bluuebunny/crossref_metadata_2025 huggingface dataset:
Satellite lines from auto-ionizing states of Fe xvi and the problems with the X-ray Fe xvii lines
Authors: Del Zanna G , Badnell N R , Storey P J
Published: June 2024

We present new calculations of atomic data needed to model auto-ionizing states of Fe xvi. We compare the state energies, radiative and excitation data with a sample of results from previous literature. We find a large scatter of results, the most significant ones in the auto-ionization rates, which are very sensitive to the configuration interaction and state mixing. We find relatively good agreement between the auto-ionization rates and the collisional excitation rates calculated with the R-matrix suite of programs and autostructure. The largest model, which includes J-resolved states up to $n=10$, produces ab-initio wavelengths and intensities of the satellite lines which agree well with solar high-resolution spectra of active regions, with few minor wavelength adjustments. We review previous literature, finding many incorrect identifications, most notably those in the NIST data base. We provide several new tentative identifications in the 15–15.7 Å range, and several new ones at shorter wavelengths, where previous lines were unidentified. Compared to the previous CHIANTI model, the present one has an increased flux in the 15–15.7 Å range at 2 MK of a factor of 1.9, resolving the discrepancies found in the analysis of the Marshall Grazing Incidence X-Ray Spectrometer observation. It appears that the satellite lines also resolve the long-standing discrepancy in the intensity of the important Fe xvii 3D line at 15.26 Å.
A fast-cadenced search for gamma-ray burst orphan afterglows with the Deeper, Wider, Faster programme
Authors: Freeburn James , Cooke Jeff , Möller Anais , Dobie Dougal , Zhang Jielai , Salafia Om Sharan , Siellez Karelle , Auchettl Katie , Goode Simon , Abbott Timothy M C , Andreoni Igor , Allen Rebecca , Van Bemmel Natasha , Webb Sara
Published: June 2024

The relativistic outflows that produce long gamma-ray bursts (LGRBs) can be described by a structured jet model where prompt $\gamma$-ray emission is restricted to a narrow region in the jet’s core. Viewing the jet off-axis from the core, a population of afterglows without an associated GRB detection can be predicted. In this work, we conduct an archival search for these ‘orphan’ afterglows (OAs) with minute-cadence, deep ($g\sim 23$) data from the Dark Energy Camera (DECam) taken as part of the Deeper, Wider, Faster programme (DWF). We introduce a method to select fast-evolving OA candidates within DWF data that comprises a machine learning model, based on a realistic synthetic population of OAs. Using this classifier, we recover 51 OA candidates. Of these candidates, 42 are likely flare events from M-class stars. The remaining nine possess quiescent, coincident sources in archival data with angular profiles consistent with a star and are inconsistent with the expected population of LGRB host galaxies. We therefore conclude that these are likely Galactic events. We calculate an upper limit on the rate of OAs down to $g\lt 22$ AB mag of 7.46 deg$^{-2}$yr$^{-1}$ using our criteria and constrain possible jet structures. We also place an upper limit of the characteristic angle between the $\gamma$-ray-emitting region and the jet’s half-opening angle. For a smooth power law and a power law with core jet model, respectively, these values are $58.3^{\circ }$ and $56.6^{\circ }$, for a power-law index of 0.8 and $75.3^{\circ }$ and $76.8^{\circ }$ for a power-law index of 1.2.
Intrinsically disordered regions regulate RhlE RNA helicase functions in bacteria
Authors: Hausmann Stéphane , Geiser Johan , Allen George Edward , Geslain Sandra Amandine Marie , Valentini Martina
Published: June 2024

RNA helicases—central enzymes in RNA metabolism—often feature intrinsically disordered regions (IDRs) that enable phase separation and complex molecular interactions. In the bacterial pathogen Pseudomonas aeruginosa, the non-redundant RhlE1 and RhlE2 RNA helicases share a conserved REC catalytic core but differ in C-terminal IDRs. Here, we show how the IDR diversity defines RhlE RNA helicase specificity of function. Both IDRs facilitate RNA binding and phase separation, localizing proteins in cytoplasmic clusters. However, RhlE2 IDR is more efficient in enhancing REC core RNA unwinding, exhibits a greater tendency for phase separation, and interacts with the RNase E endonuclease, a crucial player in mRNA degradation. Swapping IDRs results in chimeric proteins that are biochemically active but functionally distinct as compared to their native counterparts. The RECRhlE1-IDRRhlE2 chimera improves cold growth of a rhlE1 mutant, gains interaction with RNase E and affects a subset of both RhlE1 and RhlE2 RNA targets. The RECRhlE2-IDRRhlE1 chimera instead hampers bacterial growth at low temperatures in the absence of RhlE1, with its detrimental effect linked to aberrant RNA droplets. By showing that IDRs modulate both protein core activities and subcellular localization, our study defines the impact of IDR diversity on the functional differentiation of RNA helicases.
Cooperative Gsx2–DNA binding requires DNA bending and a novel Gsx2 homeodomain interface
Authors: Webb Jordan A , Farrow Edward , Cain Brittany , Yuan Zhenyu , Yarawsky Alexander E , Schoch Emma , Gagliani Ellen K , Herr Andrew B , Gebelein Brian , Kovall Rhett A
Published: June 2024

The conserved Gsx homeodomain (HD) transcription factors specify neural cell fates in animals from flies to mammals. Like many HD proteins, Gsx factors bind A/T-rich DNA sequences prompting the following question: How do HD factors that bind similar DNA sequences in vitro regulate specific target genes in vivo? Prior studies revealed that Gsx factors bind DNA both as a monomer on individual A/T-rich sites and as a cooperative homodimer to two sites spaced precisely 7 bp apart. However, the mechanistic basis for Gsx–DNA binding and cooperativity is poorly understood. Here, we used biochemical, biophysical, structural and modeling approaches to (i) show that Gsx factors are monomers in solution and require DNA for cooperative complex formation, (ii) define the affinity and thermodynamic binding parameters of Gsx2/DNA interactions, (iii) solve a high-resolution monomer/DNA structure that reveals that Gsx2 induces a 20° bend in DNA, (iv) identify a Gsx2 protein–protein interface required for cooperative DNA binding and (v) determine that flexible spacer DNA sequences enhance Gsx2 cooperativity on dimer sites. Altogether, our results provide a mechanistic basis for understanding the protein and DNA structural determinants that underlie cooperative DNA binding by Gsx factors.
Line manager training and organizational approaches to supporting well-being
Authors: Dulal-Arthur T , Hassard J , Bourke J , Roper S , Wishart M , Belt V , Bartle C , Leka S , Pahl N , Thomson L , Blake H
Published: June 2024

Background

Employee mental health and well-being (MH&WB) is critical to the productivity and success of organizations. Training line managers (LMs) in mental health plays an important role in protecting and enhancing employee well-being, but its relationship with other MH&WB practices is under-researched.

Aims

To determine whether organizations offering LM training in mental health differ in the adoption of workplace- (i.e. primary/prevention-focused) and worker-directed (including both secondary/resiliency-focused and tertiary/remedial-focused) interventions to those organizations not offering LM training and to explore changes in the proportions of activities offered over time.

Methods

Secondary analysis of enterprise data from computer-assisted telephone interview surveys. The analysis included data from organizations in England across 4 years (2020: n = 1900; 2021: n = 1551; 2022: n = 1904; 2023: n = 1902).

Results

Offering LM training in mental health was associated with organizations’ uptake of primary-, secondary-, and tertiary-level MH&WB activities across all 4 years. The proportion of organizations offering primary-, secondary- and tertiary-level interventions increased over time. On average, tertiary-level activities were most adopted (2020: 80%; 2021: 81%; 2022: 84%; 2023: 84%), followed by primary-level activities (2020: 66%; 2021: 72%; 2022: 72%; 2023: 73%) and secondary-level activities (2020: 62%; 2021: 60%; 2022: 61%; 2023: 67%).

Conclusions

Offering LM training in mental health is associated with the adoption of other MH&WB practices by organizations. Suggesting that organizations that are committed to the mental health agenda are more likely to take a holistic approach (including both worker and workplace strategies) to promoting workforce mental health, rather than providing LM training in isolation.
Burnout: half a century of controversy
Authors: Bianchi R , Schonfeld I S
Published: June 2024

As one marks the 50th anniversary of burnout, this commentary discusses five areas of controversy surrounding the entity. These areas include the aetiology, prevalence, distinction from depression, stigma load and basic definition of burnout. The state of the art reveals that much of what was once taken for granted about the syndrome requires reconsideration. Many beliefs about burnout have turned into ‘zombie beliefs’, continuing to haunt the field despite their lack of validity.
Differential phosphorylation of Ca2+-permeable channel CYCLIC NUCLEOTIDE–GATED CHANNEL20 modulates calcium-mediated freezing tolerance in Arabidopsis
Authors: Peng Yue , Ming Yuhang , Jiang Bochen , Zhang Xiuyue , Fu Diyi , Lin Qihong , Zhang Xiaoyan , Wang Yi , Shi Yiting , Gong Zhizhong , Ding Yanglin , Yang Shuhua
Published: June 2024

Plants respond to cold stress at multiple levels, including increasing cytosolic calcium (Ca2+) influx and triggering the expression of cold-responsive genes. In this study, we show that the Ca2+-permeable channel CYCLIC NUCLEOTIDE–GATED CHANNEL20 (CNGC20) positively regulates freezing tolerance in Arabidopsis (Arabidopsis thaliana) by mediating cold-induced Ca2+ influx. Moreover, we demonstrate that the leucine-rich repeat receptor-like kinase PLANT PEPTIDE CONTAINING SULFATED TYROSINE1 RECEPTOR (PSY1R) is activated by cold, phosphorylating and enhancing the activity of CNGC20. The psy1r mutant exhibits decreased cold-evoked Ca2+ influx and freezing tolerance. Conversely, COLD-RESPONSIVE PROTEIN KINASE1 (CRPK1), a protein kinase that negatively regulates cold signaling, phosphorylates and facilitates the degradation of CNGC20 under prolonged periods of cold treatment, thereby attenuating freezing tolerance. This study thus identifies PSY1R and CRPK1 kinases that regulate CNGC20 activity and stability, respectively, thereby antagonistically modulating freezing tolerance in plants.
SUPPRESSOR OF FRIGIDA 4 cooperates with the histone methylation reader EBS to positively regulate root development
Authors: Huang Can , Wang Diao , Yang Yanqi , Yang Hong , Zhang Biaoming , Li Haitao , Zhang Haitao , Li Yan , Yuan Wenya
Published: June 2024

Maintenance and homeostasis of the quiescent center (QC) in Arabidopsis (Arabidopsis thaliana) root apical meristems are critical for stem cell organization and root development. Despite great progress in relevant research, the molecular mechanisms that determine the root stem cell fate and QC still need further exploration. In Arabidopsis, SUPPRESSOR OF FRIGIDA 4 (SUF4) encodes a C2H2-type zinc finger protein that represses flowering by transcriptional activation of FLOWERING LOCUS C (FLC) through the FRIGIDA (FRI) pathway, and EARLY BOLTING IN SHORT DAYS (EBS) is a bivalent histone reader that prevents premature flowering. Here, we found that SUF4 directly interacts with EBS in vivo and in vitro. Loss of function of SUF4 and/or EBS resulted in disorganization of the QC, aberrant cell division, and stunted root growth. RNA-seq and reverse transcription quantitative real-time polymerase chain reaction analysis revealed that SUF4 and EBS coregulate many root development-related genes. A series of biochemical analyses demonstrated that SUF4 directly binds to the promoter of SCARECROW (SCR), which encodes a key regulator of root development. Chromatin immunoprecipitation assay indicated that both SUF4 and EBS are recruited to the SCR locus in an interdependent manner to promote H3K4me3 levels and suppress H3K27me3 levels, thereby activating the expression of SCR. These findings improve our understanding of the function of SUF4 and EBS and provide insights into the molecular mechanism that couples a transcription factor and a histone methylation reader to modulate QC specification and root development in Arabidopsis.
The effect of experimentally induced sleep fragmentation and estradiol suppression on neurobehavioral performance and subjective sleepiness in premenopausal women
Authors: Grant Leilah K , Gonsalvez Irene , Cohn Aviva Y , Nathan Margo D , Harder Jessica A , Klerman Elizabeth B , Scheer Frank A J L , Kaiser Ursula B , Crawford Sybil , Luo Tianyu , Wiley Aleta , Rahman Shadab A , Joffe Hadine
Published: June 2024

Study Objectives

Menopause is associated with nighttime sleep fragmentation, declining estradiol, and impaired cognition. In a model of pharmacologically induced estradiol suppression mimicking menopause, we examined the impact of menopause-pattern sleep fragmentation on daytime neurobehavioral performance and sleepiness in premenopausal women.

Methods

Twenty premenopausal women completed two five-night inpatient studies in the mid-to-late follicular phase (estrogenized) and after pharmacological estradiol suppression (hypo-estrogenized). During each study, participants had an uninterrupted 8-hour sleep opportunity for two nights, followed by three nights where sleep was experimentally fragmented to mimic menopause-pattern sleep disturbance, and during which the sleep opportunity was extended to prevent shortening of the sleep duration. Neurobehavioral performance and subjective sleepiness were measured using the Psychomotor Vigilance Task and Karolinska Sleepiness Scale (KSS).

Results

Compared to unfragmented sleep, sleep fragmentation increased attentional lapses (+ 0.6 lapses, p < .05), slowed reaction time (+ 9.4 milliseconds, p < .01), and increased daytime sleepiness (+ 0.5 KSS score, p < .001). Estradiol suppression increased attentional lapses (+ 0.8; p < .001) and reaction time (+ 12.3, p < .01) but did not significantly affect daytime sleepiness. The effect of sleep fragmentation on neurobehavioral performance differed by estradiol state, such that the adverse effects of sleep fragmentation on attentional lapses (+ 0.9, trend p = .06) and reaction time (+ 15, p < .05) were observed only when estrogenized.

Conclusions

Menopause-pattern sleep fragmentation and estradiol suppression worsened neurobehavioral performance and daytime sleepiness, even while sleep duration was not reduced. The adverse effects of sleep fragmentation in the context of an adequate sleep duration highlight the importance of sleep continuity as a vital aspect of good sleep health.
Exploring the impact of gamification on engagement in a statistics classroom
Authors: Jack Eilidh , Alexander Craig , Jones Elinor M
Published: June 2024

In recent years, the integration of gamification into educational settings has garnered significant attention as a means to enhance student engagement and learning outcomes. By leveraging gamified elements such as points and leaderboards, educators aim to promote active participation, motivation and deeper understanding among students. This study investigates the effect of gamification on student engagement in a flipped statistics classroom environment. The findings suggest that gamification strategies, when effectively implemented, can have a positive impact on student motivation and engagement. This paper concludes with recommendations for educators, potential challenges such as superficial engagement and demotivation and future directions for research to address these challenges and further explore the potential of gamification in fostering student success.
Beyond Abdominal Cavity: Peritoneal and Retroperitoneal Anatomy as It Relates to Disease Spread—Part 2
Authors: Mariussi Miriana , Gambetta Sofia
Published: June 2024

The peritoneal cavity is commonly affected by disease processes such as bowel perforation, infections, malignancy, and trauma. Recognizing the anatomy of the peritoneal and retroperitoneal regions is essential for identifying diseases and formulating differential diagnoses during radiological interpretation. Understanding how diseases can spread through the abdomen and pelvis is crucial for an accurate interpretation of radiological findings. Radiologists must be familiar with the peritoneal and retroperitoneal anatomy to avoid potential diagnostic misinterpretations. This article aims to discuss the anatomic principles of peritoneal ligaments and spaces and retroperitoneal spaces and planes, review the basic embryological development of the peritoneum, describe the mechanism by which diseases spread through the abdomen and pelvis, and provide key diagnostic findings.
Drug allergy awareness and perspectives with the implementation of the International Classification of Diseases-11
Authors: Tanno Luciana Kase , Briand Yann , Perie Alain , Castells Mariana , Demoly Pascal
Published: June 2024

Purpose of review

To understand the current global scale of drug hypersensitivity (DH) and drug allergy (DA), and to identify possible strategies to increase the accuracy of epidemiological data.

Recent findings

Global patterns of DH/DA seem to be changing and increasing worldwide, but there are still great challenges in capturing quality DH/DA mortality and morbidity statistics (MMS). DH/DA MMS may gain new perspectives with the global implementation of the International Classification of Diseases (ICD)-11. Improving the quality of epidemiological data related to DH/DA should clarify areas of uncertainty, which would lead to better strategies to reduce the burden of these conditions.

DH/DA remains a complex and unaddressed problem globally that often deprives patients of optimal medication choices and places them at risk for life-threatening reactions. DH/DA labels should contribute to people well being, by protecting true allergic individuals from being re-exposed to their allergic drugs and providing needed medications to individuals wrongly labeled as allergic or who have lost allergic sensitivity. The true rate of DH/DA is in fact unknown due to a number of factors, such as misdiagnosis, miscoding and under- and over-notification, among others. Moreover, there is lack of data about DH/DA epidemiology in many countries. Difficulties on collecting accurate and comparable data should be acknowledged, with great impact in the correct labeling DH/DA in electronic health records and official statistics. More accurate definitions, classification and coding may contribute to a better-quality MMS thanks to the ICD-11, under implementation worldwide. Improving the quality of epidemiological data related to DH/DA should clarify areas of uncertainty, which would lead to better strategies to reduce the burden of these conditions. As knowledge derived from populations is key information for more realistic decision-making, the construction of the new section addressed to DH/DA in the ICD-11 will allow the collection of more accurate epidemiological data to support quality management of patients, and facilitate healthcare planning to implement public health measures to prevent and reduce the morbidity and mortality attributable to these conditions.
Patient Characteristics and Postoperative Outcomes of Surgically Treated Inferior Pole Patellar Sleeve Fractures
Authors: Desai Vineet M. , DeFrancesco Christopher J. , Yellin Joseph L. , Nguyen Jie C. , Williams Brendan A.
Published: June 2024

Background:

Despite representing over half of all pediatric patella fractures, inferior pole patellar sleeve fractures (PSFs) are a relatively uncommon pediatric injury. As a result, existing literature on PSFs is limited to case reports and small case series. The purpose of this study was to evaluate the radiographic and clinical characteristics of operatively treated PSFs as well as outcomes following surgical management.

Methods:

A retrospective review of all inferior pole PSFs requiring surgery from 2007 to 2023 was performed at a single urban tertiary care children’s hospital. Cases were identified using diagnostic and billing codes. Patient demographics, injury characteristics, surgical techniques, and postoperative rehabilitation practices were recorded. Regional skeletal maturity, fracture characteristics, and postreduction patellar height were recorded. Postoperative complications were recorded and categorized using the modified Clavien-Dindo Classification System (CDS).

Results:

Thirty-eight inferior pole PSFs were identified meeting study criteria. The majority of patients were male (86.8%), and the mean age at injury was 11.0 years (range: 7.2 to 15.0). Mean BMI was 21.1. Radiographically, the majority of patients were Epiphyseal Fusion Stage 0 (nonunion), with a median postreduction Caton-Deschamps index (CDI) of 1.2 (IQR: 1.1 to 1.3). These fractures were predominantly treated with suture-based fixation (84%). Postoperative immobilization varied within the cohort, and the initiation of knee ROM was permitted at a median of 3.5 (IQR: 2.0 to 4.6) weeks. All patients regained full range of motion and straight leg raise without extensor lag, and return-to-sport was achieved by a median of 17.6 weeks (IQR: 12.8 to 30.3). Complications occurred in 10 (26.3%) patients, with 3 (7.9%) requiring a return to the OR (CDS Grade III).

Conclusions:

Inferior pole PSFs appear to occur most commonly among prepubertal males of normal BMI and normal patellar height. Despite variable rehabilitation protocols, operative management resulted in restoration of extensor mechanism function. Eight percent of patients experienced complications requiring unplanned surgery. This large series improves our understanding of the epidemiology, injury characteristics, and postoperative outcomes of an operatively treated cohort of a rare injury pattern.

Level of Evidence:

Level IV.
How to Prevent Nerve Root Injury in Uniportal Full Endoscopic Lumbar Fusion Surgery? Insights From a Cadaveric Anatomic Study With Simulation Surgery
Authors: Hsu Yu-Chia , Liu Yuan-Fu , Chang Chao-Jui , Hsiao Yu-Meng , Huang Yi-Hung , Liu Keng-Chang , Chen Chien-Min , Kim Hyeun-Sung , Lin Cheng-Li
Published: June 2024

Study Design.

The study included 2 fresh-frozen cadavers.

Objective.

To elucidate the positional relationship between surgical instruments and nerve roots during full endoscopic facet-sparing (FE fs-TLIF) and full endoscopic facet-resecting (FE fr-TLIF) transforaminal lumbar interbody fusion and propose safe instrumentation insertion procedures and recommend cage glider designs aimed at protecting nerve roots.

Background.

Endoscopic surgical techniques are increasingly used for minimally invasive lumbar fusion surgery, with FE fr-TLIF and FE fs-TLIF being common approaches. However, the risk of nerve root injury remains a significant concern during these procedures.

Patients and Methods.

Eight experienced endoscopic spine surgeons performed uniportal FE fr-TLIF and FE fs-TLIF on cadaveric lumbar spines, totaling 16 surgeries. Postoperation, soft tissues were removed to assess the positional relationship between the cage entry point and nerve roots. Distances between the cage entry point, traversing nerve root, and exiting nerve root were measured. Safe instrumentation design and insertion procedures were determined.

Results.

In FE fr-TLIF, the mean distance between the cage entry point and traversing nerve root was significantly shorter compared with FE fs-TLIF (3.30 ± 1.35 vs. 8.58 ± 2.47 mm, respectively; P < 0.0001). Conversely, the mean distance between the cage entry point and the exiting nerve root was significantly shorter in FE fs-TLIF compared with FE fr-TLIF (3.73 ± 1.97 vs. 6.90 ± 1.36 mm, respectively; P < 0.0001). For FE fr-TLIF, prioritizing the protection of the traversing root using a 2-bevel tip cage glider was crucial. In contrast, for FE fs-TLIF, a single-bevel tip cage glider placed in the caudal location was recommended.

Conclusion.

This study elucidates the anatomic relationship between cage entry points and nerve roots in uniportal endoscopic lumbar fusion surgery. Protection strategies should prioritize the traversing root in FE fr-TLIF and the exiting root in FE fs-TLIF, with corresponding variations in surgical techniques.

Level of Evidence.

Level V.
Elite controllers microbiome: unraveling the mystery of association and causation
Authors: Bai Xiangning , Sönnerborg Anders , Nowak Piotr
Published: June 2024

Purpose of review

To unravel the current knowledge and possible link between the gut microbiome and HIV-1 virological control in elite controllers (EC), who can suppress viral replication in the absence of antiretroviral therapy. In addition, to discuss the limitations of current research and propose future research directions.

Recent findings

EC possess a different gut bacterial microbiota profile in composition and functionality from that of treatment-naive HIV-1 viremic progressors (VP). Specifically, EC have a richer bacterial microbiota as compared to VP, which closely resembles the microbiota in HIV-1 negative healthy controls (HC). Differentially abundant bacteria are found between EC and VP or HC, though results vary among the few existing studies. These data imply that the gut microbiome could contribute to the natural suppression of HIV-1 infection.

An association between the gut microbiome and HIV-1 virological control is evidenced by recent studies. Yet, there are substantial knowledge gaps, and the underlying mechanism of how the microbiome influences the EC phenotype is far from clarified. Future research should consider diverse microbial communities, the complex microbe-host interactions, as well as yet-unidentified causal links between microbiome alterations and HIV-1 disease progression.
Sensitivity after Clitoral Reconstruction in Patients with Female Genital Mutilation
Authors: von Fritschen Uwe , Strunz Cornelia , Scherer Roland , Fricke Alba
Published: June 2024

Background:

In the past decades, reconstructive choices after female genital mutilation extended beyond de-infibulation and scar release. The current trend to expand techniques addressing sexual and aesthetic aspects by reconstructing the clitoris and prepuce, and dissecting the clitoral nerves raises concern, as there is a paucity of evidence on the functional outcomes and suspected iatrogenic lacerations.

Methods:

A total of 128 female genital mutilation patients were included in the study. To evaluate clitoral sensitivity after elevation, the Semmes-Weinstein-monofilament test was performed before and after genital reconstruction.

Results:

Preoperatively, patients with a visually intact clitoris showed significantly better sensitivity compared with patients with a mutilated clitoris or infibulation (P < 0.0001). Surgery was performed in 84 patients. After clitoral reconstruction (CR), 70 of 73 patients were able to perceive 2.83 monofilaments (95.9%), whereas three perceived 3.61. Patients with a visually intact clitoris served as control, and 95.0% perceived 2.83 monofilaments. We showed a significant improvement of clitoral sensitivity (P = 0.0020) in the subgroup consisting of patients with a mutilated clitoris in whom the test was performed before and after reconstruction.

Conclusions:

Clitoral sensitivity improves significantly after CR. Seventy of 73 patients attained the same sensitivity as unharmed women. No patient showed a decreased sensitivity compared with their preoperative findings. Therefore, our study supports the argument that CR offers sufficient improvement of objective clitoral sensitivity without additionally addressing clitoral nerves.
Sex-Age Interplay Among Young Aged Egyptians With First Acute Myocardial Infarction
Authors: EL-Dosouky Ibtesam I. , El Seqelly Montaser M. , Ebrahiem Ahmed M. , Mohamed Mohamed Abdelhady
Published: June 2024

Background:

The burden of modifiable risk factors in young Egyptian adults presenting with first acute myocardial infarction (AMI), sex differences, sex-age interplay, and its relationship with demographic, angiographic characteristics, and type of AMI is a good topic for discussion.

Methods:

The study enrolled 165 young (≤45 years old) consecutive, eligible patients diagnosed with first AMI (ST-elevation myocardial infarction, non-ST-elevation myocardial infarction), for their demographic, angiographic, echocardiographic, and laboratory investigations and gender differences.

Results:

Our population were 29–45 years old and 12.1% were females, most of whom had ST-elevation myocardial infarction; obesity in females and smoking in males were the most prevalent; and the younger the age of females presenting with AMI the more aggressive underlying risk factors and the more reduction in left ventricular ejection fraction. Most of the female culprit lesions were thrombotic and the severity of atherosclerotic culprit lesions correlated positively with blood pressure.

Conclusions:

The age paradox in young females (regarding left ventricular ejection fraction and the traditional risk factors) and the thrombotic nature of the culprit lesion mandate early intensive 1-year and 2-year preventive strategies against coronary heart disease (CHD) with special concern for obesity as the main trigger early in life with proper control of blood pressure. In males, smoking cessation programs are the main target to ameliorate the progress of CHD hand in hand with the other 1-year and 2-year preventive strategies of CHD.
Validity of the Triglyceride–Glucose Indices for Predicting the Severity of Coronary Artery Disease in Patients With Nondiabetic Chronic Coronary Syndrome
Authors: El-Dosouky Ibtesam I. , Ammar Ahmed S. , Ahmed Abdelmaaboud Abdelmaaboud , Elkot Moataz A.
Published: June 2024

Background:

The triglyceride–glucose (TyG) index was shown to be an independent predictor of coronary artery disease (CAD) progression and prognosis. However, whether the TyG index can predict the severity of CAD in nondiabetic patients with chronic coronary syndrome remains unclear.

Methods:

A total of 118 individuals who underwent elective coronary angiography were classified into group A (59 with coronary lesions) and group B (59 with normal coronary arteries; as a control group) after coronary angiography and laboratory tests for fasting and the postprandial (PP) TyG index. The complexity of CAD was determined by the Synergy Between Percutaneous Coronary Intervention (SYNTAX) score (SYNTAX score >22 indicated moderate–high risk), and patients diagnosed with diabetes or prediabetes were excluded.

Results:

The TyG index was not related to the SYNTAX score in groups A and B; however, in the CAD group with an low-density lipoprotein (LDL) concentration <70 mg/dL (group A1), a fasting TyG index ≥8.25 and a PP TyG index ≥11 could predict moderate–high SYNTAX risk score; in addition, the odds ratio (OR) was 4.3× higher and the relative risk (RR) was 1.8× greater (OR = 4.3, RR = 1.8, 95% confidence interval = 1.4–13.5, P < 0.05) for individuals with a higher fasting TyG index ≥8.25 to have a moderate–high SYNTAX risk score. Individuals with a higher PP TyG index ≥11 had OR of 2.6× higher and a RR of 1.4× greater to have moderate–high SYNTAX risk score.

Conclusions:

Both fasting and PP TyG levels were associated with greater coronary anatomical complexity (SYNTAX score >22) in nondiabetic chronic coronary patients with LDL <70 mg/dL. Fasting and the PP TyG indices can serve as noninvasive predictors of CAD complexity in nondiabetic patients with LDL <70 mg/dL and could change the management and therapeutic approaches.
Current Gaps in the Provision of Safe and Effective Anticoagulation in Atrial Fibrillation and the Potential for Factor XI-Directed Therapeutics
Authors: Goodman Shaun G. , Roy Denis , Pollack Charles V. , Leblanc Kori , Kwaku Kevin F. , Barnes Geoffrey D. , Bonaca Marc P. , True Hills Mellanie , Campello Elena , Fanikos John , Connors Jean M. , Weitz Jeffrey I.
Published: June 2024

The global prevalence of atrial fibrillation is rapidly increasing, in large part due to the aging of the population. Atrial fibrillation is known to increase the risk of thromboembolic stroke by 5 times, but it has been evident for decades that well-managed anticoagulation therapy can greatly attenuate this risk. Despite advances in pharmacology (such as the shift from vitamin K antagonists to direct oral anticoagulants) that have increased the safety and convenience of chronic oral anticoagulation in atrial fibrillation, a preponderance of recent observational data indicates that protection from stroke is poorly achieved on a population basis. This outcomes deficit is multifactorial in origin, stemming from a combination of underprescribing of anticoagulants (often as a result of bleeding concerns by prescribers), limitations of the drugs themselves (drug–drug interactions, bioaccumulation in renal insufficiency, short half-lives that result in lapses in therapeutic effect, etc), and suboptimal patient adherence that results from lack of understanding/education, polypharmacy, fear of bleeding, forgetfulness, and socioeconomic barriers, among other obstacles. Often this adherence is not reported to treating clinicians, further subverting efforts to optimize care. A multidisciplinary, interprofessional panel of clinicians met during the 2023 International Society of Thrombosis and Haemostasis Congress to discuss these gaps in therapy, how they can be more readily recognized, and the potential for factor XI-directed anticoagulants to improve the safety and efficacy of stroke prevention. A full appreciation of this potential requires a reevaluation of traditional teaching about the “coagulation cascade” and decoupling the processes that result in (physiologic) hemostasis and (pathologic) thrombosis. The panel discussion is summarized and presented here.
Efficacy of Inclisiran in Patients Having Familial Hypercholesterolemia: Heterozygous Compared to Homozygous Trait, a Systematic Review and Meta-analysis
Authors: Rai Rahul , Devi Payal , Kumar Kapeel , Naeem Kainat , Kumar Hanesh , Kumari Kajal , Kumar Anish , Kumar Aman , Muhammad Aqeel , Khan Muhammad Sohaib , Qadir Ghulam , Ali Shaheryar , Maheshwari Mahveer , Jawwad Mohammad
Published: June 2024

Objective:

To find out whether inclisiran sodium has different efficacy in heterozygous familial hypercholesterolemia (HeFH) and homozygous familial hypercholesterolemia (HoFH) patient groups.

Methods:

We conducted the systematic review and meta-analysis of ORION clinical trials. PubMed, Embase, and Clinicaltrials.gov databases were searched for the relevant studies. Atheroscalerotic parameters considered for our objective were low-density lipoprotein cholesterol, total cholesterol, proprotein convertase subtilisin/kexin type 9 (PCSK9), apolipoprotein B, and nonhigh-density lipoprotein cholesterol. Primary outcomes were the percentage difference in atheroscalerotic parameters at follow-up relative to baseline values. Our study examined these primary outcomes to determine whether there is a statistically significant difference between the HeFH and HoFH groups. Risk of bias was assessed by the Cochrane risk of bias tool. Meta-analysis was performed when at least 2 studies reported on the same variable.

Results:

Four ORION clinical trials provided the data related to the mean difference in the atheroscalerotic parameters at follow-up relative to baseline, of HeFH and HoFH patient populations, after administration of 300 mg inclisiran subcutaneously. We pooled together these mean differences for each group and applied a statistical test to analyze if the values were significantly different between the groups. The results of our study unveiled the significant difference in pooled mean differences in low-density lipoprotein cholesterol (HeFH: −48.62%; HoFH: −9.12%; P < 0.05), total cholesterol (HeFH: −30.31%; HoFH: −11.50%; P < 0.05), apolipoprotein (HeFH: −39.97%; HoFH: −14.68%; P < 0.05), and nonhigh-density lipoprotein (HeFH: −44.51%; HoFH: −12.22%; P < 0.05) between HeFH and HoFH groups. However, the difference in pooled mean difference in PCSK9 values (HeFH: −68.41%; HoFH: −56.25%; P = 0.2) between HeFH and HoFH groups was statistically insignificant. Studies were of high quality.

Conclusions:

There was a significant difference in the reductions in atherosclerotic lipid parameters in heterozygous and homozygous populations after the administration of inclisiran except for PCSK9 parameter. Further studies are needed to support this conclusion.
Ceftaroline Fosamil as a Potential Treatment for Central Nervous System Infections in Children
Authors: Bradley John S. , Cattaneo Dario , Kantecki Michal , Costa Teresa Dalla
Published: June 2024

Ceftaroline has been reported to show efficacy in limited adult clinical case studies including a report of a patient with a methicillin-resistant Staphylococcus aureus (MRSA) infection of a ventriculopleural shunt, and in 2 reports for use as a salvage therapy in a case of an epidural abscess infected with MRSA, as well as a case of methicillin-resistant Staphylococcus epidermidis (MRSE) ventriculostomy-related infection. The pharmacokinetic (PK) and pharmacodynamic (PD) properties of ceftaroline in healthy adults and neurosurgical patients have been assessed to develop population PK models used to perform simulations to evaluate the probability of target attainment of different ceftaroline dosing regimens for central nervous system (CNS) infections. Results from the simulations indicated that the penetration of ceftaroline into the cerebrospinal fluid was dependent on the degree of meningeal inflammation, suggesting that inflammation associated with infection would provide adequate antibiotic exposure, similar to other β-lactam antibiotics. Ceftaroline has a potential, unique role as a β-lactam antibiotic in the treatment of MRSA and coagulase negative staphylococci causing CNS infections as an alternative to vancomycin, the current standard of care. Support for treatment of CNS infections may be derived from further cerebrospinal fluid PK studies followed by PK/PD modeling prior to the conduct of prospective phase 2/3 clinical studies aimed at assessing the efficacy and safety of ceftaroline for the treatment of pediatric CNS infections. Ceftaroline's penetration enhanced by meningeal inflammation suggests that the drug could be a candidate to treat MRSA CNS infections.
Building a cardiogenic shock response team: key considerations necessary to improve outcomes
Authors: Varma Bhavya , Katz Jason N. , Alviar Carlos L.
Published: June 2024

Purpose of review

This review provides key information about cardiogenic shock (CS) teams, including published evidence and practical recommendations to create a CS team and program.

Recent findings

CS is a complex disease process with a high in-hospital mortality rate ranging from 30% to 70% according to recent registries and randomized studies. The explanation for the elevated rates is likely multifactorial, including the various etiologies of cardiogenic shock as well as delays in recognition and deployment of appropriate therapies. Accordingly, the use of cardiogenic shock team has been implemented with the aim of improving outcomes in these patients. The CS team typically consists of members with critical care or cardiac critical care expertise, heart failure, cardiothoracic surgery, and interventional cardiology. A number of retrospective studies have now supported the benefits of a CS team, particularly in selecting the appropriate candidates for tailored mechanical circulatory support therapies and providing interventions in a timely manner, which have translated into improved outcomes.

CS teams provides a platform for expedited recognition of CS and timely, standardized, and multidisciplinary discussions regarding appropriate management and care.
Xuebijing injection combined with alprostadil in the treatment of diabetic nephropathy: A PRISMA-compliant systematic review and meta-analysis
Authors: Hao Na , Liu Yang , Guo LuXuan , Li Wanwen , Zhao Pengbo
Published: June 2024

Background:

Diabetes nephropathy (DN), as one of the common complications of diabetes, is characterized by persistent albuminuria, decreased glomerular filtration rate, and elevated arterial blood pressure. At present, Xuebijing injection is widely used in the treatment of DN. However, few systematic reviews and meta-analysis related to Xuebijing injection intervention in DN were published. In order to more systematically and objectively evaluate the clinical efficacy of Xuebijing injection intervention in DN, we conducted systematic reviews and meta-analysis to verify it.

Objective:

The purpose of the research was to systematically evaluate the clinical efficacy of Xuebijing injection combined with alprostadil in the treatment of diabetic nephropathy.

Methods:

We searched the China National Knowledge Infrastructure (CNKI), China Biomedical Database (SinoMed), Weipu Database (VIP), Wanfang Database, PubMed, The Cochrane Library, Embase, Web of Science and other databases by computer, and searched the randomized controlled trials of Xuebijing injection combined with alprostadil in the treatment of DN at home and abroad from the establishment of the database to 2022. The main outcome indicators included blood glucose, and the secondary outcome indicators included blood lipid, renal function, urinary protein, and safety. Two evaluators independently screened the literature, extracted the data and evaluated the risk of bias in the included studies. RevMan 5.3 software was used to analyze the data.

Results:

A total of 14 randomized controlled trials were included, including 1233 cases, 618 cases in the treatment group and 615 cases in the control group. The results of meta-analysis demonstrated that compared with the control group, the treatment group could effectively reduce fasting plasma glucose [mean difference [MD] = −1.90, 95% CI (−2.40, −1.40), P < .00001], glycosylated hemoglobin A1c [MD = −2.38, 95% CI (−2.51, −2.25), P < .00001], 2h postprandial blood glucose [MD = −2.92, 95% CI (−3.95, −1.89), P < .00001], triacylglycerol [MD = −1.08, 95% CI (−1.66, −0.50), P = .0003], total cholesterol [MD = −1.17, 95% CI (−1.39, −0.95), P < .00001], low-density lipoprotein cholesterol [MD = −1.19, 95% CI (−1.60, −0.78), P < .00001], high-density lipoprotein cholesterol [MD = 0.32, 95% CI (0.23, 0.42), P < .00001], serum creatinine [MD = −42.95, 95% CI (−57.46, −28.43), P < .00001], blood urea nitrogen [MD = −2.24, 95%CI (−2.62,−1.86), P < .00001], blood β2 microglobulin [SMD = −1.49, 95% CI (−1.70, −1.28), P < .00001], urine β2 microglobulin [SMD = −0.81, 95% CI (−1.04, −0.58), P < .00001], 24-hour urinary protein quantification [MD = −0.20, 95% CI (−0.26, −0.14), P < .00001], urinary albumin excretion rate [SMD = −1.15, 95% CI (−1.38, −0.93), P < .00001].

Conclusion:

Xuebijing injection combined with alprostadil has more advantages in treating DN compared to routine Western medicine.
Global research landscape and emerging trends in Graves’ disease: A bibliometric analysis
Authors: Yang Yan , Li Peijin , Zhou Chunjian , Liu Feng , Liu Tao , Wang Qian , Ding Zhiguo
Published: June 2024

Background:

Graves’ disease is a prevalent thyroid disorder and is the primary cause of hyperthyroidism. Significant progress has been made in understanding the epidemiology, pathogenesis, diagnosis, treatment, and prognosis of this disease. However, bibliometric analyses on Graves’ disease are lacking. We aimed to comprehensively summarize the research, progression, and focal points of Graves’ disease through data mining and integrated analysis of the existing literature.

Methods:

We retrieved relevant literature on Graves’ disease from 2003 to 2023 from the Web of Science database. We performed bibliometric analysis using CiteSpace and the R package Bibliometrix.

Results:

We identified 10,901 publications from 132 countries, with a steady rise in the number of publications over the past 5 years. The US leads in publication volume, with the University of California System being the primary contributing institution. The journal Thyroid had the highest publication output, while the Journal of Clinical Endocrinology and Metabolism was the most frequently cited. These publications involved 2305 authors, with Antonelli Alessandro and Smith Terry being the most prolific. The most frequently cited articles were the “2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis” and the “Thyroid Association/European Group on Graves’ orbitopathy guidelines for the management of Graves’ orbitopathy.” Analysis of the bursts of cited references, keywords, and their clustering revealed that research on Graves’ disease predominantly centers on clinical management, thyroid-stimulating hormone receptors, thyroid hormones, autoimmunity and inflammation, Graves’ ophthalmopathy, thyroid nodules, and thyroid cancer.

Conclusion:

This is the first comprehensive bibliometric study to summarize progress and trends in Graves’ disease research. These results highlight recent research hotspots and promising directions, thereby providing a valuable reference for other scholars.
Efficacy evaluation and exploratory analysis of influencing factors of Banxia Houpu Decoction in the treatment of refractory gastroesophageal reflux disease
Authors: Song Shunzhe , Zhang Yunshu , Zhang Jingwen , Jiang Yongshan , Gong Aixia
Published: June 2024

Approximately 10% to 40% of patients with gastroesophageal reflux disease (GERD) exhibit poor response to proton pump inhibitors (PPIs), indicating refractory GERD (RGERD). Banxia Houpu Decoction is a traditional Chinese medicine formula used for treating GERD, particularly for atypical symptoms. This study aimed to investigate the improvement of different symptoms in RGERD patients treated with Banxia Houpu Decoction and identify relevant factors influencing its efficacy. From November 2021 to November 2022, a total of 89 RGERD patients voluntarily participated in this clinical study at our hospital. They were randomly assigned to 2 treatment groups: the Banxia Houpu Decoction group and the Western medicine group. The former received standard-dose Banxia Houpu Decoction, while the latter had a switch in PPI type with double-dose maintenance and the addition of magnesium aluminum carbonate as an acid suppressant. The improvement of different symptoms was compared between the 2 groups. Clinical data, including age, gender, gastric mucosal status, and esophagitis severity, were collected. Univariate analysis was performed to explore factors influencing the therapeutic effect of Banxia Houpu Decoction. Both treatment groups showed significant improvement in Frequency Scale for the Symptoms of GERD (FSSG) scores. The Banxia Houpu Decoction group exhibited the most significant efficacy in relieving throat burning sensation (P = .003) and frequent hiccups (P = .003). It also demonstrated improvement in swallowing difficulty (P = .048) and postprandial abdominal distension (P = .041), surpassing the Western medicine group. The Western medicine group had the most significant improvement in heartburn sensation (P = .008) and showed significant improvement in gastric burning sensation (P = .022), surpassing Banxia Houpu Decoction. Age (P = .025) and gastroesophageal flap valve (GEFV) grade (P = .014) were identified as factors influencing the efficacy of Banxia Houpu Decoction. Banxia Houpu Decoction exhibits superior efficacy compared to double-dose PPI combined with acid suppressants in relieving symptoms such as throat burning sensation, swallowing difficulty, and frequent hiccups. It shows significant efficacy in patients under 60 years of age and with GEFV grades I-II.