bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating Vesicle-Mediated Regulation of Pollen Tube Growth through BFA Inhibition and AS-ODN Targeting of TfRABA4D in Torenia fournieri
Authors: Jin Xingyue , Mizukami Akane G , Okuda Satohiro , Higashiyama Tetsuya
Published: January 2025

In flowering plants, pollen tube growth is essential for delivering immotile sperm cells during double fertilization, directly influencing seed yield. This process relies on vesicle-mediated trafficking to drive tip growth and maintain fertility. However, investigating pollen tube growth is challenging in non-model plants due to the lack of transgenic tools. Here, we established a method to transiently inhibit vesicle activity in pollen tubes of the wishbone flower (Torenia fournieri), a classic plant for sexual reproduction studies, using brefeldin A (BFA) and antisense oligodeoxynucleotides (AS-ODNs) targeting key genes. BFA broadly disrupted vesicle gradient homeostasis in T. fournieri pollen tubes, leading to widespread changes in cell wall deposition, ROS distribution, and pollen tube morphology. To assess the role of specific genes, we designed AS-ODNs against TfANX, the sole ANXUR homolog in T. fournieri, which successfully penetrated cell membranes and suppressed TfANX expression. This inhibition impaired pollen tube tip growth, causing pollen tube leakage at the shank region and, in some cases, multiple leakages. Similarly, AS-ODN targeting TfRABA4D, a pollen-specific vesicle regulator, induced a bulging phenotype and disrupted pectin deposition and reduced ROS distribution, mirroring BFA effects. These findings elucidate vesicle-mediated regulation in pollen tube tip growth and introduce an accessible method for genetic manipulation in reproductive research of non-model plants.
Association of the tomato co-chaperone gene Sldnaj harboring a promoter deletion with susceptibility to Tomato spotted wilt virus (TSWV)
Authors: Qi Shiming , Meng Liangzhe , Lou Qianqi , Li Yushun , Shen Yuanbo , Zhang Shijie , Wang Xinyu , Zhao Pan , Wang Jin , Wang Bo , Chen Xiubin , Zhang Chunmei , Du Yu , Zhao Jiantao , Zhan Xiangqiang , Liang Yan
Published: January 2025

Tomato spotted wilt virus (TSWV) poses a significant threat as a devastating pathogen to the global production and quality of tomato (Solanum lycopersicum). Mining novel resistance genes within the tomato germplasm is an effective and environmentally friendly approach to combat TSWV. In this study, we investigated the mechanisms underlying high TSWV resistance in a specific tomato line after experimental inoculation, despite not possessing any known TSWV resistance genes. The candidate causal genes of disease resistance traits were finely mapped by constructing different genetic populations and performing bulk segregant analysis sequencing. This approach identified SlDnaJ (Solyc10g081220) as a key locus potentially regulating TSWV resistance. We determined a structural variant of SlDnaJ (designated Sldnaj) containing a 61-bp promoter sequence deletion that was specifically present in the germplasm of the susceptible M82 tomato plant lines. Sldnaj-knockout transgenic plants were significantly more resistant to TSWV than wild-type plants. Up-regulated expression of Sldnaj affected the salicylic acid/jasmonic acid signaling pathway, which induced and promoted the systemic infection of TSWV in M82 susceptible plants. In summary, this study identified a new candidate TSWV susceptibility gene with a natural deletion variation in tomato. These findings provide insights into the molecular mechanism underlying pathogen resistance while offering a target for breeding strategies of tomato with TSWV resistance.
Disease-State Dependent Associations Between Intrinsic Brain Function and Symptoms of Fatigue, Depression, and Anxiety in Crohn’s Disease
Authors: Thomann Anne Kerstin , Schmitgen Mike-Michael , Stephan Jule Cara , Knoedler Laura-Louise , Gass Achim , Thomann Philipp Arthur , Ebert Matthias Philip , Reindl Wolfgang , Wolf Robert Christian
Published: January 2025

Background

Extraintestinal symptoms (EIS) in inflammatory bowel diseases, including fatigue, depression and anxiety, are highly prevalent, but poorly understood. Alterations of brain function may contribute to EIS, but their association with disease activity is unclear. This study analyzed intrinsic neural activity (INA) of individuals with Crohn’s disease (CD) in different disease states and examined the relationship between INA and EIS.

Methods

Patients with CD (n = 92) and healthy controls (n = 41) underwent functional magnetic resonance brain imaging and completed symptom-specific psychometry. Temporal (amplitude of low-frequency fluctuations, ALFF) and spatial (regional homogeneity, ReHo) markers of INA were compared between CD and controls and between active (patients with active Crohn’s disease [aCD]) versus remitted (rCD) disease. Regression analyses explored disease-state-dependent associations between INA and EIS.

Results

Patients exhibited aberrant INA in frontotemporal, occipital, and thalamic regions. Patients with aCD exhibited lower ALFF in left subcallosal cortex and inferior temporal gyri compared to rCD. Regional homogeneity in aCD was lower in left medial orbital gyrus and higher in right superior frontal, left inferior temporal, and left precentral gyrus. Compared to rCD, aCD showed higher ALFF predominantly in superior, ventro-, and dorsolateral prefrontal regions. Distinct associations between INA and EIS were detected in patients, particularly in the remitted state.

Conclusions

Intrinsic brain function in patients with CD varies by disease state, with prominent frontal cortex changes in active disease. These brain activity changes are at least partly related to the magnitude of neuropsychiatric symptoms and highlight a role of disturbed brain–gut interactions in the development of EIS especially in rCD.
Improving large language model applications in biomedicine with retrieval-augmented generation: a systematic review, meta-analysis, and clinical development guidelines
Authors: Liu Siru , McCoy Allison B , Wright Adam
Published: January 2025

Objective

The objectives of this study are to synthesize findings from recent research of retrieval-augmented generation (RAG) and large language models (LLMs) in biomedicine and provide clinical development guidelines to improve effectiveness.

Materials and Methods

We conducted a systematic literature review and a meta-analysis. The report was created in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 analysis. Searches were performed in 3 databases (PubMed, Embase, PsycINFO) using terms related to “retrieval augmented generation” and “large language model,” for articles published in 2023 and 2024. We selected studies that compared baseline LLM performance with RAG performance. We developed a random-effect meta-analysis model, using odds ratio as the effect size.

Results

Among 335 studies, 20 were included in this literature review. The pooled effect size was 1.35, with a 95% confidence interval of 1.19-1.53, indicating a statistically significant effect (P = .001). We reported clinical tasks, baseline LLMs, retrieval sources and strategies, as well as evaluation methods.

Discussion

Building on our literature review, we developed Guidelines for Unified Implementation and Development of Enhanced LLM Applications with RAG in Clinical Settings to inform clinical applications using RAG.

Conclusion

Overall, RAG implementation showed a 1.35 odds ratio increase in performance compared to baseline LLMs. Future research should focus on (1) system-level enhancement: the combination of RAG and agent, (2) knowledge-level enhancement: deep integration of knowledge into LLM, and (3) integration-level enhancement: integrating RAG systems within electronic health records.
Comparing microsatellites and single nucleotide polymorphisms to evaluate genetic structure and diversity in wolverines (Gulo gulo) across Alaska and western Canada
Authors: Stacy Elise M , Robards Martin D , Jung Thomas S , Kukka Piia M , Sullivan Jack , Hohenlohe Paul A , Waits Lisette P
Published: January 2025

The Wolverine (Gulo gulo) is a cold-adapted species of conservation interest because it is sensitive to human development, disturbance, exploitation, and climate warming. Wolverine populations have been studied across much of their distributional range to evaluate patterns of genetic diversity, genetic structure, and gene flow. Little population structure has been detected in northwestern North America with microsatellite loci, but low genomic diversity in wolverines may limit detection of genetic differences in this highly vagile species. Here, we genotyped a relatively large sample of wolverines from across Alaska (US) and adjacent Yukon (Canada) with 12 microsatellite loci (n = 501) and 4,222 single nucleotide polymorphisms (SNPs; n = 201) identified using restriction-site associated DNA sequencing. We compared the relative ability of our microsatellite and SNP datasets to evaluate population genetic structure, genetic diversity, differentiation, and isolation by distance (IBD). We predicted that the SNP dataset would detect a higher degree of genetic structure and provide more significant support for IBD. We found evidence for multiple genetic clusters, including genetic distinctiveness of wolverines in southeast Alaska and on the Kenai Peninsula. The SNP dataset detected additional genetic clusters that align largely with ecoregions, and the SNP dataset showed stronger evidence of IBD, while the 2 datasets were generally consistent in estimates of genetic diversity and differentiation among regional groups. Our results highlight the importance of genomic methods to assess gene flow in wolverines. Identifying population genetic structure allows an assessment of the potential impacts of conservation threats and is an important precursor for designing population monitoring programs.
Challenges in determining the global burden of non-malignant central nervous system tumors: an analysis of international incidence and mortality data sources
Authors: Dean Frances , Henrikson Hannah , Xu Rixing , Farah Hodo , Lu Dan , Harvey James , Fu Weijia , Pritchett Natalie , Bhakta Nickhill , Moreira Daniel C , Qaddoumi Ibrahim , Girardi Fabio , Vos Theo , Naghavi Mohsen , Finlay Jonathan L , Force Lisa M
Published: January 2025

Background

Non-malignant tumors of the CNS contribute substantially to the morbidity and mortality from CNS tumors. It is critical to understand the epidemiology of non-malignant CNS tumors separately from CNS malignancies to inform resource allocation and policy since treatment and prognosis can differ. High quality international data on non-malignant CNS tumor burden are needed to accomplish this goal.

Methods

We assessed cancer registry and vital registration data available to the Global Burden of Disease study by its inclusion of non-malignant CNS tumors, reporting on the availability of data over time and by World Bank income group. We analyzed preliminary age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and proportions of CNS tumors by behavior for adults, children, and all ages.

Results

Non-malignant CNS tumors were reported separately in 17·2% (N=66) of registry reports and in aggregate with malignant CNS tumors in 18·0% (N=69) of reports. Only seven low- and middle-income countries (LMICs) had data reporting CNS tumors separately by behavior. Across all ages combined, the median ASIR of non-malignant CNS tumor data was 0·31 (interquartile range: 0·15-0·50) and ASMR was 0·24 (0·10-0·44) per 100,000 in LMICs compared to median ASIR of 3·62 (2·62-4·97) and ASMR of 0·32 (0·16-0·65) in high-income countries (HICs). A larger proportion of incident CNS tumors across were reported as non-malignant in HIC data than LMIC data (p<0.0001).

Conclusions

Our study alludes to current challenges in understanding global non-malignant CNS tumor burden and a need for increased international data collection. Further research is needed to comprehensively investigate opportunities for future data inclusion.
Effect of Plant Versus Animal Protein on Muscle Mass, Strength, Physical Performance, and Sarcopenia: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Reid-McCann Rachel J , Brennan Sarah F , Ward Nicola A , Logan Danielle , McKinley Michelle C , McEvoy Claire T
Published: January 2025

Context

Dietary protein is recommended for sarcopenia—a debilitating condition of age-related loss of muscle mass and strength that affects 27% of older adults. The effects of protein on muscle health may depend on protein quality.

Objective

The aim was to synthesize randomized controlled trial (RCT) data comparing plant with animal protein for muscle health.

Data Sources

Forty-three eligible RCTs were sourced from Medline, Embase, Scopus, Web of Science, and CENTRAL databases.

Data Extraction

Four reviewers (R.J.R.-M., S.F.B., N.A.W., D.L.) extracted data from RCTs (study setting, population, intervention characteristics, outcomes, summary statistics) and conducted quality assessment using the Cochrane Risk of Bias 2.0.

Data Analysis

Standardized mean differences (SMDs) (95% CIs) were combined using a random-effects meta-analysis and forest plots were generated. I2 statistics were calculated to test for statistical heterogeneity.

Conclusion

Thirty RCTs (70%) were eligible for meta-analysis and all examined muscle mass outcomes. Compared with animal protein, plant protein resulted in lower muscle mass following the intervention (SMD = –0.20; 95% CI: –0.37, –0.03; P = .02), with stronger effects in younger (<60 years; SMD = –0.20; 95% CI: –0.37, –0.03; P = .02) than in older (≥60 years; SMD = –0.05; 95% CI: –0.32, 0.23; P = .74) adults. There was no pooled effect difference between soy and milk protein for muscle mass (SMD = –0.02; 95% CI: –0.20, 0.16; P = .80) (n = 17 RCTs), yet animal protein improved muscle mass compared with non-soy plant proteins (rice, chia, oat, and potato; SMD = –0.58; 95% CI: –1.06, –0.09; P = .02) (n = 5 RCTs) and plant-based diets (SMD = –0.51; 95% CI: –0.91, –0.11; P = .01) (n = 7 RCTs). No significant difference was found between plant or animal protein for muscle strength (n = 14 RCTs) or physical performance (n = 5 RCTs). No trials examined sarcopenia as an outcome. Animal protein may have a small beneficial effect over non-soy plant protein for muscle mass; however, research into a wider range of plant proteins and diets is needed.

Systematic Review Registration

PROSPERO registration no. CRD42020188658.
Impact of Nutrition on the Gut Microbiota: Implications for Parkinson’s Disease
Authors: Sobral Joana , Empadinhas Nuno , Esteves Ana Raquel , Cardoso Sandra Morais
Published: January 2025

Parkinson’s disease (PD) is a multifactorial neurodegenerative disease that is characterized by the degeneration of dopaminergic neurons in the substantia nigra pars compacta and by the anomalous accumulation of α-synuclein aggregates into Lewy bodies and Lewy neurites. Research suggests 2 distinct subtypes of PD: the brain-first subtype if the pathology arises from the brain and then spreads to the peripheral nervous system (PNS) and the body-first subtype, where the pathological process begins in the PNS and then spreads to the central nervous system. This review primarily focuses on the body-first subtype. The influence of the gut microbiota on the development of PD has been the subject of growing interest among researchers. It has been suggested that gut inflammation may be closely associated with pathogenesis in PD, therefore leading to the hypothesis that gut microbiota modulation could play a significant role in this process. Nutrition can influence gut health and alter the risk and progression of PD by altering inflammatory markers. This review provides an overview of recent research that correlates variations in gut microbiota composition between patients with PD and healthy individuals with the impact of certain nutrients and dietary patterns, including the Mediterranean diet, the Western diet, and the ketogenic diet. It explores how these diets influence gut microbiota composition and, consequently, the risk of PD. Last, it examines fecal transplantation and the use of prebiotics, probiotics, or synbiotics as potential therapeutic strategies to balance the gut microbiome, aiming to reduce the risk or delay the progression of PD.
Development of a qPCR assay for early detection and quantification of Phytopythium vexans in kiwifruit plant and soil affected by Vine Decline Syndrome
Authors: Guaschino Micol , Prencipe Simona , Somera Tracey , Tabone Giulia , Spadaro Davide
Published: January 2025

Kiwifruit Vine Decline Syndrome (KVDS) is a soilborne disease affecting Actinidia fruit trees in perennial cropping systems. Since its emergence in 2012, studies have increasingly identified the oomycete Phytopythium vexans as a major causative agent of the disease. P. vexans is also implicated in complex soilborne disease systems of woody perennial crops, including replant disease in apple and pear. To date, most molecular assays for the detection of P. vexans target the nuclear ribosomal internal transcribed spacer (ITS), a region which is ill-suited for distinguishing between closely related oomycete species. The cytochrome oxidase subunit I (COI) mitochondrial gene was targeted for the design of new primers because it was previously identified as a better marker for differentiating oomycete species. The FOR2/REV4RCA primer pair gave the best results regarding PCR specificity and was selected for use in a SYBR Green-based qPCR assay. The specificity of the qPCR assay was evaluated using 29 P. vexans strains (including different phylogenetic groups) as well as a wide variety of closely related off-target species associated with pathogenic soil communities of fruit trees. P. vexans strains were successfully quantified down to 20 fg in water and in DNA extracted from kiwifruit roots. P. vexans was also detected in artificially inoculated Actinidia plant roots as well as in a variety of naturally infected field samples of both kiwi and apple trees. These results suggest that the qPCR assay developed in this study is highly sensitive and specific to target pathogen, regardless of sample matrix.
Effects of Preharvest Application of Acibenzolar-S-methyl and Potassium Silicate on Postharvest Diseases and Fruit Quality of Blueberries
Authors: Saito S. , Wang F. , Xiao C. L.
Published: January 2025

Blueberries are highly perishable and susceptible to storage spoilage, especially fruit rot diseases caused by fungal pathogens. Alternaria rot caused by Alternaria alternata and gray mold caused by Botrytis cinerea are the primary postharvest diseases of blueberries grown in California. We conducted a three-year field experiment to evaluate the effects of preharvest application of Acibenzolar-S-methyl (ASM) and potassium silicate (PSi) on Alternaria rot and gray mold in blueberry fruit inoculated with these pathogens after harvest, as well as naturally occurring fruit rots, fruit-to-fruit spread of gray mold during cold storage, and fruit quality. After four weeks of cold storage, all inoculated fruit developed rots regardless of the treatments applied in the field. In non-inoculated fruit, ASM significantly reduced the percentage of naturally occurring decayed fruit compared to the non-treated control in 2023 but not in 2021 and 2022. PSi significantly reduced the percentage of decayed fruit compared to the non-treated control in 2021 and 2023, but not in 2022. A significant increase in soluble solids and reduction in titratable acidity were observed in the fruit treated with ASM and PSi for the second and third years of the experiment, indicating that both treatments may have enhanced fruit maturity. Our results suggested that preharvest use of ASM and PSi had limited efficacy in postharvest disease control, but may have potential as tools for adjusting fruit maturity of blueberries.
Pickleball-Related Musculoskeletal Injuries: Part 1—Slip/Trip/Fall/Dive and Use/Overuse
Authors: Gregg Arianna R. , Ma Mia , Klochko Chad , Knisely Beatrice
Published: January 2025

Pickleball, one of the fastest-growing sports in the United States, combines elements of tennis, ping-pong, and badminton. Despite its noncontact nature, the sport’s rising popularity has led to an increase in musculoskeletal injuries. The unique characteristics and recent surge in pickleball’s popularity may pose a diagnostic challenge for clinicians, potentially resulting in unnecessary radiologic studies, increased healthcare costs, and delayed diagnoses and treatment. A comprehensive understanding of these injury manifestations and mechanisms not only facilitates faster and more precise diagnoses, reducing the risk of complications, but also enables radiologists to guide clinicians in selecting the most appropriate imaging modalities for injury characterization and treatment planning.
Insights into Chronic Low Back Pain Etiology
Authors: Martinsen Amy Elise , Børte Sigrid , Spildrejorde Mari , Brumpton Ben Michael , Heuch Ingrid , Zwart John-Anker , Winsvold Bendik Slagsvold
Published: January 2025

Study Design.

Genome-wide association study (GWAS) meta-analysis with downstream analyses.

Objective.

To explore the genetic architecture of chronic low back pain (cLBP) and identify underlying biological mechanisms that contribute to its development.

Summary of Background Data.

Chronic low back pain is prevalent and debilitating, with many cases having no identifiable biological cause. Current treatment options provide only limited relief, highlighting the need for a deeper understanding of the genetic and molecular factors involved in cLBP pathogenesis. Identifying these factors may lead to more effective, targeted therapies.

Methods.

We conducted a GWAS meta-analysis involving 325,078 participants from the UK Biobank and the HUNT population studies. This was followed by downstream analyses, including gene prioritization, tissue enrichment analysis, and functional gene set analysis. Genetic loci were examined for their association with cLBP, and gene sets were assessed for functional relevance.

Results.

Eighteen genetic loci associated with cLBP were identified corresponding to as many prioritized genes, including eight novel genes not previously linked to the condition. Tissue enrichment analysis highlighted significant involvement of hippocampal brain tissue, suggesting central memory processes may contribute to cLBP. Functional gene set analysis identified 37 gene sets, many related to transcription factors involved in bone and cartilage maintenance. Literature on the prioritized genes suggested a potential role for neurological, cartilaginous, and inflammatory mechanisms, including genes implicated in the innervation of intervertebral discs, inflammatory cell death, and central sensitization. Comparison with previous GWASs indicated potential differences between individuals who seek medical care and those who do not.

Conclusion.

This study enhances our understanding of the genetic basis of cLBP, revealing distinct biological mechanisms and suggesting the existence of patient subgroups with differing treatment needs. These insights may pave the way for more tailored and effective treatment approaches in the future.

Level of Evidence.

Level 3 (observational study)
A Retrospective, Single-Center Assessment of Changes in Pain, Agitation, and Delirium Management Before and During the COVID-19 Pandemic
Authors: Winner Rachel L. , Ware Lydia R. , Dube Kevin M. , Kovacevic Mary P. , Lupi Kenneth E. , Szumita Paul M. , DeGrado Jeremy R.
Published: January 2025

IMPORTANCE:

Recent studies have found an association between COVID-19 infection and deeper sedation in mechanically ventilated patients, raising concerns about the impact of the COVID-19 pandemic on pain, agitation, and delirium (PAD) management practices overall.

OBJECTIVES:

This study aimed to assess differences in PAD management in patients without COVID-19 infection in pre- and peri-COVID-19 pandemic timeframes.

DESIGN, SETTING, AND PARTICIPANTS:

This was a single-center, retrospective, pre-/post-cohort analysis of mechanically ventilated adult patients without COVID-19 infection admitted to an ICU in Boston, MA. The “pre” and “post” groups enrolled patients in 2019 and 2021, respectively. All PAD data during the first 7 days of mechanical ventilation (MV) were collected.

MAIN OUTCOMES AND MEASURES:

The primary outcome was ventilator-free days (VFDs) during the first 28 days. A multivariable linear regression analysis was performed to assess VFD while controlling for confounders. Secondary outcomes included depth of sedation, total dose of sedatives, and in-hospital mortality.

RESULTS:

There were 339 patients included in the final analysis. There was no difference in VFD between the pre- and post-groups (22.2 vs. 22.6 d; p = 0.92); this was confirmed by multivariable linear regression (p = 0.91). Patients in the post-group experienced significantly deeper levels of sedation compared with the pre-group (58% vs. 53%; p < 0.01) within the first 48 hours of MV. The median number of Richmond Agitation-Sedation Scale assessments per 24-hour period was greater in the pre-group (13 vs. 12 assessments; p = 0.02) within the first 48 hours of MV. There were no significant differences in total cumulative dose of sedatives or in-hospital mortality between the two groups.

CONCLUSIONS AND RELEVANCE:

This study suggests that PAD practices, including depth of sedation and frequency of assessment, differed between pre- and post-COVID-19 groups in patients without COVID-19. Outcomes including VFD, mortality, and hospital length of stay were not affected. Further studies are needed to understand the broader impact of the COVID-19 pandemic on PAD management practices.
Exploring the Connection: Moyamoya Disease and Its Implications for Cardiovascular Health
Authors: Walters Benjamin P. , Trivedi Yash Vardhan , Katoch Tavishi , Gupta Vasu , Jain Rohit
Published: January 2025

Moyamoya disease (MMD) is a vascular disorder characterized by steno-occlusive alterations in cerebral arteries, often resulting in ischemic or hemorrhagic events predominantly affecting the female population and more common in Asian populations. Despite its predominantly neurological manifestations, recent research suggests a potential association between MMD and cardiovascular diseases (CVDs). MMD involves various genetic and environmental factors, with mutations in the RNF213 gene being strongly implicated in disease susceptibility, with histopathological findings revealing intimal lesions and smooth muscle proliferation, contributing to vascular occlusion as well as dysregulation of circulating endothelial and smooth muscle progenitor cells further complicating MMD’s pathogenesis. However, the exact nature of the relationship between MMD and CVD remains incompletely understood, and emerging evidence suggests a potential interplay between these pathologies. In this study, we discuss the potential link between MMD and CVD, exploring genetic factors, pathophysiological mechanisms, and studies highlighting cardiac manifestations in MMD patients.
Women’s health and climate change: an urgent call for leadership among obstetricians and gynecologists in developing countries: a perspective
Authors: Sajjad Waseem , Mushtaq Iqra , Kalsoom Umme , Gargab Nada Kamaleldin , Khan Mishaim , Akhtar Zareen , Nasrallah Jamil
Published: January 2025

Climate change, considered as the most serious health hazard to humanity, has a disproportionate impact on women’s health, particularly in poor nations. Women alongside their developing fetuses are facing growing risks from environmental factors such as pollution, natural disasters and heat when it comes to their health. Even though the contribution to climate change is very limited, obstetricians and gynecologists (OBGYNs) can lead and help resolve or at least acknowledge these issues by going for systemic solutions as well as helping patients understand all the negative outcomes climate change can have on their health.

OBGYNs are ethically responsible for understanding, monitoring, and balancing the environmental impact their practices cause as well as regulating policies that counter such effects from climate change. Known names such as the International Federation of Gynaecology and Obstetrics (FIGO) talk about the important role of their lead when it comes to solving such issues.

The aim of highlighting this perspective is to sensitize the OBGYNs of their urgent responsibility and remind them of the inevitability of their roles in the combat against climate change. This awareness not only empowers OBGYNs to advocate for their patients but also encourages collaboration with other healthcare professionals to implement sustainable practices. By fostering an environment of innovation and resilience, they can significantly contribute to a healthier future for both individuals and the planet.
Duodenal-jejunal bypass ameliorates MASLD in rats by regulating gut microbiota and bile acid metabolism through FXR pathways
Authors: Ren Mengting , Xia Yi , Pan Hanghai , Zhou Xinxin , Yu Mosang , Ji Feng
Published: January 2025

Background:

Although bariatric and metabolic surgical methods, including duodenal-jejunal bypass (DJB), were shown to improve metabolic dysfunction–associated steatotic liver disease (MASLD) in clinical trials and experimental rodent models, their underlying mechanisms remain unclear. The present study therefore evaluated the therapeutic effects and mechanisms of action of DJB in rats with MASLD.

Methods:

Rats with MASLD were randomly assigned to undergo DJB or sham surgery. Rats were orally administered a broad-spectrum antibiotic cocktail (Abx) or underwent fecal microbiota transplantation to assess the role of gut microbiota in DJB-induced improvement of MASLD. Gut microbiota were profiled by 16S rRNA gene sequencing and metagenomic sequencing, and bile acids (BAs) were analyzed by BA-targeted metabolomics.

Results:

DJB alleviated hepatic steatosis and insulin resistance in rats with diet-induced MASLD. Abx depletion of bacteria abrogated the ameliorating effects of DJB on MASLD. Fecal microbiota transplantation from rats that underwent DJB improved MASLD in high-fat diet–fed recipients by reshaping the gut microbiota, especially by significantly reducing the abundance of Clostridium. This, in turn, suppressed secondary BA biosynthesis and activated the hepatic BA receptor, farnesoid X receptor. Inhibition of farnesoid X receptor attenuated the ameliorative effects of post-DJB microbiota on MASLD.

Conclusions:

DJB ameliorates MASLD by regulating gut microbiota and BA metabolism through hepatic farnesoid X receptor pathways.
A combination regimen of Intravitreal clindamycin with dexamethasone, systemic co-trimoxazole and steroids for macular Toxoplasma retinochoroiditis in immunocompetent cases.
Authors: Satavasia Sushree , Mishra Akshay , Jadhav Vishal , Abhishek Talluri Ronnie , Kelgaonkar Anup , Patel Anamika , Basu Soumyava , Pathengay Avinash
Published: January 2025

Purpose:

To study the role of intravitreal clindamycin with dexamethasone as an adjuvant to systemic co-trimoxazole and steroids in macular Toxoplasma retinochoroiditis.

Methods:

Retrospective study of Toxoplasma retinochoroiditis cases from January 2014 to December 2021 treated with a combination of oral and intravitreal therapy in immunocompetent patients.

Results:

39 eyes of 39 patients were included in this study after meeting the inclusion criteria with the mean age of presentation being 25.25 years (± 9.30; range 4–52 years). Male preponderance with 61.53 % of males (n = 24) and 38.47% of females (n = 15) was observed. Active retinitis was unilateral in all eyes (20 right eyes; 19 left eyes). Five lines of improvement in vision acuity on ETDRS chart were noted at final visit. The location of retinitis was either foveal (n=24) or extrafoveal (n=15). The mean size of retinitis was 1.24 ± 0.70-disc diameter. The mean number of injections given was 1.79 with a mean interval of 1.39 weeks.

Conclusions:

Intravitreal clindamycin with dexamethasone when used as an adjunct to systemic therapy showed resolution of retinitis in all cases with visual improvement.
Vascular Density and Retinal Structure Relationships Across Sectors and Regions of the Optic Nerve in Patients with Primary Open Angle Glaucoma
Authors: Ritzer Lukas , Harris Alon , Arciero Julia , Siesky Brent , Fry Brendan , Januleviciene Ingrida , Oddone Francesco , Carnevale Carmela , Eckert George , Verticchio Vercellin Alice
Published: January 2025

Précis:

The relationship between structural and hemodynamic parameters in patients with primary open angle glaucoma is strongest in the temporal region of the optic nerve.

Purpose:

To investigate the relationship between radial peripapillary capillary (RPC) vessel density (VD) and retinal nerve fiber layer (RNFL) thickness in quadrants and sectors of the optic nerve head (ONH) in patients with and without primary open angle glaucoma (POAG).

Methods:

In a cross-sectional prospective analysis, 191 subjects (80 early-stage POAG; 111 non-glaucomatous controls) were assessed for RNFL thickness and RPC VD in each quadrant [superior (S), inferior (I), nasal (N) and temporal (T)] and sector [inferior-temporal (IT), temporo-inferior (TI), temporo-superior (TS), superior-temporal (ST), inferior-nasal (IN), naso-inferior (NI), naso-superior (NS), and superior-nasal (SN) sectors] of the ONH via optical coherence tomography angiography (OCTA, Avanti, Optovue). Pearson correlations were used to test for associations between measurements, with P<0.05 considered statistically significant.

Results:

Significantly stronger positive correlations were found between RPC VD and RNFL thickness in the S, I, and T quadrants in POAG patients compared to non-glaucomatous controls (all P<0.05). The temporal quadrant in POAG patients displayed the largest difference in correlation compared to controls. A stronger positive correlation was also found between RPC VD and RNFL thickness in the temporal sectors of the ONH in POAG patients compared to controls, with the largest difference in the TS sector (all P<0.05).

Conclusion:

Early-stage POAG patients have a stronger relationship between RPC VD and RNFL in the temporal regions of the ONH compared to non-glaucomatous controls, with the TS sector demonstrating the largest difference between groups. Temporal sector VD loss may represent an early-stage biomarker for vascular-linked POAG disease.
Aqueous Angiography Guided Bent Ab Interno Needle Goniectomy in High versus Low Aqueous Humor Outflow Regions in POAG: A Pilot RCT
Authors: Dada Tanuj , Gupta Ashi , Beri Nitika , Huang Alex S. , Sharma Namrata , Angmo Dewang , Maharana Prafulla K. , Pujari Amar
Published: January 2025

Précis:

Trabecular cutting minimally invasive glaucoma surgery like bent ab interno needle goniectomy (BANG) when performed in baseline aqueous angiography identified low aqueous humor outflow regions, results in greater success of intraocular pressure reduction.

Purpose:

To study the efficacy of Bent Ab Interno Needle Goniectomy (BANG) in high versus low aqueous humor outflow (AHO) regions as determined by Aqueous Angiography(AA) in patients with primary open angle glaucoma (POAG).

Methods:

A prospective, single-centre, pilot, randomized control trial recruited 30 eyes of 30 patients of POAG and visually significant cataract (45-80 y) and were randomised into two groups (“A”: BANG performed in the high-flow regions and “B”: BANG performed in the low-flow regions) of 15 each. AA was performed using indocyanine green dye (0.1%) to identify baseline high- and low-flow regions of the AHO pathways followed by BANG in these respective regions as per randomisation. Preoperative and postoperative data on IOP, number of antiglaucoma medications (AGMs) and any complications were noted over 6 months. Overall success was defined as achieving an IOP ≤15 mm Hg and ≥6 mm Hg at 6 months of follow-up with AGMs (qualified success) or without AGMs (complete success).

Results:

AA revealed high-flow regions of AHO pathways in the nasal quadrant and low-flow regions of AHO pathways in the temporal quadrant in all 30 patients. Both groups had comparable demographic composition [group A age: 65.3±6.48 y and male: female (14:1) and group B age: 64.6±7.08 y and male: female (13:2)]. The mean preoperative IOPs [group A (17.27±3.43 mm Hg); group B (17.60±5.42 mm Hg)] (P=0.842) and mean postoperative IOP at 6 months [group A (15.6±4.98 mm Hg); group B (13.13±2.29 mm Hg)] (P=0.09) were similar. However, lower qualified success was seen in group A (40.00%) compared to group B (86.67%; P=0.021). Survival in Kaplan-Meier analysis was higher in group B (P=0.021). Complications were comparable in both groups.

Conclusion:

Short-term results of BANG in low-flow AHO regions show enhanced success compared to those in high-flow AHO regions. This study suggests that trabecular cutting minimally invasive glaucoma surgeries (like BANG) may be performed in baseline low-flow AHO regions (temporal quadrant) instead of the high-flow AHO (nasal quadrant) regions.
Multidrug Resistant Gram-negative Bacteria in Surgical Site Infections: Antimicrobial Resistance and Preventive Measures
Authors: Kumar Sunil , Sharma Anil Kumar , Yadav Mukesh , Sehrawat Nirmala , Jaiswal Durgesh Kumar
Published: January 2025

Multidrug resistant (MDR) gram-negative bacteria (GNB) are responsible for high mortality and morbidity in healthcare settings worldwide. They have been declared as priority pathogens by the WHO for their continuously escalating antimicrobial resistance. Nevertheless, data associated with MDR GNB in healthcare-associated infections are insufficient. Surgical site infections (SSIs) are among the most commonly occurring healthcare-associated infections. Such infections are particularly common when bacteria from the patient's normal microflora are transferred to the surgical sites during surgical procedures. SSIs affect approximately 0.5%-3% of patients undergoing surgery, resulting in prolonged hospital stay compared with patients without SSIs. SSIs result in severe problems and lead to a heavy economic burden. Most SSIs can be avoided if suitable preventive measures are employed. Novel findings support the dedicated usage of oral preoperative surgical antimicrobial prophylaxis for specific surgeries based on sites/organs. Immediate interventions are sought to control the transmission of MDR GNB typically found in hospital settings. The present narrative review aims to describe MDR GNB in SSIs in different sites. Antimicrobial resistance epidemiology and preventive measures for SSIs are also discussed. Different intrinsic and extrinsic factors and control measures are elaborated for curbing SSIs.
The treatment of lichen planus with topical roflumilast 0.3%
Authors: Baker Andrew
Published: January 2025

Lichen planus is a rare and chronic inflammatory skin disorder that imposes a high psychosocial burden on affected patients. Currently, no FDA-approved treatments exist for lichen planus, and it remains to be a therapeutic challenge for health care practitioners, especially in patients who are uninterested in trying topical corticosteroids or systemic therapies. We describe the reduction of erythema and resolution of pruritus following treatment with a once-daily nonsteroidal topical, roflumilast cream 0.3%, in a patient with lichen planus who had previously failed topical and intramuscular corticosteroid treatment.
Lower-Limb Orthoses in Duchenne Muscular Dystrophy
Authors: Peken Avcı Gizem , İpek Dongaz Özge , Bayar Banu
Published: January 2025

Introduction

Duchenne muscular dystrophy (DMD) is associated with a mutation in the DMD gene. It is a progressive disorder characterized by deficiency or absence of the production of dystrophin protein. The mechanical stress increased by muscle contractions causes damage to the muscle cell. Delayed ambulation, frequent falls, incompetence during climbing stairs, Gower’s sign, pseudohypertrophy of the calf, and proximal muscle weakness may be seen in children. Loss of ambulation, pulmonary failure, cardiomyopathy, and early mortality are expected in the natural process of the disease. The life expectancy is 30 years with the treatments and care applied nowadays.

Materials and Methods

Physiotherapy has a substantial place during aging. Physiotherapy approaches, orthoses, and self-help devices are utilized to prevent the development of contractures and deformities characterized by long-term fixed joint position, muscle imbalance, loss of joint range of motion, and fibrotic changes.

Results

It is observed that stretching exercises are noneffective in contracture and deformity management. It should be considered that the development of lower-limb contractures may occur in the early period. Orthotic approaches can be utilized to delay the loss of ambulation.

Conclusions

Lower-limb orthoses can be recommended for controlling contracture occurrence, providing postural control, ensuring and maintaining the correct position, continuity of function, ensuring ambulation or vertical position, and preserving surgical success. The use of personalized orthoses will enhance the success of rehabilitation. Orthoses should be used with other treatments to maintain functional mobility in accordance with the patient’s condition and should be reproduced according to the course of the disease.

Clinical Relevance

Ambulation level is important in choosing a lower-limb orthosis for patients with DMD. It is recommended that ankle-foot orthoses (AFOs) be preferred during the ambulatory period and knee-ankle-foot orthoses (KAFOs) or hip-knee-ankle-foot orthoses (HKAFOs) be preferred during the nonambulatory period.
Advances in the Classification of Aggressive B-cell Lymphomas
Authors: Frauenfeld Leonie , Campo Elias
Published: January 2025

Aggressive B-cell lymphomas are a biologically and clinically very heterogeneous group of tumors that may be related to different stages of B-cell differentiation development. This review aims to summarize recent advances in the understanding of these tumors with a focus on the practical approach to the diagnosis of these entities. We analyze the defining characteristics of the different subtypes of aggressive B-cell lymphomas, including nodal and extranodal diffuse large B-cell lymphoma, virus-associated lymphomas, terminally differentiated B-cell lymphomas, high-grade B-cell lymphomas, and Burkitt lymphoma. This review particularly explores the integration of morphologic, immunophenotypic, and genetic data that refine diagnostic accuracy and prognostic stratification, underscoring the necessity for a standardized approach in clinical practice. By synthesizing current knowledge, this review aims to enhance the understanding of aggressive B-cell lymphomas within the context of the evolving classification system, paving the way for future research and clinical advancements.
Comparison the Cosmetic Outcome of the Triangular Flap Insertion Versus Direct Linear Resection in Correction of Dog Ear Deformities on the Face—A Prospective and Randomized Controlled Trial
Authors: Song Jipeng , Cui Xiwei , Fan Jincai , Jiao Hu
Published: January 2025

Background:

Compared with direct linear resection, the triangular flap insertion method is a correction method that purportedly reduces the incision tension of dog ears deformity. Randomized clinical trials comparing these 2 methods seem to be limited or absent.

Objective:

A randomized study was planned to compare the cosmetic effect and scar in the defect area between the triangular flap insertion method and direct linear resection in the repair of dog ear deformities after the suture of the facial circular defect.

Methods:

The authors' study was prospective, 2-arm, randomized, evaluator-blinded clinical trial in a single-center outpatient academic plastic surgery center. Patients were eligible if they or their parents were able to provide informed consent and had dog ear deformity higher than 8 mm at both ends of the incision after suture of a circular or oval facial defect. Each dog ear deformity at the ends of the incision, half accept direct linear random resection, the other half to accept triangular flap insert. At 3-month and 6-month follow-up, each patient and 2 blinded observers evaluated the wound using the Patient Observer Scar Assessment Scale (POSAS).

Results:

In all, 52 subjects completed the study. At the 3-month follow-up, there was a statistically significant difference in the mean total POSAS scores for both the blinded observer and patients, indicating a preference for the side with the triangular flap insertion method. However, at the 6-month follow-up, this difference was lost.

Conclusion:

Three months after surgery, the triangular flap insertion method resulted in a better scar outcome than direct linear resection in correction of dog ear deformities on the face. At 6 months’ follow-up, this difference diminished, with scars for both sides appearing similar.

Level of Evidence:

Level II
Recurrence Patterns and Management after Pleurectomy Decortication for Pleural Mesothelioma
Authors: Paajanen Juuso , Richards William G. , Xie Yue , Mazzola Emanuele , Sidopoulos Kristina , Kuckelman John , Gill Ritu R. , Bueno Raphael
Published: January 2025

Objective:

We hypothesize that recurrence following pleurectomy decortication (PD) is primarily local. We explored factors associated with tumor recurrence patterns, disease-free interval (DFI), and post-recurrence survival (PRS).

Summary Background Data:

Tumor recurrence is a major barrier for long-term survival after pleural mesothelioma (PM) surgery.

Methods:

All patients who underwent PD between 1998 and 2022 were identified. Patients with diffuse PM who achieved macroscopic complete resection and had sufficient information on tumor relapse were included. Postoperative scans were reviewed to determine the timing and sites of the first recurrence.

Results:

A total of 436 patients had tumor recurrence during follow-up. Local recurrences occurred most frequently (N=370, 85%) and represented the only recurrence site in 29% (N=129) of cases. Patients with sarcomatoid tumors relapsed earlier than other subtypes (P=0.003) with more frequent distant spread compared to other subtypes (P<0.001). Multivariable analysis revealed that age (P=0.015), preoperative tumor volume (P<0.001), epithelioid histology (P<0.001), intraoperative chemotherapy (P<0.001), and TNM stage IV (P=0.003) were associated with DFI. Similarly, age (P=0.042), performance status (P<0.001), epithelioid histology (P<0.001), intraoperative chemotherapy (P<0.001), TNM stages III and IV (P=0.003 and 0.010 respectively), type of surgery (P=0.019), and number of recurrent lesions (P=0.024) were associated with PRS. Recurrence surgery (HR 0.46, 95% CI 0.29–0.74) and chemotherapy (HR 0.69, 95% CI 0.54–0.92) were independently associated with PRS in patients with distant with or without local recurrences.

Conclusions:

PM is frequently associated with local recurrence. Repeat surgical resection is feasible and can achieve good local control in selected cases.