bluuebunny/crossref_metadata_2025 huggingface dataset:
Phylogeny, taxonomy, and biogeography of the Sphaeriinae (Bivalvia: Sphaeriidae)
Authors: Bespalaya Yulia V , Vinarski Maxim V , Aksenova Olga V , Babushkin Evgeniy S , Gofarov Mikhail Yu , Kondakov Alexander V , Konopleva Ekaterina S , Kropotin Alexander V , Mabrouki Youness , Ovchankova Nadezda B , Palatov Dmitry M , Sokolova Svetlana E , Shevchenko Alexander R , Travina Oksana V , Taybi Abdelkhaleq F , Soboleva Alena A , Zubrii Natalia A , Bolotov Ivan N
Published: November 2023

The subfamily Sphaeriinae is a diverse and ecologically significant group of freshwater invertebrates, playing a keystone role in the energy flow and nutrient cycling in aquatic ecosystems. Despite a long history of its study, the taxonomic structure and species content of this group are a matter of ongoing disputes between malacologists. We clarify the taxonomy, distribution, and evolutionary biogeography of the Sphaeriinae around the world based on the largest dataset of DNA sequences of these clams ever accumulated, which includes the data on specimens collected from various continents and countries around the globe. Our 16S rRNA and two-locus phylogenies reveal that the Sphaeriinae is a monophyletic group, containing at least seven genus-level clades: Sphaerium Scopoli, 1777, Pisidium C. Pfeifffer, 1821 (s.s.), Euglesa Jenyns, 1832, Odhneripisidium Kuiper, 1962, Conventus Pirogov & Starobogatov stat. nov., 1974, ‘Pisidium’ sterkianum group, and Hindupisidium Vinarski & Bespalaya gen. nov. Our 16S rRNA phylogenetic tree contains 80 well-supported clades corresponding to the putative species-level taxa. Four species new to science are described here: Euglesa kolymensis Bespalaya, Aksenova & Bolotovsp. nov., Euglesa kyrgyzica Bespalaya, Aksenova, Kondakov & Palatovsp. nov., Euglesa moroccana Bespalaya, Vinarski, Aksenova, Mabrouki, Kondakov & Palatovsp. nov., Odhneripisidium caucasus Bespalaya, Vinarski, Aksenova, Kondakov & Palatovsp. nov. Our fossil-calibrated phylogeny and generalized biogeographic model indicate that the most recent common ancestor of the Sphaeriidae could have originated somewhere within a broad area covering China near the Lower Cretaceous boundary.
Underexplored diversity in Palaearctic Miltogramma Meigen, 1803 (Diptera: Sarcophagidae)
Authors: Szpila Krzysztof , Walczak Kinga , Grzywacz Andrzej , Soszyńska Agnieszka , Akbarzadeh Kamran , Bystrowski Cezary , Pape Thomas
Published: November 2023

Current knowledge of the global diversity of schizophoran flies, the megadiverse group that evolved during the episode of rapid dipteran radiations in the Early Cenozoic, is far from satisfactory. A significant part of this radiation is flesh flies (Sarcophagidae), which include about 3000 known species. Miltogramma Meigen, the largest genus of the flesh fly subfamily Miltogramminae, includes 119 known species with a peak of diversity in the Middle East and Central Asia. The taxonomy of the genus is acknowledged to be challenging, partly due to logistical issues associated with the deposition of type specimens in less accessible Russian institutions. Six new distinctive species of Miltogramma collected during recent expeditions to Iran and Uzbekistan are described using methods of integrative taxonomy: Miltogramma manouchehrii Szpila & Pape, sp. nov., M. mikolajczyki Szpila & Pape, sp. nov., M. rognesi Szpila & Pape, sp. nov., M. soszynskii Szpila & Pape, sp. nov., M. thompsoni Szpila & Pape, sp. nov., and M. vervesi Szpila & Pape, sp. nov. Flies are characterized by secondary sexual dimorphism expressed in the form of species-specific chaetotaxy of the male fore tarsus, a character related to courtship behaviour. The reconnaissance surveys to both of the mentioned countries performed in the last decade brought information about a large number of potential new species of Miltogramma, despite the taxonomic work performed in this area in the past. Describing the majority of them requires extensive revisionary work, which involves accessing the type specimens and applying modern methods of species delimitation.
Safety and Efficacy Outcomes Following Spinal Endoscopic Procedures for Thoracic Ligamentous Ossification
Authors: Ye Jingyao , Guo Wenlong , Hu Youpeng , Fan Xiaohong
Published: November 2023

Study Design.

Systematic review and meta-analysis.

Objective.

This study systematically reviewed and evaluated the safety and efficacy of spinal endoscopic techniques as a treatment for thoracic ligamentum flavum ossification (TOLF).

Summary of Background Data.

The use of spinal endoscopic techniques for the treatment of TOLF has increased in recent years. The present study is the first comprehensive systematic review and meta-analysis focused on the use of spinal endoscopic techniques for TOLF.

Methods.

The Cochrane Central, PubMed, Web of Science, and Embase databases were systematically searched for studies focused on patients undergoing spinal endoscopic techniques to treat symptomatic TOLF.

Results.

This meta-analysis included 23 studies. We included 323 patients (177 males, 146 females) with a mean age of 58.40±10.06 years, with 304 total recorded lesion locations of which 245 were located in the lower thoracic spine. Complications affected 35/323 patients, and the mean operative duration for 305 patients was 108.15±47.34 minutes. For 187 patients, the mean operative bleeding was 25.13±12.54 mL, while for 87 patients the mean duration of hospitalization was 4.59±1.93 days. At last follow-up，functional assessment was performed for 260 patients, of whom 200 were in excellent condition, visual analog scale (VAS) scores were assessed for 160 patients, with a mean improvement of 4.40 (3.95,4.86) Japanese Orthopedic Association (JOA) scores were recorded for 115 patients, with a mean improvement of 2.99 (2.77,3.22) , and modified Japanese Orthopedic Association (mJOA) scores were recorded for 208 patients, with a mean improvement of 3.41 (3.17,3.64) .

Conclusions.

These results support several advantages of spinal endoscopic techniques for the treatment of symptomatic TOLF. These include low complication rates, rapid postoperative recovery, and good functional recovery when used for single-segment, non-nodular ossification and no combined dural ossification.
The scourge of Rat lungworm disease in Continental Europe, an emerging parasite
Authors: Oduoye Malik Olatunde , Nazir Abubakar , Nazir Awais , Abdulrahman Mutiu Olamide , Akilimali Aymar , Okon Inibehe I. , Kibukila Fabrice , Nyakio Olivier
Published: November 2023

In Europe, rat lungworm diseases have so far been reported exclusively at the insular level, specifically in Rattus norvegicus and R. rattus rats in Tenerife (the Canary Islands) and Atelerix algirus hedgehogs in Mallorca (the Balearic Islands). Researchers in Spain detected the parasite, the rat lungworm (Angiostrongylus cantonensis), in two different species of rats near the port of Valencia and also several kilometres from the coast. This suggests a wide distribution of rat lungworms in the city of Valencia and other European cities. Infected rats (and snails) travel by ship, which could transfer the parasite between continents and countries. Major features of rat lungworm disease are the central nervous system manifestations and complications, which include severe headache, stiffness of the neck and back, skin tingling, pain and sensitivity, sensitivity to light, hallucinations, nausea, vomiting, and sometimes coma and death that could arise from the disease. Preventive measures like health education about the signs and symptoms of the disease, a high index of suspicion by the clinicians, prompt investigations and symptomatic treatments, as well as limitations on complications, should be the ultimate goal. Nevertheless there is still a need for more research studies to be carried out on rat lungworm disease in Europe.
A pig model of chronic hepatitis E displaying persistent viremia and a downregulation of innate immune responses in the liver
Authors: León-Janampa Nancy , Caballero-Posadas Ignacio , Barc Céline , Darrouzain François , Moreau Alain , Guinoiseau Thibault , Gatault Philippe , Fleurot Isabelle , Riou Mickaël , Pinard Anne , Pezant Jérémy , Rossignol Christelle , Gaudy-Graffin Catherine , Brand Denys , Marlet Julien
Published: November 2023

Background:

Hepatitis E virus (HEV) is a zoonotic virus transmitted by pig meat and responsible for chronic hepatitis E in immunocompromised patients. It has proved challenging to reproduce this disease in its natural reservoir. We therefore aimed to develop a pig model of chronic hepatitis E to improve the characterization of this disease.

Methods:

Ten pigs were treated with a tacrolimus-based regimen and intravenously inoculated with HEV. Tacrolimus trough concentration, HEV viremia, viral diversity, innate immune responses, liver histology, clinical disease and biochemical markers were monitored for 11 weeks post-infection (p.i.).

Results:

HEV viremia persisted for 11 weeks p.i. HEV RNA was detected in the liver, small intestine, and colon at necropsy. Histological analysis revealed liver inflammation and fibrosis. Several mutations selected in the HEV genome were associated with compartmentalization in the feces and intestinal tissues, consistent with the hypothesis of extrahepatic replication in the digestive tract. Antiviral responses were characterized by a downregulation of IFN pathways in the liver, despite an upregulation of RIG-I and ISGs in the blood and liver.

Conclusions:

We developed a pig model of chronic hepatitis E that reproduced the major hallmarks of this disease. This model revealed a compartmentalization of HEV genomes in the digestive tract and a downregulation of innate immune responses in the liver. These original features highlight the relevance of our model for studies of the pathogenesis of chronic hepatitis E and for validating future treatments.
Development and clinical validation of a novel algorithmic score (GAAD) for detecting HCC in prospective cohort studies
Authors: Piratvisuth Teerha , Hou Jinlin , Tanwandee Tawesak , Berg Thomas , Vogel Arndt , Trojan Jörg , De Toni Enrico N. , Kudo Masatoshi , Eiblmaier Anja , Klein Hanns-Georg , Hegel Johannes Kolja , Madin Kairat , Kroeniger Konstantin , Sharma Ashish , Chan Henry L.Y.
Published: November 2023

Background:

Alpha-fetoprotein (AFP) and des-gamma carboxyprothrombin (DCP), also known as protein induced by vitamin K absence-II (PIVKA-II [DCP]) are biomarkers for HCC with limited diagnostic value when used in isolation. The novel GAAD algorithm is an in vitro diagnostic combining PIVKA-II (DCP) and AFP measurements, age, and gender (biological sex) to generate a semi-quantitative result. We conducted prospective studies to develop, implement, and clinically validate the GAAD algorithm for differentiating HCC (early and all-stage) and benign chronic liver disease (CLD), across disease stages and etiologies.

Methods:

Patients aged ≥18 years with HCC or CLD were prospectively enrolled internationally into algorithm development [n = 1084; 309 HCC cases (40.7% early-stage) and 736 controls] and clinical validation studies [n = 877; 366 HCC cases (47.6% early-stage) and 303 controls]. Serum samples were analyzed on a cobas® e 601 analyzer. Performance was assessed using receiver operating characteristic curve analyses to calculate AUC.

Results:

For algorithm development, AUC for differentiation between early-stage HCC and CLD was 90.7%, 84.4%, and 77.2% for GAAD, AFP, and PIVKA-II, respectively. The sensitivity of GAAD for the detection of early-stage HCC was 71.8% with 90.0% specificity. Similar results were shown in the clinical validation study; AUC for differentiation between early-stage HCC and CLD was 91.4% with 70.1% sensitivity and 93.7% specificity. GAAD also showed strong specificity, with a lower rate of false positives regardless of disease stage, etiology, or region.

Conclusions:

The GAAD algorithm significantly improves early-stage HCC detection for patients with CLD undergoing HCC surveillance. Further phase III and IV studies are warranted to assess the utility of incorporating the algorithm into clinical practice.
Vitreous-lens interface changes after cataract surgery using active fluidics and active sentry with high and low infusion pressure settings
Authors: Scarfone Hugo A. , Rodriguez Emilia C. , Rufiner Maira G. , Riera José J. , Fanego Susel E. , Charles Martín , Albano Rodrigo
Published: November 2023

Purpose:

To determine whether the infusion pressure used during phacoemulsification may have a detrimental effect on the anterior hyaloid membrane barrier (AHMB) in a pressure fluctuation-free environment using diagnostic spectral-domain optical coherence tomography (SD-OCT) postoperatively.

Setting:

Tandil Eye Clinic, Tandil, Buenos Aires, Argentina, and Centro Oftalmológico Dr. Charles, CABA, Buenos Aires, Argentina.

Design:

Prospective, randomized, multicenter, experimental, and double-masked study.

Methods:

Phacoemulsification with intraocular lens implantation was performed in all patients with the Centurion Vision System equipment with active fluidics and active sentry. Patients were randomly assigned to configuration 1 or 2. Configuration 1 had intraocular pressure (IOP) 30 mm Hg and configuration 2 IOP 80 mm Hg. Inclusion criteria were axial length >22 mm and <25 mm, age older than 50 and younger than 70 years, and complete adhesion of AHMB.

Results:

80 eyes of 80 patients were included. Berger space was identified in 17 cases (42.5%) of group 2 and 3 cases (7.5%) of group 1 postoperatively using SD-OCT. A statistically significant relationship was established using Fisher exact test (P= .0003). Postoperatively, we observed posterior vitreous detachment changes in only 1 patient (1.25%) during the 3 months of follow-up (P= .5). According to the Wong-Baker FACES Scale, the patient's subjective perception was better for the low infusion pressure group (P= .0001, Fisher exact test).

Conclusions:

Phacoemulsification with high infusion pressure can change the vitreous-lens interface. Positive Berger space after phacoemulsification is a biomarker of this change and can occur in eyes without risk factors. Incidence is directly related to the infusion pressure used.
Electrode−Modiolus Distance Affects Speech Perception for Lateral Wall Electrodes
Authors: Ding Ling , Zhang Luguang , Li Jing , Lin Tao
Published: November 2023

Objectives

The goal of this study was to use cone-beam computed tomography to locate the electrode–modiolus distance (EMD) and correlate this with speech perception in cochlear implant (CI) recipients of the 31.5-mm lateral wall (LW) electrode arrays.

Study Design

Retrospective review.

Patients

Forty-five child CI recipients with prelingual profound sensorineural hearing loss of inserted 31.5-mm LW arrays listening with a CI-alone device.

Interventions

Stepwise forward multiple linear regression was performed to control and reduce the variability in implant performance to determine whether EMD affects speech perception.

Main Outcome Measures

Electrode location (angular insertion depth [AID], EMD), together with the electrode impedance (EI), surgical approach, sex, CI age, and preimplant hearing aid usage were estimated as independent variables. The dependent variables were the Meaningful Use of Speech Scale (MUSS) and parents’ evaluation of children’s aural/oral performance (PEACH) assessed with the CI alone at 12 months postactivation.

Results

EMD and CI age were predictive variables for PEACH/MUSS. A negative correlation was found between AID and EMD (r = −0.56, p < 0.01), whereas EMD had a moderately positive correlation with EI (r = 0.32, p < 0.01).

Conclusions

The best “location-related” predictor of postoperative speech perception was EMD with a 31.5-mm array among CI-alone users.
Osteoprotegerin is associated with subclinical left ventricular systolic dysfunction in non-dipper hypertensive patients: a 2D speckle tracking echocardiographic study
Authors: Alizade Elnur , Kahyaoglu Muzaffer , Balaban Ismail , Izci Servet , Guler Ahmet
Published: November 2023

Background

Past studies have shown that non-dipper hypertensive patients have more frequent subclinical left ventricular (LV) systolic dysfunction compared to dippers. Many different parameters have been examined to predict subclinical LV dysfunction. The role of osteoprotegerin (OPG) in the pathogenesis of heart failure and LV systolic dysfunction through different mechanisms had well described. In the present study, we hypothesized that increased OPG levels could predict subclinical LV systolic dysfunction in non-dipper hypertensive patients.

Patients and methods

Hypertensive patients were divided into two groups according to the results of ambulatory blood pressure (BP) monitoring. Non-dipper patients were subsequently divided into two further groups (normal LV function and impaired LV function) according to LV global longitudinal strain (GLS).

Results

A total of 103 hypertensive patients (51 dippers, 52 non-dippers) were included in the study. In the non-dipper group, LV GLS was normal in 21 patients and impaired in 31 patients. Based on the results of the multivariate logistic regression test, it was determined that OPG levels (OR: 2.413, 95% CI: 1.284–4.535, P = 0.006) and LVMI (OR: 1.086, 95% CI: 1.013–1.165, P = 0.021) were independently associated with impaired GLS.

Conclusion

Higher OPG values were associated with subclinical LV systolic dysfunction in non-dipper hypertensive patients. It could be used for the early diagnosis of subclinical LV systolic dysfunction, which would allow for strategies to be designed to reduce the cardiovascular event rate in this patient population.
Urea cycle disorders in critically Ill adults
Authors: Long Micah T. , Kruser Jacqueline M. , Quinonez Shane C.
Published: November 2023

Purpose of review

Urea cycle disorders (UCDs) cause elevations in ammonia which, when severe, cause irreversible neurologic injury. Most patients with UCDs are diagnosed as neonates, though mild UCDs can present later - even into adulthood - during windows of high physiologic stress, like critical illness. It is crucial for clinicians to understand when to screen for UCDs and appreciate how to manage these disorders in order to prevent devastating neurologic injury or death.

Recent findings

Hyperammonemia, particularly if severe, causes time- and concentration-dependent neurologic injury. Mild UCDs presenting in adulthood are increasingly recognized, so broader screening in adults is recommended. For patients with UCDs, a comprehensive, multitiered approach to management is needed to prevent progression and irreversible injury. Earlier exogenous clearance is increasingly recognized as an important complement to other therapies.

UCDs alter the core pathway for ammonia metabolism. Screening for mild UCDs in adults with unexplained neurologic symptoms can direct care and prevent deterioration. Management of UCDs emphasizes decreasing ongoing ammonia production, avoiding catabolism, and supporting endogenous and exogenous ammonia clearance. Core neuroprotective and supportive critical care supplements this focused therapy.
A paradigm shift from office to home-based blood pressure measurement approaches in kidney transplant recipients
Authors: Tantisattamo Ekamol , Ferrey Antoney J. , Reddy Uttam G. , Malik Fatima T. , Siu Man Kit Michael , Ammary Fawaz Al , Lau Wei Ling
Published: November 2023

Purpose of review

The unattended blood pressure (BP) readings from home blood pressure (HBP) monitoring should provide more accurate BP readings than attended BP obtained from office blood pressure (OBP). Here, we review evidence supporting the clinical utility of HBP and automatic remote monitoring of blood pressure (ARM-BP) in kidney transplant recipients (KTR).

Recent findings

BP from 24-h ambulatory blood pressure monitoring (24-h ABPM) is higher than but better associated with kidney and cardiovascular outcomes compared to OBP and HBP. While there is discordance of BP readings across different BP measurement methods causing BP misclassification, HBP provides BP readings closer to the readings from the 24-h ABPM than those from OBP. Systolic and diastolic BP is better controlled within 30 days after utilizing ARM-BP.

Compared to OBP, HBP minimizes the attended effect of OBP, and its readings are closer to the gold standard 24-h ABPM. ARM-BP improves BP control in the short term and trials of longer follow-up duration are required to evaluate sustained clinical benefits in KTR. The paradigm of BP monitoring may shift toward HBP, while OBP may be utilized primarily for KTR who cannot perform HBP for hypertension diagnosis and management.
The Mediating Effect of Hope Level Between Social Support and Benefit Finding in Patients With Advanced Lung Cancer
Authors: Zhao Mengjiao , Jiang Yunxia , Xu Guangyi , Lin Xin
Published: November 2023

Background

As a protective factor, social support can influence benefit finding (BF) in patients with advanced lung cancer. However, the mechanism through which social support affects BF is controversial.

Objective

To investigate the factors influencing BF in patients with advanced lung cancer and the role of hope level in mediating the relationship between social support and BF.

Methods

This was a cross-sectional study. From September 2022 to March 2023, 286 participants completed the Social Support Rating Scale, Herth Hope Index, and Benefit Finding Scale. Data analysis included correlation analyses and multiple stepwise regression analysis; the SPSS PROCESS program was used to determine the significance of mediating effects.

Results

Social support and hope level were positively associated with BF. Monthly per-capita household income, social support and hope level entered the final regression model and explained 50.7% of BF variance. Social support’s direct and indirect effects on BF were significant (P < .05), suggesting that hope level partially mediated the relationship between social support and BF.

Conclusion

Our findings validate a positive association between social support and BF in patients with advanced lung cancer. The hope level as a mediating variable provided the impetus for their BF.

Implications for practice

Nurses should implement necessary interventions to help patients with advanced lung cancer carry out protective resources and coping strategies to facilitate their BF.
Can a Checklist Facilitate Recognition of a Transfusion-Associated Adverse Event by Prelicensure Nurses?
Authors: Scott Sue S. , Scanlon Marcia , McKelvey Michele , Nathanson Brian H. , Andrzejewski Chester
Published: November 2023

Background:

Early identification of a transfusion-associated adverse event (TAAE) is key to patient safety. Research has indicated that use of a TAAE checklist resulted in greater frequency of TAAE recognition behaviors.

Purpose:

To explore whether use of a TAAE checklist resulted in greater frequency of TAAE recognition behaviors among nursing students.

Methods:

A prospective, randomized controlled study was conducted with 62 nursing students playing the role of a registered nurse in a simulation of a patient exhibiting clinical indicators of a TAAE. Subjects were randomly assigned to have or not have a TAAE checklist. Time to recognition of the TAAE was measured.

Results:

The checklist group (CG) identified TAAEs on average 4 minutes sooner than the non-CG (P < .001). CG subjects were also significantly less likely to miss TAAEs completely.

Conclusions:

A checklist may improve the safety of transfusions by promoting earlier recognition and treatment of TAAEs.
Multicystic Clear Cell Renal Tumors With Low-grade Nuclear Features: Time to Include TFE3 Translocation-associated Carcinomas
Authors: Cai Qi , Gagan Jeffrey , Koduru Prasad , Cadeddu Jeffrey , Shah Rajal B. , Kapur Payal , Palsgrove Doreen N.
Published: November 2023

TFE3-rearranged renal cell carcinoma (RCC) is a distinct, uncommon entity with more than 20 different fusion partners identified; however, histomorphology may be suggestive of specific fusion partners in select TFE3-rearranged RCCs. For example, most MED15::TFE3 fusion associated RCCs exhibit multilocular cystic morphology, mimicking multilocular cystic renal neoplasm of low malignant potential. Here we present a case of MED15::TFE3 RCC in an older adult and review the literature with an emphasis on practical diagnostic approaches for predominantly cystic, low-grade, clear cell renal tumors.
Patient, Parent, and Provider Perceptions of Barriers to Pediatric Inflammatory Bowel Disease Care
Authors: Dotson Jennifer L. , Bricker Josh , Chisolm Deena J. , Mackner Laura M.
Published: November 2023

Objectives:

Children with inflammatory bowel disease (IBD) have a significant life-long burden as a result of disease, impacted by environmental and individual barriers. Successful health system interventions require a comprehensive approach, informed by various stakeholders. The main objective was to identify health system barriers and potential solutions from existing patients, families, and providers via focus groups.

Methods:

Participants for the focus groups were existing English-speaking patients (ages 9–18) with IBD, their caregiver(s), and providers including multiple professions (eg, physician, nurse, pediatrician, social worker, care coordinator, scheduler, and psychologist). Separate focus groups were led by experienced personnel for parents, children, and providers, using a standardized interview guide. Sessions were recorded, transcribed, and verified. Using content analysis, we systematically classified data through coding and identified themes.

Results:

Focus groups comprised (a) 3 patient groups (n = 20, 50% female, including 2 younger; mean age = 11.4 ± 1.5 years) and 1 older group (mean age = 15.6 ± 1.3 years), (b) 3 parent groups (n = 24, 83% female), and (c) 2 multidisciplinary provider groups (n = 19). Families shared several common concerns with providers (eg, school, care delay, psychosocial, and financial) but varied on specifics. Some barriers may be addressable through family or staff education, improved communication (eg, care delay/ access, transition), or training (eg, labs and diet), while others may require change at an institutional or policy level (eg, insurance).

Conclusions:

This qualitative analysis identified several barriers to IBD care, some shared, some unique to patients, parents, and providers, highlighting the importance of obtaining multiple stakeholder perspectives when exploring barriers to care.
Intrathecal production of anti-Epstein–Barr virus viral capsid antigen IgG is associated with neurocognition and tau proteins in people with HIV
Authors: Trunfio Mattia , Sacchi Alessandra , Vai Daniela , Pittaluga Fabrizia , Croce Michele , Cavallo Rossana , Imperiale Daniele , Bonora Stefano , Di Perri Giovanni , Letendre Scott Lee , Calcagno Andrea
Published: November 2023

Objective:

HIV and Epstein–Barr virus (EBV) co-infection has been linked to increased immune activation and larger HIV reservoir. We assessed whether anti-EBV humoral responses are associated with increased cerebrospinal fluid (CSF) inflammation and with neurocognitive impairment (NCI) in people with HIV (PWH).

Design:

Cross-sectional analysis in 123 EBV-seropositive PWH either on antiretroviral therapy (n = 70) or not.

Methods:

Serum and CSF anti-EBV viral capsid antigen immunoglobulin G (anti-EVI) and CSF EBV DNA were measured by commercial immunoassay and RT-PCR. Seventy-eight participants without neurological confounding factors underwent neurocognitive assessment (Global Deficit Score, GDS). CSF total tau and 181-phosphorylated-tau (ptau) were measured by immunoassays together with biomarkers of blood–brain barrier (BBB) integrity, immune activation, astrocytosis, and intrathecal synthesis. Logistic and linear regressions and moderation analysis were used to investigate the relationships between CSF anti-EVI, GDS, and biomarkers.

Results:

Twenty-one (17.1%) and 22 participants (17.9%) had detectable CSF anti-EVI (10.5–416.0 U/ml) and CSF EBV DNA (25–971 copies/ml). After adjusting for BBB integrity, age, and clinical factors, the presence of CSF anti-EVI was only associated with serum levels of anti-EVI, and not with CSF EBV DNA. CSF anti-EVI, tau and ptau showed reciprocal interactions affecting their associations with GDS. After adjusting for demographics and clinical parameters, higher CSF anti-EVI levels were associated with worse GDS (aβ 0.45, P < 0.001), and CSF levels of tau and ptau had a moderation effect on the strength of this association (models’P < 0.001).

Conclusion:

Humoral immune responses against EBV within the central nervous system may contribute to NCI in PWH through mechanisms that involve neuronal injury.
Impact of coronavirus disease 2019-related clinic closures on HIV incidence in young adult MSM and transgender women in Kenya
Authors: Wahome Elizabeth , Otieno Fredrick O. , Kimani Joshua , Boyd Anders , Okall Duncan , Nzioka Joseph , Gichuru Evans , van der Elst Elise , Mehta Supriya D. , Bailey Robert C. , Graham Susan M. , Sanders Eduard J. ,   for the Tatu Pamoja (three-site) study group†
Published: November 2023

Introduction:

Little is known about the impact that the COVID-19 pandemic had on risk of HIV acquisition in sub-Saharan Africa. We assessed the impact of COVID-19-related clinic closures on HIV incidence in a cohort of gay, bisexual, and other men who have sex with men (MSM) and transgender women in Kenya.

Methods:

MSM and transgender women enrolled in a prospective, multicentre cohort study were followed quarterly for HIV testing, behaviour assessments, and risk. We estimated the HIV incidence rate and its 95% credible intervals (CrI) among participants who were HIV-negative before COVID-19-related clinic closure, comparing incidence rate and risk factors associated with HIV acquisition before vs. after clinic reopening, using a Bayesian Poisson model with weakly informative priors.

Results:

A total of 690 (87%) participants returned for follow-up after clinic reopening (total person-years 664.3 during clinic closure and 1013.3 after clinic reopening). HIV incidence rate declined from 2.05/100 person-years (95% CrI = 1.22–3.26, n = 14) during clinic closures to 0.96/100 person-years (95% CrI = 0.41–2.07, n = 10) after clinic reopening (IRR = 0.47, 95% CrI = 0.20–1.01). The proportion of participants reporting hazardous alcohol use and several sexual risk behaviours was higher during clinic closures than after clinic reopening. In multivariable analysis adjusting for study site and participant characteristics, HIV incidence was lower after clinic reopening (IRR 0.57, 95% CrI = 0.23–1.33). Independent risk factors for HIV acquisition included receptive anal intercourse (IRR 1.94, 95% CrI = 0.88–4.80) and perceived risk of HIV (IRR 3.03, 95% CRI = 1.40–6.24).

Conclusion:

HIV incidence during COVID-19-related clinic closures was moderately increased and reduced after COVID-19 restrictions were eased. Ensuring access to services for key populations is important during public health emergencies.
A study of the pharmacokinetics, safety, and efficacy of bictegravir/emtricitabine/tenofovir alafenamide in virologically suppressed pregnant women with HIV
Authors: Zhang Haeyoung , Hindman Jason T. , Lin Ludwig , Davis Maggie , Shang Justin , Xiao Deqing , Avihingsanon Anchalee , Arora Priyanka , Palaparthy Ramesh , Girish Sandhya , Marathe Dhananjay D.
Published: November 2023

Objective:

The objective of this study was to assess the pharmacokinetics, safety, and efficacy and confirm the dose of once-daily bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF; B/F/TAF) during pregnancy.

Design:

An open-label, multicenter, single-arm, phase 1b study (NCT03960645) was conducted in 33 virologically suppressed pregnant women with HIV-1.

Methods:

Participants received B/F/TAF (50/200/25 mg) from the second or third trimester through ∼16 weeks postpartum. Steady-state maternal plasma pharmacokinetic samples were collected at the second and third trimesters and 6 and 12 weeks postpartum for BIC, FTC, and TAF. Neonates (n = 29) were followed from birth to 4–8 weeks with sparse washout pharmacokinetic sampling for BIC and TAF. The proportion of participants with HIV-1 RNA less than 50 copies/ml at delivery (missing = excluded) was evaluated.

Results:

Mean areas under the concentration–time curve over the dosing interval (AUCtau) for BIC, FTC, and TAF were lower during pregnancy versus postpartum but were closer to AUCtau values for nonpregnant adults with HIV reported in other studies. Geometric least-squares mean ratios for BIC, FTC, and TAF AUCtau during pregnancy versus postpartum ranged from 41 to 45%, 64 to 69% and 57 to 78%, respectively. Mean BIC trough concentrations during pregnancy were more than 6.5-fold greater than the protein-adjusted 95% effective concentration. In neonates, the median BIC half-life was 43 h. Virologic suppression was maintained in all adult participants throughout the study, with no virologic failure or treatment-emergent resistance to HIV-1, no discontinuations because of adverse events, and no perinatal transmission.

Conclusion:

Exposures to BIC, FTC, and TAF were lower during pregnancy than postpartum. However, mean BIC trough concentrations were maintained at levels indicative of efficacious exposure, and FTC/TAF data were concordant with published literature in this population. Pharmacokinetic and safety data, combined with maintenance of robust virologic suppression, suggest that once-daily B/F/TAF without dose adjustment is appropriate during pregnancy.
Elevated 68Ga-FAPI Activity in Klebsiella pneumoniae Invasion Syndrome
Authors: Xie Yang , Tang Wenxin , Ma Jiao , Wang Yudi , Chen Yue
Published: November 2023

Klebsiella pneumoniaeinvasion syndrome is a rare disease associated with primary liver abscess and secondary extrahepatic infection. We report a case ofK. pneumoniaeinvasion syndrome with elevated68Ga-FAPI uptake, mimicking malignancy with multiple metastases. Our case illustrated thatK. pneumoniaeinvasion syndrome should be considered as a possible etiology when diagnosing multiple68Ga-FAPI–avid liver foci with metastatic lesions. Besides, PET/CT could be an integrated tool to search for systemic occult lesions inK. pneumoniaeinvasion syndrome.
Deletion of cis-regulatory Element in FOXL2 Promoter in a Chinese Family of Type II Blepharophimosis-ptosis-epicanthus Inversus Syndrome with Polydactyly
Authors: Shen Qin , Zhao Xiaojun , Ji Yongrong , Chai Peiwei
Published: November 2023

Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) is a relatively uncommon autosomal-dominant genetic disorder, primarily attributed to mutations in the forkhead box L2 (FOXL2) gene. Albeit the involvement of protein-coding regions of FOXL2 has been observed in the majority of BPES cases, whether deficiencies in regulatory elements lead to the pathogenesis remains poorly understood. Herein, an autosomal-dominant BPES type II family was included. Peripheral venous blood has been collected, and genomic DNA has been extracted from leukocytes. A whole exome sequencing analysis has been performed and analyzed (Deposited in NODE database: OER422653). The promoter region of FOXL2 was amplified using polymerase chain reaction (PCR). The luciferase reporter assay was performed to identify the activity of this region. In this study, we present a Chinese family diagnosed with type II BPES, characterized by the presence of small palpebral fissures, ptosis, telecanthus, and epicanthus inversus. Notably, all male individuals within the family display polydactyly. A 225-bp deletion in the 556-bp 5′-upstream to transcription start site of FOXL2, decorated by multiple histone modifications, was identified in affected members of the family. This deletion significantly decreased FOXL2 promoter activity, as measured by the luciferase assay. Conclusively, a novel 255-bp-deletion of the FOXL2 promoter was identified in Chinese families with BPES. Our results expand the spectrum of known FOXL2 mutations and provide additional insight into the genotype-phenotype relationships of the BPES pathogenesis. In addition, this study indicates the important role of genetic screening of cis-regulatory elements in testing heritable diseases.
Pott Puffy Tumor Secondary to Cranial Vault Reconstruction in a Patient With Metopic Craniosynostosis
Authors: Shabih Sarah , Lewis Blair , Koenig Zachary A. , Brooke Sebastian M. , Meltzer Hal , Uygur Halil S.
Published: November 2023

Pott puffy tumor (PPT) is defined as a subperiosteal abscess of the anterior wall of the frontal sinus associated with underlying frontal osteomyelitis. PPT affects all age groups but occurs predominantly in adolescents. The potential etiologies include rhinosinusitis, a history of direct trauma to the forehead, odontogenic disease, intranasal drug abuse, diabetes, or other immunocompromised states. We introduce a case of a 6-year-old boy with a medical history of anterior cranial vault remodeling presenting with localized forehead swelling. Computed tomography imaging demonstrated mucosal thickening and a region of dehiscence in the wall of the frontal sinus; the presence of midline subperiosteal abscess was consistent with a diagnosis of PPT. Due to concerns for intracranial involvement, we utilized removal and replacement of the anterior wall of the frontal sinus, complete removal of sinus mucosa, and frontal sinus obliteration with bilateral peri-cranial flaps. To the best of our knowledge, this is the first case description of a PPT secondary to cranial vault reconstruction in a patient with metopic craniosynostosis.
Mandible Reconstruction in a Rural Population: Comparison of Radial Forearm and Free Fibula Flap Outcomes
Authors: Clegg Devin J. , Deek Andrew J. , Salomon Brett J. , Blackburn Caleb , Fahmy Mina D. , Heidel Robert E. , Stephenson Stacy M. , Herbig Kathleen S. , Chun Joseph T. , Carlson Eric R. , Boukovalas Stefanos
Published: November 2023

Comparison of microsurgical reconstructive options after mandible resection is limited in the literature. Fibula free flaps (FFFs) can be costly and have timing limitations, but dental restoration can be performed, with varied reported rates of completion. The radial forearm free flap (RFFF) with mandible plating may be an alternative in select populations. The purpose of this study was to determine if the RFFF has similar outcomes to the FFF for mandible reconstruction in a rural population. A retrospective review of patients who underwent mandibulectomy from 2017 to 2021 at a single tertiary-care academic institution was performed. Those with FFF or RFFF reconstruction were included. Mandible defects were classified using the Jewer-Boyd H-C-L system. Sixty-eight patients were included with 53 undergoing FFF and 15 undergoing RFFF. Immediate reconstruction was significantly more common with RFFF than FFF (100% versus 64.2%; P=0.01). Lateral mandible defects were most common among both groups (52.9% FFF versus 73.3% RFFF; P=0.04). Osseous defect length was similar (9.5 cm FFF versus 7.7 cm RFFF; P=0.07), but soft tissue defect size was significantly larger in the RFFF group (28.6 cm2 versus 15.3 cm2; P=0.01). Complication rates (47.1% FFF versus 46.7% RFFF; P=0.98) and disease-free status at last follow-up (96.2% FFF versus 80.0% RFFF; P=0.06) were similar. Dental restoration occurred in 21.3% of patients undergoing FFF. Patients undergoing RFFF or FFF reconstruction after mandibulectomy had similar surgical and disease outcomes, with a low rate of completed dental restoration after FFF. Our findings suggest RFFF is a reasonable alternative to FFF for mandible reconstruction in select patients.
Endoscopically Assisted Intraoral Coronoidectomy for Treatment of Coronoid Hyperplasia
Authors: Fernández Sanromán Jacinto , Chamorro Pons Manuel , Arias Gallo Javier , Fernández Ferro Martín
Published: November 2023

Hyperplasia of the coronoid process of the mandible is a rare condition defined as an abnormal and progressive elongation of the coronoid process (unilateral or bilateral). Jacob disease is the name given to a pseudo-joint formation between the coronoid process and the zygomatic bone. The main clinical finding is a progressive, painless difficulty in opening the mouth, due to contact of the coronoid process with the posterior surface of the zygomatic bone or the medial surface of the zygomatic arch. To restore the mouth opening in a stable manner, resection of the elongated coronoid process followed by physiotherapy is the only effective treatment. Surgery (coronoidetomy or coronoidectomy) can be performed through intraoral or extraoral access. Intraoral coronoidectomy is the best surgical choice for most of the cases. However, in some cases, the intraoral surgical field prevents an adequate visualization of the osteotomy line. The authors present 5 consecutive clinical cases of hyperplasia of the coronoid process treated with an endoscopically assisted coronoidectomy using ultrasound bone-cutting instruments.
Classifications of Prominent Mandibular Angle and Surgical Considerations for Mandibuloplasty
Authors: Ha Sung-Ho , Park Jun-Sang , Baek Seung-Hak , Choi Jin-Young
Published: November 2023

Contouring surgery is an operation that makes a smooth, oval-shaped face by removing protruding parts of the face. In particular, mandibuloplasty is a procedure that softens the shape of the mandible and is a popular procedure among Asians with a dominant mesocephalic profile. In this study, we tried to discuss the considerations before surgery by dividing the mandibular shape into morphologic aspects in the lateral and frontal views and anatomic considerations. In the lateral view, it is essential to consider the posterior ramal height and mandibular body length of each patient. These factors are closely related to the postoperative outcomes. Consideration of the mandibular plane angle is also essential. In the frontal view, the position of the gonial angle relative to the ramal body should be considered because the position of the gonial angle can affect the difficulty of operation. Anatomic considerations include antero-posterior ramal width, bucco-lingual width of mandibular body, amount of mouth opening, and location of inferior alveolar nerve. These are important factors that determine the difficulty of the operation. In this study, classification according to the shape and shape of the mandible was presented, and considerations for each classification were discussed. Cosmetic surgery is a socio-psychologically meaningful procedure that not only improves the esthetics but also improves the mental well-being of the patients. Therefore, it will be possible to provide better medical services to patients if clinicians are fully aware of the factors that can increase the difficulty of the operation and the factors that affect the surgical outcome.
Surgical Apgar scores predict complications after emergency general surgery laparotomy
Authors: Tracy Brett M. , Srinivas Shruthi , Baselice Holly , Gelbard Rondi B. , Coleman Julia R.
Published: November 2023

BACKGROUND

The Surgical Apgar Score (SAS) is a 10-point validated score comprised of three intraoperative variables (blood loss, lowest heart rate, and lowest mean arterial pressure). Lower scores are worse and predict major postoperative complications. The SAS has not been applied in emergency general surgery (EGS) but may help guide postoperative disposition. We hypothesize that SAS can predict complications in EGS patients undergoing a laparotomy.

METHODS

We performed a retrospective review of adult patients at a single, quaternary care center who underwent an exploratory laparotomy for EGS conditions within 6 hours of surgical consultation from 2015 to 2019. Patients were grouped by whether they experienced a postoperative complication (systemic, surgical, and/or death). Multivariable regression was performed to predict complications, accounting for SAS and other statistically significant variables between groups. Using this model, predicted probabilities of a complication were generated for each SAS.

RESULTS

The cohort comprised 482 patients: 32.8% (n = 158) experienced a complication, while 67.2% (n = 324) did not. Patients with complications were older, frailer, more often male, had worse SAS (6 vs. 7, p < 0.0001) and American Society of Anesthesiologists scores, and higher rates of perforated hollow viscus (p = 0.0003) and open abdomens (p < 0.0001). On multivariable regression, an increasing SAS independently predicted less complications (adjusted odds ratio, 0.85; 95% confidence interval, 0.75–0.96; p = 0.009). An SAS ≤4 was associated with a 49.2% predicted chance of complications, greater rates of septic shock (9.7% vs. 3%, p = 0.01), respiratory failure (20.5% vs. 10.8%, p = 0.02), and death (24.1% vs. 7.5%, p < 0.0001). An SAS ≤ 4 did not correlate with surgical complications (p = 0.1).

CONCLUSION

The SAS accurately predicts postoperative complications in EGS patients undergoing urgent laparotomy, with an SAS ≤ 4 identifying patients at risk for septic shock, respiratory failure, and mortality. This tool can aid in rapidly determining postoperative disposition and resource allocation.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV
A distinct neurogenomic response to a trade-off between social challenge and opportunity in male sticklebacks (Gasterosteus aculeatus)
Authors: Barbasch T. A. , Behrens C. , McLain M. , Arredondo E. , Bell A. M.
Published: November 2023

Animals frequently make adaptive decisions about what to prioritize when faced with multiple, competing demands simultaneously. However, the proximate mechanisms of decision-making in the face of competing demands are not well understood. We explored this question using brain transcriptomics in a classic model system: threespined sticklebacks, where males face conflict between courtship and territorial defence. We characterized the behaviour and brain gene expression profiles of males confronted by a trade-off between courtship and territorial defence by comparing them to males not confronted by this trade-off. When faced with the trade-off, males behaviourally prioritized defence over courtship, and this decision was reflected in their brain gene expression profiles. A distinct set of genes and biological processes was recruited in the brain when males faced a trade-off and these responses were largely non-overlapping across two brain regions. Combined, these results raise new questions about the interplay between the neural and molecular mechanisms involved in decision-making.
Sex-related communicative functions of voice spectral energy in human chorusing
Authors: Keller Peter E. , Lee Jennifer , König Rasmus , Novembre Giacomo
Published: November 2023

Music is a human communicative art whose evolutionary origins may lie in capacities that support cooperation and/or competition. A mixed account favouring simultaneous cooperation and competition draws on analogous interactive displays produced by collectively signalling non-human animals (e.g. crickets and frogs). In these displays, rhythmically coordinated calls serve as a beacon whereby groups of males ‘cooperatively’ attract potential female mates, while the likelihood of each male competitively attracting an actual mate depends on the precedence of his signal. Human behaviour consistent with the mixed account was previously observed in a renowned boys choir, where the basses—the oldest boys with the deepest voices—boosted their acoustic prominence by increasing energy in a high-frequency band of the vocal spectrum when girls were in an otherwise male audience. The current study tested female and male sensitivity and preferences for this subtle vocal modulation in online listening tasks. Results indicate that while female and male listeners are similarly sensitive to enhanced high-spectral energy elicited by the presence of girls in the audience, only female listeners exhibit a reliable preference for it. Findings suggest that human chorusing is a flexible form of social communicative behaviour that allows simultaneous group cohesion and sexually motivated competition.