira , Shinkai Youichiro , Kitaoka Yasushi
Published: June 2024

Purpose:

To investigate the anatomical changes and surgical outcomes of hemi-temporal internal limiting membrane (ILM) peeling and conventional ILM peeling for idiopathic macular hole (MH).

Methods:

This randomized controlled trial was conducted at 3 centers and included 50 participants with MHs of <400 µm in minimum diameter for a duration of <6 months. All participants had undergone vitrectomy with either hemi-temporal ILM peeling (Hemi group) or 360° ILM peeling (360° group) with an injection of 5% sulfur hexafluoride gas, with or without simultaneous cataract surgery, from July 2017 to January 2021. The rate of MH closure and distance of retinal migration were examined.

Results:

Of 50 eyes randomized in the 3 centers, the Hemi group comprised 23 eyes, the 360° group 23 eyes, and 4 eyes were eliminated from final analysis. There was a significantly higher rate of primary MH closure in the 360° group (Hemi group: 73.9% vs. 360° group: 100%, P = 0.009). Retinal migration to the optic disk on the nasal side was significantly shorter in the Hemi group at 1, 3, and 6 months postoperatively than in the 360° group. There was no significant difference between the two groups in retinal migration to the optic disk on the temporal side.

Conclusion:

Nasal retinal migration in patients who underwent the hemi-temporal ILM peeling method was significantly less than in those who underwent the 360° ILM peeling method. However, less nasal retinal migration did not contribute to the MH closure rate.
Efficacy of a smartphone application assisting home-based rehabilitation and symptom management for patients with lung cancer undergoing video-assisted thoracoscopic lobectomy: a prospective, single-blinded, randomised control trial (POPPER study)
Authors: Lv Chao , Lu Fangliang , Zhou Xiugeng , Li Xiang , Yu Wenhua , Zhang Chune , Chen Kaishen , Du Songtao , Han Chao , Wang Jia , Wang Yuzhao , Li Shaolei , Wang Liang , Liu Yinan , Zhang Shanyuan , Huang Miao , Song Dongdong , Zhao Dachuan , Liu Bing , Wang Yaqi , Cui Xinrun , Zhou Zhiwei , Yan Shi , Wu Nan
Published: June 2024

Background:

Video-assisted thoracoscopic (VATS) lobectomy can affect patients’ pulmonary function and quality of life significantly. No optimal protocol combining patient-reported outcome-based symptom management and postdischarge rehabilitation programme has yet been established. This study aimed to assess the efficacy of a novel smartphone app designed for home-based symptom management and rehabilitation.

Methods:

The app was developed based on three modules: a symptom reporting system with alerts, aerobic and respiratory training exercises, and educational material. Four core symptoms were selected based on a questionnaire survey of 201 patients and three rounds of Delphi voting by 30 experts. The authors screened 265 patients and randomly assigned 136 equally to the app group and usual care group. The primary outcome was pulmonary function recovery at 30 days postoperatively. Secondary outcomes included symptom burden and interference with daily living (both rated using the MD Anderson Symptom Inventory for Lung Cancer), aerobic exercise intensity, emergency department visits, app-related safety, and satisfaction with the app.

Findings:

Of the 136 participants, 56.6% were women and their mean age was 61 years. The pulmonary function recovery ratio 1 month after surgery in the app group was significantly higher than that in the usual care group (79.32 vs. 75.73%; P=0.040). The app group also recorded significantly lower symptom burden and interference with daily living scores and higher aerobic exercise intensity after surgery than the usual care group. Thirty-two alerts were triggered in the app group. The highest pulmonary function recovery ratio and aerobic exercise intensity were recorded in those patients who triggered alerts in both groups.

Interpretation:

Using a smartphone app is an effective approach to accelerate home-based rehabilitation after VATS lobectomy. The symptom alert mechanism of this app could optimise recovery outcomes, possibly driven by patients’ increased self-awareness.
Ultra-short-period perioperative pulmonary rehabilitation on short-term outcomes after surgery in smoking patients with lung cancer: a randomized clinical trial
Authors: Han Dingpei , Wang Xinyi , Sun Xin , Cao Yuqin , Li Chengqiang , Guo Wei , Hu Yanxia , Hang Junbiao , Li Jian , Xie Qing , Li Hecheng
Published: June 2024

Background:

Pulmonary rehabilitation (PR) is essential for airway management after thoracic surgery. Most current PRs are composed of 2–4-week exercises, which require significant consumption of medical resources and concerns about disease progression.

Materials and methods:

This single-center, prospective, randomized controlled trial enrolled smoking patients with pulmonary masses or nodules suitable for lobectomy, aged 18–80, with a smoking history (≥20 pack-years). Eligible patients were randomized in a 1:1 ratio into two groups. Patients in the intervention group underwent perioperative breathing exercises based on positive pressure vibration expectoration and 3-day preoperative lower limb endurance training. Patients in the control group received routine perioperative care. The primary outcome was in-hospital incidence of postoperative pulmonary complications. Secondary outcomes included postoperative hospital stay, total hospitalization cost, postoperative drainage time, drainage volume, semiquantitative cough strength score, pain score, Borg scale‐assessed fatigue, and walking distance on postoperative days 1 and 2.

Results:

A total of 194 patients were included in the study, with 94 in the intervention group and 100 in the control group. Our ultrashort PR program potentially reduced pulmonary complications incidence (24.5 vs. 33.0%), but without statistical significance (P=0.190). No significant differences were found in other perioperative outcomes, except for postoperative semiquantitative cough strength score (3 [interquartile range, 3–3.75] vs. 3 [interquartile range, 2–3], P<0.001) and change in walking distance from postoperative days 1 to 2 (60 [interquartile range, 40–82.5] vs. 30 [interquartile range, 10–60], P=0.003).

Conclusion:

There were no significant differences in postoperative complications and other hospitalizations, but our ultrashort rehabilitation program improved patients’ semiquantitative cough strength score and walking distance, indicating the potential for better outcomes. This treatment is a safe and effective means of airway management for thoracic surgery in the era of enhanced recovery (ClinicalTrials.gov Identifier: NCT03010033).
Optimizing twin-beam dual-energy CT reconstruction: Quantitative consistency and stability assessment in reference to 120 kV: An observational study
Authors: Niu Zhongfeng , Qiu Xia , Ren Hong , Jiang Yangyang , Yu Feidan , Hu Hongjie
Published: June 2024

The split filter CT can filter X-ray beam. Theoretically, the split filter CT not only provides a good low-energy beam, but also provides a more robust CT value. The aim of this study was to compare conventional single-energy computed tomography (SECT) and twin-beam dual-energy (TBDE) CT regarding the quantitative consistency and stabilities of HU measurements at different abdominal organs. Forty-four patients were prospectively enrolled to randomly receive SECT and TBDE protocols at either body part of a thorax-abdominal examination. Their overlapping scan coverage was subjected to further image analysis. For TBDE scans, composed images(c-images) and virtual monoenergetic images (VMIs) at 60, 70, 80, and 90 kiloelectron volt (keV) were reconstructed. The attenuations were measured at 5 abdominal organs and compared between SECT and TBDE to characterize quantitative consistency by intraclass correlation coefficients (ICCs), whereas their standard deviations were used to assess the Hounsfield Unit (HU) stability. The c-images, 70 keV and 80 keV VMIs from TBDE provided consistent HU values (all ICCs > 0.8) with the SECT measurements; moreover, these TBDE images had superior HU stability over SECT images in all abdominal measurements except for fat tissue. The best HU stability can be achieved in 80 keV VMIs with the lowest noise level. The c-images and VMIs derived from TBDE can produce consistent values as SECT. The 80 keV images displayed better HU stability and a lower noise level across various abdominal organs.
Efficacy of knee osteoarthritis by use of laser acupuncture: A systematic review and meta-analysis
Authors: Han Rong , Guo Chunxia , Lau Kit , Hu Jinlian
Published: June 2024

Background:

Previous studies need to be aggregated and updated. We aim to assess the efficacy of laser acupuncture (LA) in knee osteoarthritis (OA) through a meta-analysis.

Methods:

Electronic databases were searched for studies investigating laser acupuncture’s efficacy in managing OA. Data were collected from the beginning of each database to 2022 (up to March). The “WOMAC total score,” “WOMAC stiffness score,” “WOMAC pain score,” “WOMAC physical function score,” and “VAS score” were the key outcomes of interest. The Der Simonian-Laird method for random effects was used.

Results:

Twenty-five randomized controlled clinical trials met our criteria and were included (2075 patients). Comparisons of interest is the LA versus Sham LA (efficacy), LA versus. A (Acupuncture) (comparative effectiveness), LA combined with A versus A (effectiveness as an adjunct), and any other research used LA in their treatment. Laser irradiation is effective in patients with Knee OA. LA is also effective and has almost the same outcome as laser irradiation. LA can achieve almost the same effect as manual acupuncture, even better than acupuncture in some studies.

Conclusion:

Laser acupuncture is more or less effective in patients with OA; better efficacy will be achieved under appropriate laser parameters (810 nm, 785 nm) in the LA versus Sham LA group. Many studies have diverse results, possibly due to unstaged analysis of patients’ disease, inappropriate selection of acupoints, lack of remote combined acupoints, and unreasonable laser parameters. Furthermore, a combination of acupoints was found to be more effective, which aligns with the combined-acupoints application of traditional Chinese medicine.
An analysis of clinical characteristics of rare bilateral medial medullary infarction: An observational study
Authors: Hu Zhenzhu , Ban Jin , Li Zhaoying , Yang Dongdong , Li Ke , Zhang Xuanchao , Hu Fangfang , Li Qingqing , Mao Wenqi , Liang Yanjing , Luo Dehua , Chen Zhenwei , Chen Hao , Shi Yu
Published: June 2024

This study aimed to characterize the risk factors, etiology, clinical manifestations, anatomical characteristics, stroke mechanisms, imaging features, and prognosis of bilateral medial medullary infarction (BMMI). A retrospective analysis was conducted on 11 patients with BMMI who met the inclusion criteria at the Affiliated Hospital of Xuzhou Medical University from January 2013 to January 2023. The patients’ imaging and clinical features were analyzed and summarized. Eleven patients (7 male, 4 female), aged 46 to 62 years, met the inclusion criteria. Common clinical presentations included dysarthria (90.9%), dysphagia (90.9%), quadriplegia (81.8%), and so on. Within 72 hours of onset, 8 cases presented with quadriplegia, 2 cases with hemiplegia, and 1 case without limb paralysis. The main risk factor for BMMI was hypertension, followed by diabetes. “Heart appearance” infarcts occurred in 4 cases (36.4%), while “Y appearance” infarcts occurred in 7 cases (63.6%). Among the patients, 3 had unilateral vertebral artery stenosis or occlusion, 5 had bilateral vertebral artery stenosis or occlusion, 2 had normal vertebral basilar artery, and 1 did not undergo cerebrovascular examination. All patients received standardized treatment for cerebral infarction. The prognosis was poor, with 81.8% of patients having an unfavorable outcome, including 1 death, 9 cases of disability, and only 1 patient achieving self-care ability after recovery. BMMI is more prevalent in males aged 45 to 60 years. The main risk factors are hypertension and diabetes. Atherosclerosis is the primary etiological subtype. The main clinical manifestations are dyskinesia, dizziness, quadriplegia, and dysarthria. The prognosis of BMMI is poor. The specific imaging features of “heart appearance” or “Y appearance” infarcts aid in the diagnosis of BMMI.
Complex delayed blood transfusion reaction: A case report
Authors: Li Qiang , Xie Jinhui , Sun Jiali , Fang Kuo , Li Tongtong
Published: June 2024

Introduction:

Inefficient blood transfusions present a significant challenge, leading to the wastage of crucial blood resources and increased medical expenses. This study aims to address this issue by providing a comprehensive analysis of a case involving an ineffective clinical transfusion and outlining the significance of identifying multiple alloantibodies in resolving transfusion challenges.

Case report:

We present a detailed follow-up on a patient treatment journey, highlighting the critical role of identifying multiple alloantibodies through various methodologies in addressing the transfusion problem. Subsequently, a strategic intervention was implemented, leading to a successful patient outcome.

Conclusion:

This study underscores the importance of conducting a thorough analysis of ineffective transfusions and implementing scientifically formulated transfusion plans based on rational explanations. Such an approach not only improves hemoglobin levels but also contributes to better patient outcomes, thereby reducing blood resource wastage and medical costs.
Acupuncture treatment for anti-NMDAR encephalitis: A case report
Authors: Yang Tianhong , Cheng Hui , Gu Chunlei
Published: June 2024

Rationale:

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a rare disease and common type of autoimmune encephalitis. The prognosis of patients with comorbid disorders of consciousness is poor, and no such acupuncture treatment has been reported. We report a case of acupuncture in anti-NMDAR encephalitis with a high cerebrospinal fluid titer combined with impaired consciousness.

Patient concerns:

A 13-year-old girl with anti-NMDAR encephalitis presented to our hospital with impaired consciousness.

Diagnoses:

Therefore, the patient was diagnosed with anti-NMDAR encephalitis. According to the Chinese medicine theory, the diagnosis was Shenhun(phlegm obstructs the clear orifices).

Interventions:

Depending on the patient’s condition, we used the Xingnao Kaiqiao acupuncture therapeutic method.

Outcomes:

After 16 weeks of acupuncture treatment, the patient awoke and resumed a normal life with no recurrence at one-year follow-up.

Conclusion:

This case demonstrated that acupuncture can be used as a complementary and alternative treatment for anti-NMDAR encephalitis.
Inflammatory proteins may mediate the causal relationship between gut microbiota and inflammatory bowel disease: A mediation and multivariable Mendelian randomization study
Authors: Huang Yu-Liang , Zheng Jin-Min , Shi Zheng-Yi , Chen Huan-Huan , Wang Xiao-Tong , Kong Fan-Biao
Published: June 2024

This research investigates the causal relationships among gut microbiota, inflammatory proteins, and inflammatory bowel disease (IBD), including crohn disease (CD) and ulcerative colitis (UC), and identifies the role of inflammatory proteins as potential mediators. Our study analyzed gut microbiome data from 13,266 samples collected by the MiBioGen alliance, along with inflammatory protein data from recent research by Zhao et al, and genetic data on CD and UC from the International Inflammatory Bowel Disease Genetics Consortium (IIBDGC). We used Mendelian randomization (MR) to explore the associations, complemented by replication, meta-analysis, and multivariable MR techniques for enhanced accuracy and robustness. Our analysis employed several statistical methods, including inverse-variance weighting, MR-Egger, and the weighted median method, ensuring comprehensive and precise evaluation. After MR analysis, replication and meta-analysis, we revealed significant associations between 11 types of gut microbiota and 17 inflammatory proteins were associated with CD and UC. Mediator MR analysis and multivariable MR analysis showed that in CD, the CD40L receptor mediated the causal effect of Defluviitaleaceae UCG-011 on CD (mediation ratio 8.3%), and the Hepatocyte growth factor mediated the causal effect of Odoribacter on CD (mediation ratio 18%). In UC, the C-C motif chemokine 4 mediated the causal effect of Ruminococcus2 on UC (mediation ratio 4%). This research demonstrates the interactions between specific gut microbiota, inflammatory proteins, and CD and UC. Furthermore, the CD40L receptor may mediate the relationship between Defluviitaleaceae UCG-011 and CD; the Hepatocyte growth factor may mediate the relationship between Odoribacter and CD; and the C-C motif chemokine 4 may mediate the relationship between Ruminococcus2 and UC. The identified associations and mediation effects offer insights into potential therapeutic approaches targeting the gut microbiome for managing CD and UC.
Role of hematological indices in predicting preeclampsia and its severity: retrospective case–control study
Authors: Al-Nuaimi Ali Mohammed Ali
Published: June 2024

Preeclampsia (PE) is a serious condition that threatens pregnancy with severe sequelae on both the mother and infant. Early detection of PE will lead to favorable outcomes, and using readily available markers like hematological indices is an attractive choice. Examine the diagnostic utility of hematological indices in pregnant women to predict preeclampsia and its severity. In a retrospective case–control study that included 252 women, all had their complete blood picture evaluated during their first and third trimesters as part of their outpatient antenatal care during their pregnancy. They were also divided into 3 groups: healthy pregnant women (control), non-severe PE, and severe PE, each involving 84 women. The changes in platelet to lymphocyte ratio (PLR) between 1st and 3rd trimesters showed an excellent ability to differentiate between severe PE and control (area under the curve = 0.954, cutoff ≤ ‐5.45%) and a good ability to differentiate between severe PE and non-severe PE (area under the curve = 0.841, cutoff ≤ ‐7.89%). Neutrophil to lymphocyte ratio showed a good to excellent ability to differentiate between severe PE and non-severe PE compared to control in the first and third trimesters and the percentage change between them. Changes in neutrophil to lymphocyte ratio and PLR strongly predict preeclampsia and its severity since they offer more predictive values than measuring NLP and PLR at different stages of pregnancy individually.
Rectal squamous cell carcinoma treated with neoadjuvant fluorouracil, oxaliplatin, cetuximab, and radiation: A case report of pathological complete response
Authors: Fujise Yuta , Hazama Shoichi , Fujii Toshiyuki , Inoue Motoshige , Takahashi Shotaro , Yoshida Kazuya , Ikeda Akihiko , Hashiyada Hiroshi , Nakamoto Kembu , Yamashita Aogu , Hino Keisuke , Okita Kiwamu
Published: June 2024

Rationale:

Treatment strategies for rectal squamous cell carcinoma (rSCC) are yet to be established, given its rarity. Although squamous cell carcinoma has been reported to be highly sensitive to cetuximab and radiation, there is no report of combination therapy of cetuximab and radiation for rSCC. In this study, we firstly reported a case of rSCC in which a complete response was achieved with the original chemoradiotherapy comprising oxaliplatin, S-1, cetuximab, and simultaneous radiation.

Patient concerns:

A 46-year-old women presented to our hospital with lower abdominal pain and fatigue.

Diagnoses:

Based on tumor marker analyses, histological examination of biopsy specimens, and comprehensive imaging, the patient was diagnosed with rSCC.

Interventions:

Neoadjuvant chemoradiotherapy (50.4 Gy) was administered in 28 fractions, along with concurrent chemotherapy comprising SOX (S-1: 80 mg/m2, days 1–5 and 8–12, oxaliplatin: 85 mg/m2, day 1) and cetuximab (400 mg/m2, day 1, 250 mg/m2, after day 8).

Outcomes:

Five weeks after chemoradiation, the patient underwent laparoscopic partial intersphincteric resection, achieving a complete pathological response.

Lessons:

This case firstly highlights the usefulness of SOX plus cetuximab combined with radiation in the treatment of locally advanced rSCC. However, a large-scale study is required to establish safe and effective treatment regimens.
Serum level of interleukin-24 and its polymorphism in eczematic Iraqi patients
Authors: Mahmood Aseel S. , Al-Bassam Wasan W.
Published: June 2024

Eczema is a common skin disease associated with inflammation. Interleukin (IL)-24 is crucial in the pathogenesis of inflammatory diseases like eczema. The study objective was the assessment of IL-24 serum levels and its gene polymorphisms in eczematic Iraqi patients. This retrospective case-control study involved 145 participants, divided into 82 patients with eczema and 63 healthy controls. An enzyme-linked immunosorbent assay measured serum IL-24, while polymerase chain reaction and Sanger DNA sequencing were used for genotype analysis. Serum IL-24 level was significantly higher (P value < .001) in patients compared to controls (41.6 [interquartile range (IQR): 28.9–53.6] vs 9.8 [IQR: 0.8–19.6] pg/mL, respectively). DNA sequence illustrated 2 SNPs with polymorphic frequencies (rs1150256 G/A and rs3093425 del/ins). The first SNP (rs1150256 G/A) showed 3 genotypes (GG, AA, and G/A), while the second SNP (rs3093425) showed 3 genotypes (-/G del/Ins, G Ins/Ins, and - del/del). The subsequent investigation revealed the presence of the following findings within the DNA sequence of the PCR amplified region (329bp). In the control group, all participants had GG/G (wild type) genotype/allele for the rs1150256 SNP, while in eczematic patients, 24.4% GG, 50% GA, and 25.6% AA. For the second SNP genotype (rs3093425 del/ins), the genotype frequencies in patients vs control were (24.4% vs 84.1%, 50.0% vs 11.1%, and 25.6% vs 4.8; Del/Del, Del/Ins, and Ins/Ins, respectively). The presence of Ins compared to Del increased the risk of eczema by 8.91 (4.66–17.03); OR (95% CI). In conclusion, IL-24 is a good predictor of eczema and A-allele carrier for rs1150256 SNP, and insertion-allele carrier for rs3093425 SNP is associated with elevated serum IL-24 and higher risk of eczema.