bluuebunny/crossref_metadata_2025 huggingface dataset:
VdTps2 Modulates Plant Colonization and Symptom Development in Verticillium dahliae
Authors: Xiao Luyao , Tang Chen , Klosterman Steven J. , Wang Yonglin
Published: March 2023

The trehalose biosynthesis pathway is a potential target for antifungal drugs development. Trehalose phosphate synthase (TPS) and phosphatase are widely conserved components of trehalose biosynthesis in fungi. However, the role of trehalose biosynthesis in the vascular plant-pathogenic fungus Verticillium dahliae remains unclear. Here, we investigated the functions of the TPS complex, including VdTps1, VdTps2, and VdTps3 in V. dahliae. Unlike VdTps2, deletion of VdTps1 or VdTps3 did not alter any phenotypes compared with the wild-type strain. In contrast, the Δ VdTps2 strain showed severely depressed radial growth due to the abnormal swelling of the hyphal tips. Further, deletion of VdTps2 increased microsclerotia formation, melanin biosynthesis, and resistance to cell-wall perturbation and high-temperature stress. Virulence assays and quantification of fungal biomass revealed that deletion of VdTps2 delayed disease symptom development, as evident by the reduced virulence and decreased biomass of the Δ VdTps2 strain in plant stem tissue following inoculation. Additionally, increases in penetration peg formation observed in the Δ VdTps2 strain in the presence of H2O2 suggested that VdTps2 suppresses initial colonization. Our results also revealed the role of VdTps2 as a regulator of autophagy. Together, these results indicate that VdTps2 contributes to plant colonization and disease development.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Understanding the Genotypic and Phenotypic Structure and Impact of Climate on Phytophthora nicotianae Outbreaks on Potato and Tomato in the Eastern United States
Authors: Saville Amanda C. , McGrath Margaret T. , Jones Chris , Polo John , Ristaino Jean B.
Published: March 2023

Samples from potato fields with lesions with late blight-like symptoms were collected from eastern North Carolina in 2017 and the causal agent was identified as Phytophthora nicotianae. We have identified P. nicotianae in potato and tomato samples from North Carolina, Virginia, Maryland, Pennsylvania, and New York. Ninety-two field samples were collected from 46 fields and characterized for mefenoxam sensitivity, mating type, and simple sequence repeat genotype using microsatellites. Thirty-two percent of the isolates were the A1 mating type, while 53% were the A2 mating type. In six cases, both A1 and A2 mating types were detected in the same field in the same year. All isolates tested were sensitive to mefenoxam. Two genetic groups were discerned based on STRUCTURE analysis: one included samples from North Carolina and Maryland, and one included samples from all five states. The data suggest two different sources of inoculum from the field sites sampled. Multiple haplotypes within a field and the detection of both mating types in close proximity suggests that P. nicotianae may be reproducing sexually in North Carolina. There was a decrease in the average number of days with weather suitable for late blight, from 2012 to 2016 and 2017 to 2021 in all of the North Carolina counties where P. nicotianae was reported. P. nicotianae is more thermotolerant than P. infestans and grows at higher temperatures (25 to 35°C) than P. infestans (18 to 22°C). Late blight outbreaks have decreased in recent years and first reports of disease are later, suggesting that the thermotolerant P. nicotianae may cause more disease as temperatures rise due to climate change.
Predicting the Development of Renal Replacement Therapy Indications by Combining the Furosemide Stress Test and Chemokine (C-C Motif) Ligand 14 in a Cohort of Postsurgical Patients
Authors: Meersch Melanie , Weiss Raphael , Gerss Joachim , Albert Felix , Gruber Janik , Kellum John A. , Chawla Lakhmir , Forni Lui G. , Koyner Jay L. , von Groote Thilo , Zarbock Alexander
Published: March 2023

OBJECTIVES:

Optimal timing of renal replacement therapy (RRT) initiation in severe acute kidney injury (AKI) remains controversial. Initiation of treatment early in the course of AKI may lead to some patients undergoing unnecessary RRT, whereas delayed treatment is associated with increased mortality. This study aims to investigate whether the combination of the furosemide stress test (FST) and AKI-associated biomarkers can predict the development of indications for RRT.

DESIGN:

Single-center, prospective, observational study.

SETTING:

University Hospital of Muenster, Germany.

PATIENTS:

Critically ill, postoperative patients with moderate AKI (Kidney Disease: Improving Global Outcomes stage 2) and risk factors for further progression (vasopressors and/or mechanical ventilation) receiving an FST.

INTERVENTIONS:

Sample collection and measurement of different biomarkers (chemokine [C-C motif] ligand 14 [CCL14], neutrophil gelatinase-associated lipocalin, dipeptidyl peptidase 3).

MEASUREMENT AND MAIN RESULTS:

The primary endpoint was the development of greater than or equal to one predefined RRT indications (hyperkalemia [≥ 6 mmol/L], diuretic-resistant hypervolemia, high urea serum levels [≥ 150 mg/dL], severe metabolic acidosis [pH ≤ 7.15], oliguria [urinary output < 200 mL/12 hr], or anuria). Two hundred eight patients were available for the primary analysis with 108 having a negative FST (urine output < 200 mL in 2 hr following FST). Ninety-eight patients (47%) met the primary endpoint, 82% in the FST negative cohort. At the time of inclusion, the combination of a negative FST test and high urinary CCL14 levels had a significantly higher predictive value for the primary endpoint with an area under the receiver operating characteristic curve (AUC) of 0.87 (95% CI, 0.82–0.92) compared with FST or CCL14 alone (AUC, 0.79; 95% CI, 0.74–0.85 and AUC, 0.83; 95% CI, 0.77–0.89; p < 0.001, respectively). Other biomarkers showed lower AUCs.

CONCLUSIONS:

The combination of the FST with the renal biomarker CCL14 predicts the development of indications for RRT.
Adjuvant dabrafenib and trametinib for patients with resected BRAF-mutated melanoma: DESCRIBE-AD real-world retrospective observational study
Authors: Manzano Jose L. , Martin-Liberal Juan , Fernández-Morales Luis A. , Benítez Gretel , Medina Martínez Javier , Quindós María , García-Castaño Almudena , Fernández Ovidio , Simo Rocío V. , Majem Margarita , Bellido Lorena , Ayala de Miguel Pablo , Campos Begoña , Espinosa Enrique , Macías Cerrolaza José A. , Gil-Arnaiz Irene , Lorente David , Rodriguez-Lescure Alvaro , Perez Victor N. , López Castro Rafael , Gramaje María G. , Puértolas Teresa , Rodriguez Moreno Juan F. , Espasa Font Laia , Belaustegui Ferrández Guillermo , Cerezuela-Fuentes Pablo
Published: March 2023

BRAF and MEK inhibitor, dabrafenib plus trametinib, adjuvant therapy is effective for high-risk resected melanoma patients with BRAF-
V600
mutations. However, real-world evidence is limited. We aimed to determine the feasibility of this therapy in routine clinical practice. DESCRIBE-AD, a retrospective observational study, collected real-world data from 25 hospitals in Spain. Histologically confirmed and resected BRAF-mutated melanoma patients aged ≥18 years who were previously treated with dabrafenib plus trametinib adjuvant therapy, were included. The primary objectives were treatment discontinuation rate and time to discontinuation. The secondary objectives included safety and efficacy. From October 2020 to March 2021, 65 patients were included. Dabrafenib and trametinib discontinuation rate due to treatment-related adverse events (TRAEs) of any grade was 9%. Other reasons for discontinuation included patients’ decisions (6%), physician decisions (6%), unrelated adverse events (3%), disease progression (5%), and others (5%). The median time to treatment discontinuation was 9 months [95% confidence interval (CI), 5–11]. G3–4 TRAEs occurred in 21.5% of patients, the most common being pyrexia (3%), asthenia (3%), and diarrhoea (3%). Unscheduled hospitalisations and clinical tests occurred in 6 and 22% of patients, respectively. After 20-month median follow-up (95% CI, 18–22), 9% of patients had exitus due to disease progression, with a 12-month relapse-free survival and overall survival rates of 95.3% and 100%, respectively. Dabrafenib and trametinib adjuvant therapy proved effective for melanoma patients in a real-world setting, with a manageable toxicity profile. Toxicity frequencies were low leading to low incidence of unscheduled medical visits, tests, and treatment discontinuations.
Serum Concentration of Prostaglandin E2 as a Diagnostic Biomarker in Patients With Silicosis
Authors: Milovanović Aleksandar P. S. , Milovanović Andjela , Srebro Dragana , Pajic Jelena , Stanković Sanja , Petrović Tatjana
Published: March 2023

Objective

Silicosis is a prevalent incurable pneumoconiosis caused by inhalation of silica dust. Study aimed to investigate inflammatory, hematological, and biochemical parameters as additional biomarkers for diagnosing or monitoring silicosis.

Methods

Research enrolled 14 workers with silicosis and 7 healthy controls (without exposure and silicosis). The serum level of prostaglandin E2, C-reactive protein, fibrinogen, biochemical, and hematological parameters were measured. The receiver operating characteristic curve was used to determine diagnostic sensitivity of each biomarker.

Results

Patients with silicosis have a significantly higher level of prostaglandin E2, erythrocyte, hemoglobin, and hematocrit than patients without silicosis. Prostaglandin E2, hemoglobin, and the erythrocyte count are significant in separating the silicosis cases from healthy controls.

Conclusions

Prostaglandin E2 might be an adjuvant peripheral diagnostic biomarker for silicosis, while hematological parameters (erythrocytes, hemoglobin, and hematocrit) might be prognostic biomarkers.
Primary adrenocortical carcinoma: a case report
Authors: Neupane Durga , Khadka Sarada , Upadhyaya Paricha , Sah Suresh P. , Dulal Soniya , Shah Siddhartha K. , Shah Ujjwal K.
Published: March 2023

Introduction:

Adrenal tumors are very common, affecting 3–10% of the human population, and most are small, benign, nonfunctional adrenocortical adenomas. Adrenocortical carcinoma (ACC), in contrast, is a very rare disease. The median age of diagnosis is in the fifth to sixth decade. There is a predilection for the female gender (the ratio of female to male ranges from 1.5 to 2.5 : 1) the adult.

Case presentation:

A 28-year-old man who had no prior history of systemic hypertension or diabetes mellitus presented with bilateral limb swelling for 2 months and facial puffiness for 1 month. He had an episode of hypertensive emergencies. A radiological and hormonal work-up established the diagnosis of primary ACC. One cycle of chemotherapy was given until he lost follow-up and succumbed to death due to financial constraints.

Conclusions:

Adrenocortical carcinoma is an extremely uncommon tumor of the adrenal gland, and it is even more uncommon when it manifests without any symptoms. If patients exhibit signs of rapid and multiple adrenocortical hormone excess, such as weakness, hypokalaemia, or hypertension, ACC may be suspected. Recently developed gynecomastia in men may be brought on by an ACC producing too much sex hormone. To accurately diagnose the condition and give the patient a fair prognosis, a multidisciplinary approach involving endocrine surgeons, oncologists, radiologists, and internists is advised. Proper genetic counseling is recommended. It is critical to know whether the adrenal mass is malignant or not, and to get this ascertained by a computed tomography finding and biopsy.
MRI of the brain mimicking autoimmune encephalitis in Sjögren syndrome with chorea: a case report
Authors: Gajurel Bikram P. , Giri Subarna , Poudel Navin , Kharel Sanjeev , Jha Saket , Karn Ragesh , Rajbhandari Reema , Ojha Rajeev , Gautam Niraj , Shrestha Aashish
Published: March 2023

Introduction and importance:

Neurologic manifestations in primary Sjögren syndrome (SS) range in prevalence from 8 to 49%, and most of the studies suggest a prevalence of 20%. The incidence of SS patients developing movement disorders is about 2%.

Case presentation:

The authors herein report a case of a 40-year-old lady with MRI of the brain mimicking autoimmune encephalitis in SS who presented with chorea. Her MRI findings revealed T2 and FLAIR (fluid-attenuated inversion recovery) high signal intensity areas in bilateral middle cerebellar peduncles, dorsal pons, dorsal midbrain, hypothalami, and medial temporal lobes.

Clinical discussion:

There is still no evidence to support the definite use of MRI in characterizing the central nervous system involvement in primary SS, especially due to overlapping findings with age and cerebrovascular disease. Multiple areas of increased signal intensity in periventricular and subcortical white matter in FLAIR and T2-weighted image is commonly seen in primary SS patients.

Conclusion:

It is crucial to consider autoimmune diseases like SS as a cause of chorea in adults, even in those whose imaging findings are suggestive of autoimmune encephalitis.
Thyrotoxic periodic paralysis: a rare cause of periodic paralysis – a case report
Authors: Poudel Rajendra , Baral Surakshya , Adhikari Suman , Dhungana Umesh , Pradhan Ashesh , Baral Shankar , Kumal Kamal , Hamal Surya B.
Published: March 2023

Introduction:

Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism characterized by episodes of muscle weakness and hypokalemia. Patients may present with a sudden onset of muscle weakness. Though hyperthyroidism occurs more commonly in females, TPP typically occurs in young males in their third decade.

Case Presentation:

This is a case of a 32-year-old male who presented to the emergency room with a sudden onset of weakness in bilateral upper and lower limbs, which progressed to complete paralysis in an hour. A provisional diagnosis of hypokalemic periodic paralysis was made and admitted. Later, on further diagnostic workup, the final diagnosis of TPP was made.

Discussion:

Clinical features of hyperthyroidism in patients with TPP may be subtle. With immediate potassium supplementation, serious cardiopulmonary complications can be prevented and may hasten the recovery of muscle weakness. Nonselective β-adrenergic blockers can lessen and prevent the recurrence of paralytic attacks.

Conclusion:

This case is reported with the objective of generating awareness regarding the clues to the diagnosis, appropriate management, and definitive treatment to a render euthyroid state in order to prevent future recurrence of similar episodes and prevent any complications, and eventually to raise the index of suspicion among treating physicians in cases that present with paralysis in clinical practice.
An assessment of the role of surgical loupe technique in prevention of postthyroidectomy complications: a comparative prospective study
Authors: Nagaty Mahmoud , Shehata Mahmoud S. , Elkady Abdelrahman S. , Eid Mohammed , Nady Mohammed , Youssef Ahmed , Henish Mohamed I. E. , Monazea Khaled , Noreldin Rasha I. , Nasr Mohamed , Fayad Sherif , Abdelwahed Mohammed S. , Hasan Abdulkarim
Published: March 2023

Objective:

The magnification technique offered by surgical loupe is a new method that enhances visualization and helps head and neck surgeons with recurrent laryngeal nerve (RLN) and parathyroid glands identification. This study aimed to assess the safety and efficacy of using binocular surgical loupes in thyroidectomy procedures.

Material and Methods:

Eighty patients with thyroid nodules who underwent thyroidectomy procedure were divided randomly into two comparable groups, group A subjected to thyroidectomy by using binocular magnification loupe, group B underwent conventional thyroidectomy without using magnification. Patients’ demographics, operation time, and postoperative morbidities were recorded. All cases had preoperative and postoperative vocal cords assessment by video laryngoscopy. Pathology, laboratory, and radiology investigations were also conducted.

Results:

Out of 80 patients, there were 58 females and 22 males. Benign thyroid pathology was found in 74 patients and malignant pathology in 6 patients. The mean operating time was 106 min in group A compared to 138.5 min in group B. The mean amount of intraoperative bleeding was 30 ml in group A while 50 ml in group B. There were no cases of the external branch of the superior laryngeal nerve in both groups; there was better identification in group A. There was only one patient who suffered from a temporary RLN injury in group A, while three cases of temporary and one case of permanent RLN injury were recorded in group B. Permanent hypoparathyroidism was diagnosed in only one patient in group B.

Conclusion:

The utilization of binocular surgical loupe magnification in thyroid surgery is considered a safe and effective maneuver that has the advantages of decreasing the overall operating time and significantly reducing postoperative complications.
Cross-sectional study of COVID-19 infection in patients with rheumatic diseases in a sample of a Damascene population, Syria
Authors: Khalayli Naram , Kudsi Maysoun
Published: March 2023

Introduction:

Coronavirus infections have been responsible since 2019 for respiratory illnesses with varying severity worldwide. Worst outcomes from coronavirus (COVID-19) have been reported in older patients andthose with comorbidities like rheumatic diseases. Some drugs used for treating rheumatic diseases are used in patients with COVID-19. Based on the limited data, rheumatic diseases do not seem to affect the disease course of COVID-19. We aimed to analyze the course of COVID-19 infections in patients with rheumatic diseases.

Methods:

A self-reported questionnaire was distributed online and to patients admitted with respiratory involvement. Data included demographic information, clinical presentation, severity, comorbidities, and laboratory parameters. Cases were matched by age, sex, the month of admission, and COVID-19 respiratory injury for patients with rheumatic diseases and patients without rheumatic diseases.

Results:

Twenty-two patients (4.4%) had rheumatic diseases before the COVID-19 infection. There were no differences in the use of treatment for COVID-19 infections in previous or present therapy or comorbidities. We found no significant difference in the duration of COVID-19 symptoms before admission, duration of hospital stay, or chest Xray Brixia score between the two groups. The lymphocyte count was lower in the patient group, while lactate dehydrogenase, ferritin, and D-dimer concentrations were higher compared to the control group. Thrombotic events were similar in rate.

Conclusion:

The poorer outcome from COVID-19 infections in patients with rheumatic diseases is related to older age and the presence of comorbidities rather than the rheumatic disease type or its treatment.
Bilateral antrochoanal polyp: a case report of an extremely rare entity managed conservatively with a review from the past 26 years
Authors: Almarri Firas K. , AlHumaizi Abdulrahman , Alomair Alanoud M.
Published: March 2023

Introduction and importance:

Antrochoanal polyp (ACP) is a well-known benign sinonasal polyp first described in the early 20th century. ACP mostly presents as a unilateral mass and is treated solely with surgical excision.

Case presentation:

We report a rare case of a middle-aged man presenting with nasal obstruction, rhinorrhea, and sleeping disturbances, eventually diagnosed with bilateral ACPs. After confirming the diagnosis with imaging and biopsy studies, the patient was treated conservatively, with marked improvements in his symptoms during 2–3 months of regular follow-ups. A review of the relevant literature regarding the presentation, diagnosis, and outcome of this rare entity is presented, highlighting its controversial etiopathogenesis.

Clinical discussion:

Presenting symptoms of ACP in most cases is unilateral progressive nasal obstruction. The occurrence of ACP bilaterally is rarely encountered in clinical practice. Diagnosis is mainly clinical and is achievable via nasal endoscopic examination and supported by computed tomography imaging. Treatment remains to be surgical, with 2 years of regular follow-ups being advised to detect any recurrence.

Conclusion:

This case report adds to the scarce data pool on bilateral ACPs and highlights the necessity of prudent and timely diagnosis of this uncommon entity to avoid unnecessary investigations and lengthy medical or surgical treatment. Additionally, a trial of medical therapy may provide symptomatic relief for patients who do not qualify for surgery.
An Indonesian male with HIV/AIDS, pulmonary tuberculosis, and deep vein thrombosis: a case report and literature review
Authors: Dini Diah R.R. , Rusli Musofa
Published: March 2023

Introduction and Importance:

HIV/AIDS and pulmonary tuberculosis (TB) are risk factors for deep vein thrombosis (DVT). However, the simultaneous occurrence of HIV/AIDS, pulmonary TB, and DVT is rare.

Case Presentation:

An Indonesian male, 30 years old, complained of pain, erythema, tenderness, and swelling in the left leg for 1 month, weight loss, and night sweats. The patient had been diagnosed with AIDS, a new case of pulmonary TB and TB lymphadenitis on therapy. Left inferior extremity vascular Doppler ultrasound showed partial DVT in the common femoral vein, superficial femoral to left popliteal vein. He received fondaparinux and warfarin therapy, and swelling and leg pain improved.

Clinical Discussion:

Although patients with HIV have a risk for venous thromboembolism, the occurrence mechanism of this phenomenon is still uncertain. Some factors affecting venous thromboembolism in HIV are low CD4 and Mycobacterium tuberculosis, which can induce anticardiolipin antibodies and hypercoagulation conditions.

Conclusion:

The patient diagnosed with DVT, a rare complication in HIV and pulmonary TB, is reported. This patient is getting better after using fondaparinux and Warfarin.
Unusual presentation of extended iliofemoral deep vein thrombosis caused by giant retroperitoneal abscess: a rare case report
Authors: Ben Khalifa Badreddine , Naouar Sahbi , Lahouar Rayen , Sridi Chamseddine , Gazzeh Wael , Salem Braiek , El Kamel Rafik
Published: March 2023

Introduction and Importance:

Secondary deep vein thrombosis due to a mass effect on the venous system has been reported in the literature. Venous thrombosis is frequently seen in the lower extremities; however, when seen at the iliac level, the mass effect of an underlying pathology must be considered. Identifying such etiologies guides the management and reduces the risk of recurrences.

Case Presentation:

In this report, the authors present a case of an extended iliofemoral vein thrombosis caused by a giant retroperitoneal abscess (RA) in a 50-year-old woman with underlying type 2 diabetes mellitus, presenting with painful left leg swelling and fever. Color venous Doppler ultrasonography and computed tomography scan of the abdomen and pelvis findings were compatible with a left voluminous RA compressing the left iliofemoral vein with an extended deep vein thrombosis.

Conclusions:

The mass effect on the venous system is rare in RAs, but it must be kept in mind. In light of this case and literature review, the authors highlight the diagnosis and management difficulties in handling this unusual presentation form of a RA.
Successful surgical management of primary hyperparathyroidism during pregnancy: a rare case report
Authors: Musleh Asil , Shrateh Oadi N. , Abbadi Khaled , Asbah Malvina , Khader Abdellatif
Published: March 2023

Introduction:

Primary hyperparathyroidism (PHPT) in pregnancy is a rare condition. Because of gestational physiologic changes, it is easily under-recognized; in some cases, patients may remain symptomless while maintaining high serum calcium levels, posing a risk to the health of both mother and fetus.

Case Presentation:

Our patient is a pregnant woman in her 30th week of gestation admitted to the hospital with typical features of acute pancreatitis. All possible causes of acute pancreatitis were ruled out. Further investigation, including neck ultrasound, revealed a hypoechoic, well-defined, heterogeneous, and vascularized lesion measuring 1.9×1.7 cm, seen posterior to the left thyroid lobe and mostly representing a parathyroid adenoma. The patient was diagnosed to have a PHPT as the etiologic factor and underwent a successful parathyroidectomy after the failure of medical treatment.

Discussion and Conclusion:

Pregnancy-related parathyroid disease is uncommon. Several changes in calcium-regulating hormones occur during pregnancy, making the diagnosis of PHPT noticeably challenging. Therefore, serum calcium levels must be closely monitored during pregnancy for optimization of maternal and fetal outcomes. For the same reason, the appropriate management of gestational PHPT is mandatory, either medically or surgically.
Analysis of regional heterogeneity and determinants of perinatal mortality in Ethiopia: review
Authors: Adebe Kebede L. , Wake Senahara K. , Mekebo Gizachew G. , Dessalegn Reta C. , DarajeYadata Sagni , Wolde Temesgen S. , Gondol Ketema B. , Galdassa Agassa , Amega Gora A. , Gefela Tizazu Y.
Published: March 2023

Introduction:

The rate of mortality during the perinatal period is higher than at any other time in a person’s life, making it the most vulnerable. This study aimed to examine regional heterogeneity and the determinants of perinatal mortality in Ethiopia.

Methods:

The data for this study was obtained from the 2019 Ethiopia Demographic and Health Survey (2019 EMDHS) data. Logistic regression modeling and multilevel logistic modeling were used for data analysis.

Results:

A total of 5753 live birth children were included in this study. Of the total live births, 220 (3.8%) died in the first 7 days of life. Urban residence [adjusted odds ratio (AOR)=0.621; 95% CI: 0.453–0.850], residence in Addis Ababa (AOR=0.141; 95% CI: 0.090–0.220), family size of four or less (AOR=0.761; 95% CI: 0.608–0.952), age of mother at first birth of less than 20 years (AOR=0.728; 95% CI: 0.548–0.966), and using contraceptives (AOR=0.597; 95% CI: 0.438–0.814) were associated with lower risk of perinatal mortality compared to the respective reference categories whereas residence in Afar (AOR=2.259; 95% CI: 1.235–4.132), residence in Gambela (AOR=2.352; 95% CI: 1.328–4.167), no education (AOR=1.232; 95% CI: 1.065–1.572), poor wealth index (AOR=1.670; 95% CI: 1.172–2.380), and wealth index (AOR=1.648; 95% CI: 1.174–2.314) were associated with higher risk of perinatal mortality compared to the respective reference categories.

Conclusion:

In this study, the overall prenatal mortality rate was 38 (95% CI: 33–44) deaths per 1000 live births, which is high in magnitude. The study identified place of residence, region, wealth index, age of the mother at first birth, educational level of the mother, family size, and use of contraceptive methods as significant determinants of perinatal mortality in Ethiopia. Thus, mothers with no education should be given health education. Women should also be given awareness regarding the use of contraceptives. In addition, further research needs to be conducted in each region separately and information made available at the disaggregate level.
Association Between Baby Walker Use and Infant Functional Motor Development
Authors: Janusz Piotr , Pikulska Dagmara , Kapska Natalia , Kaniowska Marta , Darcz Marta , Bykowski Bartłomiej , Ekwińska Weronika , Stachowiak Emilia , Kotwicki Tomasz , Shadi Milud
Published: March 2023

Purpose:

The aim of this study was to determine the association between baby walker use and infant motor development, quality of gait, and potential development of lower extremity deformities.

Methods:

An anonymous survey was conducted among 6874 parents and legal guardians regarding the use of baby walkers, their children's development, and the occurrence of lower extremity deformities and gait disorders. A total of 969 questionnaires were returned.

Results:

Baby walkers were used by 15.6% of children. A higher percentage of children who used baby walkers omitted crawling compared with the 10.7% of children who did not use baby walkers. Gait disorders occurred at a similar percentage in both groups.

Conclusions:

Use of baby walkers may be associated with infant motor development. Infants who used a baby walker were 3 times more likely to not have crawled for mobility than those who did not use a baby walker.
“Key Roles of Conjunctiva Fornix-Bulbar conjunctiva-Tenon's Capsule in Bulbar Conjunctival Prolapse after Conjoint Fascial Sheath Suspension.”
Authors: Hao Dong-Yue , Fan Xiao , Cao Jiao , Cang Zheng-Qiang , Cui Jiang-Bo , Chen Yong-Jun , Liu Chao-Hua , Song Bao-Qiang , Peng Pai
Published: March 2023

Background

Bulbar conjunctival prolapse is one of the complications of conjoint fascial sheath (CFS) suspension and has a negative impact on surgical results. To explore the prevention methods of this complication, we compared the incidence of it between the below-conjunctiva fornix-bulbar conjunctiva- Tenon’s capsule (CBT) approach and the above-CBT approach to dissecting CFS in CFS suspension and shared our experience in the treatment of bulbar conjunctival prolapse.

Methods

From January 2020 to August 2021, 81 patients with severe congenital ptosis who underwent CFS suspension were enrolled and divided into 2 groups. Forty-five patients’ (Group A) CFS was dissected via the below-CBT approach and 36 patients’ (Group B) CFS was dissected via the above-CBT approach. The incidence and outcomes of bulbar conjunctival prolapse，and the postoperative condition were collected and analyzed.

Results

The incidence of bulbar conjunctival prolapse was 24.44% in Group A and 2.78% in Group B. Of the 12 bulbar conjunctival prolapse patients, 7 patients’ conditions improved after conservative treatment, while 5 did not. All of them underwent bulbar conjunctiva resection within 1 year and were cured. No recurrent prolapse was observed within 3 months post-operation. At the last follow-up, the mean MRD1 and PFH were 4.09±0.19mm and 9.85±0.62mm, respectively. There were no complications except lagophthalmos (16 eyelids), asymmetric eyelid contour (1 patient), and trichiasis (2 eyelids).

Conclusion

The incidence of bulbar conjunctival prolapse decreased significantly by dissecting CFS via the above-CBT approach. For patients with bulbar conjunctival prolapse after CFS suspension, bulbar conjunctiva resection could provide satisfactory results.

Level of Evidence IV
Adipose component transplantation – an advanced fat grafting strategy based on adipose tissue component selection for facial rejuvenation
Authors: Cai Junrong , He Yunfan , Liao Yunjun , Yao Yao , Feng Jingwei , Dong Ziqing , Lu Feng
Published: March 2023

Background:

Autologous fat grafting is frequently used for volume augmentation and tissue regeneration. The uniform physical and biological characteristics of fat grafts, however, limit their optimal effects in various situations. Subjecting fat tissue to different mechanical processes results in adipose-derived products with distinct biological components and physical features. The present study describes a novel facial fat grafting strategy, adipose component transplantation (ACT), which yields different adipose products that can be applied to specific injection sites.

Methods:

All patients who underwent ACT were retrospectively evaluated. Fat tissue samples were fractionated into high density fat (HDF), adipose matrix complex (AMC), stromal vascular fraction (SVF)-gel, and adipose collagen fragment (ACF), as described. Each of these fractions was processed and injected into indicated recipient sites. Additional SVF-gel was cryopreserved and, if necessary, injected during the following 3 months. Patients were followed-up after 1, 2, 3, and 6 months, and annually thereafter.

Results:

From March 2020 to September 2021, 78 patients have undergone whole face fat grafting using the ACT strategy. All operations and secondary injections of cryopreserved SVF-gel were uneventful. There were no major complications, and final aesthetic results were satisfactory in 91% patients.

Conclusion:

The ACT strategy allows specific adipose products to be applied to specific injection sites, as warranted. AMC is indicated for sufficient rigid support, HDF when large volumes are required, SVF-gel for precise injection and cryopreservation, and ACF as mesotherapy for skin rejuvenation. The ACT strategy optimizes the biological functions and physical features of different adipose-derived products.
Psychosocial, sexual, reproductive and menopausal health in women with and without HIV in a high-income setting
Authors: Scofield Ditte , Weis Nina , Andersson Mikael , Storgaard Merete , Pedersen Gitte , Johansen Isik S. , Katzenstein Terese L. , Graugaard Christian , Frisch Morten , Moseholm Ellen
Published: March 2023

Objectives:

To investigate psychosocial, sexual, reproductive and menopausal health in women with HIV (WWH) compared to women without HIV (WWOH) in Denmark.

Design:

A nationwide cross-sectional study.

Methods:

Data was retrieved from the SHARE study, a Danish nationwide cross-sectional survey examining psychosocial, sexual and reproductive health in people with HIV. Data from WWH, collected in 2021–2022, was matched 1:10 on age to a comparison group of WWOH from the nationally representative cohort study Project SEXUS. Associations between HIV status and psychosocial and sexual health outcomes were assessed by adjusted odds ratios (aOR) with 95% confidence intervals (95% CIs) obtained in logistic regression analyses controlling for potential confounding variables. The severity of menopausal symptoms in WWH was compared to published reference norms.

Results:

Among 144 WWH and 1440 WWOH, recurrent loneliness was significantly more common among WWH (aOR 2.22 [95% CI: 1.25–3.96]), and WWH had significantly fewer children and close friends (aOR 0.52 [95% CI: 0.28–0.96] for 3–9 vs. 0–2 close friends). Symptoms of anxiety and depression did not differ between groups. Lack of sexual desire (aOR 2.90 [95% CI: 1.29–6.50]), low FSFI-6 score indicating sexual dysfunction (aOR 3.40 [95% CI: 1.33–8.69]), lubrication dysfunction (aOR 8.24 [95% CI: 2.83–24.00]) and genital pain dysfunction (aOR 5.13 [95% CI: 1.26–20.86]) were significantly more common in WWH compared to WWOH. No differences were seen in menopausal characteristics.

Conclusions:

WWH in Denmark have fewer children and close friends, and more often report recurrent loneliness, lacking sexual desire and sexual dysfunction compared to WWOH. No differences were evident in menopausal characteristics.
Neuronal accumulation of hyperphosphorylated tau protein predicts stable memory impairment in people living with HIV
Authors: Gonzalez Jairo , Wilson Alyssa , Byrd Desiree , Cortes Etty P. , Crary John F. , Morgello Susan
Published: March 2023

Objectives:

As lifespans increase in people with HIV (PWH), there is concern that age-related neurodegenerative disorders may contribute to cognitive decline. We asked whether brain accumulation of Alzheimer's disease (AD)-associated proteins amyloid-beta (Aβ) and hyperphosphorylated tau (p-tau) predicted cognitive performance in middle-aged PWH.

Methods:

In a prospectively followed, cognitively-characterized autopsy sample of 135 PWH, we used immunohistochemistry to assess Aβ plaques and neuronal p-tau in medial temporal and lateral frontal lobes. These pathologies were tested for associations with cognitive performance in seven domains: motor, speed of information processing, working memory, memory encoding, memory retrieval, verbal fluency, and abstraction/executive function. Univariate and multivariate analyses accounting for HIV-associated variables, reading level, and comorbidities were conducted. Longitudinal trajectories of memory functions were evaluated in 60 individuals with a median follow-up of 6.0 years.

Results:

In this population with mean age 51.4 ± 0.9 years, 58% displayed neuronal p-tau and 29% Aβ plaques. Neuronal p-tau, but not Aβ, predicted worse memory encoding and retrieval, but not other cognitive functions. With an ordinal hierarchy of neuronal p-tau locations (entorhinal, hippocampal, neocortical), decreased memory performance correlated with neocortical distribution. Memory function trajectories could not be distinguished between individuals with and without neuronal p-tau, and over 80% of the sample showed no change over time.

Conclusion:

In this middle-aged sample, neuronal p-tau accumulation contributes to memory deficits, but is not associated with accelerated decline in function over time. In the absence of AD-like deterioration, other etiologies for neuronal p-tau in cognitively impaired PWH must be considered.
Nutrition Professionals' Confidence Recommending Integrative Medicine Modalities
Authors: Malik Neal , Paalani Michael , Becerra Benjamin
Published: March 2023

The study aimed to examine whether registered dietitians' (RDs') practice areas were associated with their confidence regarding integrative medicine (IM) modalities. An online survey was completed by 5164 members of the Academy of Nutrition and Dietetics. Post hoc analyses revealed that when compared with other practice areas, RDs practicing within IM reported the highest self-rated confidence when recommending high-quality supplements (84.2%, P < .01), disease-specific supplements (73.7%, P < .001), herbal supplements (73.7%, P < .001), and functional foods (84.2%, P < .001). RDs who utilize IM are most confident incorporating IM modalities into their practice, while those employed in other practice areas are significantly less confident.
The Relationship Between Exogenous Testosterone and Resting Energy Expenditure in Adults
Authors: Roop Karen , Coakley Kathryn E. , Cohen Deborah , Gonzales-Pacheco Diana
Published: March 2023

A systematic review was conducted to investigate the association between exogenous testosterone therapy and resting energy expenditure (REE) in adults. Eleven studies met the inclusion criteria (n = 259; 93% male). Results of this systematic review indicate that exogenous testosterone does not significantly affect REE. Registered dietitian nutritionists (RDNs) may not need to adjust individual energy needs based solely on exogenous testosterone therapy. However, this systematic review is limited because of the paucity of studies addressing this topic. RDNs should consider the most current published research regarding use of exogenous testosterone in adults when assessing REE in patients receiving exogenous testosterone therapy.
Butterfly foraging is remarkably synchronous in an experimental tropical macrocosm
Authors: Riva Federico , Drapeau Picard André-Philippe , Larrivée Maxim
Published: March 2023

Diel patterns in foraging activity are dictated by a combination of abiotic, biotic and endogenous limits. Understanding these limits is important for insects because ectotherm taxa will respond more pronouncedly to ongoing climatic change, potentially affecting crucial ecosystem services. We leverage an experimental macrocosm, the Montreal Insectarium Grand Vivarium, to test the importance of endogenous mechanisms in determining temporal patterns in foraging activity of butterflies. Specifically, we assessed the degree of temporal niche partitioning among 24 butterfly species originating from the Earth's tropics within controlled environmental conditions. We found strong niche overlap, with the frequency of foraging events peaking around solar noon for 96% of the species assessed. Our models suggest that this result was not due to the extent of cloud cover, which affects radiational heating and thus limits body temperature in butterflies. Together, these findings suggest that an endogenous mechanism evolved to regulate the timing of butterfly foraging activity within suitable environmental conditions. Understanding similar mechanisms will be crucial to forecast the effects of climate change on insects, and thus on the many ecosystem services they provide.
Dynamics of fluid-driven fractures in the viscous-dominated regime
Authors: Tanikella S. S. , Sigallon M. C. , Dressaire E.
Published: March 2023

During hydraulic fracturing, the injection of a pressurized fluid in a brittle elastic medium leads to the formation and growth of fluid-filled fractures. A disc-like or penny-shaped fracture grows radially from a point source during the injection of a viscous fluid at a constant flow rate. We report an experimental study on the dynamics of fractures propagating in the viscous regime. We measure the fracture aperture and radius over time for varying mechanical properties of the medium and fluid and different injection parameters. Our experiments show that the fracture continues to expand in an impermeable brittle matrix, even after the injection stops. In the viscous regime, the fracture radius scales as

t

4

/

9

during the injection. Post-shut-in, the crack continues to propagate at a slower rate, which agrees well with the predictions of the scaling arguments, as the radius scales as

t

1

/

9

. The fracture finally reaches an equilibrium set by the toughness of the material. The results provide insights into the propagation of hydraulic fractures in rocks.
Multiple systemic infections caused by Rhodococcus equi: case report.
Authors: Li Ning , Wu Changsheng , Cao Pengju , Chen Dongjie , Chen Falin , shen Xiuqing
Published: March 2023

Abstract
Background: Rhodococcus equi, is one of the most important causes of zoonotic infections in grazing animals, especially in the patients who are immunosuppressed or long-term treatment with immunosuppressive drugs.
Case presentation: We report a case of Rhodococcus equi in a 65-year-old man with diabetes, hypertension and adultonset Still’s disease, on long term hormone therapy. This non-HIV infected man with blood, lung tissue and sputum infected by R. equi. Initially the patient failed to improve on multiple therapy including vancomycin and meropenem. Although the symptoms improved after adjusting the application of antibiotics according to the susceptibility, the patient had not healed upon discharge.
Conclusions: In recent years the number of Rhodococcus equi cases has been increasing. We describe herein the lethal case of R. equi infection in a non-HIV person.
Gut microbial features and dietary fiber intake predict gut microbiota response to resistant starch supplementation
Authors: Devarakonda Sri Lakshmi Sravani , Superdock Dorothy K. , Ren Jennifer , Johnson Lynn M. , Loinard-González Aura (Alex) P. , Poole Angela C.
Published: March 2023

Resistant starch (RS) consumption can have beneficial effects on human health, but the response, in terms of effects on the gut microbiota and host physiology, varies between individuals. Factors predicting the response to RS are not yet established and would be useful for developing precision nutrition approaches that maximize the benefits of dietary fiber intake. We sought to identify predictors of gut microbiota response to RS supplementation. We enrolled 76 healthy adults into a seven-week crossover study. Participants consumed RS type 2 (RS2), RS type 4 (RS4), and a digestible starch, for ten days each with five-day washout periods in between. We collected fecal and saliva samples and food records before and during each treatment period. We performed 16S rRNA gene sequencing and measured fecal short-chain fatty acids (SCFAs), salivary amylase gene copy number, and salivary amylase activity (SAA). Dietary fiber intake was predictive of relative abundance of several amplicon sequence variants (ASVs) at the end of both RS treatments. Treatment order (the order of consumption of RS2 and RS4), alpha diversity, and a subset of ASVs were predictive of SCFA changes after RS supplementation. SAA was only predictive of the relative abundance of ASVs after digestible starch supplementation. Based on our findings, dietary fiber intake and gut microbiome composition would be informative if assessed prior to recommending RS supplementation. Using a precision nutrition approach to optimize the benefits of dietary fibers such as RS could be an effective strategy to compensate for the low consumption of dietary fiber nationwide.
Performance of ChatGPT on free-response, clinical reasoning exams
Authors: Strong Eric , DiGiammarino Alicia , Weng Yingjie , Basaviah Preetha , Hosamani Poonam , Kumar Andre , Nevins Andrew , Kugler John , Hom Jason , Chen Jonathan H
Published: March 2023

Importance

Studies show that ChatGPT, a general purpose large language model chatbot, could pass the multiple-choice US Medical Licensing Exams, but the model’s performance on open-ended clinical reasoning is unknown.

Objective

To determine if ChatGPT is capable of consistently meeting the passing threshold on free-response, case-based clinical reasoning assessments.

Design

Fourteen multi-part cases were selected from clinical reasoning exams administered to pre-clerkship medical students between 2019 and 2022. For each case, the questions were run through ChatGPT twice and responses were recorded. Two clinician educators independently graded each run according to a standardized grading rubric. To further assess the degree of variation in ChatGPT’s performance, we repeated the analysis on a single high-complexity case 20 times.

Setting

A single US medical school

Participants

ChatGPT

Main Outcomes and Measures

Passing rate of ChatGPT’s scored responses and the range in model performance across multiple run throughs of a single case.

Results

12 out of the 28 ChatGPT exam responses achieved a passing score (43%) with a mean score of 69% (95% CI: 65% to 73%) compared to the established passing threshold of 70%. When given the same case 20 separate times, ChatGPT’s performance on that case varied with scores ranging from 56% to 81%.

Conclusions and Relevance

ChatGPT’s ability to achieve a passing performance in nearly half of the cases analyzed demonstrates the need to revise clinical reasoning assessments and incorporate artificial intelligence (AI)-related topics into medical curricula and practice.
Comorbid hypertension and its associated factors among diabetic outpatients in West Shewa Zone public hospitals, Ethiopia: an institution based cross-sectional study
Authors: Hirpa Delessa , Abdissa Daba
Published: March 2023

Objectives

Hypertension (HTN) is the main contributor to the worldwide burden of disease and it is frequently coexists with diabetes and exacerbates its complications. The purpose of this study was to evaluate the prevalence and determinants of HTN among diabetic outpatients at West Shoa Zone public hospitals.

Methods

Facility based cross-sectional study was conducted from June to December, 2020 among diabetic patients attending their follow up at West Shewa public hospitals, Ethiopia. Data were collected using interviewer administered pretested structured questionnaire. A variable having a p-value of <0.25 in the bivariable analysis were subjected to multivariable analysis to avoid confounding variable’s effect. Adjusted odds ratios were calculated at 95% confidence interval and considered significant with a p-value of ≤ 0.05.

Results

A total of 390 participants were included in the study. Their mean age was 46.45 years (±15.6) years. Our study found that there was high prevalence of hypertension among diabetic patients. Age ≥50 year, obesity, family history of hypertension and being single were associated with hypertension among participants. Hence, necessary actions are recommended by responsible bodies for identified problems.