bluuebunny/crossref_metadata_2025 huggingface dataset:
Gravitational imaging through a triple source plane lens: revisiting the ΛCDM-defying dark subhalo in SDSSJ0946+1006
Authors: Ballard Daniel J , Enzi Wolfgang J R , Collett Thomas E , Turner Hannah C , Smith Russell J
Published: February 2024

The ΛCDM paradigm successfully explains the large-scale structure of the Universe, but is less well constrained on subgalactic scales. Gravitational lens modelling has been used to measure the imprints of dark substructures on lensed arcs, testing the small-scale predictions of ΛCDM. However, the methods required for these tests are subject to degeneracies among the lens mass model and the source light profile. We present a case study of the unique compound gravitational lens SDSSJ0946+1006, wherein a dark, massive substructure has been detected, whose reported high concentration would be unlikely in a ΛCDM universe. For the first time, we model the first two background sources in both I- and U-band HST imaging, as well as VLT-MUSE emission line data for the most distant source. We recover a lensing perturber at a 5.9σ confidence level with mass $\log _{10}(M_\mathrm{sub}/{\rm M}_{\odot })=9.2^{+0.4}_{-0.1}$ and concentration $\log _{10}c=2.4^{+0.5}_{-0.3}$. The concentration is more consistent with CDM subhaloes than previously reported, and the mass is compatible with that of a dwarf satellite galaxy whose flux is undetectable in the data at the location of the perturber. A wandering black hole with mass $\log _{10}(M_\mathrm{BH}/{\rm M}_{\odot })=8.9^{+0.2}_{-0.1}$ is a viable alternative model. We systematically investigate alternative assumptions about the complexity of the mass distribution and source reconstruction; in all cases the subhalo is detected at around the ≥5σ level. However, the detection significance can be altered substantially (up to 11.3σ) by alternative choices for the source regularization scheme.
Fundamental, harmonic, and third-harmonic plasma emission from beam–plasma instabilities: a first-principles precursor for astrophysical radio bursts
Authors: Bacchini Fabio , Philippov Alexander A
Published: February 2024

Electromagnetic fundamental and harmonic emission is ubiquitously observed throughout the heliosphere, and in particular it is commonly associated with the occurrence of type II and III solar radio bursts. Classical analytic calculations for the plasma-emission process, though useful, are limited to idealized situations; a conclusive numerical verification of this theory is still lacking, with earlier studies often providing contradicting results on e.g. the precise parameter space in which fundamental and harmonic emission can be produced. To accurately capture the chain of mechanisms underlying plasma emission – from precursor plasma processes to the generation of electromagnetic waves over long times – we perform large scale, first-principles simulations of beam–plasma instabilities. By employing a very large number of computational particles we achieve very low numerical noise, and explore (with an array of simulations) a wide parameter space determined by the beam–plasma density ratio and the ion-to-electron temperature ratio. In particular, we observe direct evidence of both fundamental and harmonic plasma emission when the beam-to-background density ratio ≤0.005 (with beam-to-background energy ratio ∼0.5), tightly constraining this threshold. We observe that, asymptotically, in this regime $\sim 0.1~{{\ \rm per\ cent}}$ of the initial beam energy is converted into harmonic emission, and $\sim 0.001~{{\ \rm per\ cent}}$ into fundamental emission. In contrast with previous studies, we also find that this emission is independent of the ion-to-electron temperature ratio. In addition, we report the direct detection of third-harmonic emission in all of our simulations, at power levels compatible with observations. Our findings have important consequences for understanding the viable conditions leading to plasma emission in space systems, and for the interpretation of observed electromagnetic signals throughout the heliosphere.
Proper motion of the radio jets in two blazars at redshift above 3
Authors: Krezinger Máté , Frey Sándor , Perger Krisztina , Gabányi Krisztina É , An Tao , Zhang Yingkang , Gurvits Leonid I , Titov Oleg , Melnikov Alexey , Paragi Zsolt
Published: February 2024

There is still a limited number of high-redshift (z > 3) active galactic nuclei (AGNs) whose jet kinematics have been studied with very long baseline interferometry (VLBI). Without a dedicated proper motion survey, regularly conducted astrometric VLBI observations of bright radio-emitting AGN with sensitive arrays can be utilized to follow changes in the jets, by means of high-resolution imaging and brightness distribution modelling. Here, we present a first-time VLBI jet kinematic study of NVSS J080518 + 614423 (z = 3.033) and NVSS J165844 − 073918 (z = 3.742), two flat-spectrum radio quasars that display milliarcsecond-scale jet morphology. Archival astrometric observations carried out mainly with the Very Long Baseline Array, supplemented by recent data taken with the European VLBI Network, allowed us to monitor changes in their radio structure in the 7.6−8.6 GHz frequency band, covering almost two decades. By identifying individual jet components at each epoch, we were able to determine the apparent proper motion for multiple features in both sources. Apparent superluminal motions range $(1-14)\, c$, and are found to be consistent with studies of other high-redshift AGN targets. Using the physical parameters derived from the brightness distribution modelling, we estimate the Doppler-boosting factors (δ ≈ 11.2 and δ ≈ 2.7), the Lorentz factors (Γ ≈ 7.4 and Γ ≈ 36.6), and the jet viewing angles (θ ≈ 4.4° and θ ≈ 8.0°), for NVSS J080518 + 614423 and NVSS J165844 − 073918, respectively. The data revealed a stationary jet component with negligible apparent proper motion in NVSS J165844 − 073918.
The origin recognition complex requires chromatin tethering by a hypervariable intrinsically disordered region that is functionally conserved from sponge to man
Authors: Adiji Olubu A , McConnell Brendan S , Parker Matthew W
Published: February 2024

The first step toward eukaryotic genome duplication is loading of the replicative helicase onto chromatin. This ‘licensing’ step initiates with the recruitment of the origin recognition complex (ORC) to chromatin, which is thought to occur via ORC’s ATP-dependent DNA binding and encirclement activity. However, we have previously shown that ATP binding is dispensable for the chromatin recruitment of fly ORC, raising the question of how metazoan ORC binds chromosomes. We show here that the intrinsically disordered region (IDR) of fly Orc1 is both necessary and sufficient for recruitment of ORC to chromosomes in vivo and demonstrate that this is regulated by IDR phosphorylation. Consistently, we find that the IDR confers the ORC holocomplex with ATP-independent DNA binding activity in vitro. Using phylogenetic analysis, we make the surprising observation that metazoan Orc1 IDRs have diverged so markedly that they are unrecognizable as orthologs and yet we find that these compositionally homologous sequences are functionally conserved. Altogether, these data suggest that chromatin is recalcitrant to ORC’s ATP-dependent DNA binding activity, necessitating IDR-dependent chromatin tethering, which we propose poises ORC to opportunistically encircle nucleosome-free regions as they become available.
The Impact of Menthol Cigarette Bans: A Systematic Review and Meta-Analysis
Authors: Mills Sarah D , Peddireddy Snigdha , Kurtzman Rachel , Hill Frantasia , Catalan Victor , Bissram Jennifer S , Ribisl Kurt M
Published: February 2024

Introduction

This review investigates the impacts of banning the sale of menthol cigarettes at stores.

Methods

A systematic search of studies published in English up to November 2022 was conducted. The following databases were searched: PubMed/Medline, CINAHL, PsycINFO, Web of Science, and Embase, as well as a non-indexed journal. Studies evaluating either the impact of real-world or hypothesized menthol cigarette bans were included. Primary outcomes include tobacco use behaviors. Secondary outcomes include cigarette sales, retailer compliance, and the tobacco industry’s response to a menthol ban. Data on tobacco use behavior after a menthol ban were pooled using random-effects models. Two pairs of reviewers independently extracted data and assessed study quality.

Results

Of the 964 articles that were identified during the initial search, 78 were included in the review and 16 were included in the meta-analysis. Cessation rates among menthol cigarette smokers were high after a menthol ban. Pooled results show that 24% (95% confidence interval [95% CI]: 20%, 28%) of menthol cigarette smokers quit smoking after a menthol ban, 50% (95% CI: 31%, 68%) switched to non-menthol cigarettes, 12% (95% CI: 3%, 20%) switched to other flavored tobacco products, and 24% (95% CI: 17%, 31%) continued smoking menthol cigarettes. Hypothesized quitting and switching rates were fairly close to real-world rates. Studies found the tobacco industry attempts to undermine menthol bans. National menthol bans appear more effective than local or state menthol bans.

Conclusions

Menthol cigarette bans promote smoking cessation suggesting their potential to improve public health.

Implications

Findings from this review suggest that menthol cigarette bans promote smoking cessation among menthol cigarette smokers and have the potential to improve public health.
Genome organization and botanical diversity
Authors: Paterson Andrew H , Queitsch Christine
Published: February 2024

The rich diversity of angiosperms, both the planet's dominant flora and the cornerstone of agriculture, is integrally intertwined with a distinctive evolutionary history. Here, we explore the interplay between angiosperm genome organization and botanical diversity, empowered by genomic approaches ranging from genetic linkage mapping to analysis of gene regulation. Commonality in the genetic hardware of plants has enabled robust comparative genomics that has provided a broad picture of angiosperm evolution and implicated both general processes and specific elements in contributing to botanical diversity. We argue that the hardware of plant genomes—both in content and in dynamics—has been shaped by selection for rather substantial differences in gene regulation between plants and animals such as maize and human, organisms of comparable genome size and gene number. Their distinctive genome content and dynamics may reflect in part the indeterminate development of plants that puts strikingly different demands on gene regulation than in animals. Repeated polyploidization of plant genomes and multiplication of individual genes together with extensive rearrangement and differential retention provide rich raw material for selection of morphological and/or physiological variations conferring fitness in specific niches, whether natural or artificial. These findings exemplify the burgeoning information available to employ in increasing knowledge of plant biology and in modifying selected plants to better meet human needs.
‘In the “too difficult” box?’ Organizational inflexibility as a driver of voluntary resignations of police officers in England and Wales
Authors: Charman Sarah , Tyson Jemma
Published: February 2024

Record numbers of police officers are voluntarily resigning in England and Wales yet there is a lack of research which analyses why. Findings from an analysis of 62 interviews with police leavers who voluntarily resigned from the police service within England and Wales between January 2021 and June 2022 suggest that officers are leaving primarily due to perceptions of organizational injustice which focus upon: a lack of voice; concerns about promotion/progression; poor leadership; and a lack of organizational flexibility. This paper takes this latter reason—organizational flexibility—as its focus and through an inductive analysis of these leavers’ voices, aims to both enrich the scarce qualitative academic literature on police workforce resignations and retention but also to offer significant evidence for future consideration of workforce optimization. The findings indicate that although sympathetic to operational policing complexities, participants were frustrated by organizational inflexibility. Three key areas were identified where the police service was perceived to be unsupportive or unreceptive—(a) dealing with additional needs, disabilities, or health issues of officers, (b) conflicts with non-work commitments, primarily those associated with childcare/parental responsibilities, and (c) supporting officers transitioning to part-time working. These structural barriers to effective workplace functioning were exacerbated by the cultural norms of overwork and ‘fitting in’ and were additionally particularly experienced by female resigners. The authors call for a challenge to the cultural barriers towards flexible working, the modelling of flexible working at all levels of the organization, and a focus on reciprocal flexibility between employer and employee. Until this issue can be tackled, it is argued that retention will continue to be an underestimated but significant site of inequality within policing.
Evaluating a novel 24-hour rest/activity rhythm marker of preclinical β-amyloid deposition
Authors: Spira Adam P , Liu Fangyu , Zipunnikov Vadim , Bilgel Murat , Rabinowitz Jill A , An Yang , Di Junrui , Bai Jiawei , Wanigatunga Sarah K , Wu Mark N , Lucey Brendan P , Schrack Jennifer A , Wanigatunga Amal A , Rosenberg Paul B , Simonsick Eleanor M , Walker Keenan A , Ferrucci Luigi , Resnick Susan M
Published: February 2024

Study Objectives

To compare sleep and 24-hour rest/activity rhythms (RARs) between cognitively normal older adults who are β-amyloid-positive (Aβ+) or Aβ− and replicate a novel time-of-day-specific difference between these groups identified in a previous exploratory study.

Methods

We studied 82 cognitively normal participants from the Baltimore Longitudinal Study of Aging (aged 75.7 ± 8.5 years, 55% female, 76% white) with wrist actigraphy data and Aβ+ versus Aβ− status measured by [11C] Pittsburgh compound B positron emission tomography. RARs were calculated using epoch-level activity count data from actigraphy. We used novel, data-driven function-on-scalar regression analyses and standard RAR metrics to cross-sectionally compare RARs between 25 Aβ+ and 57 Aβ− participants.

Results

Compared to Aβ− participants, Aβ+ participants had higher mean activity from 1:00 p.m. to 3:30 p.m. when using less conservative pointwise confidence intervals (CIs) and from 1:30 p.m. to 2:30 p.m. using more conservative, simultaneous CIs. Furthermore, Aβ+ participants had higher day-to-day variability in activity from 9:00 a.m. to 11:30 a.m. and lower variability from 1:30 p.m. to 4:00 p.m. and 7:30 p.m. to 10:30 p.m. according to pointwise CIs, and lower variability from 8:30 p.m. to 10:00 p.m. using simultaneous CIs. There were no Aβ-related differences in standard sleep or RAR metrics.

Conclusions

Findings suggest Aβ+ older adults have higher, more stable day-to-day afternoon/evening activity than Aβ− older adults, potentially reflecting circadian dysfunction. Studies are needed to replicate our findings and determine whether these or other time-of-day-specific RAR features have utility as markers of preclinical Aβ deposition and if they predict clinical dementia and agitation in the afternoon/evening (i.e. “sundowning”).
Ectopic Expression of the Executor-Type R Gene Paralog Xa27B in Rice Leads to Spontaneous Lesions and Enhanced Disease Resistance
Authors: Tian Dongsheng , Teo Joanne , Yin Zhongchao
Published: February 2024

Plant disease resistance ( R) gene-mediated effector-triggered immunity (ETI) is usually associated with hypersensitive response (HR) and provides robust and race-specific disease resistance against pathogenic infection. The activation of ETI and HR in plants is strictly regulated, and improper activation will lead to cell death. Xa27 is an executor-type R gene in rice induced by the TAL effector AvrXa27 and confers disease resistance to Xanthomonas oryzae pv. oryzae ( Xoo). Here we reported the characterization of a transgenic line with lesion mimic phenotype, designated as Spotted leaf and resistance 1 ( Slr1), which was derived from rice transformation with a genomic subclone located 5,125 bp downstream of the Xa27 gene. Slr1 develops spontaneous lesions on its leaves caused by cell death and confers disease resistance to both Xoo and Xanthomonas oryzae pv. oryzicola. Further investigation revealed that the Slr1 phenotype resulted from the ectopic expression of an Xa27 paralog gene, designated as Xa27B, in the inserted DNA fragment at the Slr1 locus driven by a truncated CaMV35Sx2 promoter in reverse orientation. Disease evaluation of IRBB27, IR24, and Xa27B mutants with Xoo strains expressing dTALE-Xa27B confirmed that Xa27B is a functional executor-type R gene. The functional XA27B-GFP protein was localized to the endoplasmic reticulum and apoplast. The identification of Xa27B as a new functional executor-type R gene provides additional genetic resources for studying the mechanism of executor-type R protein-mediated ETI and developing enhanced and broad-spectrum disease resistance to Xoo through promoter engineering.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
First Record of the Rust Fungus Uromyces gageae on Yellow Star-of-Bethlehem (Gagea lutea) in the Netherlands
Authors: Bouwmeester Klaas , Swertz Charlotte A.
Published: February 2024

Yellow Star-of-Bethlehem (Gagea lutea) is a rare and threatened bulbous plant in the Netherlands, with its largest stronghold in the northern province of Drenthe. In 2022, numerous plants within a population of G. lutea were found to be infected by a rust fungus, which was identified as Uromyces gageae based on morphological characteristics. Further examination of collected teliospores revealed differences from U. acutatus, a closely related rust species known to infect Ornithogalum and Gagea species. Rust symptoms on G. lutea plants were observed within the same population in April 2023, suggesting that teliospores surviving winter conditions serve as a viable source for recurrent infection. DNA of U. gageae and U. acutatus extracted from teliospores was used to obtain partial ribosomal DNA gene fragments by PCR. Amplicon sequencing revealed nucleotide variation between both rust species and verified the identity of the rust fungus on G. lutea as U. gageae. This confirmation substantiates the first documentation of U. gageae in the Netherlands. This study raises new avenues for research on the distribution and host range of U. gageae, as well as additional studies on the population dynamics of this potentially rare, wild plant–rust interaction.
Cytogenetic and Genomic Characterization of a Novel Wheat-Tetraploid Thinopyrum elongatum 1BS⋅1EL Translocation Line with Stripe Rust Resistance
Authors: Wu Dandan , Zhao Xin , Xie Yangqiu , Li Lingyu , Li Yinghui , Zhu Wei , Xu Lili , Wang Yi , Zeng Jian , Cheng Yiran , Sha Lina , Fan Xing , Zhang Haigin , Zhou Yonghong , Kang Huoyang
Published: February 2024

Stripe rust, caused by Puccinia striiformis f. sp. tritici, is a destructive wheat disease pathogen. Thinopyrum elongatum is a valuable germplasm including diploid, tetraploid, and decaploid with plenty of biotic and abiotic resistance. In a previous study, we generated a stripe rust-resistant wheat-tetraploid Th. elongatum 1E/1D substitution line, K17-841-1. To further apply the wild germplasm for wheat breeding, we selected and obtained a new homozygous wheat-tetraploid Th. elongatum translocation line, T1BS⋅1EL, using genomic in situ hybridization, fluorescence in situ hybridization (FISH), oligo-FISH painting, and the wheat 55K single nucleotide polymorphism genotyping array. The T1BS⋅1EL is highly resistant to stripe rust at the seedling and adult stages. Pedigree and molecular marker analyses revealed that the resistance gene was located on the chromosome arm 1EL of tetraploid Th. elongatum, tentatively named Yr1EL. In addition, we developed and validated 32 simple sequence repeat markers and two kompetitive allele-specific PCR assays that were specific to the tetraploid Th. elongatum chromosome arm 1EL to facilitate marker-assisted selection for alien 1EL stripe rust resistance breeding. This will help us explore and locate the stripe rust resistance gene mapping on the 1E chromosome and deploy it in the wheat breeding program.
Risk of Fracture and Complications Following Fixation in Patients with Pre-injury Psychiatric Illness: A Propensity-Matched Cohort Study
Authors: Zhu Kevin Y. , Bobak Lukas , Dorney Ian , Breslin Mary A. , Hendrickson Sarah B. , Vallier Heather A.
Published: February 2024

OBJECTIVE:

The purpose was to describe the frequency of orthopaedic trauma and post-surgical complications associated with psychiatric diagnoses.

METHODS:

Design:

Query of TriNetx Analytics Network

Setting:

Participating hospitals

Patient selection criteria:

Those ≥ 18 years old with psychiatric illness and orthopaedic trauma

Outcome measures and comparisons: Fractures and post-operative complications were described. A 1:1 propensity score matching function was utilized. Odds ratios compared inter-cohort complications.

RESULTS:

A total of 11,266,415 patients were identified with a psychiatric diagnosis, including bipolar disorder (8.9%), schizophrenia (3.3%), major depression (12.4%), stress-related disorder (9.6%), anxiety disorder (64.5%), borderline personality disorder (BPD) (1.1%), or antisocial personality (0.2%). Prevalence of 30.2% was found for a fracture and at least one psychiatric diagnosis. Antisocial personality disorder had the highest risk ratio relative to people without that mental disorder (RR = 5.09) of having one or more associated fracture, followed by depression (RR = 3.03), stress-related disorders (RR = 3.00), anxiety disorders (RR = 2.97), BPD (RR = 2.92), bipolar disorder (RR = 2.80), and schizophrenia (RR = 2.69). Patients with at least one psychiatric comorbidity had greater risk of pulmonary embolism, superficial and deep surgical site infections, pneumonia, urinary tract infection, deep venous thrombosis, osteonecrosis, and complex regional pain syndrome by 1 month after fixation, when compared with patients without psychiatric disorder. By 1 year, they were also at an increased risk for stroke and myocardial infarction.

CONCLUSIONS:

All psychiatric comorbidities were associated with increased relative risk of fracture and higher odds of complications compared with patients without psychiatric comorbidities. Providers should be aware of pre-existing psychiatric diagnoses during treatment of acute injuries due to these risks.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Evaluation of Intraoperative Fluoroscopic Techniques to Estimate Femoral Rotation: A Cadaveric Study
Authors: Ivanov David V. , Welby John P. , Khanna Ankur , Barlow Jonathan D. , Sems S. Andrew , Torchia Michael E. , Yuan Brandon J.
Published: February 2024

Objectives:

To compare three fluoroscopic methods for determining femoral rotation.

Methods:

Native femoral version was measured by computed tomography in 20 intact femurs from 10 cadaveric specimens. Two Steinmann pins were placed into each left femur above and below a planned transverse osteotomy which was completed through the diaphysis. Four surgeons utilized the true lateral (TL), neck-horizontal angle (NH), and lesser trochanter profile (LTP) techniques to correct the injured femur’s rotation using the intact right femur as reference, yielding 120 measurements. Accuracy was assessed by comparing the angle subtended by the two Steinmann pins before and after manipulation and comparing against version measurements of the right femur.

Results:

Absolute mean rotational error in the fractured femur compared to its uninjured state was 6.0° (95% CI, 4.6-7.5), 6.6° (95% CI, 5.0-8.2), and 8.5° (95% CI, 6.5-10.6) for the TL, NH, and LTP techniques, respectively, without significant difference between techniques (p=0.100). Compared to the right femur, absolute mean rotational error was 6.6° (95% CI, 1.0-12.2), 6.4° (95% CI, 0.1-12.6), and 8.9° (95% CI, 0.8-17.0) for the TL, NH, and LTP techniques, respectively, without significant difference (p=0.180). Significantly more femurs were malrotated by >15° using the LTP method compared to the TL and NH methods (20.0% vs 2.5% and 5.0%, p=0.030). Absolute mean error in estimating femoral rotation of the intact femur using the TL and NH methods compared to CT was 6.6° (95% confidence interval [CI], 5.1-8.2) and 4.4° (95% CI, 3.4-5.4), respectively, with significant difference between the two methods (p=0.020).

Conclusions:

The true lateral (TL), neck-horizontal angle (NH), and the lesser trochanter profile (LTP) techniques performed similarly in correcting rotation of the fractured femur, but significantly more femurs were malrotated by >15° using the LTP technique. This supports preferential use of the TL or NH methods for determining femoral version intraoperatively.
Heat-related mortality and ambulance transport after a power outage in the Tokyo metropolitan area
Authors: Yamasaki Lisa , Kamada Takuma , Ng Chris Fook Sheng , Takane Yuya , Nakajima Ko , Yamaguchi Kazuki , Oka Kazutaka , Honda Yasushi , Kim Yoonhee , Hashizume Masahiro
Published: February 2024

Background:

Air conditioners can prevent heat-related illness and mortality, but the increased use of air conditioners may enhance susceptibility to heat-related illnesses during large-scale power failures. Here, we examined the risks of heat-related illness ambulance transport (HIAT) and mortality associated with typhoon-related electricity reduction (ER) in the summer months in the Tokyo metropolitan area.

Methods:

We conducted event study analyses to compare temperature–HIAT and mortality associations before and after the power outage (July to September 2019). To better understand the role of temperature during the power outage, we then examined whether the temperature–HIAT and mortality associations were modified by different power outage levels (0%, 10%, and 20% ER). We computed the ratios of relative risks to compare the risks associated with various ER values to the risks associated without ER.

Results:

We analyzed the data of 14,912 HIAT cases and 74,064 deaths. Overall, 93,200 power outage cases were observed when the typhoon hit. Event study results showed that the incidence rate ratio was 2.01 (95% confidence interval [CI] = 1.42, 2.84) with effects enduring up to 6 days, and 1.11 (95% CI = 1.02, 1.22) for mortality on the first 3 days after the typhoon hit. Comparing 20% to 0% ER, the ratios of relative risks of heat exposure were 2.32 (95% CI = 1.41, 3.82) for HIAT and 0.95 (95% CI = 0.75, 1.22) for mortality.

Conclusions:

A 20% ER was associated with a two-fold greater risk of HIAT because of summer heat during the power outage, but there was little evidence for the association with all-cause mortality.
Full adherence to cirrhosis quality indicators is associated with lower mortality in acute variceal bleeding: Nationwide audit
Authors: Wong Yu Jun , Teng Margaret , Sim Alyssa , Thet Htay Myat , Teoh Xuhui , De Roza Marianne Anastasia , Sen Kew Guan , Koh Jia Hong , Loi Pooi Ling , Lim Kai , Kang Garrett , Kuang Jonathan , Low En Xian Sarah , HO Jing Liang , Cher Liu Yuan Gabriel , Sze Kenny , Wong Guan Wee , Kwek Boon Yew Andrew , Yang Wei Lyn , Abraldes Juan G. , Chang Jason
Published: February 2024

Background and Aims:

Acute variceal bleeding (AVB) is a major complication in patients with cirrhosis. Using a nationwide AVB audit, we performed a nested cohort study to determine whether full adherence to the AVB quality indicator (QI) improves clinical outcomes in patients with cirrhosis and AVB.

Approach and Results:

We assessed real-world adherence to AVB QI among patients with cirrhosis admitted for AVB in all public hospitals in Singapore between January 2015 and December 2020. Full adherence was considered when all 5 QIs were fulfilled: prophylactic antibiotics, vasoactive agents, timely endoscopy, endoscopic hemostasis during index endoscopy, and nonselective beta-blockers after AVB. We compare 6-week mortality between the full adherence and suboptimal adherence groups using a propensity-matched cohort.

A total of 989 patients with AVB were included. Full adherence to all AVB QI was suboptimal (56.5%). Analysis of the propensity-matched cohort with comparable baseline characteristics showed that full adherence was associated with a lower risk of early infection (20.0% vs. 26.9%), early rebleeding (5.2% vs. 10.2%), and mortality at 6 weeks (8.2% vs. 19.7%) and 1 year (21.3% vs. 35.4%) (p<0.05 for all). While full adherence was associated with a lower 6-week mortality regardless of the MELD score, nonadherence was associated with a higher 6-week mortality despite a lower predicted risk of 6-week mortality. Despite high adherence to the recommended process measures, patients with CTP-C remain at a higher risk of rebleeding, 6-week and 1-year mortality.

Conclusions:

Full adherence to the AVB QI should be the target for quality improvement in patients with cirrhosis.
Serious Adverse Events of Inclisiran in Patients With Hypercholesterolemia, a Meta-Analysis of ORION Trials
Authors: Jawwad Mohammad , Riaz Monazza , Mehtab Mehreen , Naveed Chaudhary Muhammad Yafaa , Kumari Jaya , Ahmad Waqas , Aslam Hina , Masood Fatima , Rehman Wajeeh Ur , Rahman Ihtisham , Lara-Vega Israel , Ratani Sunny , Muhammad Aqeel , Affa Baig Alnehyan , Rauf Abdul
Published: February 2024

Background:

Several studies have been conducted over the years to find an effective and safe therapeutic agent to treat hypercholesterolemia. Inclisiran is a novel drug being studied for its efficacy and safety in reducing low-density lipoprotein cholesterol levels in patients to reduce the risk of cardiovascular diseases. No previous study was done to review the trials for the serious adverse events of this drug. The primary objective of this research is to investigate the incidence of serious adverse events of this drug.

Design:

A systematic review and meta-analysis of clinical trials is performed.

Methods:

A systematic search of PubMed, Embase, and ClinicalTrials.gov, from their inception till July 3, 2023, was performed for ORION trials, studying the efficacy and safety of inclisiran. The random-effects model was used in the meta-analysis to provide a pooled proportion of serious adverse events. The risk of bias in each study was assessed by the Cochrane Risk of Bias Tool.

Results:

From 319 studies searched from the databases, only 8 relevant articles remained after a detailed evaluation. These studies, having a total of 4981 patients, were involved in the analysis, with a pooled estimate showing a nonsignificant incidence of serious adverse events. Each adverse event was studied individually, and product issues and endocrine disorders had the highest odds ratio among them. All included studies were classified as moderate quality.

Conclusion:

Following systematic review and meta-analysis, we found no significant differences in any serious adverse events following the administration of inclisiran. However, larger ongoing trials will provide additional data to evaluate the safety profile of this agent.
The Majority of Participants With Suspected Hypertrophic Cardiomyopathy Documented During Screening Echocardiography Have a Normal Electrocardiogram
Authors: Movahed Mohammad Reza , Irannejad Kyvan , Bates Sharon
Published: February 2024

Background:

Patients with hypertrophic cardiomyopathy (HCM) usually have abnormal electrocardiograms consistent with left ventricular hypertrophy (LVH). The goal of this study was to evaluate the prevalence of abnormal ECG findings (LVH, T wave inversion, left bundle branch block, and left atrial enlargement) in participants with suspected HCM detected during screening echocardiography.

Method:

The Anthony Bates Foundation has been performing screening echocardiography across the United States for the prevention of sudden death since 2001. A total of 682 subjects between the ages of 8 and 71 underwent echocardiographic screening together with ECG documentation. We evaluated the prevalence of abnormal ECG in participants with suspected HCM defined as any left ventricular wall thickness ≥15 mm.

Results:

The prevalence of LVH and T wave inversion were higher in HCM subjects as expected [HCM occurred in 23.5% (4/17) vs. 5.6% (37/665), P = 0.002, T wave inversion occurred in 17.6% (3/17) vs. 4.1% (27/664), P = 0.007]. However, despite adding these 2 common ECG abnormalities in this population, the presence of detected abnormal ECG remained less than 25% (23.5% of HCM subjects had LVH or T wave inversion on ECG vs. 8.7% of control, P = 0.036). Left bundle branch block or abnormal left atrium on ECG were not found in any participants with suspected HCM.

Conclusions:

The prevalence of abnormal ECG in the participants with suspected HCM detected during screening echocardiography is less than 25%. This suggests that ECG alone is not a sensitive marker for the detection of HCM.
Modified Method for Nanothin Descemet Stripping Automated Endothelial Keratoplasty
Authors: Zhao Zelin , Lin Lei , Zhou Weihe , Chen Jiaqi , Xiao Yinling , Jhanji Vishal , Liu Yang , Zheng Qinxiang , Chen Wei
Published: February 2024

Purpose:

The purpose of this study was to describe a method to achieve a high success rate for nanothin (NT, ≤50 μm) Descemet stripping automated endothelial keratoplasty (DSAEK) graft preparation using anterior chamber pressurizer (ACP) with a modified setting and evaluate its postoperative efficacy.

Methods:

A prospective cohort (study group) of 24 patients with corneal endothelial dysfunction was consecutively enrolled and received DSAEK grafts using the modified ACP method from December 2021 to May 2022. The control group included 24 historical patients who received DSAEK grafts using conventional ACP procedure. Central graft thickness (CGT), graft regularity (3-mm and 5-mm diameter zones), best spectacle–corrected visual acuity, and endothelial cell density (ECD) were compared between 2 groups.

Results:

A 100% ultrathin (UT, ≤100 μm) DSAEK rate and 62.5% NT-DSAEK rate was achieved at 3 months postsurgery in the study group, with a 51.3 ± 14.8 μm CGT, while a 70.8% UT-DSAEK rate and 4.2% NT-DSAEK rate was achieved in the control group, with an 89.0 ± 15.4 μm CGT (P <0.001). At 3-month postoperative follow-up, the regularity of graft thickness was significantly better in the study group (central-to-peripheral thickness difference: P = 0.044 and 0.014 for 3-mm and 5-mm diameter zones, respectively, graft thickness uniformity: P <0.001 and 0.012, respectively). There was no statistical difference in the best spectacle–corrected visual acuity (P = 0.170) or ECD (P = 0.833) between 2 groups at 3-month postoperative follow-up.

Conclusions:

DSAEK grafts harvested using modified ACP method were thinner and more regular compared with the conventional ACP method.
Ezetimibe treatment reduces oxidized low-density lipoprotein in biliary cirrhotic rats
Authors: Chang Ching-Chih , Huang Hui-Chun , Hsu Shao-Jung , Pun Chon-Kit , Chuang Chiao-Lin , Hou Ming-Chih , Lee Fa-Yauh
Published: February 2024

Background:

In liver cirrhosis, chronic inflammation is associated with an increase in oxidative stress, and subsequently an increase in the concentration of oxidized low-density lipoprotein (ox-LDL). Ezetimibe is a lipid-lowering agent with anti-inflammation and anti-oxidative stress activities. This study aimed to investigate the effect of ezetimibe treatment on ox-LDL in cirrhotic rats.

Methods:

Biliary cirrhosis was induced in Sprague-Dawley rats with common bile duct ligation (BDL). Sham-operated rats served as surgical controls. Ezetimibe (10 mg/kg/d) or vehicle was administered in the sham-operated or BDL rats for 4 weeks, after which hemodynamic parameters, biochemistry data, and oxidative stress were evaluated. Plasma and intrahepatic ox-LDL levels were also examined, and hepatic proteins were analyzed to explore the mechanism of ezetimibe treatment.

Results:

The BDL rats had typical features of cirrhosis including jaundice, impaired liver function, hyperlipidemia, and elevated ox-LDL levels compared to the sham-operated rats. Ezetimibe treatment did not affect hemodynamics, liver biochemistry, or plasma lipid levels. However, it significantly reduced oxidative stress, plasma levels of ox-LDL, and tumor necrosis factor α. In addition, ezetimibe upregulated the hepatic protein expression of an ox-LDL scavenger (lectin-like ox-LDL rececptor-1), which resulted in reductions in intrahepatic ox-LDL and fat accumulation in the BDL rats. Nevertheless, ezetimibe treatment did not ameliorate hepatic inflammation or liver fibrosis.

Conclusion:

Ezetimibe reduced plasma and intrahepatic ox-LDL levels in the cirrhotic rats. Furthermore, it ameliorated intrahepatic fat accumulation and oxidative stress. However, ezetimibe did not alleviate hepatic fibrosis or inflammation in the biliary cirrhotic rats.
Bridging the gap: Implementing a pilot radiology-focused curriculum in an acute care Nurse Practitioner program
Authors: Zuma Danielle , Zink Mara , Tran Nhani , Chen Leon
Published: February 2024

Knowledge in diagnostic radiology and performance of point-of-care ultrasound are integral to acute care nurse practitioners (ACNPs) in the inpatient settings, especially true in specialty areas such as interventional radiology and critical care. However, existing ACNP training programs, including at our institution, often lack robust relevant course content. To address this educational gap, we designed and implemented a pilot acute care radiology course, incorporating a flipped classroom approach and hands-on simulation activities led by expert faculty. Our course evaluation revealed high levels of student satisfaction, self-reported confidence, and perceived course effectiveness. The course aligns with key competencies outlined by the American Association of Colleges of Nursing, demonstrating its potential to advance ACNP education in radiology content.
Restoration of reproductive capacity in a male patient with congenital adrenal hyperplasia and bilateral testicular adrenal rest tumors (TARTs) after six months of glucocorticoid intensification: A case report
Authors: Ahmad Jihan , Ahmad Adnan , Hadid Lama
Published: February 2024

Rationale:

Congenital adrenal hyperplasia (CAH) is considered one of the most common inherited disorders. In about more than 95% of all CAH cases, the deficient enzyme is 21-hydroxylase. Infertility is an important complication of this disease, and although this topic has been studied more frequently in females, cases, and literature reviews of the causes of infertility in male patients are constantly increasing.

Patient concerns:

A 28 old male with congenital adrenal hyperplasia (we assume to be a nonclassical type) presented to our institution with infertility and suspected bilateral testicular masses after 4 years of stopping dexamethasone.

Diagnosis:

Testicular adrenal rest tumors.

Interventions:

Dexamethasone was reapplied in a supraphysiologic dose (1.5 mg before bedtime) with periodic monitoring of the patient.

Outcomes:

Treatment with supraphysiologic dose of dexamethasone led to regression of these tumors and significant improvement in sperm count, resulting in being capable of having a child.

Lessons:

There are many suspected causes of reduced male fertility in male CAH patients and the presence of testicular adrenal rest tumors is the main cause of infertility in this population. These benign tumors are believed to arise from ectopic adrenal cells in the testes, that grow under adrenocorticotropic hormone stimulation in poorly controlled patients. Annual scrotal ultrasound is recommended in all males with CAH for detection and treatment of these tumors as early as possible before they cause permanent damage to the seminiferous tubules and irreversible infertility.
Morphometric study of cervical spinal canal and transverse foramen diameter using computed tomography: Sex difference and relationship to age in Turkish population
Authors: Tuncer Işik , Alkan Ender
Published: February 2024

Accurate and detailed spinal canal diameter transverse foraminal morphometry measurements are essential for understanding spinal column-related diseases and surgical planning, especially for transpedicular screw fixation. This is especially because lateral cervical radiographs do not provide accurate measurements. This retrospective study was conducted to measure the dimensions of the transverse foramen sagittal and transverse diameter (TFD), spinal canal diameter, the distance of the spinal canal from the transverse foramina at the C1 to C7 cervical level, and the anteroposterior and TFDs in the Turkish population. A total of 150 patients who underwent cervical spine computed tomographic imaging with a 1:1 gender ratio were enrolled in the study. The sagittal and TFDs of the spinal canal, the distance of the spinal canal from the transverse foramen, and anteroposterior and TFDs in both right and left sides for all cervical levels C1 to C7. Foramina transversal diameters were measured using imaging tools of the imaging software in the radiology unit. The mean age of the study group was 47.99 ± 18.65 (range, 18–80) years. The majority of the distances of the spinal canal from the transverse foramen and antero-posterior (AP) & transverse (T) diameters for cervical vertebrae were significantly higher in male patients (P < .05). However, between age groups, a few measurements were found significantly different. Some of the distances of the spinal canal from the transverse foramen were significantly higher on the right side whereas all AP & T diameters were significantly higher on the left side in both male and female patients (P < .05). Almost all measurements were significantly higher on the left side for younger patients (<65 years) whereas only AP & T diameters were significantly higher on the left side for older patients (>65 years) (P < .05). Computed tomographic imaging is better than conventional radiographs for the preoperative evaluation of the cervical spine and for a better understanding of cervical spine morphometry. Care must be taken during transpedicular screw fixation, especially in female subjects, more so at the C2, C4, and C6 levels due to decreased distance of the spinal canal from the transverse foramina.
The characteristics and comparison between young and old patients with spontaneous isolated celiac artery dissection: Analysis based on 60 reports
Authors: Chen Xiaoliang , Wu Hongtao , Wang Shenghuan , Feng Tianbo
Published: February 2024

Background and aims:

Though increasing studies reported the management of spontaneous isolated celiac artery dissection (ICAD), the characteristics and etiology of ICAD in different age-stage patients have not been well-studied. Our study was designed to describe and further to compare the clinical features of spontaneous ICAD between young and old patients.

Methods:

We searched PubMed, Embase, and Web of Science up to March 1, 2023 for spontaneous ICAD case reports. Two reviewers screened the titles and abstracts of searched records for qualified reports according to the including and excluding criteria and extracted the data independently. Statistical analysis was performed using SPSS software (version 19.0; IBM Corp, Armonk, NY) and Stata 12.0 (Stata Corp., College Station, TX). Descriptive results were presented as the mean ± standard deviation or percent. The comparison results between young and old patients were displayed as risk ratio (RR) or standardized mean difference (SMD) with its 95% confidence intervals (CI).

Results:

We totally identified 60 reports in the present analysis. The mean age of patients was 52.4 years, with the majority of patients being male (84.4%). The majority of patients were symptomatic and commonest presentation was abdominal pain (76.7%). Most patients (63.2%) had comorbidities or history and hypertension and smoking were the top 2 conditions with proportion of 63.3% and 40.5% respectively. When comparing young to old patients with ICAD, no significant difference was found in demographic and clinical features including sex, comorbidities/history, and symptoms. However, we found that young patients with ICAD experienced significantly longer dissection length (SMD 1.01, 95% CI 0.16–1.86;P = .015) and distance from ostium (SMD 0.96, 95% CI 0.07–1.85;P = .013), but no significant difference was observed in true lumen compression (SMD −0.39, 95% CI −1.22–0.44;P = .364). In addition, our results showed that ICAD in young patients extending more to distal arteries, including common hepatic artery/hepatic artery (RR 2.04, 95% CI 1.13–3.68;P = .01), splenic artery (RR 2.36, 95% CI 1.24–4.49;P = .017) and left gastric artery (RR 25.42; 95% CI 1.55–417.74;P = .04).

Conclusions:

Though spontaneous ICAD had multitudinous clinic-pathologic features, it was apt to middle-aged males and symptomatic and abdominal pain was always the commonest presentation. Hypertension and smoking were the top 2 conditions of ICAD patients. There was significant difference between young and old patients in radiographic characteristics of ICAD which may lead to different treatment and outcomes.
Internet appointment has more advantages than traditional appointment in the nursing service of dry eye patients
Authors: Zou Yunyun , Guo Ping , Zhu Xiaoli , Liu Xinhua , Xin Na
Published: February 2024

Dry eye disease is one of the most common eye diseases. Clinical studies have found that meibomian gland expression can effectively improve the function of meibomian glands in patients with meibomian gland dysfunction. Compared with traditional appointments, Internet appointment has advantages in treating dry eye disease. A cross-sectional study was conducted to collect 300 patients with dry eye disease through an online questionnaire. Using Pearson chi-squared test, associations between the clinical parameters and appointment mode were analyzed. Spearman-rho test was executed to compare clinical data and appointment mode for correlation analysis and relationship between score of advantages of Internet booking (SOAIB), evaluation of the effectiveness of the Internet booking (EEIB), waiting in line for medical treatment (WMT). Univariate logistic regression analysis calculated the odds ratio (OR) of appointment mode for potential correlation factors. By using Pearson chi-squared test, SOAIB (P = .005), EEIB (P = .029) and WMT (P = .041) was significantly correlated with the appointment mode. Spearman correlation coefficient displayed that appointment mode was significantly correlated with EEIB (ρ = −0.126, P = .029) and WMT (ρ = 0.118, P = .041). Univariate logistic regression and concludes that EEIB (OR = 0.183, 95%CI: 0.033–1.004, P = .05), WMT (OR = 2.543, 95%CI: 1.013–6.384, P = .047) have a clear correlation with appointment mode. Spearman correlation coefficient displayed that SOAIB was significantly correlated with EEIB (ρ = −0.247, P < .001) and WMT (ρ = 0.157, P = .006). Internet appointment can effectively reduce the waiting time for dry eye disease treatment by meibomian gland expression. Effectiveness evaluation of Internet appointments is significantly higher than traditional appointments.