bluuebunny/crossref_metadata_2025 huggingface dataset:
Links between climatic histories and the rise and fall of a Pacific chiefdom
Authors: Shen Chuan-Chou , Beardsley Felicia , Gong Shou-Yeh , Kataoka Osamu , Yoneda Minoru , Yokoyama Yusuke , Hu Hsun-Ming , Huang Chun-Yuan , Liu Sze-Chieh , Chiang Hong-Wei , Wei Hsin-Lin , Chung Yun-Chuan , Jiang Leilei , Lin Albert Yu-Min , Fox James , David Mordain , Lebehn Jason , Barnabas Jason , Kohler Gus , Richards Zoe T , Hobbs Jean-Paul A , McCoy Mark D
Published: October 2024

Sea level rise and climate change are shaping present societies, particularly those on oceanic islands. Few historical examples could serve as references for these changes. One such potential model is the Saudeleur Dynasty with its capital Nan Madol on the Pacific Island of Pohnpei. However, the timing of its construction, as well as the dynasty's fluctuations and potential environmental influences, has remained unresolved. Through the analyses of 230Th ages on 171 dates on corals fragments used as building materials and charcoal 14C ages from excavations, 2 major construction phases spanning from the 10th to the 15th century CE can be discerned. The results show that the first phase of the site's construction, spanning the 10th–12th century, marked the dynasty's rise. The second period, spanning from the late 12th to the early 15th century, provides the most substantial evidence for the demise of the island-scale chiefdom and a significant societal reorganization. The phases are centuries earlier than previously believed. With this new evidence, we propose the hypothesis that variations in the El Niño-Southern Oscillation and subsidence-related sea level rise presented major challenges for building and maintaining Nan Madol, and thus, influenced the course of the island's history. This case serves as a compelling example of how adverse climatic conditions can spur investments—in this case, in seawater defense under high sea levels—yet ultimately may contribute to abandonment. It offers lessons for island nations, showcasing coastal resilience in the face of worsening catastrophic events that unfolded over generations.
People are skeptical of headlines labeled as AI-generated, even if true or human-made, because they assume full AI automation
Authors: Altay Sacha , Gilardi Fabrizio
Published: October 2024

The rise of generative AI tools has sparked debates about the labeling of AI-generated content. Yet, the impact of such labels remains uncertain. In two preregistered online experiments among US and UK participants (N = 4,976), we show that while participants did not equate “AI-generated” with “False,” labeling headlines as AI-generated lowered their perceived accuracy and participants’ willingness to share them, regardless of whether the headlines were true or false, and created by humans or AI. The impact of labeling headlines as AI-generated was three times smaller than labeling them as false. This AI aversion is due to expectations that headlines labeled as AI-generated have been entirely written by AI with no human supervision. These findings suggest that the labeling of AI-generated content should be approached cautiously to avoid unintended negative effects on harmless or even beneficial AI-generated content and that effective deployment of labels requires transparency regarding their meaning.
Indirect social influence and diffusion of innovations: An experimental approach
Authors: Miranda Manuel , Pereda María , Sánchez Angel , Estrada Ernesto
Published: October 2024

A fundamental feature for understanding the diffusion of innovations through a social group is the manner in which we are influenced by our own social interactions. It is usually assumed that only direct interactions, those that form our social network, determine the dynamics of adopting innovations. Here, we test this assumption by experimentally and theoretically studying the role of direct and indirect influences in the adoption of innovations. We perform experiments specifically designed to capture the influence that an individual receives from their direct social ties as well as from those socially close to them, as a function of the separation they have in their social network. The results of 21 experimental sessions with more than 590 participants show that the rate of adoption of an innovation is significantly influenced not only by our nearest neighbors but also by the second and third levels of influences an adopter has. Using a mathematical model that accounts for both direct and indirect interactions in a network, we fit the experimental results and determine the way in which influences decay with social distance. The results indicate that the strength of peer pressure on an adopter coming from its second and third circles of influence is approximately two-third and one-third, respectively, relative to their closest neighbors. Our results strongly suggest that the adoption of an innovation is a complex process in which an individual feels significant pressure not only from their direct ties but also by those socially close to them.
Verbal attacks on terrorist groups increase violence against civilians
Authors: Iliev Iliyan , Bet Younadam Nahrain , Kinne Brandon J
Published: October 2024

Terrorists and other transnational extremist groups are responsible for thousands of civilian deaths. In confronting extremists, governments have relied heavily on threats, demands, denunciations, and other forms of verbal conflict. Do these efforts at verbal coercion have any effect on terrorist behavior? This analysis focuses on the Islamic State in Iraq and Syria (ISIS), which continues to be the world's deadliest terrorist group and was responsible for recent high-profile attacks in Baghdad, Vienna, Kabul, and Russia. We use Bayesian structural vector autoregression models to analyze daily event data on interactions between ISIS and foreign governments for the 2014–2020 period. We find that verbal conflict initiated by governments not only failed to deter ISIS but in fact increased the frequency of ISIS's attacks on civilians. Additional empirical analyses, combined with evidence from ISIS's publications and public statements, suggest that this effect resulted from a perceived credibility deficit. Extremists use terror attacks to signal that they have the capabilities and willingness to inflict pain and suffering on civilian targets. Government attempts to coerce extremist groups verbally, rather than militarily, reflect an underestimation of the group's capabilities and resolve. In an effort to solidify their reputations, extremists engage in further violence toward civilians, thus leading to worse humanitarian consequences. We extend the analysis to Al-Qaeda in Iraq and Boko Haram and find similar results.
Female sexual dysfunctions in multiple sclerosis patients with lower urinary tract symptoms: an Italian case-control study
Authors: Balsamo Raffaele , Crocetto Felice , Barone Biagio , Fusco Ferdinando , Arcaniolo Davide , Costantini Elisabetta , Illiano Ester , Amicuzi Ugo , Torella Marco , Ranavolo Raffaele , Quattrone Carmelo , De Sio Marco , Tammaro Simone
Published: October 2024

Background

Multiple sclerosis (MS) is a recurrent, autoimmune, and inflammatory demyelinating chronic disease that typically manifests in young adulthood and exerts adverse effects on sexual functions.

Aim

The study evaluated the prevalence of sexual dysfunctions (SDs) and the relationship with neurological disability, depression, and lower urinary tract symptoms (LUTS) in a cohort of MS female patients, comparing these results with those of healthy women.

Methods

From January 2023 to January 2024, consecutive premenopausal female patients with MS, were recruited and the examination included urinalysis, ultrasonography and a urodynamic test according to the International Continence Society standard.

Outcomes

Descriptive statistics were reported as mean and standard deviation for continuous variables (analyzed by independent samples Mann-Whitney U test and independent samples Kruskal-Wallis test) while categorical variables were reported as frequency and percentage (analyzed by chi-square test with Fisher’s exact test).

Results

Female Sexual Function Index (FSFI) total score and all FSFI subscales scores were significantly lower in patients with MS vs healthy control subjects (P < .001); FSFI total scores and all FSFI subscale scores were statistically significantly lower in patients with MS with an International Prostate Symptom Score ≥20 (P < .001) and considering a cutoff for Beck Depression Inventory–II score ≥17, depression was present in 61% (n = 47 of 77) of patients with MS and completely absent in the control group.

Clinical Translation

The knowledge that SDs are a common problem in MS and in other chronic illnesses can alleviate the feeling of stigma and talking openly of sexual problems can be helpful for the patients and so the doctor-patient relationship can be reinforced.

Strengths and Limitations

The sample was drawn from a single center, and larger multicenter studies that include both genders are needed to obtain strong results.

Conclusion

Our findings confirm the idea of a polygenic and multifactorial etiology of female SDs in MS. Therefore, women with MS should be evaluated in terms of SDs during follow-ups.
Characterization and Fungicide Sensitivity of Colletotrichum spp. from Capsicum Peppers in South Korea
Authors: Shin Yeong Ung , Hassan Oliul , Chang Taehyun
Published: October 2024

Capsicum peppers, peppers from plants of the genus Capsicum (family Solanaceae), are widely cultivated in South Korea, where annual production was 92,756 tons in 2021, 54.4% higher than that of the previous year. Occurring throughout the production cycle, anthracnose is a major disease limiting commercial Capsicum pepper production worldwide, including in South Korea. This study investigates the diversity and pathogenicity of Colletotrichum species responsible for Capsicum pepper anthracnose in Gyeongbuk, South Korea, focusing on disease incidence and symptomatology in the field and the identification, morphological characteristics, pathogenicity, and fungicide sensitivity of the causative species. Disease incidence ranged from 30 to 50%, with samples categorized into three distinct symptom types, aiding accurate field diagnosis. Phylogenetic analysis classified 41 isolates into six species in the C. acutatum, gloeosporioides, and truncatum species complexes, revealing significant genetic diversity. Morphological characterization supported these identifications, providing a comprehensive profile. Pathogenicity tests confirmed that all identified species induced typical anthracnose lesions, with lesion size variations suggesting differential aggressiveness. Temperature significantly influenced mycelial growth, with optimal growth between 20 and 26°C and C. truncatum demonstrating high temperature tolerance. In vitro fungicide sensitivity tests showed variable responses, with tebuconazole being generally effective. These findings underscore the need for species-specific fungicide recommendations and highlight the importance of continuous monitoring of Colletotrichum species. Future research should explore the molecular mechanisms of pathogenicity, host specificity, and fungicide resistance, integrating these findings with breeding programs to develop resistant pepper varieties. This study provides critical insights for effective anthracnose management in pepper cultivation and future research directions.
Chemical management strategies for halo blight of hop and in vitro sensitivity of Diaporthe humulicola populations to various fungicide classes
Authors: Hatlen Ross Joaquin , Hausbeck Mary , Anthony Madeline , Sysak Roger , Smith Randal , Miles Timothy D.
Published: October 2024

Halo blight of hop, caused by Diaporthe humulicola, has increased in eastern North America since 2018. When left untreated, the disease can cause yield loss ranging from 17-56%. Currently, there are no fungicides registered for use on halo blight of hop. From 2020 to 2022 field trials were conducted using 10 fungicides registered for use on powdery and downy mildew of hop to determine their efficacy against halo blight. To validate field results, the EC50 value was determined for each active ingredient including flutriafol, tebuconazole + fluopyram, cyflufenamid, and trifloxystrobin + salicylhydroxamic acid (SHAM). Each fungicide tested had an EC50 value less than 50 ppm. A discriminatory dose was used to test the sensitivity of 206 D. humulicola isolates collected from the eastern U.S. and Canada in a poison agar assay. Results showed that tebuconazole + fluopyram decreased the incidence and severity of halo blight in the field. Also, this fungicide combination had EC50 values of 2.26 x 10-1 ppm and significantly reduced the growth of most of the isolates tested. Trifloxystrobin + SHAM decreased the presence of halo blight in the field tiral, but some isolates were less sensitive in discriminatory dose testing. Our results show that fungicides in FRAC groups 3, 7, and 11 were the most effective to control halo blight. Analyses of field trials showed a positive correlation between the severity of early season downy mildew infections and late season halo blight infections.
Epigenetic regulation of cardiovascular diseases induced by behavioral and environmental risk factors: Mechanistic, diagnostic, and therapeutic insights
Authors: Bi Feifei , Gao Chen , Guo Hongchao
Published: October 2024

Behavioral and environmental risk factors are critical in the development and progression of cardiovascular disease (CVD). Understanding the molecular mechanisms underlying these risk factors will offer valuable insights for targeted preventive and therapeutic strategies. Epigenetic modifications, including DNA methylation, histone modifications, chromatin remodeling, noncoding RNA (ncRNA) expression, and epitranscriptomic modifications, have emerged as key mediators connecting behavioral and environmental risk factors to CVD risk and progression. These epigenetic alterations can profoundly impact on cardiovascular health and susceptibility to CVD by influencing cellular processes, development, and disease risk over an individual's lifetime and potentially across generations. This review examines how behavioral and environmental risk factors affect CVD risk and health outcomes through epigenetic regulation. We review the epigenetic effects of major behavioral risk factors (such as smoking, alcohol consumption, physical inactivity, unhealthy diet, and obesity) and environmental risk factors (including air and noise pollution) in the context of CVD pathogenesis. Additionally, we explore epigenetic biomarkers, considering their role as causal or surrogate indicators, and discuss epigenetic therapeutics targeting the mechanisms through which these risk factors contribute to CVD. We also address future research directions and challenges in leveraging epigenetic insights to reduce the burden of CVD related to behavioral and environmental factors and improve public health outcomes. This review aims to provide a comprehensive understanding of behavioral and environmental epigenetics in CVD and offer valuable strategies for therapeutic intervention.
Caring for patients with diabetes in the outpatient surgical setting: current recommendations and controversies
Authors: Duggan Elizabeth W. , Umpierrez Guillermo E.
Published: October 2024

Purpose of review

Perioperative outpatient (ambulatory) care of the adult patient with diabetes requires unique considerations that vary from the inpatient setting. This review highlights specific pre, intra, and postoperative care steps for patients with diabetes undergoing ambulatory surgery, summarizing recent clinical trials, expert reviews, and emerging evidence.

Recent findings

There is a paucity of evidence examining optimal diabetes management in the outpatient setting. Currently, there are limited studies regarding preoperative management of oral hypoglycemic agents, home insulin, and carbohydrate-containing beverages.

Future research needs to specifically examine chronic blood glucose control, day of surgery targets, effective home medication management and the risk of perioperative hyperglycemia in ambulatory surgery. Education, protocols and resources to support the care of perioperative patients in the outpatient setting will aid providers on the day of surgery and provide optimal diabetes care leading up to surgery.
Assessing Abnormal Proximal Junctional Angles in Adult Spinal Deformity
Authors: Khalifé Marc , Lafage Renaud , Daniels Alan H. , Diebo Bassel G. , Elysée Jonathan , Ames Christopher P. , Bess Shay R. , Burton Douglas C. , Eastlack Robert K. , Gupta Munish C. , Hostin Richard A. , Kebaish Khaled , Kim Han-Jo , Klineberg Eric O. , Mundis Gregory , Okonkwo David O. , Gille Olivier , Guigui Pierre , Ferrero Emmanuelle , Skalli Wafa , Assi Ayman , Vergari Claudio , Shaffrey Christopher I. , Smith Justin S. , Schwab Frank J. , Lafage Virginie ,   International Spine Study Group
Published: October 2024

Study design.

Multicentric retrospective study of prospectively collected data.

Objective.

On the basis of normative data from a cohort of asymptomatic volunteers, this study sought to determine the rate of abnormal values of proximal junctional angles (PJA) in adult spinal deformity (ASD) surgery patients, and compare it with PJK rate.

Summary of Background Data.

Proximal junctional kyphosis (PJK) definition does not take the vertebral level into account.

Patients and Methods.

This study included 721 healthy volunteers and 824 ASD surgery patients with two-year postoperative follow-up. Normative values for each disc and vertebral body between T1 and T12 were analyzed, then normative values for PJA at each thoracic level were defined in the volunteer cohort as the mean±2SD. PJA abnormal values at the upper instrumented vertebra (UIV) were compared with Glattes’ and Lovecchio’s definitions for PJK in the ASD population at two years.

Results.

Mean age was 37.7±16.3 in the volunteer cohort, with 50.5% of females. Mean thoracic kyphosis (TK) was -50.9±10.8°. Corridors of normality included PJA greater than 20° between T3 and T12. Mean age was 60.5±14.0 years in the ASD cohort, with 77.2% of females. Mean baseline TK was -37.4±19.9°, with a significant increase after surgery (-15.6±15.3°, P<0.001). There was 46.2% of PJK according to Glattes’ versus 8.7% according to Lovecchio’s and 22.9% of kyphotic PJA compared with normative values (P<0.001).

Conclusion.

This study provides normative values for segmental and regional alignment of thoracic spine, used to describe abnormal values of PJA for each level. Using level-adjusted PJA values allows a more precise assessment of abnormal proximal angles and question the definition for PJK.

Level of evidence:

Level II.
Baseline characteristics of the first 302 patients included for acute malignant hypertension crisis in the prospective multidisciplinary HAMA cohort
Authors: Boulestreau Romain , Lorthioir Aurélien , Dreau Hervé , Persu Alexandre , Cremer Antoine , Tharaux Pierre-Louis , Rubin Sébastien , Maier Benjamin , Mazighi Mikael , Seris Alice , Paques Michel , Bonnin Sophie , Halimi Jean Michel , Debeugny Stéphane , Gosse Philippe ,   for the HAMA investigators∗
Published: October 2024

Background:

Malignant hypertension has not disappeared and remains the most severe form of hypertension. More than 100 years after its description, many points remain unanswered. Mechanisms, definitions, and optimal treatment are still controversial. In 2019, we decided to launch a prospective multicentre multidisciplinary cohort in France to try to fill these gaps.

Method:

This study aimed to describe the baseline characteristics of the first 302 included patients and compared these data to already published cohorts. We included patients with severe hypertension associated with severe hypertensive retinopathy and patients filling the HYP MOD (HYPertension MultiOrgan Damage) definition from a broad range of departments (cardiology, nephrology, neurology intensive care unit, emergency department, internal medicine). We collected clinical, biological, imaging, and target organ damage data at admission, along with social and demographic data. We also recorded diagnostic and therapeutic management, adverse events during hospitalization, and characteristics at discharge.

Results:

We enrolled 302 patients in 32 months (105/year) among 40 centres and different specialties. They mainly included young men (68%, mean age 48.7 ± 14.5 years). Target organ damage involved the eye in 86.7% of patients, kidney in 58.6%, heart in 50%, brain in 32.8%, and Thrombotic Microangiopathy stigmata in 15.6%. Patients with severe retinopathy shared characteristics similar to those included in the most important cohorts already published. We also reported several additional subgroups of interest: one-third of our patients were less than 40 years old, one-third were of non-European origin, 14.3% were included through the multiorgan damage definition, without fundus severe injuries, 22.8% were treated without the use of IV therapy, 40.9% had normal or low renin level, and almost all patients were not on antihypertensive therapy at the time of the enrolment.

Conclusion:

These preliminary findings already challenge long-standing dogma, raise numerous questions, and provide a solid basis to address them in ancillary studies of the cohort.
Successful emergency renal auto-transplantation in a child with renovascular disease
Authors: Wyatt Natalie , Melhem Nabil , Booth Caroline , Newton Joanna , Karunanithy Narayan , Sallam Morad , Sinha Manish D.
Published: October 2024

Renal artery occlusion is a rare but potentially catastrophic complication of paediatric endovascular renal artery intervention. Emergency auto-transplantation may be required to salvage the kidney; to date this has only been described in adults. We report our experience of performing emergency kidney auto-transplantation following acute renal artery thrombosis in a child undergoing redo renal artery angioplasty

A 20-month-old boy presented with refractory hypertension and hypertensive cardiomyopathy secondary to multifocal fibromuscular dysplasia (FMD) with a single functioning kidney. Acute thrombosis of the renal artery during redo-endovascular balloon angioplasty necessitated emergency renal auto-transplantation. Subsequent acute kidney injury was reversible with benefit to renal function in the medium-term despite prolonged warm ischaemic time of two hours. We recommend that high-risk patients undergoing renal artery intervention do so at centres with on-site renal and vascular surgical backup.
Early wave reflection of carotid artery is associated with 18F-FDG PET hypometabolism in Alzheimer's brain areas of cognitively normal adults
Authors: Zimmermann Gaétan , Joly Laure , Schoepfer Pauline , Doyen Matthieu , Roch Veronique , Grignon Rachel , Salvi Paolo , Marie Pierre-Yves , Benetos Athanase , Verger Antoine
Published: October 2024

Introduction:

Arterial stiffening likely plays a role in Alzheimer disease (AD) pathogenesis. The current study investigated whether inter-individual variations in arterial stiffness and pressure wave parameters were associated with 18F-FDG positron emission tomography (PET) metabolism in AD-associated brain areas throughout adulthood, independently of age and before the onset of any neuropsychological disorders.

Methods:

A prospective, large age-range population of 67 patients (17 young, 16 middle-aged, and 34 older adults; 37 women) underwent a: brain 18F-FDG PET, blood pressure recording, and carotid/femoral pulse wave-based measurements, including the time-to-peak of the reflected backward carotid pulse wave (bT), on the same day. Multivariable and quantitative voxel-to-voxel analyses (P-voxel < 0.005, corrected for cluster volumes) were conducted to assess associations between vascular parameters and 18F-FDG PET metabolism in AD-associated brain areas.

Results:

In the multivariable analysis, only increased age and decreased bT were independently associated with the decline of metabolic activity in AD-associated brain areas (P < 0.001). In the voxel-to-voxel analysis with age as a covariate, bT was strongly associated with the metabolic activity of 40 clusters in AD-associated brain areas (clusters cumulative volume: 63 cm3; T score max: 5.7).

Conclusion:

In a large age-range population of adult patients, who are still unaffected by neuropsychological disorders, an early reflected arterial pressure wave, as evidenced by a decreased bT value, is strongly associated with hypometabolic activity of AD-associated brain areas, independently of age.
Patients’ Experiences With Complementary and Alternative Treatments to Manage Chemotherapy Symptoms
Authors: Özmaya Esma , Uzun Sevda
Published: October 2024

This phenomenological study aims to explore the experiences of individuals undergoing chemotherapy, focusing on their symptoms and the use of complementary and alternative treatments to cope with these challenges. Thirteen individuals diagnosed with cancer in a city in the central region of Turkey were interviewed using a semi-structured, in-depth approach in this phenomenological study. The criterion sampling method was employed to select participants, and interviews continued until data saturation was achieved. Thematic analysis was applied to the audio-recorded and transcribed interviews. The study adhered to the COREQ checklist for reporting qualitative research. The data analysis revealed 2 main categories (effects of cancer and chemotherapy on individuals, the use of complementary and alternative treatments to cope with the symptoms of patients receiving chemotherapy) and 6 themes (psychological effects, social impacts, physical effects, social practices, psychological practices, and physical practices). The study demonstrated that individuals faced significant psychological, physical, and social challenges due to cancer, posing difficulties in coping. The symptoms had a substantial negative impact on individuals. The research identified the use of various alternative methods, such as yoga, the Mediterranean diet, and music therapy, as coping strategies. It is recommended that individuals undergoing chemotherapy explore complementary and alternative treatment methods to effectively manage symptoms.
Rotational stability of plate-haptic toric intraocular lenses implantation with a capsular tension ring: prospective randomized paired-eye study
Authors: Lin Xuanqiao , Ma Dongmei , Han Xiaoyan , Hua Zhixiang , Shen Wenqian , Qiu Xiaodi , Cai Lei , Yang Jin
Published: October 2024

Purpose:

To compare the rotational stability and visual outcomes of plate-haptic toric intraocular lenses (IOLs) with and without a capsular tension ring (CTR) in paired eyes.

Setting:

Eye and Ears, Nose, and Throat Hospital of Fudan University, Shanghai, China.

Design:

Prospective, randomized, paired-eye study.

Methods:

Patients with bilateral cataracts and coexisting regular corneal astigmatism were enrolled. The 2 eyes of each patient were randomly assigned to the CTR or non-CTR (NCTR) group. Both eyes of each patient were subjected to phacoemulsification and toric IOL implantation. CTRs were implanted into the eyes of the CTR group. All patients were followed up for 12 months; uncorrected distance visual acuity (UDVA), residual astigmatism (RAS), and rotational degree of the toric IOL were recorded.

Results:

186 eyes of 93 patients were eligible for analysis. At each visit, UDVA improved significantly postoperatively in all eyes (P < .001). The mean rotational degree and RAS were significantly smaller in the CTR group at the 2-week visit (P < .05). The toric IOLs achieved rotational stability at 1 week postoperatively in the CTR group while at 2 weeks postoperatively in the NCTR group. In the subgroup analyses, CTR coimplantation significantly reduced the 2-week IOL rotation in eyes meeting specific ocular measurements.

Conclusions:

CTR coimplantation could increase the rotational stability of plate-haptic toric IOLs, by reducing the amount of IOL rotation in the early postoperative period and accelerating the stabilization of IOLs in the capsular bag.
Effect of patient gender on the decision of ceiling of care: an European study of emergency physicians’ treatment decisions in simulated cases
Authors: Vromant Amélie , Alamé Karine , Cassard Clémentine , Bloom Ben , Miró Oscar , Freund Yonathan
Published: October 2024

Background and importance

Gender bias in healthcare can significantly influence clinical decision-making, potentially leading to disparities in treatment outcomes. This study addresses the impact of patient gender on the decision-making process for establishing a ceiling of care in emergency medicine, particularly the decision to limit tracheal intubation.

Objective

To determine whether patient gender influences emergency physicians’ decisions regarding the recommendation for tracheal intubation in critically ill patients.

Design

A European survey-based study was conducted using a standardized clinical scenario to assess physicians’ decisions in a controlled setting.

Settings and participants

The survey targeted European emergency physicians over a 2-week period in April 2024. A total of 3423 physicians participated, with a median age of 40 years and a distribution of 46% women. Physicians were presented with a clinical vignette of a 75-year-old patient in acute respiratory distress. The vignettes were randomized to vary only by the patient’s gender (woman/man) and level of functional status: (1) can grocery shop alone, (2) cannot grocery shop alone but can bathe independently, or (3) cannot perform either task independently.

Outcome measures and analysis

The primary outcome was the recommendation for intubation, with secondary analyses exploring the influence of patient functional status levels. Multivariable logistic regression was used to adjust for potential confounders, including physician gender, age, experience, and practice setting.

Main Results

A total of 3423 physicians responded, mostly from France, Spain, Italy, and the UK (1,532, 494, 247, and 245 respectively). Women patients were less likely to be intubated compared to male patients [67.9% vs. 71.7%; difference 3.81%; 95% confidence interval (CI), 0.7–6.9%]. The likelihood of recommending intubation decreased with lower levels of patient functional status. Women physician gender was also associated with a reduced likelihood of recommending intubation.

Conclusion

This study suggests a significant gender-based disparity in emergency care decision-making, with women patients being less likely to receive recommendations for intubation. However, these results should be interpreted with caution due to potential limitations in the representativity of respondents and the uncertain applicability of survey responses to real-life clinical practice.
Effectiveness of hypertonic saline with or without hyaluronic acid among patients with cystic fibrosis: a systematic review and meta-analysis
Authors: Khan Zarghuna , Naeem Muhammad O. , Amin Dr. Anam , Amin Laraib , Shah Abdullah , Khaliq Saad Ul. , Azhar Aima , Naz Sana , Shujauddin Syed M. , Arshad Muhammad A. , Ali Sarosh J. , Sajid Emad U. , Jawad Sayed
Published: October 2024

Background:

The clinical effectiveness of hypertonic saline (HS) in individuals with cystic fibrosis (CF) can be compromised by adverse effects. The objective of this study was to examine the efficacy of hyaluronic acid (HA) in mitigating these negative occurrences.

Methods:

A comprehensive review of the literature was carried out using three electronic databases: Medline, Cochrane Central, and Embase. This systematic review and meta-analysis investigate the efficacy of hypertonic saline (HS) with and without hyaluronic acid (HA) in treating cystic fibrosis. Primary outcomes include the incidence of cough, throat irritation, unpleasant taste, and changes in FEV1. Our findings suggest that adding HA to HS significantly reduces adverse effects and enhances patient tolerability, marking a potential improvement in cystic fibrosis therapy. Risk ratios (RRs) and mean differences (MDs) with 95% CI were used to present evaluations. The quality of RCTs was evaluated using the Cochrane Risk of Bias Tool (CRBT). The quality of the observational study was evaluated using the Newcastle–Ottawa Scale.

Results:

From the 1960 articles retrieved from the initial search, five relevant studies (n=236 patients) were included in the final analysis. Compared with patients only on HS, patients with HS and HA were significantly less likely to experience cough (RR: 0.45; 95% CI, 0.28–0.72, P=0.001), throat irritation (RR: 0.43; 95% CI, 0.22–0.81, P=0.009), and unpleasant smell (RR: 0.43; 95% CI, 0.23–0.80, P=0.09). In addition, patients with HS with HA had significantly less forced expiratory volume (FEV1) (MD: −2.97; 95% CI, −3.79–−2.15, P=0.52), compared to patients only on HS. Patients on HA + HS had significantly lower rates of cough (RR: 0.45; 95% CI, 0.28–0.72, P=0.001), throat irritation (RR: 0.43; 95% CI, 0.22–0.81, P=0.009), and bad smell (RR: 0.43; 95% CI, 0.23–0.80, P=0.09) when compared to patients on HS alone. Furthermore, compared to patients solely on HS, patients with HS plus HA exhibited a substantially lower forced expiratory volume (FEV1) (MD: −2.97; 95% CI, −3.79 to −2.15, P=0.52) as well.

Conclusion:

For CF patients who need ongoing HS therapy and have a history of poor therapy tolerance, adding HA is beneficial.
Incidental detection of three testes while evaluating an empty left scrotal sac: a case report
Authors: William Munna , Bhusal Amrit , Ahmad Waqar , Anjum Abdul Sattar , Qadeer Usman
Published: October 2024

Introduction and importance:

Poly-orchidism is a rare congenital anomaly of the genitourinary system, which is characterized by the presence of more than two testicles, also being termed as “supernumerary testis”. Tri-orchidism is the most frequently encountered form of poly-orchidism, which is defined as the presence of more than two intra- or extra-scrotal testicles.

Case presentation:

The authors present a case of a 16-year-old male who presented with a complaint of an empty left scrotal sac, and was later diagnosed as a case of tri-orchidism with each testis in bilateral hemipelvis confirmed by ultrasound with Doppler and MRI. The patient was kept in regular follow-up for 6 months with radiological assessment, which showed no changes in radiological findings as before.

Clinical discussion:

The majority of patients are asymptomatic or present with a painless inguinal or scrotal mass, undescended testis, and rarely torsion of the supernumerary testis. Imaging modalities like US, Doppler study, and MRI are required for the diagnosis. Non-scrotal location of poly-orchidism is considered as the most important risk factor for malignancy. The surgical approach is required for any malignant changes in biopsy, US showing features of malignancy, absent spermatogenesis or in cases where regular follow-up is not possible. Otherwise, a conservative approach with regular follow-up is enough if above indications are absent.

Conclusion:

The complications of poly-orchidism like undescended testes, inguinal hernia, infertility, and possibly malignancy must be borne in mind while diagnosing poly-orchidism. The above-mentioned aspects must also be considered while choosing surgical intervention versus a conservative approach with follow-up, depending upon the position of the supernumerary testicle being scrotal or ectopic.
Concordance of PD-L1 Expression in Metastatic Triple-negative Breast Cancer Between the 22C3 and E1L3N Antibodies Using Combined Positive Scoring
Authors: Erick Timothy K. , Lester Susan C. , Garrido-Castro Ana C. , Hughes Melissa , Cunningham Olivia , Lin Nancy U. , Mittendorf Elizabeth A. , Tolaney Sara M. , Brock Jane E.
Published: October 2024

For patients with metastatic triple-negative breast cancer (TNBC), treatment with pembrolizumab is dependent on the accurate determination of programmed death ligand 1 (PD-L1) expression using immunohistochemistry (IHC). This study evaluated the interobserver concordance in assessing PD-L1 expression on TNBC samples using the commercial 22C3 IHC assay and an in-house assay based on the E1L3N antibody. Concordance between the 22C3 and the E1L3N IHC assays was evaluated on TNBC samples read by a commercial laboratory and a Brigham and Women’s Hospital breast pathologist (BWH reader). Each slide was given a PD-L1 combined positive score (CPS) and was considered PD-L1 positive or negative based on the CPS cutoff of 10. Interobserver concordance for the assays was also evaluated on a subset of samples between 2 and 3 independent readers. On 71 samples, 2 independent readers (1 BWH reader and commercial laboratory) using E1L3N and 22C3, respectively, reached agreement on PD-L1 status (positive/negative) on 64 samples (90.1%). Using 22C3, 2 independent readers reached agreement on PD-L1 status on 30 of 36 samples (83.3%), and 3 independent readers reached agreement on 16 of 27 samples (59.3%). Using E1L3N, 2 BWH readers reached agreement on PD-L1 status on 18 of 27 samples (66.7%). Three BWH readers reached an agreement on 2 of 12 of the most challenging samples (16.7%). In conclusion, concordance between E1L3N and 22C3 testing using CPS for PD-L1 in metastatic TNBC was >90%. However, certain cases were challenging to agree upon using current threshold criteria, highlighting the need for more standardized evidence-based methods to assess PD-L1 expression.
Epicardial fat and liver stiffness by acoustic radiation force impulse elastography in people with HIV-1 infection without liver disease
Authors: Pastori Daniele , Del Sole Francesco , Brogi Tommaso , del Ben Maria , Fimiani Caterina , Mastroianni Claudio Maria , Mezzaroma Ivano
Published: October 2024

Objective:

To evaluate the association between increased epicardial fat thickness (EFT) and liver stiffness measurement (LSM), as assessed by elastography in people with human immunodeficiency virus type 1 (HIV-1) infection (PWH)

Methods:

Ninety-one PWH on effective antiretroviral treatment (ART) were enrolled. EFT was measured by transthoracic echocardiography. Liver steatosis was evaluated by ultrasound Hamaguchi criteria and LSM by elastography with acoustic radiation force impulse (ARFI) technique. LSM ≥8 kPa was suggestive of clinically relevant fibrosis.

Results:

Mean age was 54.3 years and 27.5% were women. EFT correlated with HIV-1 infection duration (rS 0.252, P = 0.016), age at study entry (rS 0.527, P < 0.001), BMI (rS 0.363, P < 0.001), waist circumference (rS 0.549, P < 0.001), HDL (rS −0.391, P < 0.001), triglycerides (rS 0.375, P < 0.001), Hamaguchi score (rS 0.279, P = 0.007), right lobe of the liver (rS 0.259, P = 0.014), left ventricular mass/body surface area (rS 0.220, P = 0.036).

A LSM ≥8 kPa was found in 20.9% of PWH, more commonly in those with EFT above the median >5.6 mm (30.4% vs. 11.1%, P = 0.038). LSM significantly correlated with EFT (rS 0.274, P = 0.009), CD4+ cells (rS −0.320, P = 0.003) and nadir of CD4+ cells (rS −0.292, P = 0.007).

In a subgroup (n = 53), a homeostasis model assessment of insulin resistance (HOMA-IR) index >2.33 identified increased EFT, [area under the curve (AUC) 0.73, 95% confidence interval (CI) 0.59–0.84, P = 0.001) while an HOMA-IR >3.27 predicted increased LSM (AUC 0.76, 95% CI 0.62–0.87, P = 0.005).

Conclusions:

PWH with increased EFT have worse metabolic profile and a high proportion of clinically relevant fibrosis at ARFI elastography, despite normal liver function tests. The HOMA-IR index might be used to identify PWH with increased EFT and liver fibrosis.
Trends in the Uptake of Index Testing Among Adolescents in USAID-Supported President's Emergency Plan for AIDS Relief Programs, October 2017–September 2022
Authors: Okegbe Tishina , Bishop Kristina Monroe , Rose Jessica , Srivastava Meena , Baptiste Anne Jean
Published: October 2024

Introduction:

Adolescents aged 10–19 years account for a growing proportion of people living with HIV (PLHIV). In 2023, 140,000 adolescents were diagnosed with HIV, yet knowledge of HIV status and uptake of testing services remain critically low. Index testing—offering testing to contacts of PLHIV—is an important case-finding strategy. In 2021, President's Emergency Plan for AIDS Relief expanded guidance to explicitly include older adolescents aged 15–19 years. We reviewed index testing data to assess uptake and case-finding trends among biological adolescent-aged children and siblings of PLHIV aged 10–19 years.

Methods:

Routinely collected programmatic data from 27 U.S. Agency for International Development-supported President's Emergency Plan for AIDS Relief country and regional programs were analyzed for fiscal years (FY) 2017 through FY2022 (October 2016–September 2022). We compared the volume of index testing and subsequent new diagnoses across FYs and countries among biological adolescent-aged children and siblings of PLHIV and disaggregated by age, 10–14 and 15–19 years, and sex.

Results:

Index testing among adolescents aged 10–19 years increased from FY17 to FY22, nearly doubling from 147,088 to 291,534. Similarly, new diagnoses among adolescents increased between FY17 and FY22 (3721 vs 10,730). Overall, across FYs, index testing uptake and case-finding were higher among females than males, and the gap in testing uptake between sexes was larger for older than younger adolescents.

Conclusions:

Index testing uptake has increased substantially among adolescents over time, with rebounded gains for adolescents aged 15–19 years noted beginning in FY21. However, uptake across age and sex remained uneven, highlighting an opportunity to ensure that targeted testing strategies are used to reach adolescents aged 15–19 years and males.
Automated Preoperative Planning Algorithm for Mandibular Angle Osteotomy Based on Anatomical Landmarks Detection: A Retrospective Study
Authors: Zhang Yichi , Cao Zhenggang , Xie Le , Lin Li , Chai Gang
Published: October 2024

Objective:

The aim of the study was to develop and evaluate an automated preoperative planning algorithm based on anatomical landmark point recognition for enhancing the efficiency and intelligence of preoperative planning for mandibular angle osteotomy.

Methods:

A retrospective cohort of 34 patients underwent preoperative planning with this algorithm. The present algorithm was developed using a method based on anatomical marker point recognition. The efficiency, symmetry, and safety of the automated preoperative planning and esthetics were statistically analyzed by paired t test and χ2 test.

Results:

The results showed that the automated planning algorithm was able to achieve a great improvement in preoperative planning efficiency as well as safety and symmetry. A prospective case report of 2 patients is then reported, illustrating the safety and esthetics of the algorithm with 1-year postoperative follow-up and postoperative esthetic scores.

Conclusion:

This algorithm can help to improve the efficiency of preoperative planning for surgeons while ensuring safety and esthetics and can be further applied to other craniomaxillofacial personalized design surgeries in the preoperative design in the future.
Determining Chin Dimensions for Feminizing Genioplasty: An Anatomic Study
Authors: Fodor R’ay , Kalandar Abir , Rampazzo Antonio , Isakov Raymond , Ferrando Cecile , Papay Francis , Bassiri Gharb Bahar
Published: October 2024

Background:

Feminizing genioplasty warrants chin modification to achieve feminine characteristics. This study compared female and male facial skeletal dimensions and shape to guide feminizing genioplasty.

Methods:

Skulls stored at the Cleveland Museum of Natural History were analyzed. Sex, age, and race were documented. Heights and widths of the face and chin were measured, normalized, and compared.

Results:

Forty-three male (43.58±12.52-y-old) and 43 female (40.48±12.04-y-old) skulls were included. Within each group, 25 skulls were of African American (AA) origin and 18 were of Caucasian (C) origin. Absolute chin heights were larger in AA and C males compared with females (P<0.05). After normalization to lower facial height, there was a trend toward greater chin height in AA males compared with females (P=0.07). Parasagittal chin width in AA males was significantly larger than AA females (P=0.0006). Interforaminal chin width in C males trended toward being significantly larger than females (P=0.08). Following normalization of chin widths, no significant sex-based differences were noted for AA skulls except for the interforaminal/intergonial ratio, which was smaller in AA males (P=0.04). For C skulls, most normalized ratios were significantly smaller in males (P<0.05). C females had wider angles at the point of maximum chin projection (P=0.007) and wider symphyseal inclinations (P<0.0001). These differences were not present in AA skulls (P>0.05). Regardless of race, male chins appeared square, whereas female chins were round.

Conclusions:

While chin width reduction is not needed for most patients, height reduction could be considered. Chin contouring is the most central component of feminizing genioplasty.
The Upper Extremity Lymphatic System Is Not Symmetrical in Individuals
Authors: Fanning James E. , Friedman Rosie , Chen Angela , Bustos Valeria , Aly Mohamed Ismail , Fleishman Aaron , Hong Young Kwon , Tsai Leo , Parker John A. , Donohoe Kevin , Singhal Dhruv
Published: October 2024

Objective:

We evaluated whether superficial lymphatic anatomy and functional lymph node drainage are symmetric between the right and left upper extremities of healthy female volunteers, and if handedness is associated with symmetry of superficial lymphatic anatomy.

Background:

Symmetry of lymphatic anatomy has been assumed historically. This assumption of individual anatomic symmetry is being utilized clinically and in research without validation.

Methods:

36 normal female volunteers underwent bilateral indocyanine green (ICG) lymphography and lymphoscintigraphy of the upper extremities. Eight collecting vessel pathways of each upper extremity were mapped on ICG lymphography. 13 lymph node groups were visualized on lymphoscintigraphy. Symmetry of lymphatic anatomy and functional drainage were established by comparing the right and left extremities of each participant. Hand dominance was assessed by hand grip strength on a hand dynamometer.

Results:

Among the 36 participants, 10 (28%) showed symmetry of all eight upper extremity lymphatic pathways with ICG. However, only 1 (3%) participant demonstrated complete symmetry amongst the 13 lymph node groups. Total symmetry of lymphatic channels was observed on ICG in seven (39%) participants with hand dominance and three (17%) participants without hand dominance (X2 = 2.215, P = 0.137).

Conclusion:

Lymphatic anatomy and functional drainage of the upper extremities are not consistently symmetric. Functional nodal drainage as demonstrated by lymphoscintigraphy shows less symmetry than anatomic studies of lymphatic channels using ICG. Symmetric lymphatic anatomy does not appear to correlate with hand dominance. These findings challenge the prevailing assumption of left-right lymphatic symmetry.