bluuebunny/crossref_metadata_2025 huggingface dataset:
Creeping Fat in the Pathogenesis of Crohn’s Disease: An Orchestrator or a Silent Bystander?
Authors: Tsounis Efthymios P , Aggeletopoulou Ioanna , Mouzaki Athanasia , Triantos Christos
Published: June 2023

Although the phenomenon of hypertrophied adipose tissue surrounding inflamed bowel segments in Crohn’s disease has been described since 1932, the mechanisms mediating the creeping fat formation and its role in the pathogenesis of the disease have not been fully unraveled. Recent advances demonstrating the multiple actions of adipose tissue beyond energy storage have brought creeping fat to the forefront of scientific research. In Crohn’s disease, dysbiosis and transmural injury compromise the integrity of the intestinal barrier, resulting in an excessive influx of intraluminal microbiota and xenobiotics. The gut and peri-intestinal fat are in close anatomic relationship, implying a direct reciprocal immunologic relationship, whereas adipocytes are equipped with an arsenal of innate immunity sensors that respond to invading stimuli. As a result, adipocytes and their progenitor cells undergo profound immunophenotypic changes, leading to adipose tissue remodeling and eventual formation of creeping fat. Indeed, creeping fat is an immunologically active organ that synthesizes various pro- and anti-inflammatory cytokines, profibrotic mediators, and adipokines that serve as paracrine/autocrine signals and regulate immune responses. Therefore, creeping fat appears to be involved in inflammatory signaling, which explains why it has been associated with a higher severity or complicated phenotype of Crohn’s disease. Interestingly, there is growing evidence for an alternative immunomodulatory function of creeping fat as a second barrier that prevents an abnormal systemic inflammatory response at the expense of an increasingly proliferating profibrotic environment. Further studies are needed to clarify how this modified adipose tissue exerts its antithetic effect during the course of Crohn’s disease.
Nurses’ preferences for the format of care planning clinical decision support coded with standardized nursing languages
Authors: Dos Santos Fabiana Cristina , Yao Yingwei , Macieira Tamara G R , Dunn Lopez Karen , Keenan Gail M
Published: June 2023

Current electronic health records (EHRs) are often ineffective in identifying patient priorities and care needs requiring nurses to search a large volume of text to find clinically meaningful information. Our study, part of a larger randomized controlled trial testing nursing care planning clinical decision support coded in standardized nursing languages, focuses on identifying format preferences after random assignment and interaction to 1 of 3 formats (text only, text+table, text+graph). Being assigned to the text+graph significantly increased the preference for graph (P = .02) relative to other groups. Being assigned to the text only (P = .06) and text+table (P = .35) was not significantly associated with preference for their assigned formats. Additionally, the preference for graphs was not significantly associated with understanding graph content (P = .19). Further studies are needed to enhance our understanding of how format preferences influence the use and processing of displayed information.
Challenges and opportunities in green hydrogen supply chain through metaheuristic optimization
Authors: Gorji Saman A
Published: June 2023

A comprehensive analysis of the green hydrogen supply chain is presented in this paper, encompassing production, storage, transportation, and consumption, with a focus on the application of metaheuristic optimization. The challenges associated with each stage are highlighted, and the potential of metaheuristic optimization methods to address these challenges is discussed. The primary method of green hydrogen production, water electrolysis through renewable energy, is outlined along with the importance of its optimization. Various storage methods, such as compressed gas, liquid hydrogen, and material-based storage, are covered with an emphasis on the need for optimization to improve safety, capacity, and performance. Different transportation options, including pipelines, trucks, and ships, are explored, and factors influencing the choice of transportation methods in different regions are identified. Various hydrogen consumption methods and their associated challenges, such as fuel cell performance optimization, hydrogen-based heating systems design, and energy conversion technology choice, are also discussed. The paper further investigates multi-objective approaches for the optimization of problems in this domain. The significant potential of metaheuristic optimization techniques is highlighted as a key to addressing these challenges and improving overall efficiency and sustainability with respect to future trends in this rapidly advancing area.
‘He Offered a Prayer for the Flier He Had Just Killed’
Authors: Fellows Jamie , Chong Mark David
Published: June 2023

The US Army war crimes trials held in Manila from 1945 to 1947 prosecuted around 200 Japanese military personnel for war crimes committed against US prisoners of war and Filipino non-combatants. Japanese defendants attempted to argue, with little success, that the defence of superior orders justified their actions. General Douglas MacArthur (Supreme Commander for the Allies in the Pacific or SCAP) was adamant that superior orders would not serve to excuse alleged Japanese war criminals from war crimes. What is clear from the trial documents and other archival material from Manila is that not all sections of the prosecution agreed with MacArthur’s interpretation of the law. However, it seems as though MacArthur’s pronouncement in relation to the application of superior orders may have had a profound impact on not only the Manila trials, but also with subsequent trials in World War II and beyond. This article explores the various arguments in relation to superior orders emanating from the US Army trials in Manila. The trials in Manila show that the rejection of superior orders as a defence in war crimes offered a reasonable foundation and precedent for how subsequent courts and tribunals evaluated the defence of superior orders within the context of war crimes jurisprudence.
Permissive and regulative norms in deontic logic
Authors: Olszewski Maya , Parent Xavier , Van der Torre Leendert
Published: June 2023

This article provides a systematic analysis of the well-known notions of weak and strong permission in input/output (I/O) logic. We extend the account of permission initially put forward by Makinson and Van der Torre to the whole family of I/O systems developed during the last two decades. The main contribution is a series of characterization results for strong permission, based on establishing the so-called non-repetition property. We also study an input/output logic not yet covered in the literature. It supports reasoning by cases—a natural feature of human reasoning. The output is not closed under logical entailment. At the same time, it avoids excess output using a consistency check—a technique familiar from non-monotonic logic. This makes it well suited for contrary-to-duty reasoning. The axiomatic characterization is in terms of a generalized OR rule. We discuss the implications of all this for our understanding of the notion of the coherence of a normative system. Topics for future research are identified.1
Minute-cadence observations of the LAMOST fields with the TMTS: II. Catalogues of short-period variable stars from the first 2-yr surveys
Authors: Lin Jie , Wang Xiaofeng , Mo Jun , Xi Gaobo , Filippenko Alexei V , Yan Shengyu , Brink Thomas G , Yang Yi , Wu Chengyuan , Németh Péter , Li Gaici , Guo Fangzhou , Guo Jincheng , Cai Yongzhi , Xiong Heran , Zheng WeiKang , Liu Qichun , Zhang Jicheng , Jiang Xiaojun , Chen Liyang , Xia Qiqi , Peng Haowei , Chen Zhihao , Li Wenxiong , Lin Weili , Xiang Danfeng , Ma Xiaoran , Liu Jialian
Published: June 2023

Over the past few years, wide-field time-domain surveys such as Zwicky Transient Facility and Optical Gravitational Lensing Experiment have led to discoveries of various types of interesting short-period stellar variables, such as ultracompact eclipsing binary white dwarfs (WDs), rapidly rotating magnetized WDs, transitional cataclysmic variables between hydrogen-rich and helium accretion, and blue large-amplitude pulsators (BLAPs), which greatly enrich our understandings of stellar physics under some extreme conditions. In this paper, we report the first-2-yr discoveries of short-period variables (i.e. P < 2 h) by the Tsinghua University–Ma Huateng Telescopes for Survey (TMTS). TMTS is a multitube telescope system with a field of view up to 18 deg2, which started to monitor the Large Sky Area Multi-object Fiber Spectroscopic Telescope (LAMOST) sky areas since 2020 and generated uninterrupted minute-cadence light curves for about 10 million sources within 2 yr. Adopting the Lomb–Scargle periodogram with period-dependent thresholds for the maximum powers, we identify over 1100 sources that exhibit a variation period shorter than 2 h. Compiling the light curves with the Gaia magnitudes and colours, LAMOST spectral parameters, International Variable Star Index classifications, and archived observations from other prevailing time-domain survey missions, we identified 1076 as δ Scuti stars, which allows us to study their populations and physical properties in the short-period regime. The other 31 sources include BLAPs, subdwarf B variables, pulsating WDs, ultracompact/short-period eclipsing/ellipsoidal binaries, cataclysmic variables below the period gap, etc., which are highly interesting and worthy of follow-up investigations.
The biotic and abiotic drivers of timing of breeding and the consequences of breeding early in a changing world
Authors: Sutton Alex O , Freeman Nikole E
Published: June 2023

The decision of when to breed is an important determinant of individual fitness. However, despite a multitude of studies investigating the intraspecific relationship between timing of breeding and reproductive performance, less is known about why the strength of this relationship varies between species. Furthermore, environmental change has the potential to alter the relationship between lay date and fitness, but there is still a limited understanding of what mechanisms drive these differential responses to change environmental conditions. We propose that the potential effects of environmental change on the relationship between timing of breeding and fitness are dependent on 2 primary factors: (1) the potential constraints imposed by breeding early and (2) the drivers of higher fitness of early breeders. We first summarize multiple hypotheses proposed to explain why breeding early, either based on absolute date or relative to conspecifics, increases fitness. We then summarize the factors that may constrain when individuals initiate breeding, including limits on the ability to advance their lay date or extend the length of their breeding season under favorable conditions. Understanding constraints on the timing of breeding allows for the identification of obligate (single-brooded species that do not attempt to breed after a specific date) and facultative (predominantly multi-brooding species that have long breeding seasons) early breeding species that are likely differently affected by climate change. Finally, we propose a simple mathematical formula that incorporates the costs and benefits associated with early breeding to quantify how climate change could influence the benefits of early breeding and either mitigate or exacerbate the costs. Our cost-benefit approach provides a clear framework to predict how species may shift the timing of their breeding to maximize fitness in a changing world.
The Cost-Effectiveness of a Novel Online Social Therapy to Maintain Treatment Effects From First-Episode Psychosis Services: Results From the Horyzons Randomized Controlled Trial
Authors: Engel Lidia , Alvarez-Jimenez Mario , Cagliarini Daniela , D’Alfonso Simon , Faller Jan , Valentine Lee , Koval Peter , Bendall Sarah , O’Sullivan Shaunagh , Rice Simon , Miles Chris , Penn David L , Phillips Jess , Russon Penni , Lederman Reeva , Killackey Eoin , Lal Shalini , Maree Cotton Sue , Gonzalez-Blanch Cesar , Herrman Helen , McGorry Patrick D , Gleeson John F M , Mihalopoulos Cathrine
Published: June 2023

Background

Digital interventions have potential applications in promoting long-term recovery and improving outcomes in first-episode psychosis (FEP). This study aimed to evaluate the cost-effectiveness of Horyzons, a novel online social therapy to support young people aged 16–27 years following discharge from FEP services, compared with treatment as usual (TAU) from a healthcare sector and a societal perspective.

Study design

A cost-effectiveness analysis (CEA), based on the change in social functioning, and a cost-utility analysis (CUA) using quality-adjusted life years were undertaken alongside a randomized controlled trial. Intervention costs were determined from study records; resources used by patients were collected from a resource-use questionnaire and administrative data. Mean costs and outcomes were compared at 18 months and incremental cost-effectiveness ratios were calculated. Uncertainty analysis using bootstrapping and sensitivity analyses was conducted.

Study results

The sample included 170 participants: Horyzons intervention group (n = 86) and TAU (n = 84). Total costs were significantly lower in the Horyzons group compared with TAU from both the healthcare sector (–AU$4789.59; P < .001) and the societal perspective (–AU$5131.14; P < .001). In the CEA, Horyzons was dominant, meaning it was less costly and resulted in better social functioning. In the CUA, the Horyzons intervention resulted in fewer costs but also yielded fewer QALYs. However, group differences in outcomes were not statistically significant. When young people engaged more with the platform, costs were shown to decrease and outcomes improved.

Conclusions

The Horyzons intervention offers a cost-effective approach for improving social functioning in young people with FEP after discharge from early intervention services.
Mechanistic investigation of liver injury induced by BMS-932481, an experimental ɣ-secretase modulator
Authors: Zhuo Xiaoliang , Howell Brett A , Shen Hong , Woodhead Jeffrey L , Mosure Kathy , Zhang Yueping , Scialis Renato J , Iyer Ramaswamy , Sun Yongnian , Boy Kenneth M , Lentz Kimberley A , Denton R Rex , Soars Matthew G , Johnson Benjamin M , Humphreys W Griffith
Published: June 2023

BMS-932481 was designed to modulate ɣ-secretase activity to produce shorter and less amyloidogenic peptides, potentially averting liabilities associated with complete enzymatic inhibition. Although it demonstrated the intended pharmacology in the clinic, BMS-932481 unexpectedly caused drug-induced liver injury (DILI) in a multiple ascending dose study characterized by dose- and exposure-dependence, delayed onset manifestation, and a high incidence of hepatocellular damage. Retrospective studies investigating the disposition and probable mechanisms of toxicity of BMS-932481 are presented here. These included a mass balance study in bile-duct-cannulated rats and a metabolite profiling study in human hepatocytes, which together demonstrated oxidative metabolism followed by biliary elimination as the primary means of disposition. Additionally, minimal protein covalent binding in hepatocytes and lack of bioactivation products excluded reactive metabolite formation as a probable toxicological mechanism. However, BMS-932481 and 3 major oxidative metabolites were found to inhibit the bile salt export pump (BSEP) and multidrug resistance protein 4 (MRP4) in vitro. Considering human plasma concentrations, the IC50 values against these efflux transporters were clinically meaningful, particularly in the high dose cohort. Active uptake into human hepatocytes in vitro suggested the potential for hepatic levels of BMS-932481 to be elevated further above plasma concentrations, enhancing DILI risk. Conversely, measures of mitochondrial functional decline in hepatocytes treated with BMS-932481 were minimal or modest, suggesting limited contributions to DILI. Collectively, these findings suggested that repeat administration of BMS-932481 likely resulted in high hepatic concentrations of BMS-932481 and its metabolites, which disrupted bile acid transport via BSEP and MRP4, elevating serum biomarkers of liver injury.
Comparative Genomics of Xanthomonas translucens pv. undulosa Strains Isolated from Weedy Grasses and Cultivated Wild Rice
Authors: Ledman Kristi E. , Roman-Reyna Veronica , Curland Rebecca D. , Heiden Nathaniel , Jacobs Jonathan M. , Dill-Macky Ruth
Published: June 2023

Bacterial leaf streak (BLS) of wheat ( Triticum aestivum), caused by Xanthomonas translucens pv. undulosa, is a disease of major concern in the Northern Great Plains. The host range for X. translucens pv. undulosa is relatively broad, including several small grains and perennial grasses. In Minnesota, X. translucens pv. undulosa was isolated from weedy grasses in and around wheat fields that exhibited BLS symptoms and from cultivated wild rice ( Zizania palustris) with symptomatic leaf tissue. Currently, no genomic resources are available for X. translucens pv. undulosa strains isolated from non-wheat hosts. In this study, we sequenced and assembled the complete genomes of five strains isolated from weedy grass hosts, foxtail barley ( Hordeum jubatum), green foxtail ( Setaria viridis), and wild oat ( Avena fatua), and from cultivated wild rice and wheat. These five genomes were compared with the publicly available genomes of seven X. translucens pv. undulosa strains originating from wheat and one genome of an X. translucens pv. secalis strain originating from rye ( Secale cereale). Global alignments of the genomes revealed little variation in genomic structures. Average nucleotide identity-based phylogeny and life identification numbers revealed that the strains share ≥99.25% identity. We noted differences in the presence of Type III secreted effectors, including transcription activator-like effectors. Despite differences between strains, we did not identify unique features distinguishing strains isolated from wheat and non-wheat hosts. This study contributes to the availability of genomic data for X. translucens pv. undulosa from non-wheat hosts, thus increasing our understanding of the diversity within the pathogen population.
Effect of Frailty on Hospital Outcomes Among Pediatric Cancer Patients in the United States
Authors: Conroy Abigail , Zhang Vicky , Kaito Max , Ramamoorthy Venkataraghavan , Roy Mukesh , Ahmed Md Ashfaq , Zhang Zhenwei , McGranaghan Peter , Appunni Sandeep , Saxena Anshul , Rubens Muni , Cristian Adrian
Published: June 2023

Background:

Studies on frailty among pediatric patients with cancer are scarce. In this study, we sought to understand the effects of frailty on hospital outcomes in pediatric patients with cancer.

Methods:

This retrospective study used data collected and stored in the Nationwide Inpatient Sample (NIS) between 2005 and 2014. These were hospitalized patients and hence represented the sickest group of patients. Frailty was measured using the frailty definition diagnostic indicator by Johns Hopkins Adjusted Clinical Groups.

Results:

Of 187,835 pediatric cancer hospitalizations included in this analysis, 11,497 (6.1%) were frail. The average hospitalization costs were $86,910 among frail and $40,358 for nonfrail patients. In propensity score matching analysis, the odds of in-hospital mortality (odds ratio, 2.08; 95% CI, 1.71-2.52) and length of stay (odds ratio, 3.76; 95% CI, 3.46-4.09) were significantly greater for frail patients. The findings of our study suggest that frailty is a crucial clinical factor to be considered when treating pediatric cancer patients in a hospital setting.

Conclusions:

These findings highlight the need for further research on frailty-based risk stratification and individualized interventions that could improve outcomes in frail pediatric cancer patients. The adaptation and validation of a frailty-defining diagnostic tool in the pediatric population is a high priority in the field.
Implementing Standard Physical Therapy Guidelines With Patients Acutely After Single or Bilateral Lung Transplant: A Quality Improvement Project in the Hospital Setting
Authors: Connors Catherine , Betts Traci , Lawrence Shelby , Walag Homer B. , Buchl Julie , Kaza Vaidehi
Published: June 2023

Purpose:

A quality initiative assessed standardized physical therapy (SPT) with lung transplant (LT) recipients in the hospital setting. The objective was to improve physical function evidenced by 6-minute walk distance (6MWD) and 30-second chair stand test (30s-CST).

Methods:

Standardized physical therapy was implemented with patients who underwent LT after March 8, 2021. Data were collected from July 19, 2019 to July 23, 2020 as baseline measures. Six-minute walk distance and 30s-CST were measured after hospital discharge.

Results:

After data collection, statistical analysis included descriptive statistics and a 2-sample t test with P-value <.05. The baseline group (BG) consisted of 19 patients that participated in traditional physical therapy (PT). The BG mean 6MWD was 891 feet, and mean 30s-CST was 4 repetitions. The SPT group consisted of 25 patients. The SPT group demonstrated a mean 6MWD of 1054 feet with a P-value of 0.0299 and mean 30s-CST of 7 repetitions with a P-value of 0.078.

Conclusions:

All functional outcome measures improved, with the 6MWD demonstrating statistical significance. Hospitalized LT recipients may demonstrate improved physical function with SPT; however, limited conclusions can be made.
Transanal Minimally Invasive Surgical Approach to Total Pelvic Exenteration
Authors: Beppu Naohito , Song Jihyung , Takenaka Yuuya , Kimura Kei , Kataoka Kozo , Uchino Motoi , Ikeuchi Hiroki , Ikeda Masataka
Published: June 2023

BACKGROUND:

Total pelvic exenteration, a surgical procedure for patients with highly advanced primary and recurrent rectal cancer, is technically demanding.

IMPACT OF INNOVATION:

We report the utility of a transanal minimally invasive surgical approach to total pelvic exenteration.

TECHNOLOGY‚ MATERIALS‚ AND METHODS:

A 2-team approach with a laparoscopic transabdominal approach and transanal minimally invasive surgery was adopted. During the transabdominal approach in the pelvis, dissection was performed to remove the pelvic organs and visceral branches of the internal iliac vessels. The dissection goal via the transabdominal approach is the levator ani. During the transperineal approach, dissection is performed along the levator ani, and the tendinous arch of the levator ani is penetrated at the lateral side to achieve rendezvous between the 2 approaches. The levator ani is then dissected circumferentially, with identification of the internal pudendal vessels passing through the levator ani at the 4 o’clock and 8 o’clock positions, known as Alcock’s canal. The anterior wall of Alcock’s canal is formed by the coccygeus muscle and sacrospinous ligament, which are dissected by the transperineal approach to open Alcock’s canal, thus obtaining a clear view of the internal pudendal vessels. On the anterior side, the urethra is divided with a laparoscopic linear stapler via the transperineal approach.

PRELIMINARY RESULTS:

Eight patients with rectal cancer underwent this procedure. The median (range) blood loss was 200 (120–1520) mL and operating time was 467 (321–833) minutes. Reoperation was performed in 1 internal hernia case; however, there were no mortalities, and there were no cases with severe complications or conversion to open surgery.

CONCLUSIONS AND FUTURE DIRECTIONS:

When performing total pelvic exenteration, transanal minimally invasive surgery offers direct visualization behind the tumor from the anal side and shows the deep pelvic structures, including the retroperitoneal space of the pelvic sidewall.
Serum uric acid to creatinine ratio and risk of preeclampsia and adverse pregnancy outcomes
Authors: Piani Federica , Agnoletti Davide , Baracchi Alessandro , Scarduelli Sara , Verde Carmine , Tossetta Giovanni , Montaguti Elisa , Simonazzi Giuliana , Degli Esposti Daniela , Borghi Claudio
Published: June 2023

Objective:

Preeclampsia is one of the most severe diseases among the hypertensive disorders of pregnancy (HDP) and the leading cause of maternal and fetal morbidity and mortality. It is of crucial importance to early identify women at a high risk for preeclampsia to implement appropriate preventive strategies. In our study, we aimed to test the hypothesis that serum uric acid to creatinine ratio (SUA/sCr) is related to the development of preeclampsia and maternal and neonatal complications.

Methods:

We searched for uric acid and creatine values in the medical records of 269 women who consecutively attended our HDP Clinic from December 2018 to December 2022. We compared the baseline characteristics of participants with normotensive pregnancy (n = 57), to those with HDP without preeclampsia (HDP-non-PE) (n = 100) and those with preeclampsia (n = 112), and we performed adjusted logistic regression analysis to test the associations between SUA/sCr and the development of preeclampsia and maternal and neonatal complications.

Results:

SUA/sCr was consistently higher in women with preeclampsia in all trimesters of pregnancy. Higher SUA/sCr at the third trimester was associated with an increased odd of developing preeclampsia [odds ratio (OR) 1.29, confidence interval (CI) 1.15–1.50, P = 0.001], preterm birth (OR 1.23, CI 1.05–1.45, P = 0.011), and composite neonatal outcome (OR 1.33, CI 1.12–1.59, P = 0.001), after adjustment for age, BMI before pregnancy, nulliparity, antihypertensive therapy, and acetylsalicylic acid therapy during pregnancy.

Conclusions:

Having higher SUA/sCr during pregnancy is associated with the development of PE and adverse pregnancy outcomes. Controlled prospective studies are warranted to clarify the predictive power of this novel marker during pregnancy.
Comparison of therapeutic effect of catheter direct thrombolysis and peripheral venous thrombolysis on acute pulmonary embolism
Authors: Guan Qinglong , Liu Chenglong , Li Wei , Wang Xiaofei , Chen Haibo , Li Gang , Li Tongfei
Published: June 2023

We compared the therapeutic effect of catheter direct thrombolysis (CDT) and peripheral venous thrombolysis (PVT) for patients with acute pulmonary embolism (APE). Totally, 74 patients with APE were enrolled, including 37 in the CDT group and 37 in the PVT group. The changes in clinical indicators pre and posttreatment were observed. Clinical efficacy was evaluated. Kaplan–Meier method was used to analyze the survival of patients during follow-up. In both the PVT group and CDT group, partial pressure of oxygen after treatment increased significantly than that before treatment (P < .05). However, in both groups, the levels of partial pressure of carbon dioxide, D-dimer, B-type brain natriuretic peptide, pulmonary arterial pressure, and thrombus volume after treatment were significantly decreased than those before treatment (P < .05). After treatment, patients from the CDT group had significantly lower D-dimers, partial pressure of carbon dioxide, brain natriuretic peptide, and pulmonary arterial pressure, and significantly higher partial pressure of oxygen compared to patients from the PVT group (P < .05). The total effective rate was 97.2% in the CDT group and 81.0% in the PVT group. The bleeding incidence in the CDT group was significantly lower than that in the PVT group (P < .05). The median survival time in the CDT group was significantly longer than that in the PVT group (P < .05). CDT can more effectively improve symptoms, cardiac function, and survival rate of APE patients while reducing bleeding incidence than PVT, and thus is safe and effective in treating APE.
Proliferative verrucous/multifocal leukoplakia: Updates and literature review “case report”
Authors: Alsoghier Abdullah , AlBagieh Hamad , AlSahman Lujain , Alshagroud Rana , AlSahman Roba
Published: June 2023

Rationale:

Proliferative verrucous leukoplakia (PVL) is a multifocal, slowly evolving lesion that resists all types of treatment and has a high propensity for malignant transformation into oral squamous cell carcinoma. Lack of awareness and acquaintance with white lesions of the oral cavity makes it difficult to diagnose. Besides being rare, PVL significantly aggressive, so clinicians need to be aware of it carefully. Therefore, it is recommended to have the earliest possible diagnosis and total excision of this lesion. We report this case to present typical clinical and histologic features of PVL so a For the purpose of sensitizing clinician.

Patient concern:

A 61-year-old female came to the clinic concerning of recurring painless, white patch on the tongue 2 months ago, associated with oropharyngeal dryness.

Diagnoses:

This case satisfies these major and minor criteria to diagnosed PVL.

Intervention:

An excisional biopsy of the lesion was done to check for the presence of dysplasia, as lesions were persisting. Hemostasis was achieved with single interrupted sutures.

Outcome:

no recurrence has been observed since excisional 1 year follow-up.

Lesson:

The key feature is early detection, precisely in cases of PVL it is critical for better treatment outcomes, lifesaving, quality-of-life enhancement. To detect and treat any potential pathologies, clinicians should meticulously examine the oral cavity and patients have to be aware and informed of the importance of regular screenings. This lesion is resistant to the presently available treatment modalities; therefore, total excision with free surgical margins is critical combined with a lifelong follow-up.
The currently available diagnostic tools and treatments of scabies and scabies variants: An updated narrative review
Authors: Al-Dabbagh Jacob , Younis Razan , Ismail Nemat
Published: June 2023

Scabies is a neglected tropical disease that continues to have global impacts and long-term health consequences. It is caused by the mite Sarcoptes scabei var. hominis, which is an obligate ectoparasite that lives in the epidermis of the human skin. Scabies is common in poor communities due to overcrowding in places like old age homes, prisons, and homeless and displaced children. However, developed countries are also susceptible to scabies infestations, such as in institutional outbreaks or small epidemics under war conditions or during natural disasters. The diagnosis of scabies may be assisted by invasive and noninvasive tools; However, the history and examination findings are usually adequate to confirm the clinical suspicion. Here, we present an updated review of scabies by focusing on the diagnostic approaches, treatment, and prevention of scabies.
Association between COVID-19 lockdown and sleep behaviors in Korean adolescents
Authors: Han Chang Hoon , Lee Sujin , Chung Jae Ho
Published: June 2023

To find the effect of coronavirus disease 2019 (COVID-19)-related sleep behavior changes using school-based self-reported data from a nationally representative Korean adolescent population. We analyzed web-based self-reported data from the Korean Youth Risk Behavior Web-based Survey in 98,126 participants (51,651 in 2019 [before the COVID-19 pandemic]; 46,475 in 2020 [during COVID-19 pandemic] 12 through 18 years old were included in this study. Self-report questionnaires were used to assess socioeconomic status, health behaviors, psychological factors, and sleep patterns. During the COVID-19 pandemic, Korean adolescents had a later weekend bedtime (≥1:00 am: 68.2% vs 71.5%, P < .001) and late weekend wake time (≤7:00 am: 13.3% vs 10.7%, P < .001) compared to before COVID-19 pandemic. Average sleep duration (434.7 ± 102.6 vs 428.2 ± 100.4 minutes; P < .001) was significantly lower during the COVID-19 pandemic and weekend catch-up sleep >2 hours (42.1% vs 43.7%; P < .001), late chronotype (17.1% vs 22.9%, P < .001) were significantly higher during COVID-19 pandemic. After adjusting for multiple confounding variables, short sleep duration (≦5 hours, odds ratio [OR] 1.14; 95% confidence interval [CI] 1.10–1.19), 6 hours, OR 1.07; 95% CI 1.03–1.12), long weekend catch-up sleep (OR, 1.08; 95% CI, 1.06–1.11) and late chronotype (OR, 1.43; 95% CI, 1.38–1.47) were significantly associated with COVID-19 pandemic. The COVID-19 pandemic was associated with changes in sleep behavior among Korean adolescents, resulting in later bed and wake-up times, increased weekend catch-up sleep, and a shift of chronotype toward eveningness.
Intraductal papillary mucinous neoplasm of the accessory pancreatic duct in the pancreas uncinate process: A case report
Authors: Guo Tao , Liu Ya , Yang Zhu , Li Jing , You Kun , Zhao Dejun , Chen Sujuan , Li Cong , Yang Pei , Hu Hongqiang , Zhang Hao
Published: June 2023

Rationale:

Intraductal papillary mucinous neoplasms (IPMN) of the accessory pancreatic duct (APD) are very rare and their clinical significance is not known. Here, we describe a case of IPMN originating in a branch of the duct of APD within the uncinate process of the pancreas, which initially presented with acute pancreatitis.

Patient concerns:

A 70-year-old man visited our medical center presenting with acute pancreatitis around the head and uncinate process of the pancreas.

Diagnoses:

Computer tomography scans revealed the presence of a 35-mm cystic mass-like lesion within the pancreas uncinate process communicating with a branch of the APD. The patient was diagnosed with APD-IPMN in the pancreas uncinate process accompanied by acute pancreatitis.

Interventions:

Conservative management of the acute pancreatitis relieved his symptoms, while duodenum-preserving partial pancreatic head resection (DPPHR-P) was performed to treat the APD-IPMN. Intraoperative exploration showed the presence of severe adhesions within the uncinate process of the pancreas and that the tumor’s “peduncle” – a branch of the duct of APD – was saddling just at the front of the main pancreatic ducts. Thus, surgical removal of the tumor required special handling of the region between the main duct (MD) and APD to protect the integrity of the main pancreatic ducts. Finally, a 35*30*15 mm IPMN was successfully removed and the MD was preserved combined with ligation from the root of the APD of the pancreas. The drainage volume of the ventral tube increased by around 20-fold in 24 hours on the fourth day after surgery. The presence of high amylase levels in the drainage discharge (40713.5 U/L) led to the diagnosis of postoperative pancreatic fistula (POPF). The drainage volume remained high for 3 days.

Outcomes:

The patient was discharged and POPF was successfully managed through endoscopic pancreatic duct stenting.

Lessons:

APD-IPMN in the pancreas uncinate process has its own characteristics of localized pancreatitis, and MD-preserving DPPHR-P not only protects the exocrine and endocrine functions of the pancreas, but it also protects the physiological and anatomical integrity. The appearance of POPF after DPPHR-P may be managed by endoscopic pancreatic duct stenting.
A rare presentation of Sintilimab-induced swelling along the vessels: Case report
Authors: Liu Liqiong , Yu Yang , Xia Juan , Ning Yanting
Published: June 2023

Rationale:

Immune-related adverse events are occasionally reported in Sintilimab treatment. This study reports a forward and reverse swelling case along the vein after infusion of Sintilimab. At present, swelling along the vascular direction during peripheral infusion are limitedly reported at home and abroad, especially when choosing a vein with thick, elastic, and good blood return.

Patient concerns:

A 56-year-old male who suffered from esophageal cancer and liver cancer and received albumin-bound paclitaxel and nedaplatin chemotherapy in combination with Sintilimab immunotherapy appeared swelling along the vessel after infusion of Sintilimab. The patient was punctured 3 times.

Diagnoses:

Sintilimab-induced vascular edema may be a side effect resulted from a combination of variables such as relatively poor vascular function of the patient, chemical extravasation, allergic skin reactions, venous valves, vascular intima, and diameter stenosis. Sintilimab rarely causes vascular edema only when drug allergic reaction is the underlying factor. As only a few cases of vascular edema caused by Sintilimab have been reported, causes to such a drug-induced vascular edema remained unclear.

Interventions:

The swelling was controlled by an intravenous specialist nurse according to delayed extravasation treatment and the doctor anti-allergy treatment, but the uncertainty of repeated puncture and symptom diagnosis caused pain and anxiety to the patient and his family.

Outcomes:

The symptom of swelling was gradually relieved after the anti-allergic treatment. The patient completed the following drug infusion without discomfort after the third puncture. When the patient was discharged the next day, swelling in his both hands disappeared, and the patient had no anxiety or discomfort.

Lessons:

The side effects of immunotherapy may accumulate over time. Early identification and appropriate nursing management are the keys to minimizing patients’ pain and anxiety. To effectively treat symptoms, nurses could benefit from quickly identifying the source of swelling.
Diagnostic accuracy of circulating exosomal circRNAs in malignances: A meta-analysis and systematic review
Authors: Yuan Xia , Mao Ye , Ou Shuangyan
Published: June 2023

Background:

Pathogenesis of malignant tumors are often accompanied by aberrant expression of circular RNAs (circRNAs), indicating the potential diagnostic value of circRNAs in tumors. CircRNAs have been found to be enriched, stable and ubiquitous in serum and plasma exosomes. The study aims at evaluating the diagnostic performance of circulating (plasma and serum) exosomal circRNA in different types of cancer by synthesis of published data.

Methods:

A comprehensive literature search was conducted in PubMed, Embase, Medline and the Web of Science databases to identify potentially eligible studies published before April 2021. We conducted the meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.

Results:

Eleven articles comprising 21 studies were included, and a total of 1609 cases and 1498 controls were evaluated. Six types of cancer were involved in these studies, including lung cancer, hepatocellular carcinoma, colorectal cancer, gastric cancer, multiple myeloma and osteosarcoma. The pooled sensitivity and specificity were 0.72 (95% confidence interval [CI], 0.62–0.81) and 0.83 (95% CI, 0.78–0.88), respectively. Summary receiver operating characteristic curve was constructed and the pooled value of area under curve was 0.86 (95% CI, 0.83–0.89), indicating a favorable diagnostic efficacy of circulating exosomal circRNAs in malignancies.

Conclusions:

In conclusion, our study evaluated the diagnostic power of circulating exosomal circRNAs in 6 types of cancer by synthesis of published data comprising 21 studies from eleven articles. The pooled analysis provided the evidence supporting circulating exosomal circRNAs as a promising noninvasive diagnostic biomarkers for malignancies.
Clinical analysis of diabetes in pregnancy with stillbirth
Authors: Wang Zhenyu , Chen Jia , Long Tuhong , Liang Lixuan , Zhong Caijuan , Li Yingtao
Published: June 2023

We analyzed the clinical characteristics of patients with diabetes in pregnancy (DIP) associated with stillbirth and explored strategies to reduce its incidence. We retrospectively analyzed 71 stillbirths associated with DIP (group A) and 150 normal pregnancies (group B) during 2009 to 2018. The incidence of the following was higher in group A (P < .05): hypertensive disorders (38.03% vs 6.00%), placenta previa (14.08% vs 2.67%), placental abruption (5.63% vs 0.67%), fetal malformation (8.45% vs 0.67%), fasting plasma glucose (FPG) ≥ 7.0 mmol/L (46.48% vs 0.67%), 2-h postprandial plasma glucose ≥ 11.1 mmol/L (57.75% vs 6.00%), HbA1c ≥ 6.5% (63.38% vs 6.00%), and polyhydramnios (11.27% vs 4.67). The incidence of oligohydramnios (4.23% vs 6.67%) was lower in group A than in group B (P < .05). According to the gestational age at the time of stillbirth, Group-A cases were subgrouped into miscarriages (20–27+6 weeks), premature deliveries (28–36+6 weeks), and full-term deliveries (≥37 weeks). Age, parity, and DIP type did not differ among the subgroups (P > .05). Among patients with DIP, antenatal FPG, 2-h postprandial plasma glucose, and HbA1c were significantly associated with stillbirth (P < .05). Stillbirth was first detected at 22 weeks and typically occurred at 28–36+6 weeks. DIP was associated with a higher incidence of stillbirth, and FPG, 2-h postprandial plasma glucose, and HbA1c were potential indicators of stillbirth in DIP. Age (odds ratio [OR]: 2.21, 95% confidence interval [CI]: 1.67–2.74), gestational hypertension (OR: 3.44, 95% CI: 2.21–4.67), body mass index (OR: 2.86, 95% CI: 1.95–3.76), preeclampsia (OR: 2.29, 95% CI: 1.45–3.12), and diabetic ketoacidosis (OR: 3.99, 95% CI: 1.22–6.76) were positively correlated with the occurrence of stillbirth in DIP. Controlling perinatal plasma glucose, accurately detecting and managing comorbidities/complications, and timely termination of pregnancy can reduce the incidence of stillbirths associated with DIP.
Implementing a Virtual Team Model in the Acute Care Setting
Authors: Trepanier Sylvain , Schlegel Sherene , Salisbury Cynthia , Moore Andria
Published: June 2023

Health care has forever changed in early 2021. Three years after the beginning of the COVID-19 world pandemic, we must seriously look at the role of the nurses and the model we deploy to ensure our health system's viability. In this article, the authors offer insights into the journey of deconstructing the nurses' role and planning for a Co-Caring Model where virtual and bedside nurses practice and unlicensed assisting personnel work as a team to care for those in need of health care. We also provide a list of actions for nurse leaders to consider. Finally, we aim to spark an international conversation on how we can bring back the joy of practice to ensure we create the best possible places to give and get care.
Managing the Current Workforce
Authors: Grubaugh Martha , Africa Larissa , Neisinger Kristen
Published: June 2023

A structured transition to practice (TTP) program is beneficial to the professional success and retention of new graduate nurses (NGNs). The COVID-19 pandemic impacted clinical preparation and the TTP experience of NGNs. Data from the Versant National Database between 2018 and 2021 were analyzed to determine the current state of NGN well-being and clinical development. Key findings from the analysis indicate that NGNs that are a part of a comprehensive TTP program remain highly committed to their organization, have increased satisfaction working with their colleagues, and indicate low intent to leave their position. However, there are opportunities to address individual rewards and recognition, clinical assignments, morale, feelings of belongingness, and well-being. These findings further support the importance of a nurse residency program as part of an overall workforce strategy and that individual, programmatic, and practice environment outcomes must be longitudinally measured and analyzed to be able to make necessary evidence-based changes to meet the future needs of NGNs and the profession.
Stability Changes in Fall-Prone Individuals With Parkinson Disease Following Reactive Step Training
Authors: Monaghan Andrew S. , Hooyman Andrew , Dibble Leland E. , Mehta Shyamal H. , Peterson Daniel S.
Published: June 2023

Background and Purpose:

Poor reactive steps may lead to falls in people with Parkinson disease (PwPD). However, whether reactive steps can be improved in PwPD at risk for falls or whether step training reduces falls remains unclear. This study aimed to determine whether 2 weeks of reactive step training result in (1) immediate and retained improvements in stepping and (2) fewer prospective falls in PwPD at fall risk.

Methods:

Twenty-five PwPD (70.52 years ± 7.15; Hoehn & Yahr range 1-3) at risk for falls completed a multiple baseline, open-label, uncontrolled pre-/postintervention study. Stepping performance was assessed at 2 baseline assessments (B1 and B2) followed by a 2-week, 6-session training protocol. Stepping was assessed immediately (P1) and 2 months after training (P2). Primary outcomes were anterior-posterior margin of stability (MOS), step length, and step latency during backward stepping. Fall frequency was measured for 2 months before and after training.

Results:

MOS during backward steps was significantly larger (better) after training (P < 0.001, d = 0.83), and improvements were retained for 2 months (P = 0.04, d = 0.66). Step length was not statistically significant different after training (P = 0.13, d = 0.46) or at follow-up (P = 0.08, d = 0.62), although effect sizes were medium and large, respectively. Step latency improved after initial exposure (P = 0.01, d = 0.60) but not following training (P = 0.43, d = 0.35). Twelve participants experienced fewer falls after training than before (10 = no change, 5 = increase; P = 0.12). Greater improvements in MOS were related to fewer falls (P = 0.04).

Discussion and Conclusions:

Two weeks of reactive step training resulted in immediate and retained improvements in some reactive stepping outcomes in PwPD at risk for falls and may reduce fall risk. Reactive step training may be a viable approach to reduce falls in PwPD.
Fluid Balance and Its Association With Mortality and Health-Related Quality of Life: A Nonprespecified Secondary Analysis of the Life After Pediatric Sepsis Evaluation
Authors: Stenson Erin K. , Banks Russell K. , Reeder Ron W. , Maddux Aline B. , Zimmerman Jerry , Meert Kathleen L. , Mourani Peter M. ,   for the Life After Pediatric Sepsis Evaluation (LAPSE) Investigators
Published: June 2023

OBJECTIVES:

To evaluate the association between fluid balance (FB) and health-related quality of life (HRQL) among children at 1 month following community-acquired septic shock.

DESIGN:

Nonprespecified secondary analysis of the Life After Pediatric Sepsis Evaluation. FB was defined as 100 × [(cumulative PICU fluid input – cumulative PICU fluid output)/PICU admission weight]. Three subgroups were identified: low FB (< 5%), medium FB (5%–15%), and high FB (> 15%) based on cumulative FB on days 0–3 of ICU stay. HRQL was measured at ICU admission and 1 month after using Pediatric Quality of Life Inventory 4.0 Generic Core or Infant Scales or the Stein-Jessop Functional Status Scale. The primary outcome was a composite of mortality or greater than 25% decline in HRQL 1 month after admission compared with baseline.

SETTING:

Twelve academic PICUs in the United States.

PATIENTS:

Critically ill children between 1 month and 18 years, with community-acquired septic shock who survived to at least day 4.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Two hundred ninety-three patients were included of whom 66 (23%) had low FB, 127 (43%) had medium FB, and 100 (34%) had high FB. There was no difference in Pediatric Risk of Mortality Score 3 (median 11 [6, 17]), age (median 5 [1, 12]), or gender (47% female) between FB groups. After adjusting for potential confounders and comparing with medium FB, higher odds of mortality or greater than 25% HRQL decline were seen in both the low FB (odds ratio [OR] 2.79 [1.20, 6.57]) and the high FB (OR 2.16 [1.06, 4.47]), p = 0.027. Compared with medium FB, low FB (OR 4.3 [1.62, 11.84]) and high FB (OR 3.29 [1.42, 8.00]) had higher odds of greater than 25% HRQL decline.

CONCLUSIONS:

Over half of the children who survived septic shock had low or high FB, which was associated with a significant decline in HRQL scores. Prospective studies are needed to determine if optimization of FB can improve HRQL outcomes.