bluuebunny/crossref_metadata_2025 huggingface dataset:
Anomalies of the noise spectrum of a charged liquid helium surface
Authors: Rybalko A. S. , Borzenets V. V. , Grigor'ev V. N.
Published: December 2024

The spontaneous oscillations (noise) spectrum of a charged liquid-helium surface has been measured in the frequency range 17–2 ⋅ 104 Hz. The data obtained reveal a peak corresponding to surface excitations with a wave number of the order of the reciprocal capillary constant and a significant change in this spectral region in the range of clamping field intensity values at which the transition from the homogeneous state into the charged-dimple-crystal state occurs.
Appearance of chaos in a superconducting ring closed by a Josephson junction
Authors: Dmitrenko I. M. , Konotop D. A. , Tsoĭ G. M. , Shnyrkov V. I.
Published: December 2024

Stochastic behavior of the main part of a high-frequency squid, a superconducting ring closed with a Josephson junction, is observed experimentally. The corresponding current–voltage and amplitude–frequency characteristics and the spectral density of the noise are presented. It is shown that when the parameters of the hf squid are varied continuously, the dynamic system changes smoothly from periodic oscillations to stochastic oscillations in the hysteresis regime. Complicated changes in the oscillations occur near this transition: the appearance of "1/f noise," transformation of its spectral density in the high frequency range, and periodic dependence on the external (signal) flux. The results obtained demonstrate that the hf squid is a convenient object for direct detailed study of stochastic instability in real dynamic systems.
Generation of magnetic fields in pulsars
Authors: Sedrakyan D. M.
Published: December 2024

We consider a new mechanism of generation of magnetic fields in neutron stars, based on the superfluidity and superconductivity of neutrons and protons in the “pre” phase of a neutron star.

The currents of neutron “drag” of protons results in the formation of a dense network of proton vortices around a neutron vortex. The size of the region in which the magnetic field is not zero depends on the coefficient of the “drag” of superconducting protons.

A microscopic theory that has been developed for the interaction of the neutron and proton condensates has yielded analytic expressions for the “drag” coefficient at temperatures near the superconducting transition point of protons.

As is seen from the formula derived as well as from estimates made by other authors, the “drag” coefficient should be of the order of unity as T→0. It has been shown that (average) magnetic fields of the order of 10 G can be generated in neutron stars. This field is concentrated in proton vortices which occupy only 10% of the volume of the neutron star.
Propagation of sound in a two-phase He II-solid helium system
Authors: Grigor’ev V. N. , Dyumin N. E. , Svatko S. V.
Published: December 2024

Using acoustic transducers capable of radiating and detecting first and second sound, we have investigated the propagation of sound in the two-phase region of He II-bcc 4He. Two acoustic modes with significantly different velocities have been discovered. Analysis has shown that the faster mode is associated with the propagation of the first sound through the region of liquid and solid helium while the slow mode corresponds to first sound in solid helium and second sound in liquid helium. The data obtained indicate that the coefficient of transformation of first sound into second sound at the liquid-solid helium interface has a substantial value.
Topological order of atomically rough boundaries of crystals
Authors: Marchenko V. I.
Published: December 2024

It is shown that three types of atomically rough crystal boundaries exist. One, two, or even three rough states, between which specific phase transitions occur, can exist on a face, depending on its symmetry.

An analogy has been noted between the transition from an atomically smooth to an atomically rough state and the transition from a commensurate to an incommensurate state. An estimate of the temperatures of these phase transitions is given.
Hydrodynamics equations for a rotating crystal
Authors: Vardanyan G. A. , Papoyan K. V. , Sedrakyan D. M.
Published: December 2024

In order to explain the physical picture of the rotation of a superfluid crystal we consider the case in which the crystal contains linear defects of the type of vortex filaments; as the condensate revolves around these defects the phase of its wave function changes by 2π.

Vortex filaments are responsible for motion throughout the crystal with the curl of the velocity equal to twice the frequency of rotation of the crystal. As a consequence, forces which are associated with the curl of the superfluid velocity and angular velocity of the crystal appear in the equations of motion.

The stress tensor of the crystal in this case contains a part which is due to the vortices and, therefore, the thermodynamic functions undergo substantial changes.

The correction to the momentum flux tensor consists of two parts, as in the case of a superfluid liquid: the renormalization of the pressure and the tension of the filaments. In the hydrodynamics equations the velocity of the vortex filaments is taken into account along with the velocity of the lattice sites.
Understanding the opposite optomagnetic responses of different-sized magnetic nanoparticles
Authors: Patrick Chris
Published: December 2024

Model confirms Mie scattering is responsible for the inverse signals of dimers and monomers in magnetic nanoparticle agglutination-based optomagnetic biosensing, a tool for point-of-care testing.
Artificial dynamic structure ensemble-guided rational design of a universal RNA aptamer–based sensing tag
Authors: Hou Jianing , Guo Pei , Wang Junyan , Han Da , Tan Weihong
Published: December 2024

Artificially functional RNAs, such as fluorogenic RNA aptamer (FRApt)-based biosensing tag, represent significant advancements in various biological applications but are limited by the lack of insight into dynamic structure ensembles and universal design concepts. Through the development of an artificial RNA structure ensemble, we rationally established an RNA reconstitution model, “SSPepper-Apt,” to generate a universal fluorogenic RNA biosensing tag. By utilizing various target-recognizing RNA motifs, SSPepper-Apt enables the modular generation of sensing tags for low-background, highly selective imaging of metabolites, peptides, and proteins in living cells. Additionally, by employing single guide RNA (sgRNA) as the recognition RNA motif, SSPepper-Apt generates fluorescence in both CRISPR-mediated imaging and gene editing only when the Cas9–sgRNA complex is successfully assembled; therefore, it can be an effective sgRNA screening tool for gene editing. Our fluorogenic RNA-sensing tag provides a universal approach for constructing functional RNA systems, avoiding the laborious and time-consuming process of sequence combination, and expanding the application of synthetic biological tools.
SKA2 enhances stress-related glucocorticoid receptor signaling through FKBP4–FKBP5 interactions in neurons
Authors: Hartmann Jakob , Klengel Claudia , Dillmann Larissa J. , Hisey Erin E. , Hafner Kathrin , Shukla Rammohan , Soliva Estruch Marina , Bajaj Thomas , Ebert Tim , Mabbott Katharine G. , Rostin Luise , Philipsen Alexandra , Carlezon William A. , Gisabella Barbara , McCullumsmith Robert E. , Vergis John M. , Klengel Torsten , Berretta Sabina , Daskalakis Nikolaos P. , Pantazopoulos Harry , Gassen Nils C. , Ressler Kerry J.
Published: December 2024

Genes involved in regulating the hypothalamic–pituitary–adrenal (HPA) axis, including the glucocorticoid receptor (GR), are linked to various stress-related psychopathologies including bipolar disorder as well as other mood and trauma-related disorders. The protein product of the cell cycle gene,
SKA2,
is a GR interaction partner in peripheral cells. However, the precise roles of SKA2 in stress and GR signaling in the brain, specifically in nonreplicating postmitotic neurons, and its involvement in HPA axis regulation remain unclear. Here, we demonstrate, using diverse in vitro cell assays, a mechanism by which SKA2 promotes GR signaling through enhancing GR–FKBP4 interaction leading to dissociation of FK506-bindingprotein 51 (FKBP5) from the complex. FKBP4 and FKBP5 are cochaperones known to regulate GR function in opposite directions. Notably in mice, SKA2 in
Crh
+
neurons of the paraventricular nucleus of the hypothalamus is crucial for HPA axis responsiveness and for maintaining the negative feedback loop underlying allostasis. Moreover, we show that SKA2 expression is increased in postmortem human hippocampus and amygdala from individuals with BD. Our study highlights a critical role of SKA2 in HPA axis function, adds to the understanding of the molecular basis of stress-related psychiatric disorders, and points to potential targets for intervention.
Investigation of compressive strength of 3D-printed PLA/continuous glass fibers composites manufactured by simultaneous impregnation extrusion-based additive manufacturing
Authors: Safi Jahanshahi Amin , Akhoundi Behnam , Quagliato Luca
Published: December 2024

The enhancement of stiffness and strength in additively manufactured components has garnered significant attention from scientists and engineers in recent years. This study explores the improvement of compressive strength in polylactic acid (PLA) composites reinforced with continuous glass fibers (CGFs) using a simultaneous impregnation extrusion-based additive manufacturing process. In this method, continuous fibers are introduced into the molten polymer through a side nozzle, coated with the polymer, and subsequently deposited onto the substrate or previously deposited layers. The primary advantage of this technique lies in its elimination of the need for pre-impregnated fibers, enabling the use of various continuous fiber types as reinforcing phases and different thermoplastics as matrices. To evaluate the impact of fiber orientation, fibers were aligned both parallel and perpendicular to the load direction, allowing an analysis of tensile lateral strain during compression. Compression test results revealed that neat PLA exhibited compressive strengths of 84.6 MPa and 72.3 MPa for parallel and perpendicular raster orientations, respectively. For the composite specimens, parallel fiber alignment resulted in delamination between the PLA matrix and fibers, with a compressive strength of 40.7 ± 1.2 MPa. Conversely, perpendicular fiber alignment increased compressive strength to 93 ± 1.1 MPa. The main innovation of this research is enhancing the compressive strength of composite samples by positioning continuous fibers perpendicular to the load direction within the samples. This arrangement induces transverse strain when the compressive force is applied, resulting in tensile stress being exerted on the continuous fibers, which in turn contributes to an increase in the compressive strength of the composite samples. Failure in these specimens occurred in regions where tensile strain direction changed, particularly at the corners of rounded-square cross-sections. This study demonstrates that aligning CGFs perpendicular to the loading direction enhances compressive strength by approximately 10.5%, introducing a bilinear elastic behavior and a more brittle-like fracture. The findings provide valuable insights for improving the crashworthiness and energy-absorbing capabilities of components in the automotive industry.
An insulating composite material defects detection CNN model using knowledge-based 2D structured ultrasonic signals
Authors: Liu Xiaojian , Li Zhifeng , Song Shaoheng , Li Hang , Suo Haodong , Liu Weihua , Liu Dongliang , Song Yaqin
Published: December 2024

Defects detection of insulators is crucial for the safe operation of power grid. A strategy of domain knowledge-assisted convolutional neural network is implemented for evaluating various depths and sizes of internal defects in insulating composite materials. A novel periodic-based 2D structuring method for ultrasonic signals is used to assist the CNN feature extraction process, leveraging the invariance of defect types with respect to the ultrasound sampling window and real background noise levels for data augmentation to enhance signal fidelity. Two supervised learning-based CNN models are trained to demonstrate the effectiveness of the proposed method. It is observed that the periodic-based 2D representation of ultrasonic signals facilitated superior performance of the 2DCNN compared to the 1DCNN using one-dimensional signals. In our strategy, the 2D ultrasonic signal can be interpreted as a feature map depicting the dependencies among different reflected echoes, as well as the intra- and inter-periodic variations of individual echoes. This domain-knowledge-compliant representation enhances the interpretability of the convolutional neural network. The results show that the trained 2DCNN achieved a defect recognition accuracy of 98.3% on unseen test sets and provided a relatively conservative accuracy estimate of 90% for defect-free samples, fully meeting the real industrial detection requirements to avoid misjudgment and missed judgment. Utilizing domain knowledge to assist neural networks effectively improves the quality of models required for industrial inspection.
Machine learning configuration-dependent friction tensors in Langevin heatbaths
Authors: Sachs Matthias , Stark Wojciech G , Maurer Reinhard J , Ortner Christoph
Published: December 2024

Dynamics of coarse-grained particle systems derived via the Mori–Zwanzig projection formalism commonly take the form of a (generalized) Langevin equation with configuration-dependent friction tensor and diffusion coefficient matrix. In this article, we introduce a class of equivariant representations of tensor-valued functions based on the Atomic Cluster Expansion framework that allows for efficient learning of such configuration-dependent friction tensors from data. Besides satisfying the correct equivariance properties with respect to the Euclidean group E(3), the resulting heat bath models satisfy a fluctuation-dissipation relation. We demonstrate the capabilities of the model approach by fitting a model of configuration-dependent tensorial electronic friction calculated from first principles that arises during reactive molecular dynamics at metal surfaces.
Multimorbidity patterns, sociodemographic characteristics, and mortality: Data science insights from low-resource settings
Authors: Bazo-Alvarez Juan Carlos , Del Castillo Darwin , Piza Luis , Bernabé-Ortiz Antonio , Carrillo-Larco Rodrigo M , Smeeth Liam , Gilman Robert H , Checkley William , Miranda J Jaime
Published: December 2024

Multimorbidity data is typically analysed by tallying disease counts, which overlooks nuanced relationships among conditions. We identified clusters of multimorbidity and subpopulations with varying risks and examined their association with all-cause mortality using a data-driven approach. We analysed 8-year follow-up data of people ≥35 years who were part of the CRONICAS Cohort Study, a multisite cohort from Peru. First, we used Partitioning Around Medoids and multidimensional scaling to identify multimorbidity clusters. We then estimated the association between multimorbidity clusters and all-cause mortality. Second, we identified subpopulations using finite mixture modelling. Our analysis revealed three clusters of chronic conditions: respiratory (cluster 1: bronchitis, COPD and asthma), lifestyle, hypertension, depression and diabetes (cluster 2), and circulatory (cluster 3: heart disease, stroke and peripheral artery disease). While only the cluster comprising circulatory diseases showed a significant association with all-cause mortality in the overall population, we identified two latent subpopulations (named I and II) exhibiting differential mortality risks associated with specific multimorbidity clusters. These findings underscore the importance of considering multimorbidity clusters and sociodemographic characteristics in understanding mortality risks. They also highlight the need for tailored interventions to address the unique needs of different subpopulations living with multimorbidity to reduce mortality risks effectively.
SARS-CoV-2 infection and risk of subsequent demyelinating diseases: national register–based cohort study
Authors: Montgomery Scott , Vingeliene Snieguole , Li Huiqi , Backman Helena , Udumyan Ruzan , Jendeberg Johan , Rasmussen Gunlög , Sundqvist Martin , Fall Katja , Hiyoshi Ayako , Nyberg Fredrik
Published: December 2024

Demyelinating diseases including multiple sclerosis are associated with prior infectious exposures, so we assessed whether SARS-CoV-2 infection is associated with subsequent diagnoses of non-multiple sclerosis demyelinating diseases and multiple sclerosis. All residents of Sweden aged 3–100 years were followed between 1 January 2020 and 30 November 2022, excluding those with demyelinating disease prior to 2020, comprising 9 959 818 individuals divided into uninfected and those who were infected were categorized into those with and without hospital admission for the infection as a marker of infection severity. Cox regression assessed the risk of two separate outcomes: hospital diagnosed non-multiple sclerosis demyelinating diseases of the CNS and multiple sclerosis. The exposures were modelled as time-varying covariates (uninfected, infection without hospital admission and infected with hospital admission). Hospital admission for COVID-19 was associated with raised risk of subsequent non-multiple sclerosis demyelinating disease, but only 12 individuals had this outcome among the exposed, and of those, 7 has an unspecified demyelinating disease diagnosis. Rates per 100 000 person-years (and 95% confidence intervals) were 3.8 (3.6–4.1) among those without a COVID-19 diagnosis and 9.0 (5.1–15.9) among those admitted to hospital for COVID-19, with an adjusted hazard ratio and (and 95% confidence interval) of 2.35 (1.32–4.18, P = 0.004). Equivalent associations with multiple sclerosis (28 individuals had this outcome among the exposed) were rates of 9.5 (9.1–9.9) and 21.0 (14.5–30.5) and an adjusted hazard ratio of 2.48 (1.70–3.61, P < 0.001). Only a small number of non-multiple sclerosis demyelinating disease diagnoses were associated with hospital admission for COVID-19, and while the number with multiple sclerosis was somewhat higher, longer duration of follow-up will assist in identifying whether the associations are causal or due to shared susceptibility or surveillance bias, as these diseases can have long asymptomatic and prodromal phases.
The contributions of relative brain viscosity to brain function and health
Authors: McIlvain Grace
Published: December 2024

Magnetic resonance elastography has emerged over the last two decades as a non-invasive method for quantitatively measuring the mechanical properties of the brain. Since the inception of the technology, brain stiffness has been the primary metric used to describe brain microstructural mechanics. However, more recently, a secondary measure has emerged as both theoretical and experimental significance, which is the ratio of tissue viscosity relative to tissue elasticity. This viscous-to-elastic ratio describes different but complementary aspects of brain microstructural health and is theorized to relate to microstructural organization, as opposed to stiffness, which is related to tissue composition. The relative viscosity of brain tissue changes regionally during maturation, aging and neurodegenerative disease. It also exhibits unique characteristics in brain tumours and hydrocephalus, and is of interest for characterizing traumatic head impacts. Most notably, regional measures of relative brain tissue viscosity appear to hold a unique role in describing cognitive function. For instance, in young adults, relatively lower hippocampal viscosity compared to elasticity repeatedly and sensitively relates to spatial, declarative and verbal memory performance. Importantly, these same trends are not found with hippocampal stiffness, or hippocampal volume, highlighting a potential sensitivity of relative viscosity to underlying cellularity that contributions to normal healthy brain function. Likewise in young adults, in the orbitofrontal cortex, lower relative viscosity relates to better performance on fluid intelligence tasks, and in the Broca’s area of children ages 5–7, lower relative viscosity is indicative of better language performance. In these instances, this ratio shows heightened sensitivity over other structural MRI metrics, and importantly, provides a quantitative and intrinsic alternative to measuring structure–function relationships with task-based fMRI. There are ongoing efforts to improve the accuracy and repeatability of the relative viscosity measurement, and much work is needed to reveal the cellular underpinning of changes to tissue viscosity. But it appears clear that regionally measuring the viscous-to-elastic ratio holds the potential to noninvasively reveal an aspect of tissue microstructure that is clinically, cognitively and functionally relevant to our understanding of brain function and health.
Dysplasia of the tricuspid valve leading to recurrent atrial flutter and fibrillation: a case report
Authors: Yoshida Taemi , Gatterer Edmund , Strouhal Andreas , Harrer Marieluise , Stöllberger Claudia
Published: December 2024

Background

Atrial flutter (AFL) is usually effectively treated by cavotricuspid isthmus (CTI) ablation. If AFL recurs despite ablation, there is risk of progression to atrial fibrillation (AF) and clinicians should consider underlying structural heart diseases. This consideration becomes especially critical when right-heart-chambers are dilated.

Case summary

A 50-year-old man presented with palpitations due to AFL. Fifteen years earlier, after polytrauma, mild tricuspid regurgitation (TR) and pericardial effusion had been diagnosed on transthoracic echocardiography (TTE). At present, TTE showed dilated right-heart-chambers and moderate TR. Despite two CTI-ablations, he developed AF for which he underwent pulmonary vein isolation (PVI). A further ablation was performed because of right-sided AFL due to transcrista conduction. Atrial fibrillation recurred, accompanied by heart failure. Tricuspid regurgitation severity and right-heart-chamber dilatation worsened. Finally, 3D-transoesophageal echocardiography (3D-TEE), performed 20 years after the first TTE, revealed that TR was due to restriction of the septal leaflet. The patient underwent surgery. The tricuspid valve was repaired by ring annuloplasty and a cleft between the anterior and septal leaflets was closed. Three years post-operatively, he is asymptomatic with chronic AF but no recurrent AFL. Transthoracic echocardiography shows only mild TR, though the right-heart-chambers remain dilated, likely due to long-standing TR.

Discussion

Tricuspid regurgitation and AFL/AF have a bidirectional relationship. Tricuspid regurgitation can both cause and result from AFL/AF. Structural heart diseases, including post-traumatic valve damage, should be considered in patients with recurrent AFL despite CTI-ablation and progression to AF. In cases with TR and right-heart-chamber enlargement, 3D-TEE is essential for accurate diagnosis and should be performed without delay.
Vaccines And Verdicts: How Smallpox Court Decisions Affect Anti-Vaccine Discourse and Mortality
Authors: Brehm Paul , Saavedra Martin
Published: December 2024

We estimate the effect of compulsory vaccination court decisions on anti-vaccine discourse and mortality. We measure anti-vaccine discourse using language in American newspapers. Using human-classified training data and machine learning techniques, we predict anti-vaccine discourse for nearly 48,000 newspaper pages. Staggered difference-in-differences estimates show that anti-vaccine discourse increased for a period of two years after pro-vaccine state-level Supreme Court decisions before returning to baseline. Regression-discontinuity-in-time estimates yield similar findings following the Jacobson v. Massachusetts US Supreme Court decision. While compulsory vaccinations increase anti-vaccine discourse, mandates appear to remain effective, and we estimate that smallpox mortality rates fell in the wake of pro-vaccine decisions.
Successful Treatment of Candida auris Ventriculitis With Intravenous Liposomal Amphotericin B and Oral Flucytosine: A Case Report
Authors: Kang Nayoung , Hsu Victor Yu-Ching , Bailey Charles Christopher
Published: December 2024

Candida auris is a rapidly emerging fungal pathogen associated with high resistance rates, particularly in healthcare settings. It most commonly affects patients with severe underlying medical conditions and requiring complex medical care. Patients with invasive medical devices tend to be at increased risk for getting C auris and developing infection. This article presents a case of C auris ventriculitis successfully treated with intravenous liposomal amphotericin B and oral flucytosine. A 41-year-old man with multiple comorbidities, including recent placement of a ventriculoperitoneal shunt, presented with suspected sepsis. Candida auris was isolated from cerebrospinal fluid cultures. Antifungal therapy along with removal of the shunt led to resolution of infection without complications. This case highlights the challenges posed by C auris infections and underscores the importance of appropriate treatment strategies.
Improving Senior Nursing Students’ Readiness Through Screen-Based Virtual Multipatient Simulation
Authors: Whiffen Lisa A. , DiCarlo Kristine
Published: December 2024

The goal in nursing education is to prepare students with knowledge, skills, and abilities to thrive as professional nurses. The purpose of this quasi-experimental quantitative study was to evaluate the use of a screen-based, virtual multipatient simulation for improving self-perception of readiness for practice in a sample of senior nursing students. Utilizing the Casey-Fink Readiness for Practice Survey, the results showed a significant increase in self-perception of readiness. Providing multipatient experiences through simulation can prepare nursing students with requisite skills to transition into professional practice.
Developing Practice Guidelines on Chest Masculinization: Designing Male Neo-nipple–Areolar Complex
Authors: Alaniz Leonardo , Ventura Jenny , Ghafari Arman , Cho Hoyune E. , Willens Sierra , Arora Jagmeet , Vallurupalli Medha , Cordero Justin , Tang Cathy J.
Published: December 2024

Background:

Successful nipple–areolar complex (NAC) reconstruction greatly influences patient outcomes for transgender patients undergoing chest masculinization. Despite the recent rise in case volume, little is known on designing the ideal NAC that maintains its aesthetics in dynamic settings. This study aimed to examine the characteristics of male NACs and their dimensional variability to help develop guidelines on designing the neo-NAC.

Methods:

Thirty cisgender male participants were enrolled. NAC height and width, sternal notch-to-nipple distance, and internipple distance (IND) were measured in standing and supine positions with stable room temperature to prevent measurement bias. Other variables recorded included chest circumference, NAC angulation, body mass index, weight, height, age, and ethnicity.

Results:

Mean standing and supine measurements were as follows: NAC height, 21.2 mm (SD, 3.9) versus 23.4 mm (SD, 4.7); NAC width, 29.0 mm (SD, 5.1) versus 29.7 mm (SD, 5.6); sternal notch-to-nipple distance, 20.8 cm (SD, 2.1) versus 19.3 cm (SD, 1.8); and IND, 22.4 cm (SD, 2.3) versus 23.5 cm (SD, 2.5). NAC height-to-width ratio decreases from supine to standing, as well as IND, indicating a medialization of the NACs when upright.

Conclusions:

Our findings suggest that during chest masculinization surgery, the design of the male neo-NAC has a risk of being positioned too medial and elliptical with upright positioning. Care must be taken intraoperatively to account for changes in neo-NAC dimensions that occur with body position changes. We strongly recommend that surgeons determine the final position of the neo-NAC intraoperatively while having the patient in upright sitting position.
Establishing a Microsurgical Practice in a Limited Resource African Setting: The Kapsowar Hospital Experience
Authors: Rhodes Isaiah J. , Arbuiso Sophia , Alston Chase C. , Zhang Ashley , Medina Samuel J. , Liao Matthew , Chesang Patricia , Hayden Giles , Batdorf Niles J. , Rhodes William R. , Otterburn David M.
Published: December 2024

Background:

Microsurgical technique is still not readily available in many low- and middle-income countries. Few works in the scholarly literature describe the establishment of microsurgical practice on the African continent, and there are virtually no descriptions of the financial aspects of free flap performance by locally staffed teams in sub-Saharan Africa. The Kapsowar Hospital is a hospital in rural Kenya with 2 plastic and reconstructive surgeons certified by the American Board of Plastic Surgery and has recently expanded clinical practice to include microsurgical procedures.

Methods:

A retrospective chart review was conducted on patients who received a free flap at the Kapsowar Hospital in 2022–2023. Captured parameters included age, sex, relevant medical history, etiology of wound, flap performed, intraoperative time, complications, surgical revisions, and length of stay. Billing information for all domestic patients who received free flaps were audited, and disability-adjusted life years was calculated.

Results:

Nineteen free flaps were performed on 17 patients. The most common flap performed was the anterolateral thigh flap (n = 11). Flap survival rate was 94.7%. The surgical cost associated with performing an anterolateral thigh flap was $548 ± $35. The total cost associated with other free flap performances was $863 ± $269. The cost per disability-adjusted life years averted was $121, indicating that the procedure was very cost-effective.

Conclusions:

Despite obstacles, microsurgical practices can be safely established in limited-resource African settings. Free flaps can be performed with greater cost-efficiency when performed by local teams. Surgical mission trips should emphasize educational components and ultimately transition care to local surgeons.
Risk prediction models for non-invasive ventilation failure in patients with chronic obstructive pulmonary disease: A systematic review
Authors: Gao Yuming , Yuan Bo , Fan Peng , Li Mingtao , Chen Jiarui
Published: December 2024

Background:

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition with high morbidity and mortality. Noninvasive mechanical ventilation (NIV) is often used to manage acute COPD exacerbations, but failure can lead to worse outcomes. This systematic review aimed to evaluate risk prediction models for NIV failure in patients with COPD.

Methods:

PubMed, Embase, Web of Science, The Cochrane Library, CINAHL, CBM, CNKI, Wanfang, and VIP databases, from database inception to January 10, 2024, were searched for studies on risk prediction models for failure in NIV among COPD patients. Two reviewers independently screened the literature, extracted data, assessed the quality of included studies using the Prediction Model Risk of Bias Assessment Tool, and conducted a systematic evaluation of the prediction models.

Results:

A total of 11 studies were included, encompassing 13 risk prediction models. The area under the receiver operating characteristic curve for the included models ranged from 0.810 to 0.978. Predictive factors in the models mainly included Acute Physiology And Chronic Health Evaluation II score, pH value, PaCO2, consciousness status, serum albumin level, and respiratory rate.

Conclusion:

Existing risk prediction models for failure in NIV among patients with COPD demonstrated overall good predictive performance, but exhibited a risk of bias. Further validation is needed to assess the clinical applicability of these models.
Idiopathic non-cirrhotic portal hypertension: A case report
Authors: Nie Qilong , Liang Qiuyan , Li Mingyang , Zhu Ronghuo , Ren Jian , Jiang Kaiping , Li Jianhong
Published: December 2024

Rationale:

Idiopathic noncirrhotic portal hypertension (INCPH) is a rare liver disorder with elevated portal pressure without cirrhosis, making diagnosis challenging. This case report presents a 46-year-old Chinese male with INCPH, highlighting the crucial role of liver biopsy.

Patient concerns:

A 46-year-old male presented with persistent fatigue that lasted for 2 months and significantly worsened over the last 3 days. The patient described his fatigue as a profound lack of energy that persisted throughout the day, which progressively impaired his ability to perform daily activities and maintain his usual work responsibilities. He reported feeling exhausted even after light physical exertion, such as walking or standing for short periods. The severity of the fatigue also led to frequent short rests during the day, and he experienced difficulty concentrating and carrying out routine tasks. In addition, he noted a loss of appetite and mild discomfort in the upper abdomen. Given his previous history of abnormal liver function tests and a liver biopsy showing mild chronic liver damage, the patient was initially diagnosed with cirrhosis at a local hospital. This initial diagnosis caused significant emotional distress, as the patient experienced a state of panic and anxiety over the implications of having a progressive liver disease. The psychological burden was evident in his reported difficulty sleeping and persistent worry about his health and future.

Diagnoses:

Initial imaging suggested portal hypertension and cirrhosis, but a liver biopsy ruled out cirrhotic changes, confirming INCPH by excluding other causes such as chronic hepatitis.

Interventions:

The patient received symptomatic treatment (acid suppression, gastric and liver protection) and underwent a liver biopsy. Histological analysis confirmed INCPH, ruling out cirrhosis.

Outcomes:

After the definitive diagnosis, the patient’s anxiety lessened. Fatigue and weakness improved with ongoing symptomatic treatment, and psychological support enhanced his overall well-being. His follow-up plan includes regular liver function monitoring, imaging for portal pressure changes, and potential anticoagulation therapy for thrombosis risks.

Lessons:

This case highlights the diagnostic difficulty of INCPH and underscores the importance of liver biopsy. Further research is needed to develop specific diagnostic tools and treatments for INCPH.
Genetic correlation between genes targeted by lipid-lowering drugs and venous thromboembolism: A drug-target Mendelian randomization study
Authors: Li Min , Duan Hangyu , Luo Jinwen , Tan Yu , Liu Min , Zhao Xiaohan , Shi Dazhuo , Ma Xiaojuan
Published: December 2024

Dyslipidemia has been established as a potential risk factor for venous thromboembolism (VTE) in several observational studies. Statins and novel lipid-modifying agents are being explored for their potential in VTE prevention, encompassing deep vein thrombosis (DVT), and pulmonary embolism (PE). Nonetheless, conclusive evidence supporting the effectiveness remains uncertain. Without definitive proof, the current recommendation of lipid-lowering drugs (LLDs) for preventing VTE, either primarily or secondarily, is not support. An investigation into the impact of 8 classes of LLDs on VTE was conducted using a drug-target Mendelian randomization approach. The drug categories examined included 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), apolipoprotein B, proprotein convertase subtilisin/kexin type 9, Niemann–Pick C1-like 1, lipoprotein lipase (LPL), angiopoietin-like 3, apolipoprotein C3 (APOC3), and peroxisome proliferator-activated receptor alpha. Leveraging genetic variants situated proximate to or within drug-target genes linked with low-density lipoprotein and triglycerides, we acted as proxies for LLDs. The UK Biobank study was the source of data on VTE, PE, and DVT of lower extremities (LEDVT). We employed the inverse-variance weighted method for the core analysis in Mendelian randomization, complemented by sensitivity analysis to investigate horizontal pleiotropy and heterogeneity. Employing genetic proxies to inhibit HMGCR revealed a notable correlation with reduced LEDVT risk (odds ratio [OR]: 0.995, 95% CI: 0.992–0.998, P = .002), VTE (OR: 0.994, 95% CI: 0.988–1.000, P = .033), but a no significant association with PE (OR: 1.000, 95% CI: 0.994–1.002, P = .246). The suppression of APOB was linked with an elevated risk of experiencing LEDVT (OR: 1.002, 95% CI: 1.001–1.004, P = .006), VTE (OR: 1.005, 95% CI: 1.002–1.007, P < .001), and PE (OR: 1.002, 95% CI: 1.000–1.004, P = .031). Similarly, the activation of LPL was associated with increased risks for VTE (OR: 1.003, 95% CI: 1.001–1.005, P = .003) and PE (OR: 1.003, 95% CI: 1.002–1.005, P < .001). Additionally, the inhibition of APOC3 was linked to a higher DVT risk (OR: 1.002, 95% CI: 1.000–1.004, P = .038). Research has shown that HMGCR, out of 8 lipid-lowering drug-targets evaluated, exhibited a significant correlation with VTE and LEDVT, highlighting its potential as an effective target for the treatment or prevention of these conditions. In contrast, APOB, LPL, and APOC3 each contribute to an increased risk of VTE, PE, and LEDVT in various degrees, pharmacovigilance for VTE, PE, and LEDVT risk among users of APOB inhibitors, LPL activation, and APOC3 inhibitors may be warranted.
Evaluation of elderly patients with bacteremia in the cardiology intensive care unit
Authors: Doğan Kaya Sibel , Kizmaz Yeşim Uygun , Yiğit Fatih
Published: December 2024

In this study, the blood culture results of patients aged >65 years who were admitted to the cardiology intensive care unit in a training and research hospital and who had positive blood cultures within the first 48 hours were evaluated. This was a retrospective, observational and nonrandomized study. Patient data at the time of the blood culture were included in the study. Sex, age, length of hospital stay, mortality, Acute Physiology Chronic Health Evaluation II score, laboratory values, and microorganisms grown in blood culture included in the study. Two hundred forty-seven patients, 43.3% of whom were female (n = 107), were included in the study. The median age of the patients was 75 (range 70–83). The mean hospital stay was 5 days (range 3–8). All patients had a median Acute Physiology Chronic Health Evaluation II score of 21 (range 19–23). The overall mortality rate 48.2% (n = 119). The results showed that 49.8% of those died and 50.2% of survivors had positive blood culture results. The most common gram-positive cocci in those died were Staphylococcus hominis (15.6%), Staphylococcus epidermis (14.8%), Enterococcus faecium (9.6%). The most common gram-negative cocci were Escherichia coli (9.6%), Klebsiella pneumoniae (9.6%), Acinetobacter baummanii (1.6%). With an increase in the elderly population, infection management in elderly patients hospitalized in cardiology intensive care units has become increasingly critical.
The factors associated with clozapine polypharmacy for schizophrenia patients discharged from a large public psychiatric hospital in Taiwan, 2006–2021
Authors: Shih Yu-Ju , Lin Ching-Hua , Chou Li-Shiu
Published: December 2024

Clozapine treatment continues to be recognized as the gold standard for managing treatment-resistant schizophrenia. Combining clozapine with other antipsychotics (i.e., clozapine polypharmacy) has emerged as an option for clozapine-resistant schizophrenia. We aimed to investigate the factors associated with clozapine polypharmacy in schizophrenia patients discharged on clozapine from a public psychiatric hospital. The analysis included patients with schizophrenia who were discharged between 2006 and 2021 and prescribed clozapine upon discharge. All patients were divided into 2 groups: clozapine monotherapy and clozapine polypharmacy. Multivariate logistic regression was used to identify factors associated with clozapine polypharmacy. A total of 1396 (42.7%) schizophrenia patients discharged on clozapine polypharmacy. In a multivariate logistic regression model, the clozapine polypharmacy was more likely to be male gender, to be younger, to be earlier age of onset, to have a greater number of previous hospitalizations, to have a shorter length of hospital stay, and to have a lower clozapine daily dose. The prevalence of clozapine significantly increased from 22.4% in 2006 to 50% in 2021. Compared with clozapine monotherapy, clozapine polypharmacy was associated with male gender, younger, earlier age of onset, a greater number of previous hospitalizations, shorter length of hospital stay, and lower clozapine daily dose. The utilization of clozapine polypharmacy has seen a significant increase over time. Further research is necessary to clarify its efficacy, safety, and overall risk/benefit ratio.
Contrast-enhanced ultrasound for diagnosing testicular infarction: Findings from a retrospective cohort analysis
Authors: Li Zhihai , Yin Meiling
Published: December 2024

This study aims to evaluate the ultrasonographic features associated with testicular infarction, determine the diagnostic effectiveness of contrast-enhanced ultrasound (CEUS) in assessing the testicular vascular system, and investigate the etiological factors contributing to testicular infarction. A retrospective analysis was performed involving 12 patients with confirmed testicular infarction. Each participant underwent standard superficial ultrasound examinations, followed by CEUS. The acquired imaging data were subsequently analyzed, taking into consideration the clinical conditions preceding the imaging assessments. A total of 13 lesions were detected across the 12 patients, with 1 individual exhibiting bilateral infarcts in the left testis. Based on the CEUS imaging findings, a classification system was developed to categorize the lesions into 4 distinct types: mediastinal branch infarction, small vessel infarction, capillary infarction, and mixed testicular infarction. This classification system offers a structured approach for understanding and potentially mitigating the causes of testicular infarction. CEUS markedly improves the diagnostic accuracy for testicular infarction and serves as a crucial tool in both the diagnosis and etiological assessment of this condition.
Efficacy of combined electroacupuncture and moxibustion for treatment of neurogenic bladder after spinal cord injury: A retrospective analysis
Authors: Wang Juan , Wu Jie
Published: December 2024

This retrospective study evaluates the clinical efficacy of combined electroacupuncture and moxibustion for the treatment of neurogenic bladder in patients with spinal cord injury. Ninety patients with neurogenic bladder after spinal cord injury who were admitted to the hospital between January 2021 and August 2023 were included. The patients were divided into the study and control groups (n = 45 each) using a random number table method. The study group was treated with electroacupuncture combined with moxibustion, while the control group was treated with electroacupuncture alone. The variables evaluated to assess the clinical efficacy of each treatment included number of cases in which bladder function reached a balanced state, initial bladder capacity sensation, maximum detrusor pressure before versus after treatment, maximum urine flow rate, maximum renal pelvic separation width, urine white blood cell count, and subjective quality of life profile score. In the study group, bladder pressure, residual urine volume, frequency of urination, and subjective quality of life profile score increased after versus before treatment (P < .05), whereas the maximal renal pelvis separation width and urinary white blood cell count decreased after versus before treatment (P < .05). Moreover, the study group exhibited significantly greater improvement than the control group (P < .05). The efficacy rates in the study and control groups were 75.6% and 95.6%, respectively; this difference was statistically significant (P < .05). Compared to electroacupuncture alone, electroacupuncture combined with moxibustion reduced the incidence of urinary tract infection, reduced residual urine volume, increased bladder capacity, and achieved balanced bladder function in patients with neurogenic bladder.
Exploring the mechanism of avenanthramide in the treatment of atherosclerosis based on network pharmacology and molecular docking: An observational study
Authors: Wang Zhigang , Fang Longzhi , Han Meng , Liu Kangzhe , Zheng Yuanmei , Zhan Yibei
Published: December 2024

Atherosclerosis (AS) is a disease characterized by the buildup of fat and fibrous elements within the walls of arteries and is a primary factor in the occurrence of heart failure and mortality. The potential targets and mechanisms underlying the anti-atherosclerotic effects of avenanthramide (Avn) were investigated using network pharmacology, molecular docking, and molecular dynamics simulations. Target information for Avn A, B, and C was collected from the PubChem and Swiss Target Prediction databases. Potential therapeutic targets for AS were identified by mining the OMIM, DrugBank, DisGeNET, and GeneCards databases. A protein–protein interaction (PPI) network of shared targets was constructed and visualized using the STRING database and Cytoscape 3.9.1. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were conducted to explore the functions of core targets within the PPI network. Molecular docking was performed using the AutoDockTool to verify the correlation between the 3 types of Avns and the core targets. Furthermore, molecular dynamics simulations were performed using the 3 highest molecular docking binding energies to validate and confirm the binding of potent compounds to the target. The results revealed 109 respective targets for Avn, with 55 common targets identified by intersection with AS-related targets. Five pivotal genes, matrix metalloproteinase-9 (MMP9), epidermal growth factor receptor (EGFR), ICAM1, CASP3, and MMP2, were selected from the PPI network. Molecular docking results showed a strong binding affinity between Avn and MMP9 as well as EGFR. Molecular dynamics simulations showed good binding capacity of Avn A, B, and C with EGFR, validating the reliability of the molecular docking results. Avn potentially exerts its effects through multiple targets and displays anti-inflammatory and anti-oxidative stress properties.