bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of A0 minimum ablative margins for colorectal liver metastases: multicentre, retrospective study using deformable CT registration and artificial intelligence-based autosegmentation
Authors: Paolucci Iwan , Albuquerque Marques Silva Jessica , Lin Yuan-Mao , Laimer Gregor , Cignini Valentina , Menchini Francesca , Meira Marcio , Shieh Alexander , O’Connor Caleb , Jones Kyle A , Gazzera Carlo , Fonio Paolo , Brock Kristy K , Calandri Marco , Menezes Marcos , Bale Reto , Odisio Bruno C
Published: August 2024

Background

Several ablation confirmation software methods for minimum ablative margin assessment have recently been developed to improve local outcomes for patients undergoing thermal ablation of colorectal liver metastases. Previous assessments were limited to single institutions mostly at the place of development. The aim of this study was to validate the previously identified 5 mm minimum ablative margin (A0) using autosegmentation and biomechanical deformable image registration in a multi-institutional setting.

Methods

This was a multicentre, retrospective study including patients with colorectal liver metastases undergoing CT- or ultrasound-guided microwave or radiofrequency ablation during 2009–2022, reporting 3-year local disease progression (residual unablated tumour or local tumour progression) rates by minimum ablative margin across all institutions and identifying an intraprocedural contrast-enhanced CT-based minimum ablative margin associated with a 3-year local disease progression rate of less than 1%.

Results

A total of 400 ablated colorectal liver metastases (median diameter of 1.5 cm) in 243 patients (145 men; median age of 62 [interquartile range 54–70] years) were evaluated, with a median follow-up of 26 (interquartile range 17–40) months. A total of 119 (48.9%) patients with 186 (46.5%) colorectal liver metastases were from international institutions B, C, and D that were not involved in the software development. Three-year local disease progression rates for 0 mm, >0 and <5 mm, and 5 mm or larger minimum ablative margins were 79%, 15%, and 0% respectively for institution A (where the software was developed) and 34%, 19%, and 2% respectively for institutions B, C, and D combined. Local disease progression risk decreased to less than 1% with an intraprocedurally confirmed minimum ablative margin greater than 4.6 mm.

Conclusion

A minimum ablative margin of 5 mm or larger demonstrates optimal local oncological outcomes. It is proposed that an intraprocedural minimum ablative margin of 5 mm or larger, confirmed using biomechanical deformable image registration, serves as the A0 for colorectal liver metastasis thermal ablation.
Myocardial ischaemic syndromes: a new nomenclature to harmonize evolving international clinical practice guidelines
Authors: Boden William E , De Caterina Raffaele , Kaski Juan Carlos , Bairey Merz Noel , Berry Colin , Marzilli Mario , Pepine Carl J , Barbato Emanuele , Stefanini Giulio , Prescott Eva , Steg Philippe Gabriel , Bhatt Deepak L , Hill Joseph A , Crea Filippo
Published: August 2024

Since the 1960s, cardiologists have adopted several binary classification systems for acute myocardial infarction (MI) that facilitated improved patient management. Conversely, for chronic stable manifestations of myocardial ischaemia, various classifications have emerged over time, often with conflicting terminology—e.g. ‘stable coronary artery disease’ (CAD), ‘stable ischaemic heart disease’, and ‘chronic coronary syndromes’ (CCS). While the 2019 European guidelines introduced CCS to impart symmetry with ‘acute coronary syndromes’ (ACS), the 2023 American guidelines endorsed the alternative term ‘chronic coronary disease’. An unintended consequence of these competing classifications is perpetuation of the restrictive terms ‘coronary’ and ‘disease’, often connoting only a singular obstructive CAD mechanism. It is now important to advance a more broadly inclusive terminology for both obstructive and non-obstructive causes of angina and myocardial ischaemia that fosters conceptual clarity and unifies dyssynchronous nomenclatures across guidelines. We, therefore, propose a new binary classification of ‘acute myocardial ischaemic syndromes’ and ‘non-acute myocardial ischaemic syndromes’, which comprises both obstructive epicardial and non-obstructive pathogenetic mechanisms, including microvascular dysfunction, vasospastic disorders, and non-coronary causes. We herein retain accepted categories of ACS, ST-segment elevation MI, and non-ST-segment elevation MI, as important subsets for which revascularization is of proven clinical benefit, as well as new terms like ischaemia and MI with non-obstructive coronary arteries. Overall, such a more encompassing nomenclature better aligns, unifies, and harmonizes different pathophysiologic causes of myocardial ischaemia and should result in more refined diagnostic and therapeutic approaches targeted to the multiple pathobiological precipitants of angina pectoris, ischaemia and infarction.
Pairwise synchronization of second-order matrix-weighted networks
Authors: Lv Pengchao , Liu Bo , Huang Junjie
Published: August 2024

This paper deals with the pairwise synchronization of second-order linear time invariant (LTI) systems with incommensurable outputs through a matrix-weighted graph. The pairwise synchronization here means that the relative outputs have pairwise synchronized solutions for the identical LTI systems. For the matrix-weighted network, some necessary and sufficient conditions on the pairwise synchronization are given by means of the Jordan form, matrix decomposition and effective conductance. Moreover, the relationship between the global synchronization and the connectivity of its interconnection graph is also discussed. Examples and simulations are shown to verify the theoretical results.
Radial Sclerosing Lesion (Radial Scar): Radiologic-Pathologic Correlation
Authors: Yan Pamela , Bean Gregory , Bao Jean , Dashevsky Brittany Z
Published: August 2024

Radial sclerosing lesions (RS, also referred to as “radial scars”) and complex sclerosing lesions (CSL) are uncommon breast lesions often grouped together as a single entity in practice. RS/CSL have an incidence of <0.1% to 1% at core needle biopsy (CNB). When detected on CNB, imaging and pathology features must be carefully evaluated to determine appropriate surgical management or imaging follow-up due to potential for malignant upgrade at surgery. Detection of RS/CSL has increased with the advent of tomosynthesis, in which an RS/CSL is typically detected as architectural distortion with or without associated mass with spiculated margins. On US, an RS/CSL is most often occult or manifests as subtle distortion with adjacent cysts. Imaging findings cannot distinguish benign RS/CSL from those upgraded to malignancy at surgery, although larger lesion size may be associated with higher upgrade rates. Histologically, an RS has a central fibroelastotic nidus with entrapped-appearing ducts and proliferative changes at the periphery appearing to radiate from the center; CSL are larger than RS, more disorganized, and typically include multiple patterns of epithelial proliferations, including sclerosing adenosis, sclerosing papillomas, usual ductal hyperplasia, and cysts. RS/CSL with associated atypia at CNB have a 16%to 29% rate of upgrade to malignancy on surgical excision, thus rendering surgical excision essential. Conversely, an RS/CSL without associated atypia, particularly when ≤1 cm in size, has <3% rate of upgrade to malignancy at surgery, allowing consideration of imaging follow-up in lieu of excision. Here, we review recent literature as well as radiology and pathology findings of RS/CSL.
Obesity alters the macrophages’ response to Leishmania major in C57BL/6 mice
Authors: Martins Vinicius Dantas , Vaz Leonardo , Barbosa Sara Candida , Paixão Pierre Henrique de Menezes , Torres Licia , de Oliveira Marcos Felipe Andrade , Oliveira Mariana de Almeida , Vieira Leda Quercia , de Faria Ana Maria Caetano , Maioli Tatiani Uceli
Published: August 2024

Obesity is a global pandemic associated with several comorbidities, such as cardiovascular diseases and type 2 diabetes. It is also a predisposing factor for infectious diseases, increasing mortality rates. Moreover, diet-induced obesity can cause metabolic fluctuations that affect macrophage differentiation in various organs. In this sense, we investigated how bone marrow-derived macrophages and tissue-resident macrophages in the skin, which have been differentiated in a host with metabolic syndrome and with previous inflammatory burden, respond to Leishmania major infection. Our findings suggest that bone marrow-derived macrophages from obese C57BL/6 mice, even when cultivated in vitro with inflammatory stimuli, are more susceptible to L. major. These macrophages produce less tumor necrosing factor (TNF) and nitric oxide (NO) and show higher arginase activity. Furthermore, obese mice infected with an intermediate dose of L. major in the skin had more severe lesions when analyzed for ulceration, diameter, thickness, and parasite burden. The increase in lesion severity in obese mice was associated with a higher frequency of tissue-resident macrophages, which are less efficient in killing parasites. We also used CCR2−/− mice, which predominantly have tissue-resident macrophages, and found that lesion resolution was delayed in association with CCR2 deficiency. Additionally, obesity potentiated tissue damage, resulting in higher frequency of tissue-resident macrophages. Our results demonstrate that obesity can alter macrophage responses to infection, leading to increased susceptibility to L. major and more severe cutaneous leishmaniasis. These findings may have important implications for managing obesity-related infections and the development of new therapies for cutaneous leishmaniasis.
Blood-feeding stable flies, Stomoxys calcitrans (Diptera: Muscidae), are attracted to, and transmit Staphylococcus aureus (Bacillales: Staphylococcaceae), a causal agent of bovine mastitis: a laboratory pilot study
Authors: Nayani Saif , Meraj Sanam , Renyard Asim , Gries Gerhard
Published: August 2024

Stable flies, Stomoxys calcitrans (Linnaeus) (Diptera: Muscidae), are common blood-feeding ectoparasites of cows and thus potential vectors of the skin-dwelling bacterium Staphylococcus aureus, a causal agent of bovine mastitis which inflicts udder inflammation in cows. Our objectives were to determine whether stable flies (i) are attracted to disease-causing strains of S. aureus, and (ii) transmit S. aureus from infected blood to sterile blood. In 3-chamber olfactometers, five of eight S. aureus strains grown on agar and tested versus sterile agar attracted female stable flies. When flies ingested droplets of blood inoculated with S. aureus at doses of 0 (control), 105 (low), 107 (medium), and > 109 (high) colony-forming units per milliliter and subsequently ingested sterile blood, they transmitted S. aureus to the sterile blood. The dose of S. aureus in blood droplets fed upon by flies during their first feeding bout dose-dependently affected the amount of bacteria that flies transmitted to sterile blood during their second feeding bout, but the time elapsed between feeding bouts (0 h, 1 h, 8 h, and 24 h) had no effect on the amount of microbes transmitted to sterile blood. Our data infer the existence of a positive feedback loop. First, stable flies carrying S. aureus and feeding on cows transmit S. aureus, thereby causing mastitis. As S. aureus bacteria of afflicted cows proliferate, they attract even more flies which, in turn, worsen the infection. This type of feedback loop underscores the need for effective stable fly control tactics that curtail the incidence of bovine mastitis in cows.
Effects of permethrin-treated uniforms on tick submissions to a military passive tick surveillance program
Authors: Nadolny Robyn , Jones Jessica , Taylor Bonnie J , Bowman Loretta , Harkins Kevin
Published: August 2024

Permethrin-treated clothing is often recommended as a first line of defense against tick-borne diseases. In 2012, the permethrin factory-treated Army Combat Uniform was first made available to active duty Soldiers, Army National Guard, Army Reserve Enlisted Soldiers, and the Senior/Junior Reserve Officers Training Corps. Subsequently, Air Force and Marine Corps personnel were also offered permethrin factory-treated uniforms. Here, we use the passive surveillance data collected through the Military Tick Identification/Infection Confirmation Kit (MilTICK) program to determine the effectiveness of permethrin-treated uniforms at protecting Department of Defense personnel from exposure to tick-borne pathogens in the United States. We analyzed whether submissions by self-reported users of the permethrin-treated uniforms had smaller proportions of engorged ticks, certain cohorts of MilTICK users were better protected than others, and specific tick species were better repelled than others. We found that permethrin use resulted in significantly lower proportions of engorged ticks submitted across MilTICK users. Army and Army National Guard personnel reported more permethrin-treated uniform use than other services. For submissions from active duty personnel serving in uniform, the proportion of tick engorgement in the presence of permethrin increased over time, possibly indicating that permethrin-treated uniforms suffer from reduced performance over the life of the garment. We also found that while permethrin reduced all tick species’ ability to feed until engorgement or repletion, blacklegged tick adult females were better able to resist permethrin’s lethal effects than lone star tick and American dog tick adult females. Permethrin-treated clothing plays an important role in keeping military personnel safe from tick-borne diseases.
Effects of Peromyscus spp. (Rodentia: Cricetidae) presence, land use, and ecotone on Ixodes scapularis (Acari: Ixodidae) ecology in an emergent area for tick-borne disease
Authors: Dill Griffin M , Rounsville Thomas F , Bryant Ann M , Groden Eleanor , Gardner Allison M
Published: August 2024

As the range of Ixodes scapularis Say expands, host abundance and land use can play important roles in regions where ticks and their associated pathogens are emerging. Small mammal hosts serve as reservoirs of tick-borne pathogens, with Peromyscus leucopus Rafinesque often considered a primary reservoir. A sympatric species Peromyscus maniculatus Wagner is also a competent reservoir and is notoriously difficult to differentiate from P. leucopus. Anthropogenic land use can alter host and habitat availability, potentially changing tick exposure risk. We tested the hypotheses that tick infestation and pathogen prevalence differ between the two Peromyscus spp. and that host-seeking I. scapularis density and pathogen prevalence differ across land use and ecotone gradients. We live trapped small mammals and collected ticks across 3 land-use classifications and ecotones in Maine, an emergent area for tick-borne disease. We tested each small mammal and tick sample for Borrelia burgdorferi, Anaplasma phagocytophilum, and Babesia microti. While both Peromyscus spp. serve as hosts for immature ticks, P. leucopus exhibited a higher tick infestation frequency and intensity. We did not detect any significant difference in pathogen infection prevalence between the two species. The density of I. scapularis nymphs and the density of infected nymphs did not differ significantly between land-use types, though did differ across ecotones. We also noted a significant north/south gradient, with higher tick densities and pathogen prevalence at the southern end of the study area. Our study highlights the potential variability in tick density and pathogen prevalence across fine spatial scales within an emerging region for tick-borne disease.
Internal Drivers, External Powers, and Nuclear Test Decisions: The Case of India
Authors: Mistry Dinshaw , Chowdhury Saurabh Dutta
Published: August 2024

This article argues that a combination of internal and international factors explain national nuclear test decisions. Internal factors involve the presence and influence of pro-test and anti-test actors (nuclear scientists, government bureaucrats, and the political leadership) in the inner circle making test decisions. International factors involve external power initiatives, in the form of sanctions and incentives, that seek to restrain states from testing. The article applies this framework to analyze variations in India's nuclear testing propensity from the 1960s to the 2020s. Such a framework explains why India tested nuclear weapons in 1974 and 1998 but not at other times, and adds to scholarship on India's nuclear program. Moreover, by specifically examining nuclear test decisions, rather than a country's overall exploration and pursuit of nuclear weapons, this article contributes to the broader literature on nuclear proliferation.
A case of a transplanted kidney with an orthotopic kidney stone
Authors: Jin Zhaofang , Lai Jianjun , Zhang Jianjun
Published: August 2024

A 39-year-old man was admitted to our hospital with kidney stones after kidney transplantation. Kidney, ureter, and bladder radiographs showed multiple stones in the transplanted and orthotopic kidneys, which had not been reported previously. Owing to the larger size of the stones in the transplanted kidney, they needed to be removed. Percutaneous nephrolithotomy and ureteroscopy were performed under B-mode ultrasound guidance. The stone measured 1.9 × 1.6 cm and was located under the calyx of the kidney. A titanium laser fiber was used to dissolve the stones, which were subsequently removed. No adverse reactions occurred during or after the surgery. The causes of stone formation included dietary factors, related drugs, improper fluid intake, and urinary tract infections. As neither the donor nor the recipient had a history of kidney stones, we hypothesized that the stones were a new entity that either developed following transplantation or a long-term complication.
Isolated cuboid dislocation: case report
Authors: de Oliveira Lima Amaurilio , de Albuquerque Filho Antonio Bezerra , Ambrosio Gustavo Henrique Carillo , Coelho Leonardo Vasconcelos , Massuda Vitor Yoshiura , Lara Paulo Henrique Schmidt
Published: August 2024

Isolated cuboid dislocation without fracture is a rare injury, and there is a lack of literature describing its treatment. Studies report the use of closed or open reduction, with Kirschner wire fixation in the treatment of these injuries. This case report presents the clinical condition of a 24-year-old male patient who arrived at the emergency department with an isolated dislocation of the right foot cuboid bone without the presence of a fracture, after suffering trauma during a football game. Open reduction was performed in the surgical center with stabilization and fixation using a Kirschner wires. The patient showed an excellent response to the treatment, with no loss of the foot’s range of motion.
The nature and effects of remittance scripts in rural Kosovo
Authors: Möllers Judith , Arapi-Gjini Arjola
Published: August 2024

Remittances play an essential role in the interlinkage of migration and development. While past research has focused mainly on the monetary flows and their determinants, this article offers a deeper understanding of remitting as a social practice. Our research contributes to the emerging literature on remittance transfers in several directions. Using a rich ethnographic dataset of an area described as the quintessential land of migration, Opoja in Kosovo, it offers intriguing insights into the reasons and patterns behind remitting or ‘remittance scripts’. Our work complements the existing literature with a unique empirical analysis of changing remittance scripts over time and a discussion of the implications of such changes in terms of well-being in a rural context. By applying Carling’s concept of scripting remittances, the study makes an important contribution to testing this concept. Our findings exemplify how a conservative rural environment may slow down a shift away from traditional remittance scripts. The analysis revealed how remittances unfold not only positive effects, such as contributing to the village’s monetary well-being, but also various adverse effects. We identify a cautious development towards a new and still fragile script system, in which recipients provide social visibility as the core requital to the remittances they receive. Although remittance scripts are doubtlessly region-specific, we believe that our study not only underlines the usefulness of the remittance script concept but is illustrative of phenomena that might be found in many places strongly affected by outmigration and remittance dependency.
Modelling the disc around the primary star of the X-ray binary system: MT91-213
Authors: Ghoreyshi M R , Jones C E , Carciofi A C , Kolka I , Aret A , Eenmäe T , Neito R
Published: August 2024

The viscous decretion disc (VDD) scenario has been used to model the observables of the Be stars. Its capability to predict individual observables has been confirmed for several Be stars. Here, we simultaneously analyse the spectroscopic and $BVI$-band photometric data for the Be star MT91-213 with the Monte Carlo radiative-transfer code hdust to determine the stellar parameters, geometry, and physical conditions for its circumstellar disc. MT91-213 is the primary component of a binary system whose companion is the pulsar PSR J2032+4127. We find that the VDD model can simultaneously reproduce the multiple observables qualitatively, but not quantitatively. We determine the mass of the primary star to be 13.1 ${\rm M}_{\odot }$ which is smaller than reported in the literature. We present a dynamical scenario for the evolving disc density from a diffuse to a dense phase. Also, we determine that the inclination of the disc is about 40$^{\circ }$ which means it is 20$^{\circ }$ tilted from the orbit of the secondary star. Our results indicate that the mass loss rate for MT91-213 is $\sim 10^{-7}$ to $10^{-6} {\rm M}_{\odot }\,\mathrm{yr}^{-1}$ which is in agreement with the suggested values in the literature, required to explain the observed X-ray synchrotron luminosity, $L_\mathrm{x}$, for PSR J2032+4127.
Clues to growth and disruption of two neighbouring spiral arms of the Milky Way
Authors: Funakoshi Natsuki , Matsunaga Noriyuki , Kawata Daisuke , Baba Junichi , Taniguchi Daisuke , Fujii Michiko
Published: August 2024

Studying the nature of spiral arms is essential for understanding the formation of the intricate disc structure of the Milky Way. The European Space Agency’s Gaia mission has provided revolutionary observational data that have uncovered detailed kinematical features of stars in the Milky Way. However, so far the nature of spiral arms continues to remain a mystery. Here, we present that the stellar kinematics traced by the classical Cepheids around the Perseus and Outer spiral arms in the Milky Way show strikingly different kinematical properties from each other: the radial and azimuthal velocities of Cepheids show positive and negative correlations in the Perseus and Outer arms, respectively. We also found that the dynamic spiral arms commonly seen in an N-body/hydrodynamic simulation of a Milky Way-like galaxy can naturally explain the observed kinematic trends. Furthermore, a comparison with such a simulation suggests that the Perseus arm is being disrupted, while the Outer arm is growing. Our findings suggest that two neighbouring spiral arms in distinct evolutionary phases – growing and disrupting phases – coexist in the Milky Way.
Efficacy and safety of Janus kinase inhibitors in patients with difficult-to-treat rheumatoid arthritis
Authors: Anno Shohei , Okano Tadashi , Mamoto Kenji , Yamada Yutaro , Mandai Koji , Orita Kazuki , Iida Takahiro , Tada Masahiro , Inui Kentaro , Koike Tatsuya , Nakamura Hiroaki
Published: August 2024

Objectives

This study evaluated the effectiveness of Janus kinase inhibitors (JAKi) in patients with difficult-to-treat rheumatoid arthritis (D2T RA).

Methods

This study included 220 patients with RA who were treated with JAKi. Sixty-two patients were naïve to biological disease-modifying antirheumatic drugs (bDMARDs)/JAKi (1st group), 57 patients were failure to one bDMARDs/JAKi (2nd group), and 101 patients were failure to ≥ 2 bDMARDs/JAKi. Of these 101 patients, 25 did not meet the D2T RA criteria (non-D2T RA group) and 76 met the D2T RA criteria (D2T RA group).

Results

: DAS28-ESR was improved in all groups at 24 weeks (1st: P < .01, 2nd: P < .01, non-D2T RA: P = .01, D2TRA: P = .02), and improvement ratio of DAS28-ESR was not different between DT2RA group and 2nd (P = .73) or non-D2T RA group (P = .68). Glucocorticoid use [odds ratios: 8.67; 95% confidence interval (CI): 1.23–60.90; P = .03] and number of past bDMARD/JAKi uses ≥ 3 (odds ratios: 10.55; 95% CI: 1.39–80.30; P = .02) were risk factors for DAS28-ESR ≥ 3.2 at 24 weeks in the D2T RA group.

Conclusions

Clinical efficacy of JAKi in D2T RA group did not differ from that in 2nd and non-D2T RA groups. Glucocorticoid use and multiple bDMARD/JAKi failure were poor prognostic factors for D2T RA.
Telemedicine-based serious illness conversations, healthcare utilization, and end of life care among patients with advanced lung cancer
Authors: Dhawale Tejaswini M , Bhat Roopa S , Johnson P Connor , Srikonda Shanivi , Lau-Min Kelsey S , Boateng Kofi , Lee Howard , Amonoo Hermioni L , Nipp Ryan , Lindvall Charlotta , El-Jawahri Areej
Published: August 2024

Purpose

Little is known about serious illness conversations (SIC) conducted during telemedicine visits and their impact on end-of-life (EOL) outcomes for patients with advanced cancer.

Patients and Methods

We conducted a retrospective analysis telemedicine visits for patients with metastatic lung cancer conducted during the first surge of the COVID-19 pandemic (October 3, 2020-October 6, 2020). We used natural language processing (NLP) to characterize documentation of SIC domains (ie, goals of care [GOC], limitation of life-sustaining treatment [LLST], prognostic awareness [PA], palliative care [PC], and hospice). We used unadjusted logistic regression to evaluate factors associated with SIC documentation and the relationship between SIC documentation and EOL outcomes.

Results

The study included 634 telemedicine visits across 360 patients. Documentation of at least one SIC domain was present in 188 (29.7%) visits with GOC and PA being the most discussed domains. Family presence (odds ratio [OR], 1.66; P = .004), progressive or newly diagnosed disease (OR, 5.42; P < .000), age ≥ 70 (OR, 1.80; P = .009), and male sex (OR, 2.23; P < .000) were associated with a greater likelihood of discussing ≥ 1 SIC domain. Of the 61 patients who died within 12 months of the study period, having ≥ 1 SIC domain discussed was associated with a lower likelihood of hospitalization in the last 30 days of life (OR, 0.27; P = .020).

Conclusion

In this study of telehealth visits, we identified important factors associated with an increased likelihood of having documentation of an SIC and demonstrated that SIC documentation correlated with lower likelihood of hospitalization at EOL.
Nontransformation methods for studying signaling pathways and genes involved in Brassica rapa pollen–stigma interactions
Authors: Zhang Lili , Cui Xiaoshuang , Yang Lin , Raziq Abdul , Hao Shiya , Zeng Weiqing , Huang Jiabao , Cao Yunyun , Duan Qiaohong
Published: August 2024

Self-incompatibility (SI) is a mechanism in plants that prevents self-fertilization and promotes outcrossing. SI is also widely utilized in the breeding of Brassicaceae crops. Understanding the regulatory mechanisms of SI is essential but has been greatly restrained in most Brassicaceae crops due to inefficient transformation. In this study, we developed methods for examining signaling pathways and genes of pollen–stigma interactions in Brassicaceae crops lacking an efficient genetic transformation system. We pretreated excised stigmas of Brassica rapa (B. rapa L. ssp. Pekinensis) in vitro with chemicals to modify signaling pathways or with phosphorothioate antisense oligodeoxyribonucleotides (AS-ODNs) to modify the expression of the corresponding genes involved in pollen–stigma interactions. Using this method, we first determined the involvement of reactive oxygen species (ROS) in SI with the understanding that the NADPH oxidase inhibitor diphenyleneiodonium chloride, which inhibits ROS production, eliminated the SI of B. rapa. We further identified the key gene for ROS production in SI and used AS-ODNs targeting BrRBOHF (B. rapa RESPIRATORY-BURST OXIDASE HOMOLOGF), which encodes one of the NADPH oxidases, to effectively suppress its expression, reduce stigmatic ROS, and promote the growth of self-pollen in B. rapa stigmas. Moreover, pistils treated in planta with the ROS scavenger sodium salicylate disrupted SI and resulted in enlarged ovules with inbred embryos 12 d after pollination. This method will enable the functional study of signaling pathways and genes regulating SI and other pollen–stigma interactions in different Brassicaceae plants.
Distinct clinical trajectories of gastrointestinal progression among patients with systemic sclerosis
Authors: Perin Jamie , Hughes Michael , Mecoli Christopher A , Paik Julie J , Gelber Allan C , Wigley Fredrick M , Hummers Laura K , Shah Ami A , Zeger Scott L , McMahan Zsuzsanna H
Published: August 2024

Objectives

Systemic sclerosis (SSc) is heterogeneous in its clinical presentation. Common manifestations cluster together, defining unique subgroups. This investigation aims to characterize gastrointestinal (GI) phenotypes and determine whether they can be distinguished by temporal progression.

Methods

We examined a well-established SSc patient cohort with a modified Medsger GI severity score measured over time to determine heterogeneity in disease progression. Growth mixture models estimated each patient's phenotype and disease severity trajectory over time. We compared the characteristics of estimated phenotypes using non-parametric statistics and linear and logistic regression to compare patient characteristics between phenotypes while adjusting for disease duration.

Results

We examined 2696 SSc patients with at least two Medsger GI scores, identifying four unique phenotypes. The most common phenotype (‘Stable’, n = 2325) had an average score of 1 that was consistent over time. Two phenotypes were progressive (‘Early Progressive’, n = 142, and ‘Late Progressive’, n = 115) with an initial average score of 1. The Early Progressive group increased initially and stabilized, and the Late Progressive group worsened slowly over time. A fourth phenotype (‘Early Severe GI’, n = 114) had an initial average Medsger GI score just below 3 with high mortality and improving GI severity over time.

Conclusions

Clinically distinct GI phenotypes exist among patients with SSc. These phenotypes are not only distinguished by GI and extra-intestinal SSc clinical complications, but they are also temporally distinct. Distinct autoantibody profiles are associated strongly with more severe GI disease.
Classical dendritic cells contribute to hypoxia‐induced pulmonary hypertension
Authors: Mickael Claudia , Sanders Linda A. , Lee Michael H. , Kumar Rahul , Fonseca‐Balladares Dara , Gandjeva Aneta , Cautivo‐Reyes Kelly , Kassa Biruk , Kumar Sushil , Irwin David , Swindle Delaney , Phang Tzu , Stearman Robert S. , Molofsky Ari B. , McKee Amy S. , Stenmark Kurt R. , Graham Brian B. , Tuder Rubin M.
Published: August 2024

Pulmonary hypertension (PH) is a chronic and progressive disease with significant morbidity and mortality. It is characterized by remodeled pulmonary vessels associated with perivascular and intravascular accumulation of inflammatory cells. Although there is compelling evidence that bone marrow‐derived cells, such as macrophages and T cells, cluster in the vicinity of pulmonary vascular lesions in humans and contribute to PH development in different animal models, the role of dendritic cells in PH is less clear. Dendritic cells' involvement in PH is likely since they are responsible for coordinating innate and adaptive immune responses. We hypothesized that dendritic cells drive hypoxic PH. We demonstrate that a classical dendritic cell (cDC) subset (cDC2) is increased and activated in wild‐type mouse lungs after hypoxia exposure. We observe significant protection after the depletion of cDCs in ZBTB46 DTR chimera mice before hypoxia exposure and after established hypoxic PH. In addition, we find that cDC depletion is associated with a reduced number of two macrophage subsets in the lung (FolR2+ MHCII+ CCR2+ and FolR2+ MHCII+ CCR2−). We found that depleting cDC2s, but not cDC1s, was protective against hypoxic PH. Finally, proof‐of‐concept studies in human lungs show increased perivascular cDC2s in patients with Idiopathic Pulmonary Arterial Hypertension (IPAH). Our data points to an essential role of cDCs, particularly cDC2s, in the pathophysiology of experimental PH.
Treatment of Diabetes in Pregnancy With Metformin
Authors: Newman Christine , Dunne Fidelma P.
Published: August 2024

Metformin is a commonly used drug in the treatment of type 2 diabetes and has been used to treat gestational diabetes since the 1970s. In pregnancy, its proven benefits include reduced gestational weight gain and reduced fetal size; some studies have shown reduced risk of cesarean delivery and lower rates of hypertension. Metformin can reduce the need for insulin therapy but does not eliminate such need in many patients. Despite these benefits, metformin crosses the placenta and has been associated with increases in the risk of giving birth to small-for-gestational-age neonates in some studies of individuals with type 2 diabetes in pregnancy. In addition, higher body mass index (BMI) z-scores have been observed among exposed offspring in some of the long-term follow-up studies. Nevertheless, metformin's low cost, ease of administration, and global reach make it a reasonable intervention in a population affected by rising rates of obesity and diabetes in pregnancy. Further follow-up studies are required to monitor the long-term health of exposed offspring.
Extracorporeal Membrane Oxygenation-Supported Patient Outcome Undergoing Transcatheter Aortic Valve Replacement
Authors: Banga Akshat , Bansal Vikas , Pattnaik Harsha , Amal Tanya , Agarwal Anjali , Guru Pramod K.
Published: August 2024

The efficacy and safety of extracorporeal membrane oxygenation (ECMO) support during transcatheter aortic valve replacement (TAVR) remains unknown. We conducted a meta-analysis to compare benefit and risk of ECMO in TAVR patients. Bibliographic databases were searched from inception to January 1, 2024. Included studies involved patients ≥18 years old undergoing TAVR and using ECMO emergently or prophylactically. Mortality and procedure success were primary outcomes. Peri- or postoperative complications were the secondary outcomes. We identified 11 observational studies, including 2,275 participants (415 ECMO and 1,860 non-ECMO). The unadjusted mortality risk in ECMO-supported patient was higher than non-ECMO patients (odds ratio [OR] 1.73). The mortality unadjusted risk remained high (OR 3.89) and statistically significant for prophylactic ECMO. Prophylactic ECMO had lower mortality risk compared with emergent ECMO (OR 0.17). Extracorporeal membrane oxygenation-supported patients had lower procedural success rate (OR 0.10). Extracorporeal membrane oxygenation patients undergoing TAVR had significantly increased risk of bleeding (OR 3.32), renal failure (OR 2.38), postoperative myocardial infarction (OR 1.89), and stroke (OR 2.32) compared with non-ECMO patients. Clinical results are not improved by ECMO support in patients with high-risk TAVR. Prophylactic ECMO outperforms emergent. Overall, ECMO support increases mortality and postoperative complications. Transcatheter aortic valve replacement outcomes may improve with prophylactic ECMO in high-risk situations.
Differential Outcomes in Colorectal Cancer Detection
Authors: El Deen Alkhadraa Izz , Uebel Linnea , Kromodikoro Indy , van Nieuwenhoven Michiel
Published: August 2024

Background:

In 2021, a nation-wide screening program for colorectal cancer (CRC) was step-wise implemented in Region Örebro County (RÖC) for patients aged 60 to 74 years, utilizing the fecal immunochemical test (FIT) to refer patients for colonoscopy. Concurrently, the standardized care course for colorectal cancer (SCC-CRC), initiated in 2016, employs a fast-track pathway for patients with alarm symptoms to undergo colonoscopy. This study compares CRC screening colonoscopies with SCC-CRC colonoscopies in RÖC among patients aged 60 to 67 years.

Methods:

An initial analysis of the Swedish colorectal screening cohort was combined with a retrospective cohort study, analyzing data from 307 CRC screening patients and 441 age-matched SCC-CRC patients in RÖC. Data included demographics, colonoscopy participation rates, and pathology findings. Statistical analyses compared outcomes between the 2 groups.

Results:

Among the screening group, 2% tested positive for FIT, with an 86% colonoscopy participation rate (N=9296). In RÖC, 266 screening patients underwent colonoscopy, with 10% diagnosed with CRC, compared with 20% in the SCC-CRC group. In addition, 39% of the screening group in RÖC were diagnosed with advanced adenomas, versus 15% in the SCC-CRC group

Conclusions:

Screening participation was high, with effectiveness aligning with international counterparts. The SCC-CRC pathway excels in diagnosing CRC among symptomatic patients, while the nationwide screening program is effective in early detection of CRC and advanced adenomas. underscoring the importance of integrating and optimizing both approaches within the Swedish health care system to optimize CRC prevention and management.
Diagnostic and prognostic value of serum Cys-C, retinol-binding protein, and ischemia-modified albumin in patients with coronary heart disease: A diagnostic accuracy study
Authors: Yuan Youhua , Tian Wenqian , Wei Xiaoxia , Zhu Ya , Liu Fengzhen , Zhang Xiaohuan
Published: August 2024

The use of 3 biomarkers – cystatin-C (Cys-C), retinol-binding protein (RBP), and ischemia-modified albumin (IMA) – for the clinical classification and outcome of coronary heart disease (CHD) has not been adequately evaluated. We explored the serum levels of these 3 markers and evaluated their diagnostic and prognostic values in patients with CHD. This retrospective case–control study, conducted between June 2017 and June 2018, included 201 patients with CHD hospitalized at the Henan Provincial People’s Hospital and 127 healthy individuals from Henan Provincial People’s Hospital as controls. Cys-C, RBP, IMA levels, and other laboratory parameters in the 2 groups were determined, and patient outcomes were analyzed. Cys-C, RBP, and IMA levels were higher in the case group than in the control group (P < .05). Logistic regression analysis confirmed that these 3 biomarkers were independent risk factors for CHD. Each indicator has clinical significance in the diagnosis and prognosis of CHD, with RBP being the most significant. The AUC value for CHD detection using a combination of the 3 indicators was 0.783, and the sensitivity and specificity values were 78% and 74.6%, respectively. Simultaneous detection of Cys-C, RBP, and IMA could be an optimal method for early diagnosis and prognosis of CHD.
COVID-19 Stressors and Resilience Among Nurse Leaders
Authors: Montgomery Aoyjai P. , Patrician Patricia A.
Published: August 2024

The COVID-19 pandemic introduced many new stressors to nurses in general, yet little is known about COVID-19–related stressors and resilience among nursing leaders. The aims of this study were to explore (1) the COVID-19–related stressor and resilience by personal and work demographics, (2) the relationship between COVID-19 stressors and resilience, and (3) resilience strategies used by leaders and their recommendations to other nurse leaders. This descriptive, cross-sectional study employed an electronic survey to measure COVID-19–related stressors and resilience and included qualitative open-ended questions. A total of 57 nurse leaders responded to the survey. Nurse leaders who were female, African American, chief nurse executive or nursing director, and had more than 10 years of experience reported highest COVID-19 stress in most of subscales. Nurse leaders who were male, African American, chief nurse executive or nursing director, and had more than 10 years of experience reported highest resilience scores. Nurse leaders with higher resilience levels had lower levels of COVID-19 stress in all subscales. Nurse leaders reported the top 3 resilience strategies as (1) prayer and faith, (2) social support, and (3) self-care and the top 3 recommendations to other nurse leaders as (1) disconnect, (2) positive and creative thinking, and (3) self-care.
Advancing the Art and Science of Professional Nursing Practice With the Virtually Integrated CareSM Model
Authors: Harmon Keeley , Kaufman Mia , Murphy Diane , Gunn Shawna , Altree Missie , Tremper Jordan
Published: August 2024

The purpose of this article is to share the transformative vision of 2 nurse executives and how this vision paved the way for the development of a revolutionary model that changed care delivery. The CommonSpirit Health Virtually Integrated Care Team operationalized the vision by leveraging technology to develop a team-based care model that seamlessly integrates a virtual nurse as part of the care team. This article will discuss the spark that created the impetus for the creation of this metamorphic, interprofessional care delivery model and how this model unburdens the workload of the nurses to idealize the art and science of professional nursing practice.
Beyond the Basics
Authors: Tellson Alaina , Huddleston Penny , Powell Kristine , Tolentino Remy , Cassity Walter , Weller Stephen , Vaughn Barbara
Published: August 2024

Workplace violence (WPV) has become a crisis for health care workers, with a significant increase in violent events taking place in health care settings across the nation. Health care organizations should develop a comprehensive WPV program that includes recognition, management, and reporting of all types of WPV. A large health care system developed strategies and a program to address WPV. The health care system believes that a safe and respectful work environment is foundational to the goal of zero preventable harm. The “Safety in the Workplace” initiative was designed to raise awareness of concerning behaviors and to offer tools and resources for identifying, responding to, and reporting incidents of violence, aggression, or disruptive behaviors of WPV. During a 6-month pilot of a WPV bundle, there was a 44% reduction in physical violence reports and a 44% reduction in reported incidents of WPV. From June 2020 to June 2021, there was a 10% decrease in WPV overall.
Real-Time Workload Assessment to Enhance Performance
Authors: Lindsay Mary
Published: August 2024

Workforce shortages, increasing costs, decreased reimbursement, and focus on quality outcomes are crucial issues for health care leaders. To remain competitive, profitable, and productive, health care organizations need to provide structure, a safe working environment, and an acceptable leader workload to guarantee effective leader performance. Poorly designed work environments and interfaces can increase workload resulting in decreased performance and satisfaction. Excessive workload has led to reduced job satisfaction, productivity, and resilience. Due to leadership turnover and vacancy rates, leader workload was perceived to be unreasonable in the respiratory therapy (RT) department of an academic medical institution in central North Carolina. The aim of this quality initiative was to explore the workload of health care leaders in the RT department to identify the factors that influenced workload as well as implement strategies to decrease perceived workload. A workload assessment was performed, which identified inefficiencies and opportunities to partner with ancillary departments to align the workload with appropriate clinical teams. The redistribution of workload provided alignment, top of scope practice, and improved satisfaction among the RT department leaders. This article identifies the strategies utilized which can be translated to other institutions.
The Clinical Nurse Specialist
Authors: DiLibero Justin , Mohr Lynn D. , Burton-Williams Kristen M. , Calvert Patricia L. , Dresser Susan , Mason Tina M. , Schaefer Karen A. , Tidwell Jerithea
Published: August 2024

The United States health care system is facing an unprecedented nursing shortage, increasing complexity of care, and fewer experienced nurse mentors. These factors contribute to a cycle of burnout, turnover, decreased quality and safety, and a worsening financial bottom line. Improving these contributing factors depends on our ability to mitigate the structural causes of burnout and turnover. The clinical nurse specialist role is essential to improving the work environment, advancing evidence-based nursing practice, reducing turnover, and stabilizing the bottom line.
Centralized Scheduling of Nursing Staff
Authors: Morse Lisa , Duncan Hillary , Apen Lynette V. , Reese Karin , Crawford Cecelia L.
Published: August 2024

Background

Centralized scheduling of nursing professionals is regarded as an effective strategy for optimizing workforce allocation and mitigating critical staffing shortages. The aim of this review is to (1) determine the effect of centralized scheduling on unit productivity (ie, overtime, contract labor, and floating), time savings for managers, and staff perceptions and retention and (2) discuss current approaches in the implementation of centralized scheduling in inpatient hospital settings.

Methods

This rapid review of the evidence follows methodological guidance from the Cochrane Rapid Reviews Methods Group. Four electronic bibliographic databases were searched for research published from 2013 to 2023. A total of 446 articles were identified and screened, with a total of 12 articles included. Studies and reports were included if they addressed the operational question and were conducted in an inpatient hospital within the United States.

Results

Case study reports describe improved labor productivity (ie. less overtime and less contracted labor), more consistently balanced staffing of frontline nursing professionals, less staff reassignment (ie, floating), and increased satisfaction and time savings for managers after transitioning to a centralized scheduling model. These findings were consistent with a computational, experimental study that found centralized scheduling resulted in less labor costs and fewer undesirable shifts from the frontline nurse’s point of view compared to decentralized scheduling.