bluuebunny/crossref_metadata_2025 huggingface dataset:
Loneliness links Adverse Childhood Experiences to Mortality Risk across 26 years
Authors: Curtis Aisling , Kirwan Emma , Luchetti Martina , Creaven Ann-Marie , Turiano Nicholas , McGeehan Máire , Graham Eileen K , O’Súilleabháin Páraic S
Published: February 2025

Objectives

Adverse Childhood Experiences (ACEs) are associated with increased mortality risk. Individuals with a history of certain adversity during childhood tend to report higher levels of loneliness in later life. In our pre-registered study, we examined whether loneliness mediates the ACEs to mortality risk relation.

Methods

Participants were from the Midlife in the United States Survey (N = 4963; M [SD] 46.44 [12.52] years, 53.3% female). Follow-up period spanned 26 years. A comprehensive measure of ACEs was employed consisting of 20 ACEs from five categories: physical abuse, emotional abuse, socioeconomic disadvantage, adverse family structure, and poor health at age 16 years.

Results

ACEs was a significant predictor of mortality risk. Loneliness mediated the ACEs-mortality risk relation. In other words, loneliness in adulthood accounted for the relation between ACEs and future death. These effects withstood a range of sensitivity checks and adjustments for important factors, such as social isolation.

Discussion

Loneliness appears to be a central mechanism in the long-term impact of ACEs on longevity, such that, for adversity during childhood, loneliness experienced during adulthood may be a toxic pathway to future death.
The genome of Vitis vinifera cv. Mgaloblishvili reveals resistance and susceptibility factors to downy mildew in the Rpv29 and Rpv31 loci
Authors: Ricciardi Valentina , Minio Andrea , Massonnet Melanie , Wittenberg Alexander H J , Figueroa-Balderas Rosa , Maghradze David , Toffolatti Silvia Laura , Failla Osvaldo , Cantu Dario , De Lorenzis Gabriella
Published: February 2025

Mgaloblishvili, a grapevine variety from Georgia (Southern Caucasus), exhibits a unique resistance mechanism against downy mildew. Mgaloblishvili resistance mechanism, involving pathogen recognition, activation of ethylene signalling pathway, structural and chemical defences, is mediated by the resistance loci Rpv29, Rpv30, and Rpv31. Mgaloblishvili genome was sequenced using PacBio HiFi, resulting in a chromosome-scale diploid assembly of 986 Mbp, including 58,912 predicted protein-coding genes across two phased chromosome sets. Comparative analysis with the susceptible PN40024 genome allowed us to identify differences in structure, gene content, and gene expression, as well as the impact of structural variants (SVs) and single nucleotide polymorphisms (SNPs) between Mgaloblishvili and PN40024 loci. Resistance haplotypes were identified through DNA sequencing of a self-pollinated Mgaloblishvili population. Compared to orthologous regions in PN40024, the Rpv29 locus in Mgaloblishvili exhibits reduced gene content, while the Rpv31 locus has similar gene content. In both Mgaloblishvili and PN40024, most genes within these loci are associated with plant defence pathways. While genes in both genotypes perform similar functions, SVs and SNPs were identified as key determinants of the structural differences between the genomes. Defining the Rpv30 locus was challenging due to ambiguous marker localization. DNA sequencing allowed us to identify resistance haplotypes for both Rpv30 and Rpv31 on Mgaloblishvili haplotype 2, though insights into the Rpv29 locus remain limited. Our results indicate that Mgaloblishvili's resistance is driven by numerous small SVs and SNPs, which lead to the loss of susceptibility factors and unique transcriptional regulation of defence-related genes.
Natural History of Chapare Virus Infection in Strain 13 Guinea Pigs
Authors: Johnson Dylan M , Fenton Karla A , Dobias Natalie , Geisbert Thomas W , Cross Robert W
Published: February 2025

Chapare virus (CHAPV) is an emerging arenavirus first discovered in Bolivia. Clinical cases have a high case fatality rate and a concerning capacity for person-to-person spread. Animal models of CHHF are needed to study pathogenesis and development of medical counter measures. Here, we present a narrowly focused study describing lethal infection of strain 13 guinea pigs with CHAPV. Animals challenged with CHAPV had progressive weight loss, lymphocytopenia, neutropenia, thrombocytopenia, hepatitis, vascular leakage, and gastrointestinal hemorrhage, resulting in uniform lethality between 7- and 16-days following challenge. This work lays the foundation for development of a small animal model of CHAPV infection.
Patient-reported outcome measures (PROMs) used to assess sexual functioning in prostate cancer patients: a systematic review of psychometric properties
Authors: Abu-Odah Hammoda , Ho Ka-Yan , Ng Chi-Fai , Wu Siyuan , Lam Katherine-Ka-Wai , Yorke Janelle
Published: February 2025

Background

Prostate cancer (PCa) significantly impacts patients’ sexual functioning and quality of life. Patient-reported outcome measures (PROMs) are essential for accurately assessing these issues, yet a comprehensive evaluation of their psychometric properties in PCa patients is lacking.

Aims

This systematic review aimed to provide a comprehensive evaluation of all generic and specific PROMs used to assess sexual functioning in PCa patients and make recommendations the application of PROMs in this patient group.

Methods

Six electronic databases were searched from up to May 5, 2024. Studies reporting the development and/or validation of PROMs for PCa patients or generic instruments administered to this population were included. The COSMIN risk of bias checklist was adopted to assess the methodological quality and psychometric properties of included PROMs. Psychometric properties of the PROM in each included study were rated against the criteria for good measurement properties based on the COSMIN guideline.

Outcomes

The main outcome was to identify the appropriate PROM that can be adopted and used for assessing sexual functioning in PCa patients in clinical setting.

Results

A total of 10 PROMs were identified across 32 studies, primarily focusing on localized PCa patients after radical prostatectomy. The Expanded Prostate Cancer Index Composite (EPIC-26) was the most frequently evaluated and widely used PROM in clinical practice. EPIC-26 (Spanish, Italian, Chinese versions) and UCLA Prostate Cancer Index (UCLA-PCI) demonstrated better psychometric properties compared to other scales. However, no PROM met all COSMIN standards.

Clinical Implications

In a clinical setting, it is crucial to utilize well-validated PROMs with good psychometric properties to effectively identify patients with PCa experiencing sexual difficulties who may require additional support.

Strengths and Limitations

We applied strict inclusion criteria related to study design and study population, ensuring the assumption of transitivity and the consistency of the analysis.

Conclusion

Although EPIC-26 is a shortened version with strong psychometric properties, it may still be too lengthy for patients with significant health issues. Furthermore, the included PROMs do not address issues related to partner relationships, or the psychological impact of sexual dysfunction in sufficient detail. Future research should aim to develop and validate new PROMs that fill these gaps. These tools should be both psychometrically robust and practical for routine use, enabling real-time monitoring and improved care delivery.
The NEXT complex regulates H3K27me3 levels to affect cancer progression by degrading G4/U-rich lncRNAs
Authors: Yang Qianqian , Zhou Zihan , Li Lian , Lu Runhui , Hou Guofang , Huang Caihu , Huang Jiayi , Li Hongyan , Zhang Yafan , Li Junya , Zhang Yixin , Xu Anan , Chen Ran , Wang Yanli , Zhao Xian , Huang Jian , Wang Yiwei , Zhao Xiaojing , Yu Jianxiu
Published: February 2025

Polycomb repressive complex 2 (PRC2) is responsible for depositing H3K27me3 and plays essential roles in gene silencing during development and cancer. Meanwhile, the nuclear exosome targeting (NEXT) complex facilitates the degradation of numerous noncoding RNAs in the nucleoplasm. Here we find that the functional deficiency of the NEXT complex leads to an overall decrease in H3K27me3 levels. Specifically, ZCCHC8 depletion results in significant upregulation of nascent long noncoding RNAs (lncRNAs) containing G-quadruplex (G4) and U-Rich motifs (G4/U-Rich lncRNAs). The G4 motif binds to EZH2, blocking the chromatin recruitment of PRC2, while the U-Rich motif is specifically recognized by the NEXT complex for RNA exosome-mediated degradation. In tumor tissues with high ZCCHC8 expression in clear cell renal cell carcinoma (ccRCC) and lung adenocarcinoma (LUAD) patients, the NEXT complex excessively degrades nascent G4/U-Rich lncRNAs. Consequently, PRC2 core subunits are released and recruited to neighboring genomic loci, resulting in increased H3K27me3 levels and downregulation of adjacent genes, including tumor suppressors like SEMA5A and ARID1A. Notably, the EZH2 inhibitor Tazemetostat (EPZ-6438) exhibits greater sensitivity in cells with higher ZCCHC8 expression. Altogether, our findings demonstrate a novel mechanism that the NEXT complex regulates H3K27me3 levels by degrading nascent G4/U-Rich lncRNAs in cancer cells.
Evolving a terminal deoxynucleotidyl transferase for commercial enzymatic DNA synthesis
Authors: Forget Stephanie M , Krawczyk Mikayla J , Knight Anders M , Ching Charlene , Copeland Rachelle A , Mahmoodi Niusha , Mayo Melissa A , Nguyen James , Tan Amanda , Miller Mathew , Vroom Jonathan , Lutz Stefan
Published: February 2025

Enzymatic DNA synthesis, using stepwise nucleotide addition catalyzed by template-independent polymerases, promises higher efficiency, quality, and sustainability than today’s industry-standard phosphoramidite-based processes. We report the directed evolution of a terminal deoxynucleotidyl transferase that uses 3′-phosphate-blocked 2′-deoxynucleoside triphosphates (dNTPs) to control the polymerization reaction. Over 32 iterative rounds of laboratory evolution, 80 amino acid substitutions—constituting ∼20% of the coding protein sequence—were introduced. The engineered polymerase exhibits uniformly high catalytic activity, raising incorporation efficiency by 200-fold to >99% for dNTPs with a 3′-reversible terminator while reducing extension times by >600-fold to 90 s. The same enzyme variant displays improved enzyme robustness, as reflected in the 20°C increase in thermostability. Based on these performance characteristics, the engineered polymerase represents an operational prototype for biocatalytic DNA synthesis at a commercial scale.
The Rise and Fall of Cranial Deformation in Southwestern France
Authors: Crubézy Eric , Gérard Patrice , Paya Didier , Fleury Guillaume , Djouad Sélim , Duchesne Sylvie
Published: February 2025

In southwest France, cranial deformations, common from the seventeenth to the early twentieth centuries, were rooted in religious change and the cultural evolution of headwear fashion. A headdress was placed on an infant’s head after baptism and remained a part of women’s attire throughout their lives, while men wore hats. As fashion evolved again in the nineteenth century, the deformations gradually disappeared, leaving little trace in the popular memory, because they were invisible in the public space and the practice was bound up with major societal changes. Previously, from the fifth to the sixth centuries AD, cranial deformation was associated with a specific fashion among the Visigothic elite during the migrations from east Europe; the practice quickly disappeared when a new Frankish elite came to power.
Icons in Time
Authors: Mac Carthy Ita
Published: February 2025

For five centuries, Ludovico Ariosto’s Orlando furioso has enjoyed the status of literary icon. Traversing space and time, it has traveled within and outside Italy, often in the company of Boiardo’s Orlando innamorato and Tasso’s Gerusalemme liberata, to be widely read across borders of class, gender, and race. This chapter introduces Ariosto and his iconic companions to new readers. It explores how the Furioso comes to represent manifold things relating to Italy and its past: from the chivalric imaginary to evolutions in the epic-romance genre; from the culture and society of early modern Emilia-Romagna to the Italian Renaissance as a whole. Considering a little-known chapter of the Furioso’s nineteenth-century fortunes, it examines how Ariosto and Boiardo were received in Britain through the refracted light of Italian unification and goes on to reflect on how Italian icons can be used or abused, then as now, both at home and abroad.
Strategic Culture
Authors: Becker Jordan
Published: February 2025

The concept of strategic culture is central to understanding NATO. Strategic culture is defined as a multi-dimensional set of ideational factors that shape groups’ collective understandings of how to influence other actors or groups to advance their priorities. Two key questions frame this enquiry. First, whether there is an emerging NATO strategic culture, to which the answer is probably not right now, and only in fits and starts in the past. Second, how do national strategic cultures affect the behaviour of allies, to which the answer is to a significant extent. On both questions, strategic culture has a wealth of scholarship to draw upon, but the concept remains a work in progress. It is an underexplored and potentially fertile area of study for scholars interested in NATO allies’ (and other states’) behaviour. It is of particular relevance when considering allied burden-sharing.
Partnerships
Authors: Petersson Magnus
Published: February 2025

Partnerships are a way of extending NATO’s purposes and influence beyond its membership, and of preparing non-members for accession. In this chapter, the development of NATO’s partnership policy is divided into three phases: from the end of the Cold War to 11 September 2001 (9/11); from 9/11 to the Russian annexation of Crimea in 2014; and the period after 2014. In this chapter, the treatment of these three phases is framed by a number of questions: why was the partnership policy launched by NATO and how has it developed? What has been the partnership policy and what structures has it entailed? And how can the partnership policy and the cooperation with partners be characterized?
Bone Tool Technology
Authors: David Éva
Published: February 2025

The chapter presents the main bone and antler tool types used in the daily activities of populations during the Mesolithic, along with the technical principles and concepts underlying their manufacture and utilization. Three industrial systems are recognized as distinct templates used in animal-based material exploitation (including sea shell). Their identification indicates that the regular production of tools made from animal carcasses resulted from technical choices derived from, linked to, or embedded in subsistence strategies. The emergence of compound tools appears to be specific to the Mesolithic period and is discussed based on evidence found on the hunting and fishing gear with non-detachable heads as well as on the socketed heavy-duty tools. The diverse hafting and gripping (including different kinds of engraving) systems point to distinct chronological periods. Mesolithic hunters and gatherers also used their equipment as a means of expressing symbolic thoughts through a tangible relationship in their art of decorating certain bone points and bevel-ended tools and, even, of covering the body of the deceased with osseous materials in the tombs.
Orwell’s Beasts
Authors: Gibbs Sarah
Published: February 2025

This chapter examines George Orwell’s portrayal of animals in his book-length works, from Down and Out in Paris and London (1933) to Nineteen Eighty-Four (1949). It argues that Orwell deploys the animal figure in three literary modes: the descriptive, the metaphorical, and the symbolic. His renderings of faunae, both wild and domestic, support a single theme: that engagement with the natural world is necessary in order to counter the intellectual and emotional degradation that both industrialism and political extremism foster. In Orwell’s oeuvre, nature’s productive anarchy is an antidote to the economic and governmental regimes’ social engineering, and the destruction of self it entails.
Orwell and Childhood
Authors: Keeble Richard Lance
Published: February 2025

In his exploration of Orwell’s ‘plain style’, Alex Woloch highlights ‘forms of absence, neglect, occlusion and deprivation’ and suggests there is ‘a strange blankness, or emptiness, at the deliberate heart of his work’. Following on from that, this chapter, in focusing on Orwell’s comments about childhood, argues that he tends to blend, tantalizingly, revelation with reticence, openness with silence. Fictionalization crucially helps to provide a certain distance for Orwell to deal with difficult, even traumatic events. André Gide wrote of Oscar Wilde’s dramas that ‘the greatest interest lies between the lines’. Indeed, Orwell always invites us to read his works critically—and between the lines. This is particularly relevant to his writings on childhood.
Orwell, Englishness, and Class
Authors: Clarke Ben
Published: February 2025

This chapter argues that from the late 1930s Orwell’s patriotism was integral to his socialism and that it was oriented towards the future rather than to the past, to the production of a new, egalitarian England rather than to the recovery of a lost, hierarchical one. Focusing on Coming Up for Air, which is often described as his most nostalgic novel, it argues that the text challenges conservative ideas of England that identified the country with a myth of unchanging rural communities whose coherence and stability was founded on traditional class structures. Bowling’s failure to return to the Lower Binfield of his childhood, which he imagines in these terms, insists on the impossibility of a retreat from modernity. The novel is an important part of Orwell’s contribution to contemporary left-wing claims that nations were materially and culturally specific sites of political struggle.
Orwell and Bertrand Russell
Authors: Brian Barry Peter
Published: February 2025

Two of the great Englishmen of the twentieth century, George Orwell and Bertrand Russell, were mutual admirers and sympathetic collaborators. That Orwell was familiar with and thought highly of Russell’s work is well known, yet a pervasive interpretation of Orwell as being scarcely capable of understanding philosophical monographs is persistent. Russell is a demonstrable influence on Orwell’s thought, although the full range of Russell’s influence has not always been appreciated, especially as it pertains to Orwell’s philosophical commitments. Russell’s views about power greatly influenced Orwell’s piqued interest in the topic during the 1940s, and Russell’s sympathies with British sentimentalism are discernible in Orwell’s own favoured moral psychology. There is also reason to think that Russell inspired a memorable passage in Nineteen Eighty-Four where Winston cannot recall the fallacy of which he suspects O’Brien is guilty: the unnamed fallacy likely has its origins in Russell’s critique of idealism.
Orwell and Victor Serge
Authors: Vaninskaya Anna
Published: February 2025

This chapter offers a comparative analysis of George Orwell and the francophone writer and socialist revolutionary of Russian origin, Victor Serge (1890–1947). It first traces the biographical and political connections between the two authors and then undertakes a comparative reading of their fiction, non-fiction, and poetry, focusing on the key contrasts of collectivism vs individualism and hope vs despair. In particular, the chapter explores the thematic parallels and formal differences between Orwell’s and Serge’s novels of totalitarianism and argues that Serge’s commitment to revolutionary hope provides a necessary affective corrective to Orwell’s well-known fixation on failure.
Recurring red flags: a retrospective study of MBRRACE-UK Perinatal Mortality Surveillance (2015–21) to identify maternity services most consistently reporting higher-than-average deaths
Authors: McDonagh Hull P , Boulton T , Lashewicz B
Published: February 2025

Background

This study aimed to identify hospital trusts in England most consistently reporting higher-than-average rates of extended perinatal mortality (EPM), including stillbirths and neonatal deaths.

Methods

We conducted a retrospective study of MBRRACE-UK Perinatal Mortality Surveillance Reports (2015–21) comparing EPM rates for births occurring in 124 hospital trusts in England between 2013 and 2019. Utilizing MBRRACE-UK definitions and designations, including coloured bands (red and amber indicate higher death rates), we devised a scoring method to determine which trusts most consistently reported higher-than-average rates of EPM throughout seven years.

Results

We identified 23 (18.5% of 124) ‘red flag’ trusts most consistently falling into MBRRACE-UK red and amber bands. They included Shrewsbury and Telford Hospitals NHS Trust (SaTH) and East Kent Hospitals University Trust, both under investigation during the parliamentary Health and Social Care Committee’s inquiry into the safety of maternity services in England. Seven trusts, including SaTH, reported higher-than-average deaths in all seven years. Indications of regional patterns were evident.

Conclusions

By examining maternity services mortality data over an extended period, patterns of clinical significance may emerge. We found evidence of a minority of trusts in England consistently reporting higher-than-average rates of EPM. These red flags may warrant further attention.
Repeated Evolution of Storage Root and Invasions of Alpine Biome Drove Replicated Radiations of the Megadiverse Corydalis (Papaveraceae) in the Qinghai–Tibet Plateau
Authors: Peng Huan-Wen , Ling Yuan-Yuan , Xiang Kun-Li , Erst Andrey S , Li Xiao-Qian , Lian Lian , Liu Bing , Erst Tatyana V , del C. Ortiz Rosa , Jabbour Florian , Wang Wei
Published: February 2025

The interplay of key innovation and ecological opportunity is commonly recognized to be the catalyst for rapid radiation. Underground storage organs (USOs), as a vital ecological trait, are advantageous for adaptation of plants to extreme environments, but receive less attention compared to aboveground organs. Repeated evolution of various USOs has occurred across the plant tree of life. However, whether repeated occurrences of a USO in different clades of a group can promote its replicated radiations in combination with the invasion of similar environments remains poorly known. Corydalis is a megadiverse genus in Papaveraceae and exhibits remarkable variations in USO morphology and biome occupancy. Here, we first generated a robust phylogeny for Corydalis with wide taxonomic and genomic coverage based on plastome and nuclear ribosomal DNA sequence data. By dating the branching events, reconstructing ancestral ranges, evaluating diversification dynamics, and inferring evolutionary patterns of USOs and biomes and their correlations, we then tested whether the interplay of USO evolution and biome shifts has driven rapid diversification of some Corydalis lineages. Our results indicate that Corydalis began to diversify in the Qinghai–Tibet Plateau (QTP) at ca. 41 Ma, and 88% of dispersals happened through forests, suggesting that forests served as important dispersal corridors for range expansion of the genus. The storage root has originated independently at least six times in Corydalis since the Miocene, and its acquisition could have operated as a key innovation towards the adaptation to the alpine biome in the QTP. Repeated evolution of this game-changing trait and invasions of alpine biome, in combination with geoclimatic changes, could have jointly driven independent radiations of the two clades of Corydalis in the QTP at ca. 6 Ma. Our study provides new insights into the joint contribution of USO repeated evolution and biome shifts to replicated radiations, hence increasing our ability to predict evolutionary trajectories in plants facing similar environmental pressures. [Biome shift; diversification rates; Papaveraceae; phylogenomics; Qinghai–Tibet Plateau; underground storage organs.]
Mast Cells are Key Mediators in the Pulmonary Inflammatory Response to Formaldehyde Exposure
Authors: Gibb Matthew , Reinert Angela N , Schedin Troy , Merrick Daniel T , Brown Jared M , Bauer Alison K
Published: February 2025

Formaldehyde (FA) is a common chemical linked to respiratory problems such as airway hyperresponsiveness and pulmonary inflammation. Due to its toxicological effects and ease of mass production, FA is also recognized as a significant chemical threat by the U.S. Department of Homeland Security. This study investigates the role of mast cells in the pulmonary inflammatory response to acute high dose FA exposure. Using wild type (C57BL/6J) and mast cell-deficient (KitW-sh) mouse models, we assessed the impact of oropharyngeal aspiration of FA on lung pathology. Our findings reveal that C57BL/6J mice experienced significant increases in cellular infiltration, altered immune cell populations, and changes in lipid mediator profiles. In contrast, KitW-sh mice exhibited significantly reduced inflammatory responses. Notably, the presence of mast cells was associated with enhanced dendritic cell migration and differential production of bioactive lipid mediators, such as specialized pro-resolving mediators and pro-inflammatory leukotrienes in C57BL/6J mice. These results highlight the crucial role of mast cells in the immune response to formaldehyde and suggest they could be therapeutic targets for treating FA-induced lung inflammation.
Pandemics Are a Continuing Danger, Warns Monitoring Board
Authors: Roush Karen
Published: February 2025

Nurses are key to educating the public and mitigating disease spread.
Applying TRIZ in Clinical Product Design
Authors: Zhang Xiao-dong , Zhao Yun-xia , Huo Yong-chao , Geng Yan
Published: February 2025

Using an inventive problem-solving theory in nurse–engineer collaborations
The Effects of the Physical and Professional Workplace Environments on the Well-Being of Nursing Staff
Authors: Jennings Rebecca , Outhwaite Ian , Granek Iris , Haq Farah
Published: February 2025

Background:

Nursing services are often compromised by excessive stress, burnout, and low job satisfaction. These experiences can cause nurses to leave jobs or the profession entirely, exacerbating staffing deficiencies that can have deleterious consequences for patient care.

Purpose:

The aim of this study was to determine which aspects of the physical and social hospital environments might be related to nurses' well-being. Identifying factors and intervening in areas that could reduce staff stress and burnout or improve job satisfaction could help combat nursing staff turnover and improve patient outcomes.

Methods:

A total of 2,115 nurses at one tertiary health care campus were anonymously surveyed using Qualtrics. Of these, 393 returned their surveys and provided informed consent. Outcome measures included overall psychological stress, burnout, job satisfaction, and job stress. Data were analyzed using SPSS Statistics software.

Results:

Nurses' appreciation of the physical workplace environment was strongly associated with a positive perception of outcome measures, notably job satisfaction. There was a strong correlation between all outcome measures and nurses' perception of control over their practice, independent of their perception of their physical environment.

Conclusion:

This study supports the idea that improvements in nurses' physical working environment can improve nursing staff well-being and job satisfaction. Notably, interventions that are designed to make it easier for nurses to perform their duties may have a positive impact on their well-being. In workplace environments, these include improving orientation, reducing excessive noise, and facilitating increased control over nursing practice by and for nursing staff.
Nationwide Assessment of Gestational Age Distribution at Delivery for Patients With Placenta Accreta Spectrum Disorder
Authors: Matsuo Koji , Einerson Brett D. , Matsuzaki Shinya , Pon Fay F. , Chavez Jimenez Zaira N. , Yao Jennifer A. , Buckley de Meritens Alexandre , Benipal Savvy , Givens Matthew B. , Mandelbaum Rachel S. , Ouzounian Joseph G. , Silver Robert M. , Wright Jason D.
Published: February 2025

OBJECTIVE:

To assess the distribution of gestational age at delivery for patients with placenta accreta spectrum (PAS) in the United States.

METHODS:

This serial cross-sectional study examined 26,375 hospital deliveries with a diagnosis code for PAS identified in the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project National Inpatient Sample from 2016 to 2021. Descriptive analysis was performed to evaluate the distribution of gestational age at delivery of patients with PAS and related obstetric characteristics. The incidence of PAS codes was also assessed among 21,212,493 hospital deliveries.

RESULTS:

The majority of patients with PAS delivered preterm (before 37 weeks of gestation, 56.9%); 43.1% delivered at term (37 weeks of gestation or more). Compared with patients with PAS who had preterm deliveries, those with PAS who had term deliveries were more likely to deliver vaginally (32.0% vs 6.9%) and in a rural-setting (9.7% vs 2.3%) or small-bed-capacity (18.6% vs 8.4%) hospital and were less likely to have placenta previa (9.3% vs 50.5%) and increta and percreta subtypes (8.6% vs 27.4%) (all P<.001). Incidences of hemorrhage or blood transfusion or both (62.9% vs 71.5%), shock or coagulopathy or both (6.2% vs 9.8%), hysterectomy (25.6% vs 65.3%), urinary tract injury (2.5% vs 10.0%), and maternal mortality (0.0% vs 0.2%) were lower for patients with PAS who had term compared with preterm deliveries (all P<.001). When any hospital deliveries were included in the analysis, 1 in every 804 delivering patients had a diagnosis of PAS. The incidence sharply decreased from 1 in 83–300 hospital deliveries in the preterm period to 1 in 705–3,037 hospital deliveries after 37 weeks of gestation. The incidence of PAS increased by 15.4% (95% CI, 10.7–20.4), from 114.8 to 132.5 per 100,000 hospital deliveries during the 6-year study period (P trend<.001).

CONCLUSION:

In this nationwide, cross-sectional study in the United States, nearly 40% of patients with PAS delivered at term and had distinct clinical and obstetric characteristics and outcomes compared with patients with PAS who delivered preterm. Continued increase in the incidence of PAS at the national level calls for attention and evaluation.
Is Pelvic Fixation a Risk Factor for Pelvic Incidence Change After Surgery for Adult Spinal Deformity? A Retrospective Analysis
Authors: Daher Mohammad , Roussouly Pierre , Aoun Marven , Kreichati Gaby , Kharrat Khalil , Sebaaly Amer
Published: February 2025

Study Design.

Retrospective analysis of prospectively collected data

Objective.

This study will evaluate whether the presence of pelvic fusion can affect this PI modification.

Background.

In Adult spinal deformity (ASD), restoring sagittal spinal alignment can positively modify the quality of life in patients post-operatively. Restoring this alignment is based on the measurement of the pelvic incidence (PI) which was postulated to be a constant value specific to each person. However, the literature has recently shown that this pelvic parameter can change after ASD surgery.

Methods.

This is a retrospective multicenter study of 290 patients who have undergone ASD surgery between 2012 and 2022. These patients were divided into two groups, group A who received pelvic fusion, and group B who did not. Post-operative PI change was defined by an absolute difference of ≥ 6° between pre- and post-operative values. Furthermore, patients were divided into 3 groups pre-operatively based on their PI: low (<40°), medium (40°-60°), and high (>60°).

Results.

Of the patients in group A, 80.0% had a change in PI compared to 12.8% in group B (Odds-Ratio=27.2 [13.8; 53.5], P<.001). Furthermore, this change occurred more frequently in males when compared to females (P=0.02). In addition, a logistic regression model controlling for gender, pre-operative PI groups, the change in lumbar lordosis and sacral slope, and pelvic fixation showed that only the latter predicted the post-operative change in PI with an adjusted odd-ratio of 26.3.

Conclusion.

In our cohort, 32.1% of the patients operated for ASD had a post-operative change of PI of ≥ 6° which was well within the reported range in the literature. Moreover, pelvic fusion was found to be the only independent risk factor for PI change with an adjusted OR of 26.3.
The in-vitro performance of a modern portable respirator in different lung models and as an alternative intensive care respirator
Authors: Schneider Celine Josianne , Both Christian Peter , Fries Daniel , Wendel-Garcia Pedro David , Buehler Philipp Karl , Grass Beate , Cannizzaro Vincenzo , Escher Christian , Schmitz Achim , Thomas Jörg
Published: February 2025

BACKGROUND

Transporting ventilated patients safely and without loss of efficacy is a challenge. Portable ventilators are generally used to transport critically ill patients, but their performance is often limited.

OBJECTIVE

This study aimed to compare the in-vitro performance of a modern portable respirator with a modern intensive care respirator for different lung settings.

DESIGN

An in-vitro testing of a portable and an intensive care respirator.

SETTINGS

Anaesthesia Department at the University Children's Hospital Zurich.

MAIN OUTCOME MEASURES

The portable respirator Hamilton T1 was compared with the established intensive care respirator bellavista1000 (BV) while applying different settings with the ASL 5000 (ASL) device. The ASL can simulate neonatal, paediatric, and adult lung settings with normal or impaired lung function. Accuracy of delivered tidal volumes, proximal and distal airway pressures and mechanical lung properties were assessed.

RESULTS

Bland-Altman analyses showed higher accuracy for applied tidal volumes delivered by the portable respirator, 12.6% [95% confidence interval (CI) −8.9 to 34.2], compared with the intensive care respirator, 15.9% (95% CI −18.5 to 50.3). In neonatal and infant lung models particularly, the accuracy of delivered tidal volumes by the portable respirator, 13.2% (95% CI −8.9 to 35.3) was superior to those delivered by the intensive care respirator, 20.9% (95%CI −15.9 to 57.7). Lung compliance estimation was performed more accurately by the intensive care respirator, whereas the portable respirator measured airway resistance more accurately. However, both respirators showed only moderate overall accuracy when assessing lung mechanics.

CONCLUSION

The tested portable respirator proved to be a useful device for invasive ventilation of critically ill patients. The overall performance is non-inferior to a conventional intensive care respirator.
Hypothesis: reactive increases in plasma renin activity attenuate the fall in blood pressure caused by salt depletion and renin–angiotensin system inhibition
Authors: Sealey Jean E. , Blumenfeld Jon D.
Published: February 2025

There are inconsistencies in the effect of raising or lowering body salt on blood pressure (BP). We hypothesize that they are caused in part by differences in plasma renin activity (PRA). PRA changes reciprocally with body salt. PRA is the rate limiting step in the formation of the vasoconstrictor peptide angiotensin II (Ang II) in the circulation where it cleaves Ang I from plasma angiotensinogen, and then Ang I is rapidly converted to Ang II by angiotensin-converting enzyme in plasma and vascular endothelial cells. We hypothesize that PRA levels above 0.65 ng/ml/h lead to sufficient Ang II production to cause vasoconstriction, whereas lower levels do not. PRA is usually more than 0.65 in normotensives who are not on a high-salt diet; in them, the increase in PRA/Ang II vasoconstriction caused by reduction in body salt (low-salt diet, diuretic use) is large enough to prevent BP from falling. By contrast, a similar reduction in body salt lowers BP in the 30% of hypertensive patients with low baseline PRA (<0.65 ng/ml/h), because vasoconstriction does not increase in that range. A similar reduction in body salt also lowers BP in the 60% of hypertensive patients with baseline PRA between 0.65 and 4.5 ng/ml/h, but for a different reason; the rise in PRA and the increase in vasoconstriction is too small to prevent BP from falling. However, after body salt has been reduced enough to raise PRA above 4.5 ng/ml/h, further salt depletion increases PRA to a greater extent, and BP does not fall. Renin–angiotensin system (RAS) inhibitors leave a small amount of renin unblocked. In salt-depleted hypertensive patients, they also raise PRA enough to prevent BP from falling significantly. We propose that this PRA/Ang II vasoconstrictor effect related to reactive increases in PRA can prevent or attenuate the decrease in BP caused by excessive salt depletion, even during concurrent RAS inhibition. This phenomenon, if confirmed, could inform new strategies to optimize the treatment of hypertension, cardiovascular disease (CVD) and chronic kidney disease (CKD).
Combined Intravitreal Aflibercept and Anti-inflammatory Oral Supplementation in the Treatment of Diabetic Macular Edema: Two-Year Randomized Controlled Trial Results
Authors: Marolo Paola , Volti Giovanni Li , Nicolosi Anna , Avitabile Teresio , Longo Antonio , Fallico Matteo , Russo Andrea , Borrelli Enrico , Parisi Guglielmo , Toro Mario Damiano , de Sanctis Ugo , Motta Lorenzo , Reibaldi Michele
Published: February 2025

Purpose:

To compare intravitreal aflibercept alone versus aflibercept combined with oral anti-inflammatory supplementation in patients with diabetic macular edema (DME).

Methods:

A prospective, randomized study included 134 treatment-naive eyes with central-involving DME. Participants were assigned to receive either intravitreal aflibercept (Group A) or aflibercept with oral Lenidase® supplementation (Group B, containing baicalin, bromelain, and escin). Both groups followed a treat-and-extend (T&E) regimen. The primary outcome was the number of injections over 24 months. Secondary outcomes included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and safety assessments.

Results:

At 24 months, Group A required a mean of 14.34 ± 0.51 injections, while Group B required 12.96 ± 0.44 (P < 0.0001). Both groups showed significant improvement in BCVA: from 0.62 ± 0.12 logMAR (20/83 Snellen) to 0.43 ± 0.13 logMAR (20/54 Snellen) in Group A and from 0.64 ± 0.13 logMAR (20/87 Snellen) to 0.42 ± 0.15 logMAR (20/53 Snellen) in Group B (P < 0.0001 for both). CMT also significantly decreased in both groups (P < 0.0001). No significant differences were found between the groups for vision improvement (P=0.918) or CMT reduction (P=0.777). No ocular complications were reported.

Conclusions:

Oral supplementation with Lenidase® showed similar efficacy to aflibercept monotherapy in DME, with fewer injections, potentially reducing treatment burden.
Prevention and management of postcataract cystoid macular edema
Authors: Paruchuri Satya S. , Mahmoudzadeh Raziyeh , Wheeler Sydney , Randolph Jessica
Published: February 2025

Purpose of review

This review highlights treatment options, both under investigation and currently available, for treating postcataract macular edema. An update on current clinical studies for postcataract macular edema has been summarized.

Recent findings

Pseudophakic cystoid macular edema (PCME) is a common complication of cataract surgery leading to decreased visual acuity due to inflammation promoting vascular permeability and macular edema. There is no gold standard protocol for treatment with physicians choosing topical NSAIDs and corticosteroids most commonly. Recent developments in a therapeutic approach to PCME include improved delivery methods via implantation and improved drugs and combinational therapies.

While PCME treatments are poorly studied due to their common sudden resolution without medical intervention, chronic PCME is debilitating for patients. Clinical studies show hope for improved drug delivery methods, practices to prevent potential PCME, and improved therapeutics.
Longitudinal chop against hard/thick nuclear cataracts to reduce strain on the zonule of Zinn
Authors: Hama Yuki , Akimoto Masayuki
Published: February 2025

In nucleofractis during cataract surgery, inserting an ultrasound (US) tip near the posterior part of the nucleus is difficult in the limited space available. While disassembling harder/thicker nuclear cataracts, surgeons may damage the zonule of Zinn by pushing on the nucleus with the phacochopper and phaco-tip. In this study, a chop technique is described in which the phacochopper is inserted from the posterior part of the nucleus and the US tip from the anterior part, sandwiching the nucleus longitudinally to facilitate its crushing. The nucleus was successfully disassembled in a second and third division. US time and mean cumulative dissipated energy (grade III), and corneal endothelial cell loss (grade IV) were significantly lower with this technique. Supporting the nucleus from below with a phacochopper can be useful for advanced cataracts cases and those with a weak zonule.
Long-term stability of an artificial iris and intraocular lens complex fixated through the Yamane technique in traumatic aniridia and aphakia
Authors: Lam Brandon Chau , Das Prerna , Madaik Harsh , Khalaf Hamzah , Waldman Corey
Published: February 2025

Introduction:

Traumatic aniridia and aphakia can be difficult to manage surgically. In this study, we describe a case managed with scleral fixation with flanged intraocular lens (IOL) haptics (Yamane technique) in combination with an artificial iris in a case of traumatic aniridia and aphakia with demonstration of long-term stability.

Patient and Clinical Findings:

A 68-year-old woman with a history of traumatic aniridia and aphakia complicated by glaucoma with Ahmed tube shunt placement presented with significant photophobia and poor tolerance to vision correction through contact lens or spectacles.

Diagnosis, Intervention, and Outcomes:

The patient underwent implantation of an artificial iris and IOL lens complex scleral fixated through the Yamane technique with improved postoperative function and aesthetics that remained stable for 4 years with the eventual development of corneal decompensation from declining endothelial cell count secondary to trauma, multiple surgeries, and the existing tube shunt.

Conclusions:

Artificial iris and IOL complex scleral fixation can be implanted through the Yamane technique with excellent structural stability and improved visual function in traumatic aniridia and aphakia; however, these cases can eventually result in corneal endothelial decompensation long-term.
Age-Specific Relationship between Prolonged Sedentary Time and Low Handgrip Strength: Stronger Impact Among Young Korean Workers (KNHANES 2016-2019)
Authors: Yang Junsu , Lee Wanhyung
Published: February 2025

Objective

This study examined the relationship between sedentary time and handgrip strength with age-group stratification.

Methods

This study used 11,295 Korean workers. Participants were divided into two age groups: ≤39 and ≥ 40 years. Handgrip strength was measured, and sedentary time was self-reported. Multiple logistic and linear regression models were used to examine the association between sedentary time and handgrip strength.

Results

Those with ≥6 hours of daily sedentary time had slightly higher odds of low handgrip strength, though not significant overall (OR 1.09, 95% CI 0.95-1.26). However, younger adults with high sedentary time showed significantly higher odds (OR 1.55, 95% CI 1.13-2.12). Linear regression also indicated a stronger negative association in younger adults.

Conclusions

Interventions to reduce sedentary time could help maintain muscle strength, especially in younger populations.
Association of Menstrual-related Symptoms and Presenteeism: A Cross-sectional Study of Working Women in Japan
Authors: Koh Sumire , Okawara Makoto , Hirashima Keiki , Kuwazuru Tomoichiro , Yamashita Satoshi , Ohkubo Naoaki , Tateishi Seiichiro , Fujino Yoshihisa
Published: February 2025

Objective

This study aimed to examine the association between menstruation-related symptoms and presenteeism.

Methods

The study was conducted under a cross-sectional design using an Internet survey of working women from December 7 to 18, 2023. The analysis included 3332 working women with menstruation. Questions listing specific symptoms were used to identify menstrual symptoms. The Work Functioning Impairment Scale (WFun) was used to measure presenteeism. Poisson regression analysis with robust variance was performed with presenteeism as the dependent variable and each menstrual symptom as the independent variable.

Results

Prevalence ratio for presenteeism increased with increasing symptom severity for each menstrual symptom on both age-adjusted and multivariable analysis (all p-values for trend <0.001).

Conclusions

This study found that the greater the severity of menstrual symptoms, the higher the level of presenteeism.
Return to Work and Cost Implications of Physical Therapy in Conjunction with Rotator Cuff Repair in the Treatment of Work-Related Rotator Cuff Tears
Authors: Bernacki Edward J. , Tsourmas Nicholas F. , Hunt Dan L. , Kalia Nimisha , Leung Nina , Yuspeh Larry , Green-McKenzie Judith , Kauffman Paul , Tao Xuguang (Grant)
Published: February 2025

Objective

Assess the utilization and costs of physical therapy (PT) and rotator cuff repair (RCR) in the treatment of work-related rotator cuff tears (RCT).

Methods

8,814 lost-time RCT claims filed to a nationwide workers’ compensation insurance carrier from 2007 to 2022 were investigated.

Results

89.1% of claimants with RCTs received both PT and RCR, 8.6% received PT only, and 2.0% had only an RCR. PT accounted for 19.9% of medical costs on average. RCT claimants, who had RCR without PT and no PT or RCR, had the shortest times out from work. Increasing amounts of PT treatment was associated with longer lost time and higher claim costs.

Conclusion

The addition of PT to RCR is associated with increasing time off work and claim costs proportionate to the duration of PT rendered.
The effect of ketamine-assisted group therapy on treatment-resistant mental health conditions in firefighters: a prospective observational case series
Authors: Tsang Vivian WL , Lin Michelle CQ , Choles Cassandra M , Kryskow Pamela
Published: February 2025

Objective

Firefighters display elevated risk for diagnoses of mental health illnesses. Psychedelic-assisted therapies show promise in the treatment of clinically challenging conditions. This observational case series analyzed data from firefighters with mental health diagnoses who participated in a 12-week ketamine-assisted group therapy treatment plan.

Methods

Questionnaire scores (GAD-7; PHQ-9; PCL-5; B-IPF) collected throughout the program were scored and statistically analyzed for changes. Qualitative data were analyzed through thematic analysis.

Results

Significant decreases with large effect sizes were detected in GAD-7 and PCL-5 scores post-completion in the 12-week treatment plan, which persisted 6 months later. Participants noted it was beneficial being in a cohort with fellow firefighters.

Conclusions

Statistically and clinically significant improvements to PTSD and anxiety diagnoses were detected in the cohort of firefighters after the RTT-KAT program, with results retained six months post treatment.