bluuebunny/crossref_metadata_2025 huggingface dataset:
Autoimmune Thyroid Disease: An Unusual Cause or Confounder of Vertigo
Authors: Moody Minhee P , Schieve Bailey , Ruhl Douglas S
Published: August 2024

Over the last decade, the published literature investigating the association between thyroid function and recurrent or persistent vertigo has become more robust. We present an interesting case of persistent vertigo in a healthy 31-year-old active duty Navy pilot who was restricted from operating single-pilot rotary aircraft because of the severity of her symptoms. During her work-up, she was newly diagnosed with autoimmune thyroid disease and started on thyroid hormone supplementation. Adequately treating her underlying thyroid disease was associated with resolution of dizzy symptoms and she was granted a waiver to return to flying. This case highlights the importance of autoimmune thyroid disease as a less common but important diagnosis to consider in the broad differential for vertigo. This is especially relevant to the military population since dizziness contributes to spatial disorientation for aviators and can be highly debilitating for warfighters. Astutely diagnosing and treating underlying causes of dizziness may allow service members to return to physically demanding and mentally arduous duties, improving overall military readiness.
Exploring the impact of galactic interactions and mergers on the central oxygen abundance of APEX/EDGE–CALIFA galaxies
Authors: Garay-Solis Y , Barrera-Ballesteros J K , Carigi L , Colombo D , Sánchez S F , Lugo-Aranda A Z , Villanueva V , Wong T , Bolatto A D
Published: August 2024

In this study, we explore the impact of the galactic interaction/mergers on the central oxygen abundance. We analyse 234 star-forming galaxies included in the Calar Alto Legacy Integral Field Area survey with integrated molecular gas observations from the Atacama Pathfinder EXperiment millimeter telescope and the CARMA interferometer. This database has the most optical integral field spectroscopy data with CO data for yet, with integrated measurements within $\sim 1~{R_{\rm{eff}}}$. Our sample includes 125 isolated galaxies (control sample) and 109 galaxies in different merging stages. We find that despite whether the merging galaxies show an increase or decrease in their molecular gas fraction, the oxygen abundance does not vary significantly, in comparison to our control sample. Therefore, the enhancement and suppression of oxygen abundance are similar in both isolated galaxies and interacting/merging galaxies. On the contrary, regardless of the merger stage (including isolated sample), galaxies that present an increase in their specific star formation rate present a metallicity dilution. We suggest that both internal and external events affect the chemical composition of merging galaxies.
Searching for pulsars, magnetars, and fast radio bursts in the sculptor galaxy using MeerKAT
Authors: Hurter H , Venter C , Levin L , Stappers B W , Barr E D , Breton R P , Buchner S , Carli E , Kramer M , Padmanabh P V , Possenti A , Prayag V , Turner J D
Published: August 2024

The Sculptor Galaxy (NGC 253), located in the Southern Hemisphere, far off the Galactic Plane, has a relatively high star-formation rate of about 7 M$_{\odot }$ yr−1 and hosts a young and bright stellar population, including several super star clusters and supernova remnants. It is also the first galaxy, apart from the Milky Way Galaxy to be associated with two giant magnetar flares. As such, it is a potential host of pulsars and/or fast radio bursts in the nearby Universe. The instantaneous sensitivity and multibeam sky coverage offered by MeerKAT therefore make it a favourable target. We searched for pulsars, radio-emitting magnetars, and fast radio bursts in NGC 253 as part of the TRAPUM large survey project with MeerKAT. We did not find any pulsars during a 4 h observation, and derive a flux density limit of 4.4 µJy at 1400 MHz, limiting the pseudo-luminosity of the brightest putative pulsar in this galaxy to 54 Jy kpc2. Assuming universality of pulsar populations between galaxies, we estimate that detecting a pulsar as bright as this limit requires NGC 253 to contain a pulsar population of ⪞20 000. We also did not detect any single pulses, and our single pulse search flux density limit is 62 mJy at 1284 MHz. Our search is sensitive enough to have detected any fast radio bursts and radio emission similar to the brighter pulses seen from the magnetar SGR J1935+2154 if they had occurred during our observation.
Obesity-associated non-oxidative genotoxic stress alters trophoblast turnover in human first-trimester placentas
Authors: Hoch Denise , Majali-Martinez Alejandro , Bandres-Meriz Julia , Bachbauer Martina , Pöchlauer Caroline , Kaudela Theresa , Bankoglu Ezgi Eyluel , Stopper Helga , Glasner Andreas , Hauguel-De Mouzon Sylvie , Gauster Martin , Tokic Silvija , Desoye Gernot
Published: August 2024

Placental growth is most rapid during the first trimester (FT) of pregnancy, making it vulnerable to metabolic and endocrine influences. Obesity, with its inflammatory and oxidative stress, can cause cellular damage. We hypothesized that maternal obesity increases DNA damage in the FT placenta, affecting DNA damage response and trophoblast turnover. Examining placental tissue from lean and obese non-smoking women (4–12 gestational weeks), we observed higher overall DNA damage in obesity (COMET assay). Specifically, DNA double-strand breaks were found in villous cytotrophoblasts (vCTB; semi-quantitative γH2AX immunostaining), while oxidative DNA modifications (8-hydroxydeoxyguanosine; FPG-COMET assay) were absent. Increased DNA damage in obese FT placentas did not correlate with enhanced DNA damage sensing and repair. Indeed, obesity led to reduced expression of multiple DNA repair genes (mRNA array), which were further shown to be influenced by inflammation through in vitro experiments using tumor necrosis factor-α treatment on FT chorionic villous explants. Tissue changes included elevated vCTB apoptosis (TUNEL assay; caspase-cleaved cytokeratin 18), but unchanged senescence (p16) and reduced proliferation (Ki67) of vCTB, the main driver of FT placental growth. Overall, obesity is linked to heightened non-oxidative DNA damage in FT placentas, negatively affecting trophoblast growth and potentially leading to temporary reduction in early fetal growth.
Patchwork Conditions for Holographic Nonlinear Responses: A Computational Method for Electric Conductivity and Friction Coefficient
Authors: Ishigaki Shuta , Nakamura Shin , Takasan Kazuaki
Published: August 2024

We propose a new method to compute nonlinear transport coefficients in holography, such as nonlinear DC conductivity and the nonlinear friction coefficient. The conventional method can be applied only to the models whose action in the gravity dual has the “square-root structure,” i.e. the Dirac–Born–Infeld action of the probe D-branes or the Nambu–Goto action of the probe strings. Our method is applicable to a wider range of holographic models whose action does not have such a square-root structure. We propose a condition to obtain regular physical configurations in the gravity dual in the form of two simultaneous equations, which we call the patchwork condition. Our method also enables us to estimate the effective temperature of the nonequilibrium steady states in a wider range of holographic models. We show that a general model exhibits different effective temperatures for different fluctuation modes.
Reducing motion artifacts in craniocervical background subtraction angiography with deformable registration and unsupervised deep learning
Authors: Zhou Chaochao , Abdalla Ramez N , An Dayeong , Faruqui Syed H A , Sadrieh Teymour , Alzein Mohayad , Nehme Rayan , Shaibani Ali , Ansari Sameer A , Cantrell Donald R
Published: August 2024

Background

In clinical practice, digital subtraction angiography (DSA) often suffers from misregistration artifact resulting from voluntary, respiratory, and cardiac motion during acquisition. Most prior efforts to register the background DSA mask to subsequent postcontrast images rely on key point registration using iterative optimization, which has limited real-time application.

Purpose

Leveraging state-of-the-art, unsupervised deep learning, we aim to develop a fast, deformable registration model to substantially reduce DSA misregistration in craniocervical angiography without compromising spatial resolution or introducing new artifacts.

Materials and Methods

We extend HyperMorph, an open source deep learning deformable registration framework, to reduce motion artifacts in DSA. Novel image similarity loss functions with vessel layer estimation were introduced to optimize background registration, making it robust to the variable presence of intravascular iodinated contrast.

Results

A total of 516 studies with 5,240 angiographic series were collected and divided into training (5,046 series) and hold-out test (194 series) sets. Blinded algorithm rankings and Likert scores on 5-point scales (1 = worst, 5 = best) were generated by 3 practicing interventional neuroradiologists using 50 series randomly selected from the hold-out test set. Compared to traditional DSA, our learning-based background subtraction angiography (BSA) significant improved vascular fidelity (2.4 ± 0.6 for DSA vs. 3.6 ± 0.5 for BSA), subtraction artifacts (2.0 ± 0.4 for DSA vs. 3.9 ± 0.3 for BSA), and overall quality (2.1 ± 0.5 for DSA vs. 3.9 ± 0.4 for BSA) (P < .0001). Learning-based BSA also significantly outperformed affine registration-based BSA (P < .0001). The average inference time for learning-based BSA was 30 milliseconds per frame on our hardware.

Conclusion

The results demonstrate that deep learning deformable registration, combined with an appropriate loss function, can significantly reduce the motion artifacts that degrade DSA.
Budesonide and N-acetylcysteine inhibit activation of the NLRP3 inflammasome by regulating miR-381 to alleviate acute lung injury caused by the pyroptosis-mediated inflammatory response
Authors: Zhang Rongfang , Yang Aiping , Fu Jin , Zhang Li , Yin Liyue , Xu Ting , Dai Chunhui , Su Wenbing , Shen Wanling
Published: August 2024

Background

The anti-inflammatory effects of budesonide (BUN) and N-acetylcysteine (NAC) attenuate acute lung injury (ALI). The aim of this study was to investigate the effects of combination therapy consisting of BUN and NAC on ALI and the underlying mechanisms.

Methods

In vitro and in vivo models of ALI were generated by LPS induction. Western blotting was used to detect the expression levels of pyroptosis-related proteins and inflammation-related factors, and RT–qPCR was used to detect the expression of miR-381. Cell proliferation and apoptosis were detected by CCK-8 and flow cytometry, respectively. ELISA was used to detect the levels of inflammation-related factors. HE staining was used to detect lung injury.

Results

The results showed that LPS effectively induced pyroptosis in cells and promoted the expression of pyroptosis-related proteins (Caspase1, Gasdermin D and NLRP3) and inflammatory cytokines (TNF-α, IL-6 and IL-1β). The combination of BUN and NAC significantly alleviated LPS-induced pyroptosis and inflammation. In addition, the combination of BUN and NAC effectively promoted miR-381 expression. Transfection of miR-381 mimics effectively alleviated LPS-induced pyroptosis and inflammation, while transfection of miR-381 inhibitors had the opposite effect. miR-381 negatively regulates NLRP3 expression. Treatment with a miR-381 inhibitor or pc-NLRP3 reversed the effects of the combination of BUN and NAC. In a mouse model of ALI, the combination of BUN and NAC effectively improved lung injury, while treatment with a miR-381 inhibitor or pc-NLRP3 effectively reversed this effect.

Conclusion

Overall, this study revealed that BUN + NAC inhibits the activation of NLRP3 by regulating miR-381, thereby alleviating ALI caused by pyroptosis-mediated inflammation.
The Supply of Surgical Specialists and Subspecialists to the U.S. Medicare Population: National Trends from 2013 to 2019
Authors: Talbott Jennifer , Khurana Aditya , Wasson Megan
Published: August 2024

Purpose

The U.S. population is rapidly aging. The supply of surgeons needed to meet this demand should be evaluated. This study evaluated the trends in supply of Medicare surgeons by specialty and by U.S. state and region.

Method

All surgeons associated with a National Provider Identifier for cardiothoracic surgery, colorectal surgery, general surgery, gynecologic oncology, hand surgery, neurosurgery, obstetrics-gynecology, ophthalmology, oral and maxillofacial surgery, orthopedic surgery, otolaryngology, plastic and reconstructive surgery, surgical oncology, urology, and vascular surgery from 2013 to 2019 on the Centers for Medicare & Medicaid Services website were included. The absolute number of physicians was adjusted per 100,000 Medicare beneficiaries. Annual change was calculated by linear regression model, and the compound annual growth rate (CAGR) was calculated per specialty.

Results

The absolute number of physicians per 100,000 beneficiaries increased in 6 of 15 specialties during the study period. Vascular surgery had the largest annual increase (+0.23; CAGR, +2.75%), and obstetrics-gynecology had the largest annual decrease (−1.08; CAGR, −1.44%). Surgical oncology showed the largest positive CAGR (+4.20%). Oral and maxillofacial surgery had the largest negative CAGR (−2.86%). The Northeast was above the national average in supply for each specialty. The Midwest had the most specialties with positive CAGRs. The South did not meet the national average for physicians in any specialty.

Conclusions

This analysis of 15 surgical specialties provides important context to predicted physician shortages to the Medicare population. The study found geographic variation by region across specialty, which has important implications for health care planning from the level of undergraduate medical education to provision of hospital resources. Overall, the supply of surgeons across all specialties may not be sufficient to meet the demand of the rapidly aging U.S. population. Future study is needed to evaluate why surgeons are leaving the Medicare program.
Gender Differences in Autonomy Granted to Residents and Fellows During Procedural Training: A Systematic Review and Meta-Analysis
Authors: Lund Sarah , Griffeth Elaine M. , Williamson Andrea , Collings Amelia , Gudmundsdottir Hallbera , Han Amy , Kearse LaDonna , Kratzke Ian M. , Wilkins Parvathi , Prokop Larry J. , Cook David A.
Published: August 2024

Purpose

Supervisors may be prone to implicit (unintentional) bias when granting procedural autonomy to trainees due to the subjectivity of autonomy decisions. The authors aimed to conduct a systematic review and meta-analysis to assess the differences in perceptions of procedural autonomy granted to physician trainees based on gender and/or race.

Method

MEDLINE, Embase, CENTRAL, Scopus, and Web of Science were searched (search date: January 5, 2022) for studies reporting quantitative gender- or race-based differences in perceptions of procedural autonomy of physician trainees. Reviewers worked in duplicate for article selection and data abstraction. Primary measures of interest were self-reported and observer-rated procedural autonomy. Meta-analysis pooled differences in perceptions of procedural autonomy based on trainee gender.

Results

The search returned 2,714 articles, of which 16 were eligible for inclusion. These reported data for 6,109 trainees (median, 90 per study) and 2,763 supervisors (median, 54 per study). No studies investigated differences in perceptions of autonomy based on race. In meta-analysis of disparities between genders in autonomy ratings (positive number favoring female trainees), pooled standardized mean differences were −0.12 (95% confidence interval [CI], −0.19 to −0.04; P = .003; n = 10 studies) for trainee self-rated autonomy and −0.05 (95% CI, −0.11 to 0.01; P = .07; n = 9 studies) for supervisor ratings of autonomy.

Conclusions

Limited evidence suggests that female trainees perceived that they received less procedural autonomy than did males. Further research exploring the degree of gender- and race-based differences in procedural autonomy, and factors that influence these differences is warranted.
Predicting Surgical Resident Performance With Situational Judgment Tests
Authors: Gardner Aimee K. , Costa Paula
Published: August 2024

Purpose

Situational judgment tests (SJTs) have been proposed as an efficient, effective, and equitable approach to residency program applicant selection. This study examined how SJTs can predict milestone performance during early residency.

Method

General surgery residency program applicants during 3 selection cycles (2018–2019, 2019–2020, 2020–2021) completed SJTs. Accreditation Council for Graduate Medical Education milestone performance data from selected applicants were collected in March and April 2019, 2020, and 2021 and from residents in March 2020, August 2020, March 2021, September 2021, and March 2022. Descriptive statistics and correlations were computed and analysis of variance tests performed to examine differences among 4 SJT performance groups: green, top 10% to 25%; yellow, next 25% to 50%; red, bottom 50%; and unknown, did not complete the SJT.

Results

Data were collected for 70 residents from 7 surgery residency programs. Differences were found for patient care (F
3,189 = 3.19, P = .03), medical knowledge (F
3,176 = 3.22, P = .02), practice-based learning and improvement (F
3,189 = 3.18, P = .04), professionalism (F
3,189 = 3.82, P = .01), interpersonal and communication skills (F
3,190 = 3.35, P = .02), and overall milestone score (F
3,189 = 3.44, P = .02). The green group performed better on patient care, medical knowledge, practice-based learning and improvement, professionalism, and overall milestone score. The yellow group performed better than the red group on professionalism and overall milestone score, better than the green group on interpersonal and communication skills, and better than the unknown group on all but practice-based learning and improvement. The red group outperformed the unknown group on all but professionalism and outperformed the green group on medical knowledge.

Conclusions

SJTs demonstrate promise for assessing important noncognitive attributes in residency applicants and align with national efforts to review candidates more holistically and minimize potential biases.
First In Vivo Electromyographic Analysis of Mechanical Load Scenarios of the Cervicothoracic Junction During Daily Activities as a Basis for Future Postoperative Behavioral Instructions
Authors: Schröder Bennet Mathis , Koller Heiko , Liodakis Emmanouil , Sehmisch Stephan , Körner Sonja , Decker Sebastian
Published: August 2024

Study Design:

Clinical Research.

Objectives:

Study participants were twenty- eigth healty volunteers.

Background:

Soft tissue complications after posterior cervicothoracic fusion surgery occur frequently. Postoperative myofascial dehiscence (PMD) can cause disability and pain. So far, it is unknown whether patients can affect PMD development through behavioral adjustment. Consequently, this study aimed to analyze how much mechanical stress daily activities exert on the posterior muscles and fascia at the cervicothoracic junction.

Materials and Methods:

Surface electromyography was applied next to the upper thoracic spine at the trapezius muscle. All volunteers performed 22 different daily activities, such as tooth brushing, dressing, standing up, and different horizontal positions. During the exercises, the electromyographic activity was measured. For each volunteer, root mean square values were determined. All exercises were then repeated with the use of a clavicular bandage to unload the shoulder and cervicothoracic muscles. Afterwards, the rankings were statistically compared interindividually.

Results:

Among the different tasks, significant differences in regard to the root mean square values were noted. For instance, horizontal positions caused significantly lower muscle activation compared with all other exercises (P ≤ 0.001). Notably, no relevant electromyographic differences were detected between the tasks with and without a clavicular bandage.

Conclusions:

This in vivo electromyographic analysis of cervicothoracic muscle activity during daily activities demonstrates that myofascial strain differs among various daily activities. Data indicate that potential postoperative mobilization protocols and behavioral instructions may have the potential to reduce the biomechanical load and consequently the risk of PMD and, therefore, may reduce the risk for surgical wound-related complications, disability, and need for revision surgery.
Nursing Variables Predicting Readmissions in Patients With a High Risk
Authors: Lee Ji Yea , Park Jisu , Choi Hannah , Oh Eui Geum
Published: August 2024

Unplanned readmission endangers patient safety and increases unnecessary healthcare expenditure. Identifying nursing variables that predict patient readmissions can aid nurses in providing timely nursing interventions that help patients avoid readmission after discharge. We aimed to provide an overview of the nursing variables predicting readmission of patients with a high risk. The authors searched five databases—PubMed, CINAHL, EMBASE, Cochrane Library, and Scopus—for publications from inception to April 2023. Search terms included “readmission” and “nursing records.” Eight studies were included for review. Nursing variables were classified into three categories—specifically, nursing assessment, nursing diagnosis, and nursing intervention. The nursing assessment category comprised 75% of the nursing variables; the proportions of the nursing diagnosis (25%) and nursing intervention categories (12.5%) were relatively low. Although most variables of the nursing assessment category focused on the patients' physical aspect, emotional and social aspects were also considered. This study demonstrated how nursing care contributes to patients' adverse outcomes. The findings can assist nurses in identifying the essential nursing assessment, diagnosis, and interventions, which should be provided from the time of patients' admission. This can mitigate preventable readmissions of patients with a high risk and facilitate their safe transition from an acute care setting to the community.
Pelvic congestion syndrome analysis through quantitative 2-dimensional phase-contrast MRI: a promising vision from an observational cohort study
Authors: Li Chen-Yu , Chen Chien-Wei , Kao Chih-Chen , Hsu Yin-Chen , Lee Chung-Yuan , Lin Chieh-Chao , Yang Teng-Yao , Wang Shih-Chung , Chen Sheng-Ya , Lin Yu-Hui , Wong Min Yi , Chang Chee-Jen , Huang Yao-Kuang
Published: August 2024

Background:

To examine the application of quantitative 2-dimensional phase-contrast MRI (2D PC-MRI) for treating patients with pelvic congestion syndrome (PCS).

Materials and Methods:

The authors conducted a retrospective cross-sectional analysis by using quantitative 2D PC-MRI data enrolled between April 2017 and September 2023. In addition, 32 healthy female controls (HCs) were included.

Results:

Most patients with PCS presented with chronic pelvic pain and more than half had extrapelvic venous symptoms (80/81, 98% and 45/81, 56%, respectively). Quantitative 2D PC-MRI analyzed the 81 patients with PCS, 239 patients without PCS, and 32 HCs. The patients with PCS had higher stroke volume (SV), absolute SV (ASV), and mean flux (MF) in the calf region (interstitial pixel shift) than did the HCs. In the left gonadal vein, the patients with PCS had higher SV, backward flow volume (BFV), ASV, and MF and lower forward flow volume (FFV), stroke distance (SD), and mean velocity (MV) than did the HCs. However, the patients with PCS had lower SV, FFV, MF, SD, and MV in the great saphenous veins. Quantitative 2D PC-MRI analysis revealed that the PCS group had higher SV, FFV, BFV, ASV, and MF in the calf region than did the non-PCS group. The variables that most strongly differentiated the patients with PCS from the HCs were SV in the great saphenous veins, SD in the great saphenous veins and left gonadal vein, and MV in the great saphenous veins and left gonadal vein. Caudal flow in the left gonadal vein was identified in half of the patients with PCS (39/81, 48.1%); 14 of them received embolization for left gonadal vein.

Conclusions:

In additional to providing an objective 3-dimensional morphology of the pelvic veins and extrapelvic leaks, quantitative 2D PC-MRI analysis reveals distinct hemodynamic profiles between patients with PCS, those without PCS, and HCs, especially in the gonadal veins and regional perfusion of the calves.
Efficacy and safety of combining short-course neoadjuvant chemoradiotherapy with envafolimab in locally advanced rectal cancer patients with microsatellite stability: a phase II PRECAM experimental study
Authors: Wang Fei , Lai Chuanxi , Lv Yiming , Zhang Feixiang , Shi Liming , Wang Yunfei , Shen Yanbin , Xu Lingna , Hu Peng , Tang Wen , Xu Dengyong , Cao Gaoyang , Shan Lina , Jia Xiya , Chen Yiyi , Larson David W. , Wang Da , Lao Weifeng , Gu Hongcang , Sun Xiaonan , Huang Xuefeng , Dai Sheng
Published: August 2024

Background:

Conventional neoadjuvant chemoradiotherapy (nCRT) yields a pathologic complete response (pCR) rate of 15–30% for locally advanced rectal cancer (LARC). This study ventures to shift this paradigm by incorporating short-course nCRT with immunotherapy, specifically Envafolimab, to achieve improved treatment efficacy and possibly redefine the standard of care for LARC.

Materials and methods:

The PRECAM study is a prospective, single-arm, phase 2 clinical trial for LARC in patients with microsatellite stable (MSS) tumors. Participants received short-course radiotherapy (25Gy/5f), followed by two cycles of CAPEOX chemotherapy and six weekly doses of Envafolimab, a PD-L1 antibody, before total mesorectal excision surgery. The primary endpoint was the pCR rate.

Results:

From April to December 2022, 34 patients were enrolled, of whom 32 completed the study, each diagnosed with an MSS rectal adenocarcinoma. All patients underwent preoperative CRT combined with Envafolimab. Remarkably, a pCR rate of 62.5% (20/32) was attained, and a significant pathologic response rate of 75% (24/32) was achieved. Additionally, 21 of 32 participants achieved a neoadjuvant rectal (NAR) score below 8, suggesting an effective treatment response. Common adverse events included tenesmus (78.1%), diarrhea (62.5%), and leukocyte decrease (40.6%). Two Grade 3 adverse events were noted, one related to liver function abnormality and the other to a decrease in platelet count. Surgical procedures were performed in all cases, with minor complications, including ileus, infections, and anastomotic leakage. As of this report, there have been no reported cases of recurrence or death during the follow-up period, ranging from 12 to 20 months.

Conclusion:

In LARC patients exhibiting MSS tumors, combining short-course nCRT with Envafolimab demonstrated favorable efficacy, leading to a significant pCR rate. Minor adverse effects and surgical complications were observed. These preliminary but promising results underscore the potential of this approach and call for further exploration and validation through a randomized controlled trial.
Exploring the causal relationships between cholelithiasis, cholecystitis, cholecystectomy, and gastroesophageal reflux disease: a bidirectional two-sample Mendelian randomization study
Authors: Lin Huahang , Lu Runda , Shang Qixin , Gu Yimin , Liu Yixin , Yang Yushang , Chen Longqi
Published: August 2024

Background:

Biliary disorders and gastroesophageal reflux disease (GERD) frequently coexist. However, precise linkages between these conditions remain to be clarified.

Methods:

Univariable Mendelian randomization (MR), Bayesian weighted MR (BWMR) along with multivariable MR approaches were conducted using genetic instruments to evaluate the causality involving biliary disorders and GERD. Furthermore, an investigation was conducted on the potential mediating roles of biliary disorders (or GERD), on the linkage involving BMI and GERD (or biliary disorders).

Results:

Univariable MR analyses revealed significant causal effects of genetically predicted cholelithiasis [odds ratio (OR)=1.04, P=0.0001], cholecystitis (OR=1.06, P=0.0004), and cholecystectomy (OR=2.56, P=1.05×10-6) on GERD. These findings were replicated in the FinnGen cohort and were also confirmed by BWMR and multivariable MR analyses. Additionally, mediation analyses demonstrated that cholelithiasis and cholecystitis acted as partial mediators, linking BMI causally to GERD. Conversely, GERD exhibited causal effect on cholelithiasis (OR=1.52, P=9.17×10-30) and cholecystitis (OR=1.90, P=3.32×10-28), which remained significant after BWMR and multivariable MR analyses. Mediation analyses further revealed significant mediating effect of GERD on how BMI influenced cholelithiasis/cholecystitis.

Conclusion:

Our study elucidates the bidirectional causal linkages involving cholelithiasis, cholecystitis, cholecystectomy, and GERD. These results highlight the significance of GERD risk assessment in individuals suffering from biliary diseases and vice versa.
Severe acquired hemophilia A associated with COVID-19 vaccination: A case report and literature review
Authors: Kim Hong Jun , Jung Ye Ji , Lee Jun Ho , Lee Hyun Jung , Maeng Chi Hoon , Baek Sun Kyung , Han Jae Joon
Published: August 2024

Rationale:

Acquired hemophilia A (AHA) is a rare autoimmune disease caused by an antibody that inhibits coagulation factor VIII activity. More than half of patients with AHA cannot identify underlying disorders. The remaining patients are associated with malignancies, autoimmune diseases, skin diseases, infections, and medications. Here, we present a case of 56-year-old Korean man with underlying hypertension, dyslipidemia, and diabetes mellitus who developed AHA following the second dose of BNT162b2 COVID-19 vaccination.

Patient concerns:

He presented with a large 20 × 30 cm-sized hematoma along the psoas muscle and intracranial hemorrhage, necessitating intensive care with mechanical ventilation and continuous renal replacement therapy. Laboratory testing demonstrated that activated partial thromboplastin time and prothrombin times were 74.7 seconds (normal range 29–43 seconds) and 17.2 seconds (normal range 12.5–14.7 seconds), respectively.

Diagnoses:

Laboratory tests confirmed AHA with undetectable factor VIII activity (<1.5%) and a positive factor VIII antibody with a titer of 8.49 Bethesda units/mL.

Interventions:

Recombinant factor VIIa (NovoSeven®) was administered every 2 hours to control the bleeding, alongside immunosuppression with methylprednisolone 1 mg/kg daily and cyclophosphamide 2 mg/kg daily to eliminate the autoantibody.

Outcomes:

Despite the treatments, the patient developed sepsis and succumbed 14 weeks after admission.

Lessons:

This rare case underscores the importance of monitoring for AHA following COVID-19 vaccination. Although the benefits outweigh the risks of vaccination, AHA should be considered in the differential diagnosis of unusual bleeding following the vaccinations. Early diagnosis and management before severe bleeding are critical for successfully controlling life-threatening bleeding.
Psychiatric Diagnosis
Authors: Aftab Awais , Banicki Konrad , Ruffalo Mark L. , Frances Allen
Published: August 2024

The controversies surrounding the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases have generated significant debate across the psy-sciences. This debate has been further fueled by the launch of the Research Domain Criteria as a framework to facilitate advances in neuroscientific research, a renewed emphasis on dimensional models of psychopathology, currently exemplified by the Hierarchical Taxonomy of Psychopathology, and development of the Psychodynamic Diagnostic Manual by the psychodynamic community. In this article, we provide a clinical overview of recent debates surrounding categorical and dimensional approaches to psychiatric diagnosis, offer a critical assessment of proposed alternatives, and discuss how clinicians can navigate a plurality of diagnostic frameworks. Our discussion emphasizes that diagnostic frameworks need to be contextualized within the process of a comprehensive clinical evaluation, and their advantages and disadvantages should be understood in relationship to the theoretical orientations and practical needs of clinicians.
Trauma center rehabilitation systems in Latin America
Authors: Padilla-Rojas Luis G. , Tamayo-Cosio Johnatan , Garín-Zertuche Darío E. , Rojas-Herrera Christian A. , Vallejo Linda , Leal Jaime A. , Soarez-Hungria José O. , Caiero Marcelo T. , Tabares-Neyra Horacio , González Roig Jorge L. , Giordano Vincenzo
Published: August 2024

Trauma is a leading cause of mortality and morbidity worldwide with high rates of disability in survivors. With improvements in care, rehabilitation of the trauma patient is a cornerstone to reducing sequelae. A lack of well-established hospital rehabilitation units and standardized protocols for managing posttraumatic injuries is a common problem in Latin American countries. Future studies should seek to understand the barriers and gaps in care so that consensus and ultimately best practice guidelines can be developed and included in rehabilitation programs throughout trauma centers in Latin America.
The U-SMASectomy Facelift
Authors: Movassaghi Kiya , Check Janna , Gougoutas Alexander
Published: August 2024

Manipulation of the superficial musculoaponeurotic system (SMAS) has become a mainstay of face lifting procedures. Traditionally, the various surgical approaches to the SMAS have been classified as either “low” or “high” SMAS techniques, the former of which, while expeditious, have been criticized for suboptimal upper midface rejuvenation. High SMAS techniques, by contrast, are lauded for their ability to improve upper midface contours, but may carry increased surgical risk, particularly in the hands of less experienced aesthetic surgeons. Presented is the U-SMASectomy facelift (USL)- an imbricating approach to the SMAS that builds upon well-described low SMAS techniques with the addition of a malar flap of mobile-only SMAS for orbitomalar rejuvenation. This novel, hybrid technique harnesses the advantages of traditional low and high SMAS techniques while mitigating surgical risk. Of 61 USLs performed, a minor complication rate of 16.4% was observed. No major complications were observed. Mean follow-up was 371 days. The USL is thus a safe and powerful facial rejuvenation technique for both beginning surgeons with advanced aesthetic training, and well-versed aesthetic surgeons alike.
Depressive and Anxious Symptoms, Experimentally Manipulated Acute Social-Evaluative Threat, and Cortisol Reactivity
Authors: Strickland Megan G. , Myszkowski Nils , Hooker Emily D. , Zoccola Peggy M. , Dickerson Sally S.
Published: August 2024

Objective

Exposure to social-evaluative threat (SET) can elicit greater physiological responses, including cortisol, compared to non-SET stressors. An individual’s level of depressive and anxious symptoms predicts variability in cortisol responses to stressors, and other research suggests that these individual differences may predict vulnerability to social evaluation. The current study integrates both lines of research, testing if there are different relationships between depressive and/or anxious symptoms and cortisol reactivity in the presence or absence of SET.

Methods

Healthy undergraduate students (N = 158, 65% female) were randomly assigned to deliver a speech in the presence (SET) or absence (non-SET) of two evaluators. Salivary cortisol was collected throughout, and self-reported depressive and anxious symptoms were assessed. We hypothesized that in the SET condition, higher levels of depressive and/or anxious symptoms would predict dysregulated cortisol responses compared to lower levels of symptoms and/or assignment to the non-SET group.

Results

In spite of inconclusive p values (which might be attributed to low statistical power), individuals with high depressive or high anxious symptoms appeared to have exaggerated cortisol responses in the SET condition, as indicated by more concave trajectories.

Conclusions

This study suggests that both depression and anxiety could be associated with increased cortisol reactivity to SET.
Emergency Department Buprenorphine and Naloxone Prescribing Disparities Among Racial and Ethnic Minorities Presenting With an Opioid Overdose
Authors: Davis Philip , Evans Dian
Published: August 2024

The aim of the Research to Practice column is to enhance the research critique abilities of both advanced practice registered nurses and emergency nurses (RNs), while also aiding in the translation of research findings into clinical practice. Each column focuses on a specific topic and research study. In this article, we used two patient scenarios as a framework to delve into the 2023 secondary analysis of Papp and Emerman’s study on “Disparities in Emergency Department Naloxone and Buprenorphine Initiation.”
A Case of Cardioversion and Management of Atrial Flutter in the Emergency Department
Authors: Troupe Ian
Published: August 2024

Atrial flutter is a supraventricular cardiac arrhythmia commonly characterized by two or three rapid atrial contractions for every ventricular contraction and a rapid ventricular rate that can be identified by a sawtooth pattern on an electrocardiogram. Patients often present with symptoms of heart failure and face the risk of atrial thrombus with a potential for systemic embolization. As such, pharmacologic rate and rhythm control, transesophageal echocardiogram, direct current cardioversion, and anticoagulation therapies may all be required for patient management. This case study provides an example of the patient presentation, exam findings, diagnostic results, and intervention modalities required for the health care provider to manage atrial flutter correctly in the emergency department setting.
Social Cognition, Executive Functioning, Mood, and Disability in Cervical Dystonia
Authors: Diepman Madeleine , Seery Christina , Rafee Shameer , Somers Rachel , O’Riordan Séan , Hutchinson Michael , O’Keeffe Fiadhnait
Published: August 2024

Background:

Individuals with idiopathic adult-onset isolated cervical dystonia (CD) may have cognitive difficulties and increased mood challenges. Social cognition and executive functioning may be particularly affected.

Objective:

To explore social cognition and executive functioning performance in individuals with CD, using the Cambridge Neuropsychological Test Automated Battery (CANTAB), as previous research has used traditional, nondigital neuropsychological assessments. We sought to investigate the relationships between social cognition, executive functioning, mood, and disability in individuals with CD.

Methods:

We recruited 37 individuals with CD, including 26 women with an age range of 33 to 69 years (M = 56.64, SD = 8.31) from a dystonia clinic in a hospital neurology department. The individuals completed selected tasks from the CANTAB measuring social cognition and executive functioning. We compared the individuals’ performance with CANTAB normative data. Depression, anxiety, disease severity, and disability were measured.

Results:

The individuals with CD had significantly lower scores than the CANTAB normative data in both social cognition and executive functioning tasks, with the largest differences evident in problem-solving, attention, and positive emotion bias tasks. Poorer emotion recognition was associated with increased difficulties in problem-solving tasks. The individuals demonstrated a bias toward identifying happiness in facial affect, which was related to a poorer recognition of emotions. Cognitive performance was not related to CD severity or disability or to current mood symptoms.

Conclusion:

Difficulties with both social cognition and executive functioning were identified in the individuals with CD, and are likely important targets for clinical interventions.
Intraoperative Neuromonitoring for the Lower-Extremity Region Using Motor-Evoked Potential With Direct Cortical Stimulation in Brain Tumor Surgeries
Authors: Takatani Tsunenori , Matsuda Ryosuke , Hayashi Hironobu , Maeoka Ryosuke , Nakase Kenta , Morisaki Yudai , Yokoyama Shohei , Takeshima Yasuhiro , Nakagawa Ichiro , Momoyama Yasushi , Kawaguchi Masahiko
Published: August 2024

Purpose:

To evaluate the motor function of the lower extremity (LE), we used direct cortical stimulation motor-evoked potential (D-MEP) monitoring with a single six-contact subdural strip electrode placed in the interhemispheric fissure.

Methods:

Intraoperative neuromonitoring using D-MEPs in the LE was performed in 18 cases (16 patients) for brain tumor surgery from December 2018 to April 2023 with a follow-up period of at least 3 months. After dural opening, a single six-contact subdural strip electrode was placed inside the interhemispheric fissure. To identify the central sulcus, phase reversal was recorded using somatosensory evoked potentials. Next, direct cortical stimulation was applied to the primary motor cortex. The baseline waveform was defined as a reproducible waveform of 30 µV or higher, and a significant decrease of ≥50% in the amplitude resulted in a warning during surgery.

Results:

The success rate of central sulcus identification in the LE was 66.7% (12/18 cases). Direct cortical stimulation motor-evoked potential monitoring could record stable contralateral motor-evoked potentials of the tibialis anterior, gastrocnemius, and abductor hallucis in 16 of 18 cases (88.9%). The mean intensity of stimulation for D-MEPs was 20.5 ± 9.9 mA, and the 16 cases showed no significant reduction in amplitude. Seventeen cases showed no deterioration of motor function of the LE at 1 and 3 months postoperatively. In the remaining case with unsuccessful D-MEP, paralysis of the LE worsened at 1 and 3 months postoperatively.

Conclusions:

The placement of electrodes in the interhemispheric fissure on the primary motor cortex of the LE enabled motor-function monitoring in the LE with D-MEPs, suggesting that D-MEP-based monitoring may be a reliable approach.
Human cell adaptation of the swine acute diarrhea syndrome coronavirus spike protein
Authors: Soriano-Tordera Clàudia , Sanjuán Rafael , Dufloo Jérémy
Published: August 2024

Swine acute diarrhea syndrome coronavirus (SADS-CoV) is a recently identified highly pathogenic swine coronavirus. In vitro, SADS-CoV can infect cell lines from many different species, including humans, highlighting its high zoonotic potential. Coronavirus spike glycoproteins play a critical role in viral entry and are involved in determining viral host range and cellular tropism. Here, we used experimental evolution to investigate how the SADS-CoV spike protein adapts to human cells and to identify potential variants with increased infectivity. We evolved a recombinant vesicular stomatitis virus expressing the SADS-CoV spike (rVSV-SADS) in three human cell lines. After ten passages, increased viral replication was observed, and spike mutations were identified by sequencing. Mutations were functionally characterized in terms of viral fitness, spike processing and fusogenicity. Our results thus identify potential human-adaptive mutations in the SADS-CoV spike that may further enhance its zoonotic potential.

Importance

Coronavirus transmission from animals represents a serious threat to humans. Pigs are of particular concern because of their proximity to humans and the several coronaviruses they harbor. In particular, the swine acute diarrhea syndrome coronavirus (SADS-CoV) is a recently identified highly pathogenic porcine coronavirus that has a very broad tropism in vitro, highlighting its high zoonotic risk. The coronavirus spike protein is a strong determinant of species tropism, and spike mutations may facilitate cross-species transmission. Here, to identify potential variants with increased ability to enter human cells, we used an experimental evolution approach to study how the SADS-CoV spike adapts to different human cell lines. These mutations, should they occur in nature, could potentially increase the zoonotic potential of SADS-CoV.
Adverse childhood experiences as a risk factor for depression-overweight comorbidity in adolescence and young adulthood
Authors: Kilpi Fanny , Goncalves Soares Ana L , Howe Laura D
Published: August 2024

Background

The comorbidity of depression and overweight is a manifestation of mental-physical multimorbidity, a marker of complex healthcare needs. We sought to examine how adverse childhood experiences (ACEs) are associated with depression-overweight comorbidity in the period of adolescence and early adulthood, and the extent to which associations are sensitive to age, sex and socioeconomic background.

Methods

Using data from 4734 adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort we estimated relative risk ratios (RRR) for the associations of multiple ACEs (physical, emotional, and sexual abuse, emotional neglect, being bullied, parental substance abuse, violence between parents, parental criminal conviction, parental separation, parental mental illness or suicide) with depression only, overweight only or their comorbidity at ages 17 and 24. We tested whether associations differed by sex and socioeconomic background, indicated by parental education.

Results

Most ACEs were associated with depression-overweight comorbidity, and there was a dose-response relationship whereby a greater number of ACEs was associated with greater risk and this continued from adolescence to young adulthood. Some ACEs associations with comorbidity appeared to be influenced by sex: at age 17, females had stronger associations for parental separation and mental health problems, and at age 24, sexual abuse had a stronger association in males. We did not find evidence that the sensitivity to ACEs varied by parental education.

Conclusions

ACEs across childhood are associated with depression-overweight comorbidity in late adolescence, which demonstrates their potential impact on the early manifestation of complex healthcare needs.
Contact-based transfer of thymidylate promotes collective tumor growth
Authors: Siddiqui Mohammad A. , Rømer Anne Mette A. , Pinna Luisa , Ramesh Vignesh , Møller Sarah S. , Gollavilli Paradesi N. , Turtos Adriana M. , Varghese Steffi , Guldborg Lærke B. , Palani Nagendra P. , Napoli Francesca , Volante Marco , Bahena Luis Córdova , Velasco Marco , Somyajit Kumar , Swietach Pawel , Ceppi Paolo
Published: August 2024

Sustained cell proliferation is a fundamental hallmark of cancer, yet its mechanism remains elusive, particularly in context of heterogenous tumor organization, intercellular interactions, and metabolite exchanges. In this study, we uncover a mechanism of tumor growth viacollective proliferation, where cells connected by gap junctions enable equilibration of thymidylate (dTMP) to allow the proliferation of cells lacking canonicalde novodTMP biosynthesis and salvage driven by thymidylate synthase (TYMS) and thymidine kinase 1 (TK1) enzymes, respectively. Collective proliferation is driven by dTMP-proficient cancer cells alongside cells of varied origins, such as macrophages and endothelial cells. The mechanism is also observed in clinical samples and is validated in a genetic mouse model of lung cancer harboring dualTyms/Tk1tumor-specific knockout, in which tumors grow despite lacking enzymatic dTMP synthesis and tumor progression is opposed by gap junction inhibition. Data further hint that this mechanism is critical driver of tumor pathophysiology, influencing key processes such as senescence, genomic instability and drug resistance. These findings revise the current dogma of ubiquitous nucleotide biosynthesis in each proliferating cancer cell in a tumor and suggest that a programmed dTMP distribution maintains collective tumor growth. This mechanism could be exploited in cancer therapy.