bluuebunny/crossref_metadata_2025 huggingface dataset:
Designing-in simulation-based learning for the police recruit Brief of Evidence education
Authors: Burnes Leighton , Davies Amanda , Aslett Duane
Published: December 2024

Historically, in police and judicial procedures that follow the ‘innocent until proven guilty’ legal process, the responsibility at court hearings is for the respective police or law enforcement officers to present a prosecution that leaves no reasonable doubt as to the guilt of the alleged offender. A critical argument for the prosecution is situated within a Brief of Evidence (BOE) a compilation of one or all of the following: police statements, witness statements, expert testimony, and physical and digital evidence. Preparing police recruits for developing a BOE has traditionally been a text-based approach. Advances in approaches to education, including simulation-based learning are elevating the level of preparation of police recruits for the reality of operational duties, through situated, authentic learning experiences. This paper presents a case study of the application of a design plan that creates authentic situated learning experiences in investigative practice subjects for developing a BOE.
Counting sign changes of partial sums of random multiplicative functions
Authors: Geis Nick , Hiary Ghaith
Published: December 2024

Let f be a Rademacher random multiplicative function. Let $$ M_f(u):=\sum_{n \leq u} f(n) $$ be the partial sum of f. Let $V_f(x)$ denote the number of sign changes of $M_f(u)$ up to x. We construct a family of increasing intervals $[y_k, X_k]$ that contain at least 1 sign change of $M_f(u)$ eventually, almost surely. As a consequence, we show that for any constant c > 2, $$ V_f(x) = \Omega ((\log \log \log x)^{1/c} ) $$ almost surely.
Macroprudential Regulation, Quantitative Easing, and Bank Lending
Authors: Orame Andrea , Ramcharan Rodney , Robatto Roberto
Published: December 2024

We show that widely used macroprudential regulations that rely on historical cost accounting (HCA) to insulate banks’ balance sheets from financial market volatility significantly affect the transmission of monetary policy onto bank lending. Using detailed supervisory data from Italian banks, we find that HCA mutes the transmission of quantitative easing and other monetary policies that affect the long end of the yield curve, weakening the effectiveness of interventions aimed at reducing firm credit constraints. We suggest alternative policies that have the benefits of HCA but allow monetary policy to pass through.
Field integration of shoot gas-exchange and leaf chlorophyll fluorescence measurements to study the long-term regulation of photosynthesis in situ
Authors: Oivukkamäki Jaakko , Aalto Juho , Pfündel Erhard E , Tian Manqing , Zhang Chao , Grebe Steffen , Salmon Yann , Hölttä Teemu , Porcar-Castell Albert
Published: December 2024

Understanding the diurnal and seasonal regulation of photosynthesis is an essential step to quantify and model the impact of the environment on plant function. Although the dynamics of photosynthesis have been widely investigated in terms of CO2 exchange measurements, a more comprehensive view can be obtained when combining gas-exchange and chlorophyll fluorescence (ChlF). Until now, integrated measurements of gas-exchange and ChlF have been restricted to short-term analysis using portable infrared gas analyzer systems that include a fluorometer module. In this communication we provide a first-time demonstration of long-term, in situ and combined measurements of photosynthetic gas-exchange and ChlF. We do so by integrating a new miniature pulse amplitude modulated-fluorometer into an existing system of automated chambers to track photosynthetic gas-exchange of leaves and shoots in situ. The setup is used to track the dynamics of the light and carbon reactions of photosynthesis at a 20-min resolution in leaves of silver birch (Betula pendula Roth) during summertime. The potential of the method is illustrated using the ratio between electron transport and net assimilation (ETR/ANET), which reflects the internal electron use efficiency of photosynthesis. The setup successfully captured the diurnal patterns in the ETR/ANET during summertime, including a large increase in noon ETR/ANET in response to a period of high temperatures and relatively low soil moisture, pointing to a drastic decrease in electron-use efficiency. The observations emphasize the value of combined and long-term in situ measurements of ChlF and gas-exchange, opening new opportunities to investigate, model and quantify the regulation of photosynthesis in situ and the connection between ChlF and photosynthetic gas-exchange. The next steps, potential and limitations of the approach are discussed.
Predicting lane-changing risk considering class imbalance problem: a control method for synthetic sample
Authors: Li Ye , Yu Le , Liu Fei , Wu Dan , Xing Lu
Published: December 2024

The class imbalance has long been a problem in traffic safety research, which significantly reduces the prediction accuracy for minority class samples. In this study, a Control Methods for Synthetic Sample (CMSS) is proposed to control samples synthesized in direction which is conducive to the improvement of prediction performance. This method first employs several oversampling methods to synthesize samples. Then, a regression model is established based on the cluster centers of synthetic samples and the corresponding value of performance improvement after adding the synthetic samples. The Shapley Additive Explanations (SHAP) technique is used to interpret it, and thus determine the features that have the most significant influence on the improvement. After that, random disturbance terms are added to several important features to make a directional adjustment. To achieve better prediction performance, the particle swarm algorithm (PSO) is utilized to search for the number of features and the value of random perturbation terms. The highD dataset is used to validate the effectiveness of CMSS by predicting the lane-changing risk. In addition, the impact of factors such as imbalance rates on the effect of CMSS is discussed. Results show that CMSS can effectively improve the prediction performance of the non-integrated learning models under different class imbalance ratios. It is also revealed that the category of the regression model has a significant effect on the results of CMSS. As a novel method, CMSS can be combined with various kinds of oversampling methods to bring new perspectives for solving the class imbalance problem.
Variation of avirulence genes in the blast fungus from Jiangxi Province, China
Authors: Li Runjing , Qiu Jiehua , Shi Huanbin , Jiang Nan , Lan Bo , Kou Yanjun
Published: December 2024

The avirulence (AVR) genes of Magnaporthe oryzae are pivotal in eliciting resistance responses in rice, which are mediated by resistance (R) genes in rice. Monitoring the variation of AVR genes in the pathogen is essential for strategically deploying R genes in rice cultivation regions. In this study, a total of 214 isolates were collected from Jiangxi Province, China, in 2022, and the distribution and variation of AVR genes in these isolates were analyzed by PCR amplification and sequencing. The results indicated that AVR-Pi9, AVR-Pib, AVR-Pita, and AVR-Pizt loci were detected in over 95% of isolates. In addition, the AVR-Pik and AVR-Pii loci were found in 84.1% and 0.9% of isolates, respectively. Notably, none of the isolates contained the AVR-Pia gene. Sequencing results revealed various types of variants, including base replacement, deletion, and insertion, in AVR-Pib, AVR-Pik, and AVR-Pita loci. Moreover, a transposon insertion was identified in the promoter region of AVR-Pib. Furthermore, variant isolates were then utilized to inoculate rice monogenic lines IRBLta-K1, IRBLkm-Ts, IRBLKh-K3 and IRBLb-B. The results demonstrated that the rice monogenic line carrying Pib or Pita was unable to recognize the isolates with variant AVR-Pib or AVR-Pita. However, the rice monogenic line with Pikm or Pikh remained capable of recognizing the isolates with AVR-Pik alleles in Jiangxi Province. The information obtained from this study is valuable for breeding blast-resistant rice varieties that will be cultivated in Jiangxi Province, China.
Statement of Partnership and Humility: A Structural Intervention to Improve Equity and Justice in Medical Education
Authors: Benoit Laura J. , Alves-Bradford Jean-Marie , Amiel Jonathan , Gordon Rachel J. , Lypson Monica L. , Pohl Daniel J. , Cunningham Hetty
Published: December 2024

Problem

Due to generational exposure to the Black Lives Matter movement, other antibias social movements, and diverse peer advocacy groups, health professions students are often more knowledgeable than their teachers about ways in which systemic racism and bias have led to scientific inaccuracies that contribute to health inequities. However, traditional hierarchies and concerns about retaliation may limit educational communities from benefiting maximally from students’ contributions.

Approach

In spring 2021, faculty and students at the Vagelos College of Physicians and Surgeons, Columbia University, designed a structural innovation to engage faculty and students in partnership toward decreasing bias in medical education. This article discusses development and implementation of a Statement of Partnership and Humility (SPH) disclosure slide on which faculty members acknowledge consideration of potential teaching biases and invite student feedback.

Outcomes

The initial primary goal of the SPH slide was to increase faculty awareness and engagement in antibias topics; however, the unexpected dividends of decreasing faculty anxiety about receiving student feedback and promoting student engagement have proven equally powerful in promoting a healthy, inclusive learning environment.

Next Steps

Next steps include gathering qualitative and quantitative data to elicit both faculty and student perspectives on the use of the SPH slide, particularly with regard to psychological safety and openness to feedback.
Hidradenocarcinoma of the Chest With Axillary Lymph Node Metastasis: Report of 2 Cases and Systematic Literature Review of a Breast Cancer Mimicker
Authors: Fortarezza Francesco , Maggioni Giuseppe , Colagrande Anna , Cazzato Gerardo , Dei Tos Angelo Paolo
Published: December 2024

Hidradenocarcinoma (HAC) is a rare malignant neoplasm originating from eccrine sweat glands, often presenting diagnostic challenges because of its resemblance to other malignancies, particularly breast cancer when occurring in the chest region. This report describes 2 cases of HAC with axillary lymph node metastasis, both initially misinterpreted clinically. The first case involved a 63-year-old woman with a sternal mass, near the right breast, initially suspected to be a sebaceous cyst. Histologic examination revealed a solid-cystic epithelial tumor with features suggestive of HAC, confirmed by immunohistochemical analysis. The second case concerned an 81-year-old woman with a subcutaneous growth in the sternal area, also diagnosed as HAC after histopathologic and immunohistochemical assessment. Both cases demonstrated strong estrogen receptor positivity, leading to the recommendation of hormonal therapy. A systematic review of the literature identified 21 similar cases of HAC in the chest wall, highlighting the diagnostic complexities and the potential for these tumors to mimic breast carcinoma. This review underscores the need for careful histologic and immunohistochemical evaluation to differentiate HAC from other malignancies, particularly in the breast region. Given the rare and the potential aggressive nature of HAC, early and accurate diagnosis is crucial for guiding appropriate therapeutic strategies and improving patient outcomes.
The Prognostic Significance of Tumor Budding and Tumor-Infiltrating Lymphocytes in Patients Diagnosed With Malignant Melanoma
Authors: Yavuz Ayşen , Şimşek Kübra , Başsorgun Cumhur İbrahim , Elpek Gülsüm Özlem , Ünal Betül
Published: December 2024

The tumor microenvironment plays a critical role in malignant melanoma, influencing progression and patient outcomes, particularly through tumor budding (TB) and tumor-infiltrating lymphocytes (TILs). Despite the importance of TB, its detailed impact still needs to be explored, especially its interaction with TILs. This study evaluates the prognostic significance of TB and TILs in malignant melanoma, assessing their potential as indicators for disease progression and survival. Conducted at Akdeniz University, the research included 92 patients diagnosed between 2014 and 2021. TB was evaluated according to the International Tumor Budding Consensus Conference guidelines, and TILs were assessed by the International Immuno-Oncology Biomarker Working Group standards. The analysis revealed significant correlations between TB and the level of anatomic invasion, Breslow thickness, satellite nodules, lymph node metastasis, distant metastasis, and stage (P < 0.05). A notable inverse relationship between TB and intratumoral TILs suggested their different roles in tumor progression. Tumor subtype, level of anatomic invasion, satellite nodules, lymphovascular invasion, lymph node metastasis, distant metastasis, stage, TILs, and TB were significant risk factors associated with poor prognosis (P < 0.005). Multivariate Cox regression identified histologic subtype and TB >10 as independent prognostic factors, underscoring the need for further research to integrate TB and TILs into clinical practice for better patient management and treatment planning.
Life-course exposure to air pollution and the risk of dementia in the Lothian Birth Cohort 1936
Authors: Jutila Otto-Emil I. , Mullin Donncha , Vieno Massimo , Tomlinson Samuel , Taylor Adele , Corley Janie , Deary Ian J. , Cox Simon R. , Baranyi Gergő , Pearce Jamie , Luciano Michelle , Karlsson Ida K. , Russ Tom C.
Published: December 2024

Background:

Air pollution in later life has been associated with dementia; however, limited research has investigated the association between air pollution across the life course, either at specific life periods or cumulatively. The project investigates the association of air pollution with dementia via a life-course epidemiological approach.

Methods:

Participants of the Lothian Birth Cohort, born in 1936, provided lifetime residential history in 2014. Participant’s air pollution exposure for time periods 1935, 1950, 1970, 1980, 1990, 2001, and 2007 was modeled using an atmospheric chemistry transport model. Lifetime cumulative exposures were calculated as time-weighted mean exposure. Of 572 participants, 67 developed all-cause dementia [35 with Alzheimer's dementia (AD)] by wave 5 (~82 years). Cox proportional hazards and competing risk models assessed the association between all-cause dementia and AD with particulate matter (diameter of ≤2.5 µm) PM2.5 and nitrogen dioxide (NO2) exposure at specific life periods and cumulatively. False discovery rate (FDR) correction was applied for multiple testing.

Results:

The mean follow-up was 11.26 years. One standard deviation (SD) higher exposure to air pollution in 1935 (PM2.5 = 14.03 μg/m3, NO2 = 5.35 μg/m3) was positively linked but not statistically significant to all-cause dementia [PM2.5 hazard ratio (HR) = 1.16, 95% confidence interval (CI) = 0.90, 1.49; NO2 HR = 1.13, 95% CI = 0.88, 1.47] and AD (PM2.5 HR = 1.38, 95% CI = 1.00, 1.91; NO2 HR = 1.35, 95% CI = 0.92, 1.99). In the competing risk model, one SD elevated PM2.5 exposure (1.12 μg/m3) in 1990 was inversely associated with dementia (subdistribution HR = 0.82, 95% CI = 0.67, 0.99) at P = 0.034 but not after FDR correction (P
FDR = 0.442). Higher cumulative PM2.5 per one SD was associated with an increased risk of all-cause dementia and AD for all accumulation models except for the early-life model.

Conclusion:

The in-utero and early-life exposure to PM2.5 and NO2 was associated with higher AD and all-cause dementia risk, suggesting a sensitive/critical period. Cumulative exposure to PM2.5 across the life course was associated with higher dementia risk. Midlife PM2.5 exposure’s negative association with all-cause dementia risk may stem from unaddressed confounders or bias.
Clinical Efficacy and Safety of Vancomycin Based on Unbound Vancomycin Concentration Monitoring
Authors: Ren Fefei , Li Shan , Liu Yixin , Li Xiangchen , Wu Xikun , Zhang Zhiqing
Published: December 2024

Objective:

To monitor total trough concentration (Cmin_total) and unbound trough concentration (Cmin_free) of vancomycin in clinical samples and analyze the factors influencing them, and to assess their correlation with clinical efficacy and acute kidney injury (AKI).

Methods:

Plasma samples were processed by protein precipitation, followed by hollow-fiber centrifugal ultrafiltration to separate unbound vancomycin from plasma. Thereafter, Cmin_total and Cmin_free were determined using high-performance liquid chromatography. Clinical data of patients were collected. Factors affecting vancomycin Cmin_total, Cmin_free, and their correlation with clinical efficacy and nephrotoxicity were investigated.

Results:

A total of 146 samples from 105 included patients were collected. Cmin_total and Cmin_free of vancomycin ranged from 0.62 to 56.08 mcg·mL−1 and 0.61–38.51 mcg·mL−1, respectively. Cmin_total and Cmin_free were correlated (r = 0.8899), influenced by basal creatinine and cystatin C. Higher level of Cmin_free (˃8.6 mcg·mL−1) and nephrotoxic drugs concomitant were risk factors of vancomycin-associated AKI (P < 0.05); Cmin_total and Cmin_free thresholds of vancomycin-associated AKI were 15.35 and 6.83 mcg·mL−1, respectively.

Conclusions:

vancomycin Cmin_total and Cmin_free, higher Cmin_total and Cmin_free were correlated and higher concentrations of both may increase the risk of AKI.
Unbound Ceftriaxone Concentrations in Plasma Measured Using Ultrafiltration Versus Equilibrium Dialysis: A Short Communication
Authors: Gijsen Matthias , Vanneste Dorian , Annaert Pieter , Debaveye Yves , Wauters Joost , Spriet Isabel
Published: December 2024

Background:

Ceftriaxone is a first-line beta-lactam antibiotic used in diverse clinical settings. Owing to pharmacokinetic alterations, ceftriaxone therapeutic drug monitoring is currently recommended for patients in the intensive care unit. Ultrafiltration is typically used to measure unbound ceftriaxone concentrations, as it is less costly and time-consuming compared with equilibrium dialysis. However, the reference method, equilibrium dialysis, has not been compared with equilibrium dialysis for ceftriaxone to measure the unbound ceftriaxone concentrations. Therefore, unbound ceftriaxone fractions measured by ultrafiltration versus equilibrium dialysis were compared in patients in the intensive care unit.

Methods:

Total and unbound ceftriaxone plasma fractions were measured by ultrafiltration (9500g at 37°C for 30 minutes) and equilibrium dialysis (12 kDa, 37°C for 4 hours) in 32 plasma samples from 28 patients who were critically ill collected during a previous prospective pharmacokinetic study. Passing–Bablok regression and Bland–Altman analyses were performed to evaluate the agreements between both methods.

Results:

The median (range) total ceftriaxone plasma concentration was 108.6 (5.2–233) mg/L. The median unbound concentration measured by equilibrium dialysis and ultrafiltration was 14.5 (0.7–52.9) and 23.3 (0.9–79.2) mg/L, respectively, showing a significant difference. Passing–Bablok regression analysis revealed significant proportional and systematic bias. This result was confirmed by Bland–Altman analysis, with a mean relative bias of 43.3% and wide agreement limits (−21% to 108%).

Conclusions:

Ultrafiltration substantially overestimates the unbound ceftriaxone fraction compared with equilibrium dialysis at 37°C. It is important to report methodological details and consider this information when interpreting unbound fractions of ceftriaxone and other drugs. These findings may impact the therapeutic drug monitoring of ceftriaxone.
Prevalence and Severity of Corneal Guttata After Descemet Membrane Endothelial Keratoplasty
Authors: Rickmann Annekatrin , Darwisch Warda , Menkene Louise Massia , Wahl Silke , Szurman Peter , Thaler Sebastian , Bodenbender Jan-Philipp , Seitz Berthold , Roberts Philipp K.
Published: December 2024

Purpose:

The postoperative occurrence of corneal guttae (CG) in patients after Descemet membrane endothelial keratoplasty (DMEK) can lead to a significant reduction in visual acuity (VA) with the subsequent need for repeat DMEK. Therefore, the aim of this study was to analyze the prevalence and clinical significance of CG in transplanted corneas after DMEK.

Methods:

The prevalence and progression of CG after DMEK of 1657 patients were examined using endothelial specular microscopy images. The severity grade of CG was classified into 3 grades (G1 <40%, G2 40-80%, G3 >80%). Central corneal thickness, VA, and endothelial cell density (ECD) were examined during a postoperative follow-up time of 19.5 ± 17.6 months (range 6–84 months).

Results:

The prevalence of CG postoperatively was 1.3% (22/1657 eyes) after 4-6 weeks. We could classify 15/22 (68%) as G1, 5/22 (23%) as G2, and 2/22 (9%) as G3. In 12/22 (55%), either preparation and/or implantation was conspicuously difficult. None of the eyes showed an increase in CG during follow-up. 21/22 were stable in VA, central corneal thickness, and ECD during the entire follow-up. One patient with G3 required a repeat DMEK after 12 months (secondary graft failure).

Conclusions:

The prevalence of CG in our study population was notably lower than previously described and was mainly characterized by mild, low-grade findings without clinical significance and were stable during the follow-up. Preoperative overlook of CG in the tissue bank cannot be completely excluded, but the remarkable proportion of intraoperative complications in this group may have led to the occurrence of these CG.
Validation of the Nurse Practitioner Knowledge and Attitudes of Patient Obesity Scale: A pilot study
Authors: Willenbrock Donna , Rose Sage
Published: December 2024

Background:

Obesity is a chronic, complex, relapsing disease requiring medical intervention that has reached epidemic proportions globally. Most patients are still experiencing bias and stigma related to their disease—even by health care providers. Our goal in this pilot study is twofold: to develop a scale to accurately measure nurse practitioner knowledge and attitude regarding the disease of obesity to determine whether bias exists and to potentially identify gaps in knowledge that can be targeted with future educational interventions.

Purpose:

To determine whether nurse practitioners in the Northeast have less stigmatized knowledge and attitudes regarding obesity.

Methodology:

A survey was created by the primary investigator as the “Nurse Practitioner Knowledge and Attitudes of Patient Obesity Scale” and distributed through email to New York State Nurse Practitioner Association members. Questions explored knowledge related to treatment of the patient living with obesity and nurse practitioner attitudes toward the disease.

Results:

The sample (N = 45) was homogenous, which did not allow for generalization. Preliminary results show that a large percentage of respondents were aware of the definition of obesity as a disease and treatment guidelines. The scale met reliability and validity criteria and showed that Nurse Practitioners (NPs) with continuing education had more positive views.

Conclusions:

More research is needed to understand nurse practitioner knowledge and attitudes regarding the disease of obesity and the benefit of continuing education in reducing bias and stigma.

Implications:

This may serve to improve NP obesity continuing education.
Nutritional specificity of frailty: from epidemiological and clinical evidence to potential mechanisms
Authors: Lengelé Laetitia , de França Natasha A. Grande , de Souto Barreto Philipe , Rolland Yves
Published: December 2024

Purpose of review

Considering the ageing of the population, age-related syndromes, such as frailty, are prominent. In this context, nutrition is a modifiable factor considered a key nonpharmacological approach to prevention and treatment. Yet, its contribution to the frailty pathophysiology is conflicting in the literature. This paper discusses the recent literature (January 2023–June 2024) on the implication of nutrition in frailty management.

Recent findings

Malnutrition is one of the main frailty risk factors. Proteins are the targeted macronutrient for their effects on muscle anabolism, not only in terms of quantity consumed but also in terms of sources. The diversity in plant and animal sources demonstrates better results than relying on a single source. More globally, anti-inflammatory and antioxidant diets are associated with a lower risk of frailty, like the Mediterranean Diet and specific food groups, like seafood, nuts, and seeds. Nutrition is pivotal in frailty prevention and treatment, and multidomain interventions providing exercises seem to yield even better results.

Diverse protein sources and anti-inflammatory and antioxidant diets associated with exercises are the primary recommendations for frailty prevention and treatment. However, there is a need to evaluate how to achieve and maintain this healthy behaviour in real life.
C1 lateral mass reconstruction using a titanium cage following total resection of the aneurysmal bone cyst: illustrative cases and literature insights
Authors: Ebrahimzadeh Kaveh , Mirahmadi Eraghi Mohammad , Hallajnejad Mohammad , Ansari Mohammad , Hoseini Tavassol Hesameddin , Mousavinejad Seyed Ali , Samadian Mohammad
Published: December 2024

Introduction:

There are limited reports of C1 lateral mass reconstruction using a titanium mesh cage following the surgical removal of an aneurysmal bone cyst (ABC). We describe two uncommon and challenging cases of C1 ABC, highlighting the obstacles and complexities involved in selecting the appropriate approach for tumor resection, C1 stabilization, and reconstruction.

Case discussion:

Case 1: A 12-year-old boy presented with 3 months of progressive upper cervical and occipital pain with no history of trauma. A heterogeneous lytic lesion with fluid-fluid levels in the right lateral mass of the atlas was detected. A gross total resection(GTR) of the C1 lateral mass ABC was performed through a posterior approach, followed by constructing the C1 lateral mass.
Case 2
: An 11-year-old girl presented with cervical pain for the past 6 months. A cervical computed tomography (CT) scan without contrast revealed a lytic-expansile mass lesion with bony erosion in the right transverse process of the C1 vertebra. A similar surgical plan was tailored for this patient. A follow-up examination at 6 weeks demonstrated complete pain relief, and routine neurologic evaluations were uneventful.

Discussion:

ABCs are uncommon, non-malignant, and highly vascular tumors, accounting for approximately 1% of all bone tumors and 15% of primary spinal tumors. The treatment of choice in this region is total resection, followed by C1 reconstruction.

Conclusion:

C1 lateral mass reconstruction using an expandable cage with vertebral artery (VA) preservation is recommended for extensive C1 lateral mass resection due to ABC.
99mTc-Sestamibi SPECT/CT Evaluation of Renal Oncocytomas
Authors: Nelson Nadia , Eichhorn Joshua , Palot Manzil Fathima Fijula
Published: December 2024

We present 2 cases of the benign renal neoplasm, oncocytoma, evaluated with 99mTc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) imaging. Oncocytoma is a benign, solid enhancing renal mass that resembles the much more common renal cell carcinoma on standard imaging studies. Differentiation can be difficult due to shared imaging and histological characteristics; therefore, diagnosis historically primarily relied on resection. However, in a subset of patients who are poor candidates for surgical excision or percutaneous biopsy, a possible option for planning follow-up management is 99mTc-sestamibi SPECT/CT imaging. These cases highlight the role of 99mTc-sestamibi SPECT/CT imaging in differentiating benign oncocytomas from malignant renal cell carcinomas.
Kidney Outcomes in Children Receiving Extracorporeal Membrane Oxygenation: A Single-Center Acute Cohort From 2009 to 2019, Followed to 2021
Authors: Strong Amy E. , Makeneni Spandana , Campos Diego , Fulchiero Rosanna , Kilbaugh Todd J. , Connelly James , Laskin Benjamin L. , Zee Jarcy , Denburg Michelle R.
Published: December 2024

Objectives:

Long-term kidney outcomes after extracorporeal membrane oxygenation (ECMO) are little quantified and understood. We aimed to describe the frequency of kidney dysfunction screening during follow-up and the prevalence of long-term kidney disease.

Design:

Retrospective cohort of pediatric ECMO patients with estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) using all post-discharge serum creatinine values to define three kidney outcomes: 1) acute kidney injury (AKI), with eGFR of less than 60 mL/min/1.73 m2, which subsequently improved to normal (≥ 90 mL/min/1.73 m2); 2) abnormal eGFR of less than 90 mL/min/1.73 m2 at last follow-up; and 3) chronic kidney disease (CKD) with eGFR of less than 90 mL/min/1.73 m2 on at least two occasions separated by greater than or equal to 90 days, without an intervening or subsequently normal eGFR.

Setting:

Single-center tertiary care children’s hospital system.

Patients:

All pediatric patients surviving ECMO from 2009 to 2019.

Interventions:

None.

Measurements and Main Results:

In the 10-year cohort of 666 patients, 399 (60%) survived at least 3 months post-discharge. Of these, 382 of 399 (96%) were followed at our institution for a median of 5 years (interquartile range, 3–8 yr). Two hundred sixty-four of 382 (69%) had at least one creatinine value post-discharge, and 209 of 382 (55%) had at least two values three months apart. Of the 264 with at least one creatinine value, 61 (23%) had an abnormal eGFR; of the 209 with at least two values greater than or equal to 90 days apart, 18 (9%) met criteria for CKD. Of those with CKD, 12 of 18 had AKI during ECMO, and seven of 18 had AKI events post-discharge (range, 1–6 episodes).

Conclusions:

This 2009–2019 pediatric ECMO cohort of survivors, followed for a median of 5 years, shows the subsequent high burden of kidney disease. We found that monitoring and following kidney function was not complete in this population, which is a concern since the rate of later AKI events and CKD is significant. Further study is needed to mitigate this post-ECMO vulnerability.
Association of Klotho and Gout in Middle-Aged and Older Adults
Authors: Wang Chaolan , Lin Ke , Jiang Yan , Wu Kangrong , Zhang Hong , Chen Jian , Li Na , Luo Wanpei , Liu Tianbao , Du Shuang
Published: December 2024

Background

Klotho, which is known to negatively regulate metabolic disorders and kidney disease, has a role in gout that remains unclear. This research explored how klotho levels correlate with the prevalence of gout.

Methods

Participants aged 40 to 79 from the National Health and Nutrition Examination Survey (2007–2016) were examined in both lines. The connection between klotho levels and gout was analyzed through weighted multivariate logistic regression. Restricted cubic splines were used to assess linearity and investigate the dose-response relationship. To ensure the stability of the results, subgroup and sensitivity analyses were conducted.

Results

In total, 9660 individuals participated, with the weighted sample size calculated at 88,892,738.77. The group included 47.79% males (4793), with the median age being 57.00 years. Upon adjusting for all covariates, the multivariate analysis indicated an odds ratio of 0.51 (95% confidence interval [CI]: 0.33~0.78, p = 0.003) for the likelihood of occurrence of gout. When compared with the lowest klotho quartile Q1 (≥151.3, <655.3 pg/mL), the adjusted odds ratios for the subsequent quartiles Q2 (≥655.5, <800.9 pg/mL), Q3 (≥801.0, <991.6 pg/mL), and Q4 (≥991.7, ≤3998.5 pg/mL) were 0.97 (95% CI: 0.68~1.38), 0.78 (95% CI: 0.50~1.21), and 0.48 (95% CI: 0.32~0.73), respectively. Analyses focusing on subgroups and sensitivity confirmed these results.

Conclusions

This research found a negative correlation between serum α-klotho concentrations and the occurrence of gout. Those with the highest levels of klotho exhibited the lowest likelihood of gout, indicating potential importance for future studies and clinical uses.
Systemic Treatment Followed by Radical Resection Combined with Intestinal Autotransplantation (RRCIA) for Locally Advanced Pancreatic Cancer
Authors: Qiao Guoliang , Bai Xueli , Li Xiang , Zhang Qi , Chen Yiwen , Ma Tao , Wu Guosheng , Xiao Wenbo , Sun Ke , Jiang Tian’an , Su Xinhui , Morse Michael A. , Liang Tingbo
Published: December 2024

Objective:

The present study aimed to assess the efficacy of this approach and establish the criteria that identify LAPC patients who may achieve survival benefits from RRCIA.

Summary Background Data:

Surgical resection for locally advanced pancreatic cancer (LAPC) remains challenging and associated with high morbidity and mortality, especially for surgery with major arterial reconstruction. We previously showed the feasibility and safety of Radical Resection Combined with Intestinal Autotransplantation (RRCIA) after systemic treatment.

Methods:

A retrospectively observational and prospectively validated study with three cohorts was conducted using multiple treatments. Overall survival (OS) and progression-free survival (PFS) were compared for both analyses. Propensity-score matching (PSM) and stabilized inverse probability of treatment weighting (IPTW) were performed to adjust for potential confounders.

Results:

Among 208 patients with LAPC we identified 48 who underwent systemic treatment followed by RRCIA. Using Propensity-score matching (PSM) and stabilized inverse probability of treatment weighting (IPTW) analyses, we observed that patients who underwent RRCIA had better overall and progression free survival compared with patients who did not have surgery (PSM cohort: median OS: 25.8 mo vs. 14.2 mo, P=0.0031, and IPTW cohort: median OS: 23.2 mo vs. 15.4 mo, P=0.0069) and PFS (PSM cohort: median PFS: 13.3 mo vs. 7.0 mo, P=0.0246, and IPTW cohort: median OS: 13.3 mo vs. 8.8 mo, P=0.002). Further prospective analysis showed that patients who received systemic treatment followed by RRCIA were associated with improved OS and PFS compared with patients who were eligible but did not receive RRCIA (median OS: 22.6 mo vs. 18.2 mo, P=0.035; median PFS: 13.2 mo vs. 10.3 mo, P=0.0412). Moreover, stratified and multivariable analysis demonstrated that preoperative CA19-9 normalization and duration of initial treatment over 8 cycles were predictors for precise selection of patients who would benefit from RRCIA. Meanwhile, adjuvant therapy after RRCIA was a significant factor for improving survival.

Conclusion:

This study suggests that RRCIA appears to be effective and associated with improved outcomes for LAPC patients with favorable response to systemic treatment. LAPC patients Should have at least 8 cycles of systemic treatment and CA19-9 normalization to be considered for RRCIA.
3-Year Survival Outcomes of Patients with Enhanced Recovery After Surgery vs. Conventional Care in Laparoscopic Distal Gastrectomy
Authors: Tian Yulong , Cao Shougen , Li Leping , Yu Wenbin , Ding Yinlu , Zhang Guangyong , Jiang Lixin , Qu Jianjun , Wang Hao , Wang Xinjian , Mao Weizheng , Zhang Huanhu , Chu Xianqun , Hui Xizeng , Zhang Dongfeng , Niu Zhaojian , Jing Changqing , Jiang Haitao , Liu Xiaodong , Li Zequn , Kehlet Henrik , Zhou Yanbing ,   on behalf of the Shandong Gastrointestinal Surgery Study Group (GISSG)
Published: December 2024

Objectives:

The efficacy of enhanced recovery after surgery (ERAS) to improve the prognosis of patients who undergo laparoscopic distal gastrectomy (LDG) for gastric cancer is uncertain. This randomized study compared oncological outcomes in LDG after ERAS or conventional care.

Background:

At present, randomized controlled trials have confirmed that ERAS can improve the short-term clinical outcomes of patients undergoing LDG, but whether it improves survival has not been reported yet.

Methods:

A multicenter, randomized, controlled trial was performed to compare oncological outcomes of ERAS versus conventional care in LDG. Between April 4, 2019, and March 18, 2020, 527 patients with locally advanced lower gastric adenocarcinoma were recruited from 13 centers in China. The primary endpoints were 3-year overall survival (OS) and disease-free survival (DFS). The secondary endpoints were complications, mortality, recovery, time of receiving adjuvant chemotherapy and medical expenses.

Results:

The full analysis set included 186 cases in the ERAS group and 184 in conventional group, well balanced with respect to patient demographics and baseline characteristics (published before). Postoperative hospital stay and the interval before adjuvant chemotherapy were obviously shorter in the ERAS group compared to conventional group as reported previously and with lower medical expenses. Compared with the conventional group, ERAS group had fewer overall complications (21.0% vs. 30.4%, respectively; P=0.037). The median (IQR) follow-up for all cases was 42.17 (range, 3.12-48.50) months. The 3-year OS and DFS in the ERAS group and conventional group were 86.56% and 80.11% (log-rank P=0.025), 79.57% and 69.57% (log-rank P=0.027), respectively. In a subgroup analysis of stage I and II disease patients, 3-year OS and DFS were similar between the groups (P=0.901; P=0.859 for stage I and P=0.421; P=0.459 for stage II). However, in the stage III disease, the ERAS group exhibited longer 3-year OS and DFS than the conventional group (79.41% vs. 64.47% for OS, log-rank P=0.046; 70.59% vs. 53.95% for DFS, log-rank P=0.046).

Conclusions:

Patients undergoing ERAS LDG had fewer overall complications, shorter hospital stay, decreased medical expenses, and improved 3-year OS and DFS rates, particularly in cases with stage III gastric cancer.
Exploring sources of (co-)variation in timing and total daily feeder visits in a wild population of black-capped chickadees
Authors: Hobbs Nathan L. , Hawkshaw Deborah M. , Wijmenga Jan J. , Mathot Kimberley J.
Published: December 2024

The timing and amount of foraging in birds are shaped by many of the same extrinsic factors, including temperature and daylength, as well as intrinsic factors, such as sex and age. Here, we investigate co-variation between these traits. We observed a population of 143 individually marked black-capped chickadees (
Poecile atricapillus
) over a 90 day period during the winter. For each day, we recorded the time an individual began and ended feeder use relative to sunrise/sunset, and the total number of feeder visits. Within-individuals, both earlier first feeder visit and later last feeder visit were associated with higher total daily feeder visits but lower feeding rates. Individuals also differed consistently in the timing of first and last feeder visits, and individuals that consistently started feeder use earlier in the day ended feeder use later and had higher total daily feeder visits compared with those that started later, but had no difference in feeding rate. Our study demonstrates that variation in the timing of foraging can have important consequences for energy acquisition at both the within- and among-individual levels.
Waveform geometry dictating optimal cruising in animals
Authors: Yoshizawa Kazuko , Motani Ryosuke
Published: December 2024

For sustained swimming and flights, vertebrates and insects oscillate their propulsors periodically within a narrow range of Strouhal number (St), a dimensionless quantity describing the rate and density of the motion, suggesting a close relationship between the range and cruising optimality. The persistence of this range across size and fluids has puzzled biologists and engineers, resulting in multiple interpretations of its cause. Here, we propose that the optimal St range is largely constrained by power output efficiency of the trailing edge of the caudal fin. A mathematical model of the periodic wake of the trailing edge, which defines the proportion of power lost without contributing to propulsion, predicts that such energy loss is minimal in the observed range of St preferred by fish. The constraints apply across a range of Reynolds number in cruising fish. The same constraints dictate the optimal speed across a wide range of swimmers, in combination with morphological characteristics. Other factors such as drag properties also affect the optimal swimming speed, but probably to a smaller extent. The result that the geometry of periodic waveforms is key to cruising optimality provides an additional angle to study animal locomotion in fluids and related bioinspired robotics.
Oxygen, angiogenesis, cancer and immune interplay in breast tumour microenvironment: a computational investigation
Authors: Mohammad Mirzaei Navid , Kevrekidis Panayotis G. , Shahriyari Leili
Published: December 2024

Breast cancer is a challenging global health problem among women. This study investigates the intricate breast tumour microenvironment (TME) dynamics utilizing data from mammary-specific polyomavirus middle T antigen overexpression mouse models (MMTV-PyMT). It incorporates endothelial cells (ECs), oxygen and vascular endothelial growth factors (VEGF) to examine the interplay of angiogenesis, hypoxia, VEGF and immune cells in cancer progression. We introduce an approach to impute immune cell fractions within the TME using single-cell RNA-sequencing (scRNA-seq) data from MMTV-PyMT mice. We quantify our analysis by estimating cell counts using cell size data and laboratory findings from existing literature. We perform parameter estimation via a Hybrid Genetic Algorithm (HGA). Our simulations reveal various TME behaviours, emphasizing the critical role of adipocytes, angiogenesis, hypoxia and oxygen transport in driving immune responses and cancer progression. Global sensitivity analyses highlight potential therapeutic intervention points, such as VEGFs’ role in EC growth and oxygen transportation and severe hypoxia’s effect on cancer and the total number of cells. The VEGF-mediated production rate of ECs shows an essential time-dependent impact, highlighting the importance of early intervention in slowing cancer progression. These findings align with clinical observations demonstrating the VEGF inhibitors’ efficacy and suggest a timely intervention for better outcomes.
Replicating the ‘seductive allure of neuroscience explanations’ effect in a classroom experiment and an online study
Authors: Väth Pearl Amber , von Petersdorff Jakob , Neumann Christof , Mundry Roger , Fischer Julia
Published: December 2024

The ‘seductive allure of neuroscience explanations’ effect refers to the observation that superfluous neuroscience information (SNI) added to an explanation can bias judgements of information quality. We report the results of a classroom experiment to sensitize undergraduate students to that issue. In contrast to previous studies, students rated good explanations without SNI the highest. Inspired by these observations, we set out to conceptually replicate the original study using an online experiment that allowed us to directly assess the statistical interactions between explanation quality, the presence of SNI and expertise levels. In this preregistered study, participants (
n 
= 430) with varying levels of expertise rated the quality of good and bad explanations, with or without SNI. Irrespective of the presence of SNI, participants across all expertise levels rated good explanations more favourably than bad ones. Still, the differences were surprisingly small, and the variation in rating was high. We also found a statistically significant interaction between the impact of SNI and expertise, with SNI boosting ratings mostly in participants with less expertise (
p 
< 0.001), corroborating previous findings. Developing a curriculum that trains students to distinguish between actual explanations and ‘crap’ would ultimately also sensitize teachers and experts that produce and review scientific information.
Learning on the job? Foraging strategies of juvenile versus adult Lesser black-backed gulls at their first migratory stopover
Authors: Morel Mélibée , Allaert Reinoud , Stienen Eric , Fijn Ruben , Verbruggen Frederick , Müller Wendt , Lens Luc
Published: December 2024

Developing efficient foraging strategies is critical for survival, especially during the high-mortality post-fledging period in birds. This period is particularly challenging for migratory species, where juveniles must navigate unfamiliar environments with limited experience and knowledge. Our study focused on the foraging strategies of 20 juvenile lesser black-backed gulls (
Larus fuscus
) during the first 20 days of their initial migratory stopover. We assessed learning through changes in their spatial (re)use and activity patterns using GPS tracking data, in direct comparison with similar data collected from 38 experienced adults. Juveniles were less exploratory and spent more time foraging than adults, but showed similar spatial consistency. Over time, both juveniles and adults reduced their range distribution areas, but only adults significantly reduced their flying time. Adults exhibited space use optimization by travelling shorter distances and spending progressively more time foraging. In contrast, juveniles showed no clear evidence of spatial learning or improved foraging skills, as there was no decrease in cumulative distance travelled nor a clear pattern in time spent foraging.
Towards an information-theoretic framework for multiple sequence alignment sub-sampling
Authors: Barrett Christopher , Bura Andrei , Huang Fenix , Reidys Christian
Published: December 2024

In this article we develop an information-theoretic framework of multiple sequence alignments (MSAs), based on sub-sampling. The key component of this framework is an information-theoretical potential defined on pairs of sites (links) within the MSA. This potential quantifies the expected drop in variation of information between the two constituent sites. The expectation is taken with respect to all possible sub-alignments, obtained by removing a finite, fixed number of rows. We show that the potential is zero for linked sites representing columns, for which symbols are in bijective correspondence and that it is strictly positive, otherwise. It is furthermore shown that the potential assumes its unique minimum for links at which each symbol pair appears with the same multiplicity. We then show that the established drop of the variation of information exceeds finite-size effects inherent to the construction of the potential. Finally, we provide as a proof of concept an application of our results to a specific MSA composed of the inverse fold solutions of three distinguished secondary structures.