bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between cementation exponent and pore geometry with varying pore pressure for the joint elastic–electrical modelling of porous sandstones
Authors: Han Tongcheng , Yang Yuting , Fu Li-Yun
Published: February 2025

Seismic and electrical surveys are the most employed geophysical exploration applications for understanding the subsurface earth. Differential effective medium (DEM) models are the models to interpret the seismic and electrical survey data with the greatest success. However, cementation exponent and pore aspect ratio as the indispensable geometric parameters in the electrical and elastic DEM models are independent, making the models not suitable for the joint elastic–electrical modelling, a key requirement for the joint interpretation of seismic and electrical exploration data to better understand the increasingly complex hydrocarbon reservoirs. We show how cementation exponent and pore aspect ratio are correlated in three Berea sandstone samples with changing porosity resulting from varying pore pressure. We find that cementation exponent inverted from the electrical DEM model shows a strong positive linear correlation with pore aspect ratio obtained from the elastic DEM model as an implicit function of porosity-induced by increasing pore pressure. We also find that the established linear correlation can enable the DEM models to calculate one physical property (e.g. elastic or electrical) from the geometric parameter describing the other property (e.g. electrical or elastic). The results reveal how the elastic and electrical geometric parameters are linked, and provide a consistent microstructure that enables the existing elastic and electrical DEM models to be suitable for the joint elastic–electrical modelling of rocks undergoing varying pore pressure.
Alcohol marketing as a commercial determinant of health: daily diary insights from young women in Kampala
Authors: Swahn Monica H , Natuhamya Charles , Culbreth Rachel , Palmier Jane , Kasirye Rogers , Dumbili Emeka W
Published: February 2025

Alcohol marketing, as a commercial determinant of health, presents an emerging threat to global health and is of particular importance in low-resource settings. This study is composed of data from ‘The Onward Project On Wellbeing and Adversity’ (TOPOWA) project, a multicomponent prospective cohort study examining the mechanistic pathways of adverse mental health conditions among women aged 18 to 24 years living in the Kampala slums in Uganda. The cohort consists of 300 women recruited in 2023 from three study sites (i.e., Banda, Bwaise, and Makindye). In this study, we deployed an underutilized tool, daily diaries, for assessing the exposure to alcohol marketing and an alcohol-promoting environment among young women living in the urban slums of Kampala, Uganda to spur new research and action. At baseline, participants completed a 5-day daily diary and an interviewer-administered survey. Findings show that alcohol-related neighborhood features were most frequently reported, including bars (Mean = 3.88 days), people drinking alcohol (Mean = 3.75), alcohol selling points (Mean = 3.45) and alcohol ads on TV (Mean = 2.51). Women who were exposed to bars (PR = 1.31) and alcohol ads on billboards (PR = 1.14) in a day were more likely to report alcohol use. Similarly, those exposed to alcohol ads on billboards (PR = 1.76) and bars (PR = 2.02) every day were more likely to report alcohol use. Higher cumulative exposure to different alcohol-related features was associated with a greater likelihood of alcohol use, particularly in the group with the highest exposure level. These findings underscore a need to develop alcohol counter-marketing strategies and harm reduction approaches. Daily diaries proved to be a feasible strategy in capturing real-time exposure data, which could in turn support prevention measures and the evaluation of intervention strategies.
Protocols for ischemic stroke in Flemish hospitals: correlation between availability and content versus adherence
Authors: Lens Charlotte , Hermans Lotte , Weltens Caroline , Vanhaecht Kris , Lemmens Robin , Coeckelberghs Ellen
Published: February 2025

Background: Stroke is globally one of the leading causes of mortality and disability. Adhering to evidence-based guidelines and protocols can improve quality of care for ischemic stroke patients. We aimed to compare the availability and content of specific protocols versus adherence to these key intervention in clinical daily practice among Flemish hospitals. We selected five key interventions for managing ischemic stroke patients. These key interventions encompassed the measurement of body temperature, glycaemia monitoring, screening of Swallowing function according to the Fever, Sugar and Swallowing protocol (FeSS protocol) and depression and Activities of Daily Living (ADL), (FeSS+ key-interventions).

Methods: A systematic quantitative and qualitative approach was designed to analyse specific protocols from 24 hospitals. A predefined data extraction matrix for the five FeSS+ key interventions was utilized for data collection. Using this matrix, protocols were scored according to completeness of content, regarding the FeSS+ interventions. These scores were used to calculate a total protocol content score, i.e. a total score for the five FeSS+ interventions and an individual score for each key intervention separately, ranging between 0 and 1, per hospital. A score of zero indicates absence of the FeSS+ interventions in the protocols, while a score of one signifies complete coverage of these interventions. In addition, we assessed the correlation between the availability and content of these protocols in relation to the adherence to interventions documented for 30 patients per hospital.

Results: The mean total protocol content score was 0.40±0.20, ranging from 0.64±0.25 for glycaemia management to 0.1±0.28 for ADL screening. With regard to the individual FeSS+ key interventions, we identified a correlation between protocol characteristics and adherence for glycaemia (rs = 0.42, p = 0.04), depression screening (rs = 0.43, p = 0.04) and ADL screening (rs = 0.44, p = 0.03). Total FeSS+-protocol content also correlated with adherence (r = 0.6140, p = 0.0014).

Conclusion: Protocol characteristics for the FeSS+ key interventions were variable and rather limited, especially for ADL- and depression screening. The identified relationship between the content of protocols and adherence to interventions underscores the value of defining these activities in hospital documentation to improve stroke care.
Penile rehabilitation after radical prostatectomy using low-intensity shockwave therapy for erectile function: late results findings from a randomized clinical trial
Authors: Lessa Pedro Fernandes , Baccaglini Willy , Salles Matheus Pascotto de , Silva Reuli Cordeiro da , Pazeto Cristiano Linck , Lopes Leonardo Seligra , Glina Sidney
Published: February 2025

Background

There is still few evidence to support the use of low-intensity extracorporeal shockwave therapy (LiESWT) in rehabilitation of erectile function after radical prostatectomy (RP).

Aim

The aim of this study is to assess the long-term results of LiWEST as a penile rehabilitation method in patients who underwent RP.

Methods

This is an assessment of the late results outcomes of our previous clinical trial registered in ReBEC (ensaiosclinicos.gov.br) RBR-85HGCG. Patients were randomized in two groups with two parallel arms and an allocation ratio of 1:1. The control group received tadalafil 5 mg/day, while the experimental group received tadalafil 5 mg/day and were submitted to 2400 shocks/session-week distributed on four different penile regions across 8 weeks of treatment. Both groups started the penile rehabilitation after the removal of the transurethral catheter. Sexual function was assessed by International Index of Erectile Function (IIEF-5) score.

Outcomes

A difference in IIEF-5 without statistical significance between the experimental and control groups.

Results

Among 77 patients included in our previous analysis, 35 patients were reassessed after a median follow-up of 45 months (95% CI, 42-50 months). Seventeen of them had to be excluded from the analysis for biochemical recurrence and/or new interventions. Remaining 7 and 11 patients in the experimental and control group, respectively. The final mean IIEF-5 score between experimental and control groups showed a difference in favor of the LiWEST group, not statistically significant (18.85, SD 5.66, 95% CI, 13.61-24.1 x 16.63, SD 5.48, 95%CI, 12.9- 20.31; respectively; P = 0.42). Subgroup analysis in patients still using IPDE5 there is a higher difference between mean IIEF5, however not statistically significantly (18.5, SD 6.12, 95%CI 12.07-24.92 x 15.85, SD 3.62, 95% CI, 12.50-19.20, P = 0.35).

Clinical implications

This study highlights that LiESWT may offer limited long-term benefit for erectile function recovery after RP.

Strengths & Limitations

This study provides valuable long-term data on the use of LiESWT as a penile rehabilitation method after RP. The randomized design and parallel group structure strengthen the reliability Journal of Sexual Medicine Journal of Sexual Medicine For Peer Review of findings, with clear intervention protocols. However, limitations include a small final sample size due to patient exclusions, which likely impacted statistical power and the generalizability of results. Additionally, while differences in IIEF-5 scores favored the LiESWT group, the lack of statistical significance limits the ability to draw definitive conclusions about its effectiveness.

Conclusion

The LiESWT showed no impact on long-term results of penile rehabilitation in patients submitted to RP.
Icariin improves erectile function in spontaneously hypertensive rats by downregulating GRK2 in penile cavernous tissue
Authors: Li Yanke , Jiang Jun , Jiang Rui
Published: February 2025

Background

Hypertension is an independent risk factor for erectile dysfunction (ED). Icariin can improve erectile function of spontaneous hypertensive rats (SHRs). GRK2 is closely related to the phosphorylation of eNOS and endothelial function.

Aim

To explore whether icariin can improve erectile function in SHRs by regulating the expression of GRK2 in penile cavernous tissue.

Methods

Eight-week-old WKY and SHR rats were randomly divided into four groups (n = 6 per group) as follows: WKY, WKY + icariin, SHR and SHR + icariin. The WKY + icariin and SHR + icariin groups were treated with 10 mg/kg/day icariin. After 4 weeks, the ICPmax/mean arterial pressure (MAP), serum testosterone, the levels of GRK2, p-AKT/AKT, p-eNOS/eNOS, and caspase-3; the protein interaction between GRK2 and AKT; the levels of nitric oxide (NO), superoxide dismutase (SOD), and malondialdehyde (MDA); and the level of apoptosis in rat penile cavernous tissue were measured.

Outcome

The expression of GRK2 in penile cavernous tissue of SHR was significantly higher than that in WKY rats, resulting in the inhibition of the AKT/eNOS/NO pathway, increased levels of oxidative stress and apoptosis, and the impairment of erectile function.

Results

The ICPmax/MAP ratio in the SHR group was significantly lower than those in WKY and SHR + icariin groups (P < .01). In the SHR + icariin group, the expression levels of GRK2 and caspase-3, the interaction between GRK2 and AKT, the level of MDA and the rate of apoptosis in the penile cavernous tissue were significantly lower, and the levels of p-AKT and p-eNOS, the p-AKT/AKT and p-eNOS/eNOS ratios, and NO and SOD were significantly greater than those in the SHR group (P < .01).

Clinical Implications

Icariin may improve the erectile function of hypertension by downregulating GRK2 expression in penile cavernous tissue.

Strengths and Limitations

The specific mechanism via which icariin downregulates GRK2 needs to be further elucidated.

Conclusion

Icariin downregulates the expression of GRK2 in the penile cavernous tissue of SHRs, upregulates the AKT/eNOS/NO pathway, decreases oxidative stress and apoptosis, and ultimately improves erectile function.
Description of the Problem: Uniform Laws and Damages
Authors: Zeller Bruno
Published: February 2025

This introductory chapter provides an overview of the economic and legal landscape in which any determination of damages takes place. Whenever a contract is being negotiated, each party attempts to identify and minimize the risks involved in the sale of goods. Several issues are important such as which law is to apply, and which jurisdiction is to be preferred. This is so as the question of calculating damages in cases of a breach is tied up in the choice of a legal system. The problem is that as long as transnational laws are not ratified and importantly embraced by the business community; a truly seamless trade system will not eventuate despite the existence of a physical transnational supply network. The United Nations Convention on Contracts for the International Sale of Goods (CISG), despite perceived shortcomings, is still the only harmonized sales law as ninety-seven countries have ratified the Convention.
Regional Developments and the CISG
Authors: Zeller Bruno
Published: February 2025

This chapter explores the various regional developments in relation to their utility compared with the United Nations Convention on Contracts for the International Sale of Goods (CISG). There were several regional developments in attempting to draft contract laws which were either in competition with the CISG or attempted to assist the CISG in the harmonization effort of creating a global contract law. The EU was a big driver in this attempt, not only creating the Principles of European Contract Law (PECL) but also the Common Frame of Reference (CFR) and lately, the Common European Sales Law (CESL). It can be argued that the problem in the EU is the issue that formulating agencies are not flexible in choosing an instrument and in conceiving ways in which hard and soft law may best supplement each other.
A calculus for modal compact Hausdorff spaces
Authors: Bezhanishvili Nick , Carai Luca , Ghilardi Silvio , Zhao Zhiguang
Published: February 2025

The symmetric strict implication calculus $\mathsf{S}^{2}\mathsf{IC}$ is a modal calculus for compact Hausdorff spaces. This is established through de Vries duality, linking compact Hausdorff spaces with de Vries algebras—complete Boolean algebras equipped with a special relation. Modal compact Hausdorff spaces are compact Hausdorff spaces enriched with a continuous relation. These spaces correspond, via modalized de Vries duality, to upper continuous modal de Vries algebras. In this paper, we introduce the modal symmetric strict implication calculus $\mathsf{MS}^{2}\mathsf{IC}$, which extends $\mathsf{S}^{2}\mathsf{IC}$. We prove that $\mathsf{MS}^{2}\mathsf{IC}$ is strongly sound and complete with respect to upper continuous modal de Vries algebras, thereby providing a logical calculus for modal compact Hausdorff spaces. We also develop a relational semantics for $\mathsf{MS}^{2}\mathsf{IC}$ that we employ to show admissibility of various $\Pi_{2}$-rules in this system.
Two temperature-responsive RNAs act in concert: the small RNA CyaR and the mRNA ompX
Authors: Guanzon David A , Pienkoß Stephan , Brandenburg Vivian B , Röder Jennifer , Scheller Daniel , Dietze Alisa , Wimbert Andrea , Twittenhoff Christian , Narberhaus Franz
Published: February 2025

Bacterial pathogens, such as Yersinia pseudotuberculosis, encounter temperature fluctuations during host infection and upon return to the environment. These temperature shifts impact RNA structures globally. While previous transcriptome-wide studies have focused on RNA thermometers in the 5′-untranslated region of virulence-related messenger RNAs, our investigation revealed temperature-driven structural rearrangements in the small RNA CyaR (cyclic AMP-activated RNA). At 25°C, CyaR primarily adopts a conformation that occludes its seed region, but transitions to a liberated state at 37°C. By RNA sequencing and in-line probing experiments, we identified the Shine–Dalgarno sequence of ompX as a direct target of CyaR. Interestingly, the ompX transcript itself exhibits RNA thermometer-like properties, facilitating CyaR base pairing at elevated temperatures. This interaction impedes ribosome binding to ompX and accelerates degradation of the ompX transcript. Furthermore, we observed induced proteolytic turnover of the OmpX protein at higher temperatures. Collectively, our study uncovered multilayered post-transcriptional mechanisms governing ompX expression, resulting in lower OmpX levels at 37°C compared with 25°C.
Structural basis of endo-siRNA processing by Drosophila Dicer-2 and Loqs-PD
Authors: Cao Na , Wang Jia , Deng Ting , Fan Boming , Su Shichen , Ma Jinbiao , Wang Hong-Wei
Published: February 2025

Endogenous small interfering RNAs (endo-siRNAs or esiRNAs) originate from either elongated endogenous transcripts capable of forming complex fold-back structures or from double-stranded regions generated through intermolecular base pairing of convergently transcribed mRNAs. The mechanism of maturation and functionality of esiRNAs exhibit significant variation across diverse species. In Drosophila melanogaster, esiRNAs reside in both somatic and germline cells, where they serve as post-transcriptional modulators for specific target RNAs. Their maturation process critically relies on Dicer-2 (Dcr-2), with the assistance of its cofactor Loqs-PD. In this study, we have successfully elucidated the cryo-EM structures of Dcr-2/Loqs-PD complex bound to esiRNA precursors (pre-esiRNAs) in various states. Our structural and biochemical results reveal that ATP is essential for the cleavage of esiRNAs by the Dcr-2/Loqs-PD complex, a process analogous to the cleavage of double-stranded RNA (dsRNA). When Loqs-PD is present, pre-esiRNAs are preferentially loaded onto the Helicase domain of Dcr-2. Moreover, as the Helicase domain exhibits a preference for binding to the rigid end of double-stranded RNA, Dcr-2 tends to cleave pre-esiRNA from the small closed loop end, rather than the loose and flexible open end.
Big cities fuel inequality within and across generations
Authors: Connor Dylan S , Xie Siqiao , Jang Jiwon , Frazier Amy E , Kedron Peter , Jain Garima , Yu Yilei , Kemeny Tom
Published: February 2025

Urbanization has long fueled a dual narrative: cities are heralded as sources of economic dynamism and wealth creation yet criticized for fostering inequality and a range of social challenges. This paper addresses this tension using a multidisciplinary approach, combining social sciences methods with satellite imagery-based spatial pattern analysis to study the US urban expansion over the past century. We examine the impact of physical urban spatial characteristics (size, population density, and connectedness) on equality of opportunity, measured through intergenerational mobility, as well as its association with levels of income, wealth, and social capital. Our findings confirm that contemporary cities, particularly population-dense and expansive ones, are indeed divisive forces—acting as centers for income and wealth generation but failing to deliver equal opportunities for economic mobility. Perhaps surprisingly, this polarizing dynamic is a recent phenomenon. In the past, the most urbanized regions performed well in terms of income creation and equality of opportunity. Our analysis supports the hypothesis that the mid-20th century marked a pivotal shift toward more unequal and less inclusive patterns of urban growth.
Building healthier communities: the role of health educational programs in enhancing health literacy in Prairie View, Texas
Authors: Lewis Joshua , Pride Lornee , Hollis Melanie , Griffith Patrick
Published: February 2025

Introduction

Increasing health literacy, the ability to understand and process health information, within underserved communities can improve health outcomes. We hypothesized that educational programs tailored by age group would effectively improve an individual’s health literacy in underserved communities. Our study examined the implication of a health-related education program among different age groups in Prairie View, Texas.

Objectives

The study aimed to (i) improve health literacy within the Prairie View, Texas community; (ii) encourage healthy lifestyles in study participants; and (iii) provide an educational experience for medical and pre-medical students.

Methods

Monthly educational modules were presented for 5 months to three groups (high school students, college students, and older adults). The improvement in health literacy after the study was evaluated based on the average of correct responses on the pre- and post-monthly assessments. We also assessed the change in pre-med and medical students’ willingness to work within underserved communities.

Results

The average percentage of correct answers increased. By the end of the study, high school students answered 96% of the questions correctly, college students answered 95% correctly, and older adult participants answered 90% correctly. Medical student and pre-med student willingness to practice medicine in underserved communities increased.

Conclusion

Programs to increase health literacy within underserved communities can lead to improved medical knowledge competency, positive health outcomes, and informed decision making. Students exposed to the research were more willing to practice medicine in underserved communities.
Radiological safety assessment of monazite industry worker due to NORM inhalation
Authors: Lee Seong Yeon , Jin Yong Ho , Kim Min Seong , Kim Ji Woo , Kim Kwang Pyo
Published: February 2025

Monazite is used as a raw material for the production of rare earth elements. The workers in the monazite industry are exposed to radiation from the raw material. Therefore, internal radiation dose should be assessed for radiological safety assessment of the workers. The objective of this study is to assess the internal radiation dose to workers of the monazite industry in Korea by means of measured particulate. Particulate properties, including size distribution, density, shape, and radioactivity concentration were analyzed. Then, the internal radiation dose coefficients were derived using the IMBA software. Work scenarios were derived by identifying the work time. Finally, internal radiation doses were calculated with the collected and calculated data. The internal radiation dose ranged from 7.48 × 10−3 to 3.25 × 10−1 mSv y−1 with dose difference by orders of magnitude. It is highlighted why such data should be directly collected at sites to realistically assess radiation dose to workers.
Evaluation of the self-shielding characteristics of an innovative radiosurgical system ZAP-X
Authors: Mingsheng Li , Xiangjie Ma , Ya Liu , Xiao Wei , Quanfu Sun , Jinsheng Cheng
Published: February 2025

Purpose

The aim of this study was to evaluate the radiation level of a ZAP-X self-shielding system by comparing it with the requirements of the Chinese radiation protection standards and to provide a practical solution for the operation of ZAP-X in China.

Methods

Under the maximum workload of the ZAP-X system, the weekly radiation dose and the instantaneous dose rate (IDR) outside the safety perimeter of the ZAP-X system were compared to the requirements of relevant standards.

Results

The maximum weekly and annual dose equivalents, derived from the IDRs and accumulative doses, were as follows:1.99 μSv/week and 0.10 mSv/year, and 3.47 μSv/week and 0.17 mSv/year, respectively.

Conclusion

The radiation levels around the ZAP-X system meet the requirements of the weekly and annual dose constraints in relevant Chinese standards. The IDRs generated by the ZAP-X system do not meet the requirements of the existing radiation protection standards. A viable solution is to adjust the safety perimeter to comply with existing standards.
Non-Biological Modular Knee Arthrodesis for Prosthetic Infections With Large Defects at 5-year Follow-up: An Alternative to Amputation
Authors: Farid Yasser R.
Published: February 2025

Introduction:

Treatment of recurrent periprosthetic knee infections is challenging. Arthrodesis may be inapplicable in prosthetic infections with large defects and amputation prosthetics do not restore adequate function. A novel implant was used for non-biological arthrodesis in infections with large defects for which amputation was otherwise considered necessary.

Methods:

Patients who had the Biomet Orthopedic Salvage System (OSS) for non-biological knee arthrodesis with a minimum 2 years of follow-up or early failure and patients who received it as a temporary spacer before the second stage revision were identified and their charts were reviewed.

Results:

Eighteen patients were included. Four patients had temporary spacers then, second stage revision. One patient had amputation for recurrent infection, and 3 were infection-free at the last follow-up. In 14 patients, non-biological arthrodesis was performed. There were 11 females and 3 males with a mean age of 65 years. Bone loss at the knee was 11 to 47 (average 26) centimeters. Seven patients had recurrent infection: 5 remained on antibiotic suppression and retained functional extremities whereas 2 patients required above-the-knee amputation. A third patient required amputation for early spacer dislocation. Eleven patients (79%) retained functional extremities, and revision-free implant survival was 50% at an average 59 months (range 24 to 126 mo).

Conclusion:

Results of non-biological arthrodesis in prosthetic knee infection with large defects were encouraging. Patients should be counseled that although the procedure may offer an alternative to amputation, the goal is containment rather than cure of infection.
Clinical efficacy and safety of sintilimab plus oral vinorelbine as first-line treatment for newly diagnosed stage IIIB–IV nonsmall cell lung cancer patients with performance status 2 or age ≥75 years
Authors: Su Wenzhong , Li Jianqiang
Published: February 2025

This study aimed to evaluate the efficacy and safety of sintilimab combined with oral vinorelbine in newly diagnosed patients with stage IIIb to IV nonsmall cell lung cancer (NSCLC) who had an Eastern Cooperative Oncology Group performance status (PS) of 2 or over 75 years of age during the initial treatment. This prospective single-center single-arm study enrolled patients with histologically confirmed NSCLC. Eligible patients were administered sintilimab and vinorelbine. The primary endpoint was progression-free survival (PFS), and the secondary endpoints included objective response rate (ORR) and disease control rate (DCR). Furthermore, this study assessed indicators of treatment response and safety. From September 2020 to December 2023, 60 eligible patients were enrolled in the Respiratory Department of Shanxi Cancer Hospital. Following treatment, PFS was 9.1 months, and ORR and DCR were 39.6 and 63.79%, respectively. In addition, there was a reduction in blood tumor marker levels and enhanced immune function. Adverse reactions had a relatively low incidence and primarily consisted of grade 1–2 cases. Sintilimab plus oral vinorelbine showed promising efficacy and safety as a first-line treatment strategy for patients with NSCLC with PS 2 or elderly patients. It also optimizes immune function in patients with NSCLC.
Remimazolam for procedural sedation
Authors: Pingel Lasse , Maagaard Mathias , Tvarnø Casper D. , Sorenson Sandra , Bukhari Shaheer , Andersen Lars Peter Kloster , Andersen Jakob Hessel , Mathiesen Ole
Published: February 2025

BACKGROUND

Midazolam and propofol are frequently used for procedural sedation. Remimazolam may provide a more controllable sedation with fewer adverse effects.

OBJECTIVE

To assess the sedation success rate and respiratory and cardiovascular complications of remimazolam versus placebo and other sedatives in adults undergoing procedural sedation.

DESIGN

A systematic review of randomised controlled trials (RCTs) with meta-analyses, trial sequential analyses (TSA), and GRADE evaluations of the certainty of evidence.

DATA SOURCES

We searched Medline, Embase, CENTRAL, BIOSIS, CINAHL, and Web of Science Core Collection from their inception to 22 June 2024.

ELIGIBILITY CRITERIA

RCTs allocating participants undergoing procedural sedation to remimazolam versus placebo or any active comparator.

RESULTS

We included 63 trials randomising 13 953 participants. All included trial results were judged to be at high risk of bias. The sedation success rate was similar with remimazolam versus active comparators, relative risk (RR) 1.04, [97.5% confidence interval (CI), 0.96 to 1.14; TSA-adjusted CI, 0.95 to 1.18], P 
= 0.26, GRADE: very low. Subgroup analyses indicated that remimazolam versus midazolam increased sedation success rate, while the risks were similar with remimazolam versus comparators. Remimazolam versus active comparators decreased the risk of respiratory complications, RR 0.47, (97.5% CI, 0.36 to 0.61; TSA-adjusted CI, 0.35 to 0.61), P < 0.01; and cardiovascular complications, RR 0.46, (97.5% CI, 0.37 to 0.56; TSA-adjusted CI, 0.38 to 0.57), P < 0.01. Subgroup analyses indicated that remimazolam versus propofol reduced respiratory and cardiovascular complications, while the risks were similar versus midazolam.

CONCLUSION

Remimazolam seems to provide a similar sedation success rate as other active comparators (propofol, ciprofol, midazolam, dexmedetomidine, etomidate), although subgroup analyses indicated that remimazolam increased sedation success rate compared to midazolam. Remimazolam compared to propofol may decrease the risk of respiratory and cardiovascular complications. The certainty of the evidence was very low to low, and firm conclusions could not be drawn.
Eltrombopag-Induced Falsely Elevated Bilirubin Concentrations in Enzymatic and Vanadate Oxidation Assays: Involvement of High Serum Eltrombopag Concentrations
Authors: Oda Shun , Doki Kosuke , Obara Naoshi , Suzuki Yoshiharu , Chiba Shigeru , Homma Masato
Published: February 2025

Background:

The administration of eltrombopag, used to restore low blood count, demonstrates a positive interference of blood bilirubin levels when analyzed through the diazo assay. However, research on bilirubin measurements using other methods is limited. Therefore, using an enzymatic assay, this study aimed to investigate the effect of serum eltrombopag on bilirubin measurements in patients with aplastic anemia. It further assessed the concentration-dependent effect of eltrombopag on bilirubin measurements using enzymatic and vanadate oxidation assays.

Methods:

Total and conjugated bilirubin concentrations measured using an enzymatic assay and serum eltrombopag concentrations were examined in 227 serum samples collected from 30 patients with aplastic anemia receiving eltrombopag. Eltrombopag-spiked samples were analyzed using the enzymatic and vanadate oxidation assays for total and conjugated bilirubin to determine its concentration-dependent effects.

Results:

A strong positive correlation was observed between total bilirubin and serum eltrombopag concentrations in patients receiving eltrombopag (r = 0.820). However, the correlation between conjugated bilirubin and serum eltrombopag concentrations was weaker (r = 0.413). In eltrombopag-spiked serum samples, the enzymatic assay showed significant false elevation of total bilirubin concentrations at ≥6.0 mcg/mL; no interference with conjugated bilirubin measurements was observed. The vanadate oxidation assay showed mild positive biases of 0.2 and 0.1 mg/dL for total and conjugated bilirubin concentrations, respectively, at a high eltrombopag concentration (50 mcg/mL).

Conclusions:

Eltrombopag causes clinically significant concentration-dependent interference in total blood bilirubin, but not in conjugated bilirubin measurements through the enzymatic assay in patients with aplastic anemia. The vanadate oxidation assay may be used as an alternative to measure total blood bilirubin when the eltrombopag concentration is below 50 mcg/mL.
Ethical Dilemmas in Plastic Surgery: Insights From a Survey Study in Saudi Arabia
Authors: Arkoubi Amr Youssef , Jefri Zainalabden E. , Aldaghri Faris A. , Obeid Faisal M. , Almodumeegh Abdulaziz Saleh , Alhadlaq Abdulmajeed , Daghistani Waiel A , Mortada Hatan
Published: February 2025

Background:

Plastic surgery often presents complex ethical dilemmas involving patient autonomy, informed consent, and resource allocation. This study aimed to explore these challenges and their impact on surgeons’ decision-making processes.

Methods:

A survey study was conducted among plastic surgeons in Saudi Arabia between May and June 2024. An online-validated questionnaire was distributed to consultants, residents, and registrars. The survey covered demographic information and ethical dilemma scenarios. Data were analyzed using SPSS, with chi-square tests used to assess associations.

Results:

Among the 75 participants, 53.3% were consultants, 82.7% were male, and the majority (38.7%) were between 30 and 39 years of age. Most surgeons (41.3%) reported rarely encountering ethical dilemmas, with managing patient expectations being the most common issue, cited by 48.0% of respondents. Professional guidelines influenced decision-making for 56.0% of the participants. Consultants and residents had differing experiences; consultants were more concerned about advertising practices (75.0% compared with 12.5%) and complications (70.0% compared with 30.0%), whereas residents focused primarily on resource allocation (100.0% versus none of the consultants).

Conclusions:

Plastic surgeons in Saudi Arabia face various ethical challenges, with differences noted between consultants and residents. The findings highlight the importance of addressing these challenges to enhance decision-making and patient care.
Spanish Translation and Validation of the LIMB-Q: A Patient-reported Outcome Measure for Lower Extremity Trauma
Authors: Alahmadi Sami , Barata Herrera Daniela M. , Heron Matthew J. , Gomez-Rexrode Amalia E. , Rivera Perla Krissia M. , Soto Edgar , Ghanem Diane , Shafiq Babar , Mundy Lily R.
Published: February 2025

Background:

Hispanic patients represent a notable portion of the adult trauma population in the United States, yet their participation in studies collecting patient-reported outcome measure data following lower extremity injuries is limited. This study aims to translate and linguistically validate the LIMB-Q in Spanish for use in this population.

Methods:

We followed guidelines from the World Health Organization and the Professional Society for Health Economics and Outcomes Research to conduct this translation. Two independent translators conducted a blind forward translation of the LIMB-Q from English to Spanish, followed by a back translation to confirm the conceptual preservation of each LIMB-Q item. Five patients then participated in cognitive debriefing interviews to collect feedback on comprehension, interpretation, and language.

Results:

Translators occasionally differed in the vocabulary they used in their forward translations. All conflicts were resolved by discussion and selection of the option with the greatest colloquial recognition and medical relevance. Back translation identified 25 differences, including items that did not fully convey semantics (n = 12), were missing parts (n = 9), or were listed out of order (n = 4). All items with inadequate semantics were revised to ensure full retention of their original meaning. Five patients participated in cognitive debriefing interviews, resulting in 5 revisions for diction and syntax.

Conclusions:

The Spanish (US) translation of LIMB-Q is now available. This instrument may be used in both clinical and research settings to better understand the quality of life and satisfaction of Hispanic patients after traumatic lower extremity injury.
PI3K-mediated Kif1a DNA methylation contributes to neuropathic pain: an in vivo study
Authors: Jiang Wei , Yu Peng , Yang Yu , Cai Meng-Tan , Gan Lin , Qu Kang , Cheng Ying-Ying , Dong Ming
Published: February 2025

Neuropathic pain (NP) is a chronic condition caused by nerve injuries, such as nerve compression. Understanding its underlying neurobiological mechanisms is critical for developing effective treatments. Previous studies have shown that Kinesin family member 1A (Kif1a) heterozygous deficient mice display sensory deficits in response to nociceptive stimuli. PI3K has been found to mitigate these sensory deficits by enhancing Kif1a transcription, highlighting KIF1A's key role in sensory pain. However, the exact mechanism through which PI3K regulates KIF1A expression in relation to pain remains unclear. In this study, we observed a significant increase in PI3K/AKT/CREB (cyclic AMP response element-binding protein) protein levels in the dorsal root ganglia and spinal cord after chronic constriction injury in both male and female C57BL/6 mice. Notably, elevated levels of TET1, as well as Kif1a mRNA and protein, were detected in both male and female mice. Activated (phosphorylated-CREB) p-CREB recruited the DNA demethylase TET1, which interacted with the Kif1a promoter, reducing methylation and increasing Kif1a mRNA and protein expression. PI3K inhibition using wortmannin reversed the demethylation of Kif1a and decreased its expression in male mice. Furthermore, TET1 knockdown or overexpression significantly affected pain-related behaviors, as well as Kif1a methylation and transcription. Female mice given intrathecal injections of PI3K inhibitors exhibited similar molecular and behavioral outcomes as male mice. These findings offer new insights into NP mechanisms, suggesting that targeting the PI3K/KIF1A axis could be a promising therapeutic approach for NP treatment.
Mortality from infectious pneumonia associated with the severity of airflow limitation in pneumoconiosis: Proportional mortality study as a case-control study
Authors: Kang WonYang , Kim Daeho , Kim Mi-Yeon , Moon Subin , Lee YouLim , Lee Sungsook , Choi Byung-Soon
Published: February 2025

Objective: The aim of this study was to investigate whether the mortality risk from infectious pneumonia was associated with the severity of airflow limitation among subjects in the cohort of pneumoconiosis.

Methods: Proportional mortality study was designed as a case-control study with 347 cases and 328 controls. Mortality odds ratios (OR) were evaluated according to the severity of airflow limitation.

Results: The odds of mortality from pneumonia among the severe and very severe airflow limitation groups who performed spirometry at the time less than 1 year ago before death were 2.34 (OR 2.34; 95% CI 1.04 to 5.28) and 8.77 times (OR 8.77; 95% CI 1.69 to 45.68) greater compared to the non-airflow limitation group.

Conclusions: Severe airflow limitation in pneumoconiosis increases mortality from infectious pneumonia, presenting a dose-response relationship.
Interactive Workshop on Identifying Health Effects of Climate Change in the Clinical Setting: An Occupational and Environmental Health Solution
Authors: Saberi Pouné , Green-McKenzie Judith
Published: February 2025

Objective

To provide clinicians an occupational framework to assess climate-related health conditions, determine at-risk workers, and devise solutions.

Methods

An interactive workshop was presented at the 2022 American Occupational Health Conference (AOHC). Six climactic events related to occupational health were chosen with corresponding cases from National Institute of Environmental Health Sciences. Participants answered and discussed scripted questions. A 5-point Likert® Scale utilized by AOHC evaluated the workshop’s quality and utility, and the audience’s ability to apply the knowledge.

Results

Sixty-one (N = 66) participants ranked the workshop highly (4.4-4.6/5). Most participants (90%) reported incorporation of practical knowledge gained, increased advocacy capacity and ability to teach about the issue.

Conclusions

Successful integration of engaging interactive sessions in clinician education on climate change and health is critical as climactic conditions can increase patient vulnerability in their role as workers.
Giant spigelian hernia in an elderly woman: a case report
Authors: Shitu Hauwa , Mubezi Isaac , Akoh Jacob A
Published: February 2025

Introduction and importance

Spigelian hernias are an uncommon type of abdominal hernia, constituting just 1-2% of all cases. These hernias develop through defects in the abdominal wall near the semilunar line. Their rarity and subtle presentation often complicate preoperative diagnosis. The case highlights the challenges of diagnosing and managing Spigelian hernias in low- and middleincome countries, where access to advanced diagnostic tools like imaging and specialized surgical care is limited, complicating patient management.

Case presentation

This case involves an elderly woman with no known chronic conditions, not on any medication, and no prior surgical history, who presented with a history of a prolonged, large, non-reducible swelling,Due to a lack of access to preoperative imaging, clinical evaluation was used to guide surgical management, leading to a successful repair.

Clinical discussion

Spigelian hernias often present without clear symptoms, making them difficult to diagnose, especially in settings with limited diagnostic resources like ultrasound or CT. In this case, the hernia involved multiple abdominal structures, which posed a significant risk for complications such as strangulation.

Early surgical intervention is critical, particularly for elderly patients who are at higher risk.

Conclusion

This case demonstrates the importance of prompt surgical intervention in managing Spigelian hernias and the challenges faced in resource-limited settings. The Operation Hernia, A Global outreach program at no cost, provided crucial access to expert care in underserved regions, significantly improving patient outcomes.
Blood Glucose Range for Hyperglycemic PICU Children With Primary Neurologic Diagnoses: Analysis of the Heart and Lung Failure—Pediatric Insulin Titration Trial
Authors: LaRovere Kerri L. , Asaro Lisa A. , Coughlin-Wells Kerry , Nadkarni Vinay M. , Agus Michael S.D. ,   for the Heart and Lung Failure—Pediatric Insulin Titration (HALF-PINT) Study Investigators
Published: February 2025

Objectives:

To compare two blood glucose (BG) ranges in critically ill children with and without primary neurologic diagnoses in the Heart and Lung Failure—Pediatric Insulin Titration trial (HALF-PINT; ClinicalTrials.gov Identifier NCT01565941).

Design:

Non-prespecified post hoc analysis.

Setting:

Thirty-one PICUs in the United States, and one in Canada.

Patients:

Non-diabetic children enrolled from April 2012 to September 2016 with cardiovascular or respiratory failure and hyperglycemia. Patients in the neurologic subgroup had primary neurologic diagnoses on ICU admission.

Interventions:

Patients were randomized to insulin infusion to target lower-BG (80–110 mg/dL; 4.4–6.1 mmol/L) or higher-BG (150–180 mg/dL; 8.3–10 mmol/L).

MEASUREMENTS AND MAIN RESULTS:

Primary diagnosis (neurologic vs. non-neurologic), daily BG and insulin values, outcomes (number of PICU-free days through day 28 and 1-y post-PICU discharge adaptive behavior composite score of Vineland Adaptive Behavior Scales, Second Edition). Of 698 patients analyzed, 64 (30 lower-BG target, 34 higher-BG target) had primary neurologic diagnoses and 634 (319 lower-BG target, 315 higher-BG target) had non-neurologic diagnoses. Within the neurologic subgroup, patients in the lower-BG targeting group had fewer ICU-free days compared with those in the higher-BG targeting group (median 8.5 vs. 21.1 d), whereas there was no difference between BG groups in the non-neurologic subgroup (20.5 vs. 19.3 d; interaction p = 0.02). One-year adaptive behavior composite score was less favorable for the lower-BG targeting group in those with neurologic diagnoses (mean 63.3 vs. 87.6), but no different in those with non-neurologic diagnoses (81.9 vs. 78.4; interaction p = 0.02). Lower-BG targeting was associated with more hypoglycemia (< 60 mg/dL) in both diagnostic subgroups, with no differential effect across subgroups (p = 0.47).

Conclusions:

In this non-prespecified analysis of the HALF-PINT trial data, lower-BG targeting in hyperglycemic critically ill children with primary neurologic diagnoses was associated with unfavorable outcomes, while such BG targeting in those with non-neurologic diagnoses was not associated with adverse outcomes.
Leveraging Communities of Practice to Support Translation of Knowledge Into Action Among State, Tribal, Local, and Territorial Public Health Agencies: Lessons Learned From the COVID-19 Pandemic
Authors: Bosold Alyssa , Machta Rachel , Brenner Jackie , Porterfield Deborah S.
Published: February 2025

Context:

During the COVID-19 pandemic, communities of practice (CoPs) supported state, Tribal, local, and territorial (STLT) public health agencies. No studies have examined the collective role of these CoPs in helping STLT public health agencies translate guidance into practice.

Objectives:

This qualitative study examines the types of CoPs that supported STLT public health agencies during the COVID-19 response, how CoPs assisted in translating guidance into practice, and the characteristics of CoPs that made them valuable to STLT public health members. We report lessons for future public health emergencies (PHEs) for STLT public health agencies and membership organizations that represent them.

Design:

We conducted 21 in-depth interviews with CoP leaders, STLT public health participants, and federal agency sponsors and collaborators.

Participants:

We interviewed 9 CoP leads, 6 STLT participants, and 6 federal agency representatives.

Results:

Three types of CoPs, each with unique advantages, supported STLT public health agencies during the COVID-19 pandemic: (1) CoPs led by federal agencies, (2) CoPs led by membership organizations or associations that represent STLT public health agencies, and (3) CoPs led by other nonfederal organizations, such as philanthropic organizations and academic institutions. The most valuable CoPs to STLT public health agencies had a clear focus on issues of significance to their members, strong connections between members, and a structure tailored to the group’s goals. STLT public health agencies valued CoP support with implementing guidance-based policies and practices and facilitating bidirectional communication with federal agencies. STLT public health agencies also benefitted from tailored and implementation-focused resources developed through CoPs.

Conclusion:

Our study affirms the importance of CoPs in facilitating collaboration and information-sharing among multiple actors during PHEs. During the COVID-19 pandemic, CoPs helped STLT public health agencies implement guidance, tailor approaches to specific contexts, and generate practice-based discoveries to advance the field.