bluuebunny/crossref_metadata_2025 huggingface dataset:
Pain in Seriously Mental Ill Populations
Authors: Owen-Smith Ashli A. , Scherrer Jeffrey F.
Published: May 2024

This chapter focuses on pain among individuals with serious mental illness (SMI), specifically among those with schizophrenia, bipolar disorder, and treatment-resistant depression. For each of these conditions, the chapter provides a review of the state of the science as it pertains to (1) the epidemiology of the condition, (2) the prevalence of pain among those with the condition, and (3) risk factors and sequelae of pain for those with the condition. The chapter also discusses the consequences of undiagnosed/undertreated pain in populations with SMI as well as the barriers to and opportunities to improve pain identification and pain management in populations with SMI. Gaps in the current scientific literature and areas for future research are identified.
Pain in Chronic Gastrointestinal Disease
Authors: Edwards David A. , Lackner Jeffrey M.
Published: May 2024

Irritable bowel syndrome and inflammatory bowel disease are two of the most prevalent medical conditions for which people present for medical care, with pain being a primary reason for treatment seeking. The pain that defines these disorders and their personal and economic impacts is poorly understood, underassessed, and undertreated partially due to the complexity of the diseases in general and visceral pain in particular. Recent advances in understanding of gastrointestinal disease epidemiology and pathophysiology have improved medical and surgical treatment outcomes. This chapter reviews the presentation and pathophysiology of irritable bowel syndrome and inflammatory bowel disease, with a focus on the biobehavioral mechanism and experience of visceral pain in this population. Points of vulnerability to pain in gastrointestinal disease are discussed, as are evidence-based treatment pharmacological and behavioral strategies.
Pain Related to Thoracic Outlet Syndrome
Authors: Freeland Rebecca , Wang Annie T. , Christo Paul J.
Published: May 2024

Thoracic outlet syndrome (TOS) encompasses a group of disorders resulting in compression of the neurovascular bundle exiting the thoracic outlet. This compression leads to a constellation of symptoms, including arm pain, numbness, tingling, weakness, and discoloration. Those more vulnerable include patients aged 20–40 years, women (female-to-male ratio of 3–4:1), people who have jobs that require substantial computer usage in non-ergonomic positions and assembly-line workers, and patients sustaining neck trauma. TOS can be classified into three main types based on whether the pathophysiology involves the brachial plexus (neurogenic) or vasculature (venous or arterial). By far the most common is neurogenic. In neurogenic TOS, occipital headaches, arm weakness, and chest wall pain often coexist. Physical therapy is often recommended and helpful. If conservative therapies are insufficient, then an anterior scalene block with local anesthetic is used as a supportive diagnostic and prognostic indicator of surgical outcome from decompressive surgery. Furthermore, studies suggest that botulinum toxin injected into the cervicothoracic muscles can ease symptoms and improve quality of life.
Pain and Youth Sports
Authors: Anthony Marcus , Ozarkar Tejas , Moncayo Juan Andres , Datta Shae
Published: May 2024

Pain in youth athletes is not synonymous with injury (tissue damage). Rather, youth athletes’ pain, be it nociceptive, neuropathic, or nociplastic, results from the cumulative impact of many biopsychosocial factors common to the youth athletic experience. Appropriate identification and correction of these factors is critical to optimal pain management in youth athletes, which should not be limited to the diagnosis and treatment of structural damage at the anatomic location of pain. This chapter provides a framework for the diagnosis and management of youth athletes’ pain that is informed by pain pathophysiology and biopsychosocial factors drawn from developmental, biomechanical, and psychosocial domains unique to the youth athlete.
Pain in the Emergency Room
Authors: Lynch Michael
Published: May 2024

Pain and vulnerability frequently coincide during visits to the emergency department (ED). Approximately 75% of ED visits involve the management of pain, with many patients also reporting chronic pain conditions. At the same time, a complex interplay of patient, provider, and systemic factors can lead to individuals experiencing vulnerability during an ED visit. Understanding the variables that contribute to pain and vulnerability is necessary to ensure that patients have access to evidence-based and equitable care. Some interventions can be deployed at the individual provider level to address these issues, but truly solving problems of inequity, vulnerability, and access to care will require a systematic approach in health care and social interventions that are outside the control of individual patients and health care providers at the time of an ED visit. This chapter provides an overview of the impact of pain and vulnerability on patient outcomes, underlying sources of vulnerability, and proposes interventions aimed at reducing vulnerability and harm while improving equitable access to care. Providing the best possible care to a patient with a goal of improving health rather than simply mitigating disease involves health care providers and the system in which they operate taking a holistic approach that includes recognition and palliation of elements that contribute to a patient’s vulnerability.
JWST UNCOVER: the overabundance of ultraviolet-luminous galaxies at z > 9
Authors: Chemerynska Iryna , Atek Hakim , Furtak Lukas J , Zitrin Adi , Greene Jenny E , Dayal Pratika , Weibel Andrea , Fujimoto Seiji , Kokorev Vasily , Goulding Andy D , Williams Christina C , Nanayakkara Themiya , Bezanson Rachel , Brammer Gabriel , Cutler Sam E , Labbe Ivo , Leja Joel , Pan Richard , Price Sedona H , van Dokkum Pieter , Wang Bingjie , Weaver John R , Whitaker Katherine E
Published: May 2024

Over the past year, JWST has uncovered galaxies at record-breaking distances up to z ∼ 13. The JWST UNCOVER (ultra-deep NIRSpec and NIRcam observations before the epoch of reionization) program has obtained ultra-deep multiwavelength NIRCam imaging of the massive galaxy cluster A2744 over ∼45 arcmin2 down to ∼29.5 AB mag. Here, we present a robust ultraviolet (UV) luminosity function derived through lensing clusters at 9 < z < 12. Using comprehensive end-to-end simulations, we account for all lensing effects and systematic uncertainties in deriving both the amplification factors and the effective survey volume. Our results confirm the intriguing excess of UV-bright galaxies (MUV <−20 AB mag) previously reported at z > 9 in recent JWST studies. In particular, a double power-law (DPL) describes better the bright end of the luminosity function compared to the classical Schechter form. The number density of these bright galaxies is 10–100 times larger than theoretical predictions and previous findings based on Hubble Space Telescope (HST) observations. Additionally, we measure a star formation rate density of ρSFR = 10−2.64 M⊙ yr−1 Mpc−3 at these redshifts, which is 4–10 times higher than galaxy formation models that assume a constant star formation efficiency. Future wide-area surveys and accurate modelling of lensing-assisted observations will reliably constrain both the bright and the dim end of the UV luminosity function at z > 9, which will provide key benchmarks for galaxy formation models.
Laboratory detection and astronomical search of N-ethynylmethanimine, H2CNCCH
Authors: Cabezas C , Endo Y , Rivilla V M , Agúndez M , Jiménez-Serra I , Martín-Pintado J , Cernicharo J
Published: May 2024

The presence in the interstellar medium of several imines suggests that other molecules of the same family could be present as well. The propargylimine molecule (HCCCHNH), which arises from CCH substitution on the C atom of methanimine (H2CNH), the simplest imine, has been recently detected in space. Therefore, the analogous CCH derivative substituted on the N atom, known as N-ethynylmethanimine (H2CNCCH), is a good candidate to be observed as well. To allow for its astronomical detection we have investigated its laboratory rotational spectra. The species has been produced by an electric discharge of acetonitrile (CH3CN) and acetylene (HCCH) in argon, and its rotational spectrum between 9 and 40 GHz has been characterized using a Balle–Flygare narrow band-type Fourier-transform microwave spectrometer. The spectral analysis allowed us to derive accurate spectroscopic parameters to obtain reliable frequency predictions for astronomical searches in different sources. We searched for H2CNCCH in several molecular clouds, G+0.693−0.027, L483, and TMC-1, but did not detect it. The upper limits to its abundance derived are consistent with a preference of the CCH substitution of H2CNH on the C atom rather than on the N atom, in line with quantum chemical calculations on the reaction between CCH and H2CNH.
Determining the Hubble constant with AGN-assisted black hole mergers
Authors: Alves Lucas M B , Sullivan Andrew G , Yang Yang , Gayathri V , Márka Zsuzsa , Márka Szabolcs , Bartos Imre
Published: May 2024

Gravitational waves from neutron star mergers have long been considered a promising way to measure the Hubble constant, H0, which describes the local expansion rate of the Universe. While black hole mergers are more abundantly observed, their expected lack of electromagnetic emission and poor gravitational-wave localization make them less well suited for measuring H0. Black hole mergers within the discs of Active Galactic Nuclei (AGN) could be an exception. Accretion from the AGN disc may produce an electromagnetic signal, pointing observers to the host galaxy. Alternatively, the low number density of AGNs could help identify the host galaxy of $1{\!-\!}5~{{\ \rm per\ cent}}$ of mergers. Here we show that black hole mergers in AGN discs may be a sensitive way to determine H0 with gravitational waves. If 1 per cent (10 per cent) of LIGO’s observations occur in AGN discs with identified host galaxies, we could measure H0 with 12 per cent (4 per cent) uncertainty in five years, possibly comparable to the sensitivity of neutron star mergers and set to considerably improve current gravitational wave measurements.
Geometric morphometrics reveal that Conus anabathrum Crosse, 1865 (Neogastropoda: Conidae) should be an accepted species
Authors: Leal José H , Herbert Gregory S , Fenzan William , Avery Aaron , Márquez Federico
Published: May 2024

In 2022, the accepted name for a marine gastropod species from Florida until then known as Conus anabathrum Crosse, 1865, was replaced by C. floridanus Gabb, 1869. The main argument was that the type of C. anabathrum, a specimen with no type locality in the description, actually represents the eastern Pacific species C. scalaris Valenciennes, 1832. This allocation of the type of C. anabathrum to an eastern Pacific taxon was based on several factors, with shell shape as the main determinant. We demonstrate via geometric morphometrics that the type of C. anabathrum actually falls outside the morphospace of C. scalaris, belonging instead to the morphospace of the Floridian taxon. We also discuss other arguments presented to assign the type of C. anabathrum to the eastern Pacific species. These discussions and our geometric morphometric analytical results demonstrate that the type of C. anabathrum actually represents the Floridian species, and that C. anabathrum should be the accepted name.
Systematic review and meta-analysis for the 2024 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis
Authors: Nakayama Yoichi , Nagata Wataru , Takeuchi Yoichi , Fukui Sho , Fujita Yuya , Hosokawa Yohei , Ueno Masanobu , Ono Kumiko , Sumitomo Shuji , Tabuchi Yuya , Nakanishi Yuichiro , Saito Shuntaro , Ikeuchi Hiroko , Kawamori Kazutaka , Sofue Hideaki , Doi Goro , Minami Runa , Hirota Tomoya , Minegishi Kaoru , Maeshima Keisuke , Motoyama Ryo , Nakamura Shohei , Suzuki Shotaro , Nishioka Norihiro , Wada Takuma Tsuzuki , Onishi Akira , Nishimura Kenichi , Watanabe Ryu , Yanai Ryo , Kida Takashi , Nishiwaki Hiroki , Yajima Nobuyuki , Kaneko Yuko , Tanaka Eiichi , Kawahito Yutaka , Harigai Masayoshi
Published: May 2024

Objectives

The aim of this article is to update evidence on the efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) and provide information to the taskforce for the 2024 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis (RA).

Methods

We searched various databases for randomised controlled trials on RA published until June 2022, with no language restriction. For each of the 15 clinical questions, two independent reviewers screened the articles, evaluated the core outcomes, and performed meta-analyses.

Results

Subcutaneous injection of methotrexate (MTX) showed similar efficacy to oral MTX in MTX-naïve RA patients. Ozoralizumab combined with MTX improved drug efficacy compared to the placebo in RA patients with inadequate response (IR) to conventional synthetic DMARD (csDMARD). Rituximab with and without concomitant csDMARDs showed similar efficacy to other biological DMARDs (bDMARDs) in bDMARD-IR RA patients. Combined Janus kinase inhibitors and MTX achieved similar clinical responses and equal safety during a 4-year period compared to tumour necrosis factor inhibitors in MTX-IR RA patients. Biosimilars showed efficacy equivalent to that of the original bDMARDs in csDMARD-IR and bDMARD-IR RA patients.

Conclusions

This systematic review provides latest evidence for the 2024 update of the Japan College of Rheumatology clinical practice guidelines for RA management.
Generating, modeling and evaluating a large-scale set of CRISPR/Cas9 off-target sites with bulges
Authors: Yaish Ofir , Orenstein Yaron
Published: May 2024

The CRISPR/Cas9 system is a highly accurate gene-editing technique, but it can also lead to unintended off-target sites (OTS). Consequently, many high-throughput assays have been developed to measure OTS in a genome-wide manner, and their data was used to train machine-learning models to predict OTS. However, these models are inaccurate when considering OTS with bulges due to limited data compared to OTS without bulges. Recently, CHANGE-seq, a new in vitro technique to detect OTS, was used to produce a dataset of unprecedented scale and quality. In addition, the same study produced in cellula GUIDE-seq experiments, but none of these GUIDE-seq experiments included bulges. Here, we generated the most comprehensive GUIDE-seq dataset with bulges, and trained and evaluated state-of-the-art machine-learning models that consider OTS with bulges. We first reprocessed the publicly available experimental raw data of the CHANGE-seq study to generate 20 new GUIDE-seq experiments, and hundreds of OTS with bulges among the original and new GUIDE-seq experiments. We then trained multiple machine-learning models, and demonstrated their state-of-the-art performance both in vitro and in cellula over all OTS and when focusing on OTS with bulges. Last, we visualized the key features learned by our models on OTS with bulges in a unique representation.
Intermittent fasting as a dietary intervention with potential sexually dimorphic health benefits
Authors: Rius-Bonet Julia , Macip Salvador , Closa Daniel , Massip-Salcedo Marta
Published: May 2024

Intermittent fasting (IF) has proven to be a feasible dietary intervention for the wider population. The recent increase in IF clinical trials highlights its potential effects on health, including changes in body composition, cardiometabolic status, and aging. Although IF may have clinical applications in different populations, studies suggest there may be sex-specific responses in parameters such as body composition or glucose and lipid metabolism. Here, the existing literature on IF clinical trials is summarized, the application of IF in both disease prevention and management is discussed, and potential disparities in response to this type of diet between men and women are assessed. Moreover, the potential mechanisms that may be contributing to the sexually dimorphic response, such as age, body composition, tissue distribution, or sex hormones are investigated. This review underscores the need to further study these sex-specific responses to IF to define the most effective time frames and length of fasting periods for men and women. Tailoring IF to specific populations with a personalized approach may help achieve its full potential as a lifestyle intervention with clinical benefits.
Prolonged complete response to adjuvant tepotinib in a patient with newly diagnosed disseminated glioblastoma harboring mesenchymal-epithelial transition fusion
Authors: Pham Lily C , Weller Lauryn , Gann Claudia N , Schumacher Karl Maria , Vlassak Soetkin , Swanson Todd , Highsmith Kaitlin , O’Brien Barbara J , Nash Sebnem , Aaroe Ashley , de Groot John F , Majd Nazanin K
Published: May 2024

The prognosis of patients with glioblastoma (GBM) remains poor despite current treatments. Targeted therapy in GBM has been the subject of intense investigation but has not been successful in clinical trials. The reasons for the failure of targeted therapy in GBM are multifold and include a lack of patient selection in trials, the failure to identify driver mutations, and poor blood-brain barrier penetration of investigational drugs. Here, we describe a case of a durable complete response in a newly diagnosed patient with GBM with leptomeningeal dissemination and PTPRZ1-MET fusion who was treated with tepotinib, a brain-penetrant MET inhibitor. This case of successful targeted therapy in a patient with GBM demonstrates that early molecular testing, identification of driver molecular alterations, and treatment with brain-penetrant small molecule inhibitors have the potential to change the outcome in select patients with GBM.
Challenges to CVAs
Authors: Smith Tom , Judd Daniel
Published: May 2024

This chapter notes the challenges of CVAs, primarily under Section 6 of the 1986 Act. Challenges to a CVAS may come in the forms of jurisdiction or two statutory grounds of challenge under section 6 of the 1986 Act. The basis of challenges varies from unfair prejudice to material irregularity. The challenge under the grounds of unfair prejudice looks into the effect of a CVA's contents on the rights of creditors, while a material irregularity challenge is focused on the circumstances and process by the approval of the CVA. A limit of 28 days is the required observance period when challenging a CVA under the aforementioned grounds.
Rational and ambitious legislators? Role theory, between open questions and new applicability
Authors: Gambacciani Paolo
Published: May 2024

Role theory utilizes sociological and political science tools to study parliamentary functioning and parliamentarians’ behavior. While scholars in the USA (1960–70) and Europe (1990–2010) have extensively applied it, this review focuses on its enduring theoretical validity. It introduces a role choice typology, categorizing parliamentarians in empirical studies. The analysis highlights role theory strengths and weaknesses, highlighting that the goal of reelection represents only one potential explanation of parliamentarian behavior. The article suggests reconsidering the sociological concept of role to derive testable hypotheses. In addition, the article extends role theory applications to studying legislative careers and less institutionalized legislatures.
Interrogating ‘Parriah Arrack’: Anxieties Over Health, Race and Drinking in Early Colonial Calcutta
Authors: Mitra Sarbajit
Published: May 2024

The colonial authorities in India had always been watchful of the drinking activities of the European soldiers and sailors, expressing concerns about their moral and physical health. The article suggests that such anxieties motivated the European population in India, particularly in its early days, to investigate the drinking practices of the local population and examine the effects of locally distilled liquor on their health and constitution. Through an analysis of a petition and a Commission report, the paper explores a dialogue between a group of European distillers and the Fort William Medical Board in early nineteenth-century Calcutta, focussing on the topics of drinking and health. The article argues that these early interrogations on the local drink not just reinforced the racial stereotypes concerning taste and technology but also consolidated the idea of the ‘tropic’ that continued to inform Anglo-Indian medical discourses in subsequent years.
Mast cell conditions and drug allergy: when to suspect and how to manage
Authors: Olivieri Bianca , Ghilarducci Alessandro , Nalin Francesca , Bonadonna Patrizia
Published: May 2024

Purpose of review

Patients with mast cell disorders frequently experience symptoms from excessive mediator release like histamine and tryptase, ranging from mild flushing to severe anaphylactic responses. Hypersensitivity reactions (HRs) to drugs are a major cause of anaphylaxis in these patients, who often worry about triggering mast cell degranulation when taking medications. The aim of this review is to explore the complex interactions between mast cell disorders and drug HRs, focusing on the clinical challenges of managing these conditions effectively to enhance understanding and guide safer clinical practices.

Recent findings

Among the drugs most commonly associated with hypersensitivity reactions in patients with mast cell disorders are non-steroidal anti-inflammatory drugs, antibiotics, and perioperative agents. Recent studies have highlighted the role of Mas-related G-protein coupled receptor member X2 (MRGPRX2) – a receptor involved in non-immunoglobulin E mediated mast cell degranulation – in exacerbating HRs. Investigations reveal varied drug tolerance among patients, underscoring the need for individual risk assessments.

Tailored diagnostic approaches are crucial for confirming drug allergies and assessing tolerance in patients with mastocytosis, preventing unnecessary medication avoidance and ensuring safety before acute situations arise.
Predictive models and applicability of artificial intelligence-based approaches in drug allergy
Authors: Núñez Rafael , Doña Inmaculada , Cornejo-García José Antonio
Published: May 2024

Purpose of review

Drug allergy is responsible for a huge burden on public healthcare systems, representing in some instances a threat for patient's life. Diagnosis is complex due to the heterogeneity of clinical phenotypes and mechanisms involved, the limitations of in vitro tests, and the associated risk to in vivo tests. Predictive models, including those using recent advances in artificial intelligence, may circumvent these drawbacks, leading to an appropriate classification of patients and improving their management in clinical settings.

Recent findings

Scores and predictive models to assess drug allergy development, including patient risk stratification, are scarce and usually apply logistic regression analysis. Over recent years, different methods encompassed under the general umbrella of artificial intelligence, including machine and deep learning, and artificial neural networks, are emerging as powerful tools to provide reliable and optimal models for clinical diagnosis, prediction, and precision medicine in different types of drug allergy.

This review provides general concepts and current evidence supporting the potential utility of predictive models and artificial intelligence branches in drug allergy diagnosis.
Findings Associated With Nonaccidental Trauma in Children With Isolated Femoral Diaphyseal Fractures
Authors: Ina Jason , Dumaine Anne M. , Flanagan Christopher , Haase Lucas , Moore Rebecca , Rimnac Clare , Gilmore Allison
Published: May 2024

Background:

Pediatric patients with isolated femoral diaphyseal fractures are difficult to assess for nonaccidental trauma (NAT). The purpose of this study was to determine (1) if there are any demographic features of isolated femoral diaphyseal fractures associated with suspected NAT and (2) if there are clinical signs associated with isolated femoral diaphyseal fractures associated with suspected NAT.

Methods:

All patients with femoral diaphyseal fractures from January 2010 to June 2018 were reviewed. We included patients younger than 4 years old with isolated femoral diaphyseal fractures. We excluded patients 4 years old and older, polytraumas, motor vehicle collisions, and patients with altered bone biology. Diagnosis of suspected NAT was determined by review of a documented social work assessment. We recorded fracture characteristics including location along femur as well as fracture pattern and presence of associated findings on NAT workup including the presence of retinal hemorrhage, subdural hematoma, evidence of prior fracture, or cutaneous lesions. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these associated findings were calculated.

Results:

Totally, 144 patients met the inclusion criteria. Social work was consulted on 50 patients (35%). Suspected NAT was diagnosed in 27 patients (19%). The average age of patients with suspected NAT was 0.82 and 2.25 years in patients without NAT (P<0.01). The rate and type of skin lesions present on exam were not different between the 2 groups. Patients with suspected NAT had no findings of retinal hemorrhage or subdural hematoma, but 5 of 27 patients (19%) had evidence of prior fracture on skeletal survey. The sensitivities of retinal hemorrhage, subdural, and skeletal survey were 0%, 0%, and 19% and the specificities of all were 100%. The NPVs were 39%, 27%, and 63%, respectively. The PPV of skeletal survey was 100%. Since there were no patients in this study with positive findings of retinal hemorrhage or subdural hematoma, the PPV for these could not be assessed.

Conclusions:

In the current study, signs of NAT such as skin lesions, retinal hemorrhage, subdural hematoma, and evidence of prior fracture on skeletal survey may not be helpful to diagnosis suspected NAT in patients with an isolated femoral diaphyseal fracture.

Level of Evidence:

Level III—diagnostic study.
Relationships between survival and real-world recurrence-free survival or distant metastasis-free survival among patients with completely resected stage IIB or IIC melanoma
Authors: Samlowski Wolfram , Silver Michelle A. , Hohlbauch Andriana , Zhang Shujing , Fukunaga-Kalabis Mizuho , Krepler Clemens , Wang Yunfei , Sruti Ila , Jiang Ruixuan
Published: May 2024

Long follow-up time is needed for overall survival (OS) data to mature for early-stage melanoma. This retrospective study aimed to describe the relationships between OS and two intermediate endpoints – real-world recurrence-free survival (rwRFS) and real-world distant metastasis-free survival (rwDMFS) – for patients with stage IIB or IIC melanoma that was completely resected from 1 January 2008 to 31 December 2017, with follow-up to 31 December 2020. We used three different approaches to describe the relationships: estimates of correlation using Kendall τ rank correlation; comparisons of all-cause survival with/without recurrence or distant metastasis using adjusted Cox proportional hazard models; and landmark analyses of all-cause survival stratified by recurrence status at 1–5 years. During a 39-month median follow-up from surgical resection, 223/567 patients (39%) experienced recurrence, among whom 171/567 patients (30%) developed distant metastasis. Median OS from surgical resection was 117.6 months [95% confidence interval (CI), 104.7-not reached], median rwRFS was 49.8 months (95% CI, 39.6–61.0), and median rwDMFS was 70.9 months (95% CI, 58.4–89.1). We observed strong correlations between rwRFS and OS, and between rwDMFS and OS (Kendall τ of 0.73 and 0.82, respectively). Risk of death was significantly greater after recurrence (all-cause survival adjusted hazard ratio [HR], 7.48; 95% CI, 4.55–12.29) or distant metastasis (adjusted HR, 11.00; 95% CI, 6.92–17.49). Risk of death remained significantly elevated with recurrence or distant metastasis by landmark years 1, 3, and 5 after surgical resection. These findings support the use of recurrence/rwRFS and distant metastasis/rwDMFS as surrogate endpoints for OS after complete resection of stage IIB or IIC melanoma.
The Risk of Ventricular Septal Defects Associated With Prenatal Marijuana Exposure: A Systematic Review and Meta-Analysis
Authors: Stonberg Ariel , Beber Samuel A. , Drugge Elizabeth , Frishman William H.
Published: May 2024

With the recent legalization of marijuana across the United States, its usage in pregnant women has increased. The aim of this meta-analysis was to determine if prenatal marijuana use increases the likelihood of ventricular septal defects. The analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search strategy identified 4 case–control studies that were ultimately included in the analysis with a combined 381,621 infant records. Quantitative analysis demonstrated prenatal marijuana usage significantly increases the likelihood of ventricular septal defects (odds ratio = 2.39, 95% confidence interval = 1.11–5.18).
Clinical Performance and Persistence on Dual Pathway Inhibition with Rivaroxaban and Aspirin in Real-World Setting
Authors: Russo Vincenzo , Fabiani Dario , Imbalzano Egidio , De Michele Mario , Castellano Paola , Colaiori Iginio , Parisi Valentina , D'Andrea Antonello , Attena Emilio
Published: May 2024

The dual pathway inhibition (DPI) with low-dose rivaroxaban and aspirin in patients with stable atherosclerotic vascular disease reduces the occurrence of cardiovascular events, with no significant increase of intracranial or other critical organ bleedings. Our observational study aimed to describe the clinical performance, adherence, and persistence of DPI therapy among a real-world setting of patients with an established diagnosis of coronary artery (CAD) and/or peripheral artery disease (PAD). We prospectively included all consecutive patients with an established diagnosis of CAD and/or PAD treated with aspirin (ASA) 100 mg once daily and rivaroxaban 2.5 mg twice daily. Clinical evaluation was performed at baseline, before starting treatment, at 1 month, and every 6 months after the study drug administration. A total of 202 consecutive patients (mean age 66 ± 10 years; male 80%) eligible to DPI therapy were included. During a mean follow-up of 664 ± 177 days, the incidence rate of major bleedings and of major adverse cardiovascular events was 0.8 and 1.1 per 100 patients/year, respectively. The adherence to pharmacological treatment was 99%. Additionally, 13.4% of patients suspended the DPI therapy during the follow-up. Minor bleedings resulted the most common cause of both temporary and permanent DPI therapy discontinuation. This observational study supports the safety of DPI with low-dose rivaroxaban and aspirin among patients with CAD and PAD in a real-world setting, showing high persistence and maximum adherence to medical treatment.
Outcomes of Mastectomy and Immediate Reconstruction Managed with Closed-incision Negative Pressure Therapy Applied Over the Whole Breast
Authors: Gabriel Allen , Chan Vivian
Published: May 2024

Background:

Incision healing after mastectomy and immediate reconstruction can be supported with closed-incision negative pressure therapy (ciNPT). Studies have reported patients receiving postoperative care with ciNPT after breast surgery exhibited lower rates of dehiscence, infection, necrosis, and seroma, compared with standard dressings. A recent approach to ciNPT involves the application of negative pressure to the incision and a wider area of surrounding tissue. In this retrospective review, we investigated the outcomes of ciNPT using full-coverage dressings over the entire breast after mastectomy and reconstruction.

Methods:

Patients underwent mastectomies and immediate prepectoral breast reconstruction with an implant or tissue expander. After surgery, patients received oral antibiotics and ciNPT with full-coverage foam dressings at −125 mm Hg.

Results:

All 54 patients (N = 105 incisions) were women, with a mean age of 53.5 years and 29.1 kg per m2 body mass index. Common comorbidities included prior chemotherapy (31.3%) or radiation (21.6%), hypertension (14.8%), and diabetes (5.6%). Procedures included skin-reducing (34.3%), skin-sparing (7.6%), and nipple-sparing (58.1%) mastectomies. Lymph nodes were removed in 38 (36.2%) incisions. All patients were discharged home with ciNPT on postoperative day (POD) 1, and ciNPT was discontinued on POD 5–7. At POD 30, three patients developed seromas, requiring revision. Of these, one required removal of the left tissue expander. The remaining 102 incisions (97.1%) healed without complication.

Conclusions:

Among this cohort, the use of ciNPT with full-dressing coverage of the breast incisions and surrounding soft tissue was effective in supporting incisional healing after mastectomy and immediate reconstruction.
Willingness of Patients With End-Stage Renal Disease to Accept a Kidney Transplant and Related Factors
Authors: CHENG Yin , LAI Hsiang-Ru , CHEN I-Hui , CHIU Yen-Ling , LEE Pei-I , PETERS Kath , LEE Pi-Hsia
Published: May 2024

Background

The prevalence of end-stage renal disease (ESRD) in Taiwan is among the highest in the world. Although kidney transplant is the most effective treatment for ESRD, the willingness of patients with ESRD to undergo kidney transplantation is low in Taiwan. The factors associated with willingness to accept kidney transplantation remain unclear, and studies on kidney transplant willingness and associated factors among Taiwanese patients with ESRD are scarce.

Purpose

The aim of this study was to assess willingness to undergo a kidney transplant and related factors among patients with ESRD in Taiwan.

Methods

A cross-sectional design was employed. Two hundred fourteen participants from a single medical center in Taiwan were recruited, and 209 valid questionnaires were collected (valid response rate: 97.7%). The study instruments included a kidney transplant knowledge scale, a kidney transplant attitude scale, and a kidney transplant willingness scale. Data were analyzed using Pearson's product–moment correlations, t tests, one-way analyses of variance, and multiple regressions.

Results

The mean kidney transplant willingness in the sample was 13.23 (out of 20). Being male, younger, married, or employed; having a college education or above; and having a shorter dialysis duration were all associated with higher kidney transplant willingness. Sociodemographics, dialysis duration, knowledge, and attitudes explained 45.4% of the variance in kidney transplant willingness, with two of these, kidney transplant attitudes (β = .61, p < .001) and dialysis duration (β = −.11, p = .041), identified as significant.

Conclusions/Implications for Practice

The findings support the important role of cultivating positive attitudes in patients with ESRD to increasing willingness to undergo kidney transplantation interventions.
Clinical Nurse Leader Practice Development
Authors: Salinas Brianna , Leger J. Michael
Published: May 2024

Background:

The Clinical Nurse Leader (CNL) is a skilled clinician qualified in outcomes-based practice and quality improvement. Publications describe the CNL training, integration, and outcomes. However, CNL practice development and its impact has not been fully explored.

Purpose:

This review aimed to synthesize existing literature related to CNL practice development and identify what influences on the care environment and nursing care outcomes.

Methods:

An integrative literature review was conducted in 5 bibliographic databases for sources published in English from January 2012 to March 2023.

Results:

Fifteen publications identified 3 interrelated themes of CNL practice, outcomes, and practice development. Staff development needs were identified across various levels of expertise.

Conclusion:

There is a need to further explore CNL practice development and how it can impact the care environment and care outcomes.
SERUM TRANSACTIVE RESPONSE DNA BINDING PROTEIN 43 ASSOCIATES WITH POOR SHORT-TERM NEUROLOGIC OUTCOME AFTER RETURN OF SPONTANEOUS CIRCULATION FOLLOWING CARDIAC ARREST
Authors: Sun Zhangping , Yu Dongping , Li Peijuan , Wang Ling , Chen Yushu , Wei Xiaojun , Gong Ping
Published: May 2024

Objective: To explore the association of serum transactive response DNA binding protein 43 (TDP-43) with 28-day poor neurologic outcome in patients with return of spontaneous circulation (ROSC) after cardiac arrest.Methods: We performed a study between January and December 2023. Eligible patients with ROSC following cardiac arrest were enrolled. Their baseline characteristics were collected, and serum levels of TDP-43, tumor necrosis factor-α, interleukin-6 and 10, C-reactive protein, and neuron-specific enolase (NSE) at 24 h after ROSC were measured. The neurologic function was assessed by the cerebral performance category scores on day 28 after ROSC.Results: A total of 92 patients were included, with 51 and 41 patients in the good and poor neurologic outcome groups, respectively. Serum TDP-43 was significantly higher in the poor than the good neurologic outcome group (P< 0.05). Univariate and multivariate logistic regression analyses showed that TDP-43, Witnessed CA, IL-6, and NSE were associated with poor 28-day neurologic outcome (allP< 0.05). Restricted cubic spline analysis revealed that TDP-43 at the serum level of 11.64 pg/mL might be an ideal cutoff value for distinguishing between good and poor neurologic outcomes. Area under curve of serum TDP-43 (AUC = 0.78) was close to that of serum NSE (AUC = 0.82). A dynamic nomogram prediction model that combined TDP-43, Witnessed CA, IL-6, and NSE was constructed and validated.Conclusion: Elevated serum TDP-43 level was associated with and could be used together with Witnessed CA, IL-6, and NSE to predict poor 28-day neurologic outcome in patients after ROSC following cardiac arrest.
Effect of Plastic Stents Following Lumen-Apposing Metal Stent Placement on Recurrence of Pancreatic Fluid Collections in Disconnected Pancreatic Duct Syndrome: A Systematic Review and Meta-Analysis
Authors: Liu Jiawen , Wei Zhengjie , Huang Qing , Yang Shizhong , Fang Yanbin , Ren Yutang , Jiang Xuan , Jiang Bo
Published: May 2024

Background and Aim:

Lumen-apposing metal stents (LAMS) are preferred to initial drainage in pancreatic fluid collections (PFCs) patients with disconnected pancreatic duct syndrome (DPDS) in recent years. However, unlike plastic stents, the long-term placement of LAMS is not recommended due to a high risk of local complications. This meta-analysis attempted to evaluate the effect of using plastic stents for prolonged drainage after LAMS removal on recurrence of PFCs in DPDS.

Methods:

A comprehensive literature search was conducted from inception until January 2023, to identify articles investigating the endoscopic ultrasound (EUS)-guided treatment of plastic stents compared with no plastic stents following LAMS removal in patients with PFCs and DPDS. The primary outcome measures included recurrence of PFCs and need for reintervention.

Results:

We identified 3 eligible articles including 520 patients with PFCs, 246 of whom with DPDS. There was a total of 143 and 103 patients in the plastic stents group and in the no plastic stents group, respectively. The plastic stents group exhibited a lower rate of PFCs recurrence following LAMS removal after PFCs resolution compared with the no plastic stents group (OR 0.15; 95% CI 0.03-0.75; P=0.02). However, there was no difference in the rates of reintervention between the two groups (OR 0.52; 95% CI 0.15-1.83; P=0.31). There was no severe adverse events and mortality associated with stent placement or exchange in all patients.

Conclusion:

Deployment of plastic stents for long-term drainage after LAMS replacement can decrease the risk of PFCs recurrence in patients with DPDS following resolution, but it does not impact reintervention rates.
Spatial and Temporal Relationships Between Atrophy and Hypometabolism in Behavioral-Variant Frontotemporal Dementia
Authors: Stocks Jane , Gibson Erin , Popuri Karteek , Beg Mirza F. , Rosen Howard , Wang Lei
Published: May 2024

Purpose:

Individuals with behavioral-variant frontotemporal dementia (bvFTD) show changes in brain structure as assessed by MRI and brain function assessed by 18FDG-PET hypometabolism. However, current understanding of the spatial and temporal interplay between these measures remains limited.

Methods:

Here, we examined longitudinal atrophy and hypometabolism relationships in 15 bvFTD subjects with 2 to 4 follow-up MRI and PET scans (56 visits total). Subject-specific slopes of atrophy and hypometabolism over time were extracted across brain regions and correlated with baseline measures both locally, via Pearson correlations, and nonlocally, via sparse canonical correlation analyses (SCCA).

Results:

Notably, we identified a robust link between initial hypometabolism and subsequent cortical atrophy rate changes in bvFTD subjects. Network-level exploration unveiled alignment between baseline hypometabolism and ensuing atrophy rates in the dorsal attention, language, and default mode networks. SCCA identified 2 significant and highly localized components depicting the connection between baseline hypometabolism and atrophy slope over time. The first centered around bilateral orbitofrontal, frontopolar, and medial prefrontal lobes, whereas the second concentrated in the left temporal lobe and precuneus.

Conclusions:

This study highlights 18FDG-PET as a dependable predictor of forthcoming atrophy in spatially adjacent brain regions for individuals with bvFTD.
Low-field MRI for use in neurological diseases
Authors: Balaji Sharada , Wiley Neale , Poorman Megan E. , Kolind Shannon H.
Published: May 2024

Purpose of review

To review recent clinical uses of low-field magnetic resonance imaging (MRI) to guide incorporation into neurological practice.

Recent findings

Use of low-field MRI has been demonstrated in applications including tumours, vascular pathologies, multiple sclerosis, brain injury, and paediatrics. Safety, workflow, and image quality have also been evaluated.

Low-field MRI has the potential to increase access to critical brain imaging for patients who otherwise may not obtain imaging in a timely manner. This includes areas such as the intensive care unit and emergency room, where patients could be imaged at the point of care rather than be transported to the MRI scanner. Such systems are often more affordable than conventional systems, allowing them to be more easily deployed in resource constrained settings. A variety of systems are available on the market or in a research setting and are currently being used to determine clinical uses for these devices. The utility of such devices must be fully evaluated in clinical scenarios before adoption into standard practice can be achieved. This review summarizes recent clinical uses of low-field MR as well as safety, workflows, and image quality to aid practitioners in assessing this new technology.
Predicting Primary Graft Dysfunction in Lung Transplantation: Machine Learning–Guided Biomarker Discovery
Authors: Nord Dianna , Brunson Jason Cory , Langerude Logan , Moussa Hassan , Gill Blake , Machuca Tiago , Rackauskas Mindaugas , Sharma Ashish , Lin Christine , Emtiazjoo Amir , Atkinson Carl
Published: May 2024

BACKGROUND

There is an urgent need to better understand the pathophysiology of primary graft dysfunction (PGD) so that point-of-care methods can be developed to predict those at risk. Here we utilize a multiplex multivariable approach to define cytokine, chemokines, and growth factors in patient-matched biospecimens from multiple biological sites to identify factors predictive of PGD.

METHODS

Biospecimens were collected from patients undergoing bilateral LTx from three distinct sites: donor lung perfusate, post-transplant bronchoalveolar lavage (BAL) fluid (2h), and plasma (2h and 24h). A 71-multiplex panel was performed on each biospecimen. Cross-validated logistic regression (LR) and random forest (RF) machine learning models were used to determine whether analytes in each site or from combination of sites, with or without clinical data, could discriminate between PGD grade 0 (n= 9) and 3 (n= 8).

RESULTS

Using optimal AUROC, BAL fluid at 2h was the most predictive of PGD (LR, 0.825; RF, 0.919), followed by multi–timepoint plasma (LR, 0.841; RF, 0.653), then perfusate (LR, 0.565; RF, 0.448). Combined clinical, BAL, and plasma data yielded strongest performance (LR, 1.000; RF, 1.000). Using a LASSO of the predictors obtained using LR, we selected IL-1RA, BCA-1, and Fractalkine, as most predictive of severe PGD.

CONCLUSIONS

BAL samples collected 2h post-transplant were the strongest predictors of severe PGD. Our machine learning approach not only identified novel cytokines not previously associated with PGD, but identified analytes that could be used as a point-of-care cytokine panel aimed at identifying those at risk for developing severe PGD.
Self-assembled DNA-collagen bioactive scaffolds promote cellular uptake and neuronal differentiation
Authors: Singh Nihal , Singh Ankur , Bhatia Dhiraj
Published: May 2024

Different modalities of DNA-Collagen complexes have been utilized primarily for gene delivery studies. However, very few studies have investigated the potential of these complexes as bioactive scaffolds. Further, no studies have characterized the DNA-Collagen complex formed from the interaction of self-assembled DNA macrostructure and collagen. Towards this investigation, we report herein the fabrication of novel bioactive scaffolds formed from the interaction of sequence-specific, self-assembled DNA macrostructure and collagen type I. Varying molar ratios of DNA and collagen resulted in highly intertwined fibrous scaffolds with different fibrillar thicknesses. The formed scaffolds were biocompatible and presented as a soft matrix for cellular growth and proliferation. Cells cultured on DNA/Collagen scaffolds promoted enhanced cellular uptake of transferrin, and the potential of DNA/Collagen scaffolds to induce neuronal cell differentiation was further investigated. The DNA/Collagen scaffolds promoted neuronal differentiation of precursor cells with extensive neurite growth in comparison to control groups. These novel, self-assembled DNA/Collagen scaffolds could serve as a platform for the development of various bioactive scaffolds with potential applications in neuroscience, drug delivery, tissue engineering, and in vitro cell culture.

Graphical Abstract
Differential prevalence and risk factors for infection with coronaviruses in bats collected during 2020 in Yunnan Province, China
Authors: Li Ruiya , Tendu Alexander , Kane Yakhouba , Omondi Victor , Ying Jiaxu , Mao Lingjing , Xu Shiman , Xu Rong , Chen Xing , Chen Yanhua , Descorps-Declère Stéphane , Bienes Kathrina Mae , Fassatoui Meriem , Hughes Alice C. , Berthet Nicolas , Wong Gary
Published: May 2024

Coronaviruses (CoVs) pose a threat to human health globally, as highlighted by severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and the COVID-19 pandemic. Bats from the Greater Mekong Subregion (GMS) are an important natural reservoir for CoVs. Here we report the differential prevalence of CoVs in bats across biological and ecological factors within Yunnan Province. We also show the coexistence of CoVs in individual bats and identify an additional putative host for SARS-related CoV, with higher dispersal capacity than other known hosts. Notably, 11 SARS-related coronaviruses (SARSr-CoVs) were discovered in horseshoe bats and a Chinese water myotis bat by pan-CoV detection and Illumina sequencing. Our findings facilitate an understanding of the fundamental features of the distribution and circulation of CoVs in nature as well as zoonotic spillover risk in the One health framework.