bluuebunny/crossref_metadata_2025 huggingface dataset:
How best to regulate voluntary assisted dying: a qualitative study of perceptions of Australian doctors and regulators
Authors: White Ben P , Haining Casey M , Willmott Lindy
Published: February 2025

It is widely accepted that voluntary assisted dying (VAD) should be regulated but little is known about the most effective way to regulate doctors in this setting. This article reports on empirical research conducted in two Australian states where VAD is lawful (Victoria and Western Australia). Interviews were conducted with 92 participants: one group comprised doctors providing VAD and the other group was regulators in this field. Participants were asked about how best to regulate doctors providing this service. Strikingly, both regulator and doctor participant groups were consistent with each other in their views on what constituted effective regulation. The nature of VAD was perceived by participants to require special regulation, although some felt this was overdone in these states. Reported features of effective regulation included regulators taking an educative approach, regulation being perceived as acceptable by doctors, and it being responsive and nimble to provide the guidance that doctors need. Participants also considered a range of regulatory tools were required to regulate VAD effectively, and some identified a need for these tools to be employed together in a holistic way. This article concludes with a set of principles for effective regulation of VAD, discerned from the views of participants.
Effective detection of azole resistance in Aspergillus fumigatus sensu stricto using a gradient diffusion plastic strip: A comparison of filtered-adjusted vs. unfiltered-unadjusted inocula
Authors: Serrano-Lobo Julia , Reigadas Elena , Muñoz Patricia , Escribano Pilar , Guinea Jesús
Published: February 2025

Gradient diffusion plastic strips are utilized for azole susceptibility testing against Aspergillus fumigatus in some clinical microbiology laboratories; however, they lack proper validation. We evaluated the performance of this method for detecting azole resistance in A. fumigatus sensu stricto, and we assessed whether skipping filtration and inoculum adjustment of conidial suspensions negatively influenced its performance. A total of 98 A. fumigatus sensu stricto isolates, previously classified as azole-susceptible or resistant, were studied. Azole-resistant isolates had specific cyp51A gene mutations, including TR34-L98H ± S297T-F495I, G54R, TR46-Y121F-T289A, and G448S. Conidial suspensions were prepared following the principles of the E.Def 9.4 method or left unfiltered and unadjusted. Based on minimum inhibitory concentration (MIC) distributions obtained with the gradient diffusion plastic strip using both types of inoculum preparations, cutoff values were proposed to classify isolates as resistant: >1 mg/l for itraconazole and voriconazole and >0.25 mg/l for posaconazole. These cutoffs coincided with EUCAST breakpoints and correctly classified all except one (TR46-Y121F-T289A) isolate. High essential agreement values (95.9%–98%) were obtained, regardless of inoculum preparation. Overall, sensitivity/specificity values of the gradient diffusion plastic strip using the proposed cutoff values for itraconazole (100%/98%), voriconazole (100%/100%), and posaconazole (100%/98%) to screen for azole resistance were not impacted by the inoculum preparation method. Thus, the gradient diffusion plastic strip is a reliable method for screening azole resistance in A. fumigatus isolates using the proposed MIC cutoffs, and inoculum preparation without filtration and adjustment of conidial suspensions did not negatively influence the performance of the method.
Spectral Insights and Evolutionary Pathways of Globular Cluster ULX in NGC 1399: A Two-Decade X-ray and Optical Study
Authors: Oh Kwangmin , Dage Kristen C , Bobrick Alexey , Aydi Elias , Bahramian Arash , Goodwin Adelle J , Haggard Daryl , Irwin Jimmy , Kundu Arunav , Strader Jay , Maccarone Thomas J , Zepf Stephen E
Published: February 2025

We present new multi-wavelength observations of two ultraluminous X-ray sources (ULXs) hosted by globular clusters (GCs) in the giant elliptical NGC 1399, focusing on CXO J0338318-352604 (GCU7), only the second GC ULX known to have luminous optical emission lines. Notably, only [N ii] and [O iii] emission is observed in the optical spectra, suggesting H-poor material. Previous work suggested the possibility that the properties of GCU7 could be explained by the tidal disruption of a horizontal branch star by an intermediate-mass black hole. We use new data to show that the lack of evolution in the X-ray or optical properties of the source over the last 20 years rules out this scenario. Instead, we use CLOUDY simulations to demonstrate that the optical emission lines are consistent with an outflow from an ultra-compact X-ray binary where a compact object—likely a neutron star (NS)—is accreting above the Eddington limit from a helium white dwarf (He WD). This binary would have dynamically formed from a direct collision between a NS and a red giant, or else via an exchange interaction. The ULX is predicted to evolve to lower mass transfer rates over time and eventually become a doppelganger to the well-studied ultra-compact X-ray binaries in Galactic GCs such as 4U 1820–30. These results show the utility of using extragalactic GCs to study short-lived phases in dynamical binary evolution that occur too rarely to be observed in Galactic clusters.
A pristine view of galactic globular clusters and their peripheries: Omega Centauri
Authors: Kuzma P B , Ishigaki M N
Published: February 2025

The central regions of the globular cluster Omega Centauri ($\omega$ Cen) have been extensively studied, but its outer regions and tidal structure have been less so. Gaia’s astrometry uncovered substantial tidal substructure associated with $\omega$ Cen, yet the lack of chemical tagging makes these associations tenuous. In this paper, we utilize the Gaia-synthetic CaHK-band photometry, metallicities from the Pristine survey and Gaia’s astrometry to explore up to a clustercentric radius of 5 deg from $\omega$ Cen. We identify $\omega$ Cen-like stars based on proper motion, colour–magnitude, and colour–colour space, exploring the morphology, and stellar populations of the outer regions. Our probabilistic approach recovers the tidal tails of $\omega$ Cen, and we investigate the metallicity distribution of $\omega$ Cen ranging from a radius of 15 arcmin to the tidal radius, and beyond into the tidal tails. We present (1) two components between 15 arcmin and tidal radius at −1.83 and −1.45 dex that are also the dominant populations within 15 arcmin, and (2) the first evidence that the same two populations in the outer regions of the cluster are present outside the tidal radius and into the tidal tails. These populations are mixed about the stream and are typically amongst the faintest stars in our sample, indicating that the tidal tails are made of tidally stripped $\omega$ Cen stars.
Structural, biological, and biomedical implications of mRNA interactions with the master regulator HuR
Authors: Clark Madeline E , Farinha Andrew , Morrison Alan R , Lisi George P
Published: February 2025

Human antigen R (HuR) is a ubiquitously expressed RNA-binding protein (RBP) that has been implicated in a vast range of biological processes including stress response, angiogenesis, cell proliferation, and differentiation. Dysregulation of HuR has been linked to a number of pathological disorders including vascular disease, inflammation, and cancers such as those of the breast and colon. Like many RBPs, HuR is composed of multiple RNA-recognition motif (RRM) domains; however, HuR and the three other members of the Hu family (HuB, HuC, and HuD) possess a unique structural composition with two RRMs separated from a third C-terminal RRM by a long, unstructured hinge region. While there has been extensive research on the role of HuR in cellular, molecular, and developmental biology, there are fewer structural and biochemical studies of HuR and many questions still remain about the molecular mechanisms of HuR. In this review, we endeavor to synthesize existing HuR research spanning the last three decades in order to define known mechanistic roles of each domain, highlight remaining uncertainties, and provide a backdrop for ongoing research into the chemistry and biology of HuR and similar multi-RRM containing proteins.
Red Blood Cell Casts on Kidney Biopsy and Progression of IgA Nephropathy
Authors: Yao Yu-Xuan , Tang Chen , Fang Shi Su- , Chen Pei , Zhou Xu-Jie , Lv Ji-Cheng , Liu Li-Jun , Zhang Hong
Published: February 2025

Background

Renal red blood cell casts (RBCC) are common in IgA nephropathy (IgAN), but their role in kidney disease progression of patients with IgAN remains unclear.

Methods

1425 patients in Peking University First Hospital IgAN (PKU-IgAN) cohort and 279 patients in TESTING trial were enrolled to test the association between RBCC and kidney outcome. RBCC was defined as positive (+) when at least one cast was identified within the renal tubules by light microscopy. Kidney endpoint was the composite of the first occurrence of a sustained 30% decrease in estimated glomerular filtration rate or end stage kidney disease or death due to kidney disease. Cox regression analysis was used.

Results

In PKU-IgAN, 529 patients (37%) had RBCC; in TESTING trial, 78 patients (28%) had RBCC. Patients with RBCC had more crescentic lesions, and less segmental sclerosis compared with patients without RBCC. In PKU-IgAN, after a median follow-up of 54 months, 119 patients (22%) with RBCC and 260 patients (29%) without RBCC reached the composite kidney endpoint (P=0.009). In multivariable analysis, RBCC was independently associated with composite kidney endpoint (HR 0.79; 95%CI 0.63 - 0.99; P=0.038). RBCC and immunosuppressive therapy (IST) had an interaction (P=0.001). RBCC was independently associated with composite kidney endpoint in patients who received IST (HR 0.56; 95%CI 0.40 - 0.77; P<0.001). In TESTING trial, after a median follow-up of 57 months, 26 patients (33%) with RBCC and 96 patients (48%) without RBCC reached the composite kidney endpoint (P=0.041). In univariate analysis, RBCC was associated with composite kidney endpoint (HR 0.64; 95%CI 0.42 - 0.99; P=0.047).

Conclusion

Renal RBCC was frequent in IgAN and was associated with a higher incidence of acute active lesions and better renal prognosis, especially in those who received IST, warranting particular attention.
Causal Assessments of Multilevel Social Determinant Factors on Meningioma Disparities in the US
Authors: Fei-Zhang David J , Sethia Rishabh , Wang Larry W , Sheyn Anthony M , D’Souza Jill N , Chelius Daniel C , Rastatter Jeffrey C
Published: February 2025

Background

Prior investigations into meningioma disparities have explored associative relationships of socioeconomic status (SES) and race-ethnicity but face gaps in the range of other social determinants/drivers of health (SDoH) factors considered and sample size. Furthermore, none have explored causal relationships between SDoH-factors and outcomes. Thus, this study aims to utilize a recent, national sampling of meningioma patients incorporating comprehensive inferential and causal-mediation approaches to delineate which SDoH-factors objectively drive care and prognostic disparities.

Methods

This retrospective study of a specialized Surveillance-Epidemiology-End Results 2020 dataset for community-/census tract-level (Yost-Index, a composite SES measure and Rurality-Urbanicity) and individual-level (sex, race-ethnicity) SDoH-factors performed age-adjusted multivariate cox-hazards and logistic regressions, and covariate-adjusted causal-mediation analyses to assess differences in overall survival, treatment receipt, and delay of treatment initiation.

Results

In age-adjusted multivariate analyses of 110,042 meningioma patients from 2010-2018, lower community-level SES significantly increased overall mortality (HR 1.31, 95%CI 1.28-1.34), decreased interventional treatment receipt (Surgery-OR 0.89, 95%CI 0.87-0.91; Radiation 0.83, 0.79-0.87), and increased treatment delay (1.13, 1.09-1.16). Minoritized race/ethnicity featured increased interventional treatment receipt (Surgery 1.18, 1.15-1.22; Radiation 1.18, 1.12-1.24) and decreased treatment delay (0.90, 0.87-0.93). In covariate-adjusted causal analyses, community-level SES showed total mediation effects of race-ethnicity in influencing overall survival and negative partial mediation effects in treatment receipt and delay.

Conclusion

For overall survival, community-level SES primarily drove meningioma disparities even when accounting for other SDoH-factors. For treatment receipt and delay, race-ethnicity caused greater differences that were partially affected by community-level SES. In turn, these comprehensive analyses provide definitive causes of meningioma disparities.
Preliminaries
Authors: Aikhenvald Alexandra Y
Published: February 2025

Almost all languages have some grammatical means for the linguistic categorization of nouns and nominals. The term ‘classifiers’ will be used here as an umbrella label for a wide range of noun categorization devices. Different types of classifier can be distinguished by their grammatical status, degree of grammaticalization, conditions for use, meaning, kinds of origin, mode of acquisition, and tendencies towards loss.
Locative and Deictic Classifiers
Authors: Aikhenvald Alexandra Y
Published: February 2025

This chapter describes two further types of classifier which have a noun phrase as their scope: locative classifiers which occur in locative noun phrases (§7.2) and deictic classifiers which occur on deictic modifiers and/or articles in head-modifier noun phrases (§7.3). More examples of these classifiers in the languages of the world would need to be discovered before their typological profile could be fully established.
A consistent light-cone-gauge superstring field theory
Authors: Ando Yuji , Fujii Ryota , Kunitomo Hiroshi , Totsuka-Yoshinaka Jojiro
Published: February 2025

Extending a recent development in the bosonic string field theory, we construct a map from the Witten-type gauge-invariant superstring field theory based on an A∞ structure to a light-cone-gauge superstring field theory via two intermediate theories, which we call the Kaku-type and Kugo-Zwiebach-type superstring field theories. We find that a naive extension only gives us an inconsistent light-cone-gauge theory that suffers from the well-known problem caused by divergence due to collisions of local operators. However, we also find that this difficulty may be resolved by considering the stubbed theory and propose it as a consistent light-cone-gauge superstring field theory. The result possibly gives a proof of the unitarity of the Witten-type superstring field theory.
Genotype-Specific Responses of Common Bean to Meloidogyne incognita
Authors: Orsi Nicole , Marques João Paulo Rodrigues , Bibiano Líllian Beatriz Januário , Camargo Luis Eduardo Aranha , Pinheiro Daniel Guariz , Vieira Maria Lucia Carneiro
Published: February 2025

The root-knot nematode Meloidogyne incognita causes large galls on roots, interfering with the flow of water and nutrients to the plant. In the common bean, no major resistance (R) genes have been described. Instead, resistance is controlled by multiple genes, which have not proved effective so far. An RNA-seq approach was used to identify genes involved in common bean response to M. incognita at the stages of nematode invasion and root-galling. When comparing infected and uninfected treatments of a moderately resistant (MR) and a susceptible (S) genotype, several genes were identified as differentially expressed. Their functional annotation indicated that both genotypes underwent complex transcriptional reprogramming from early to later periods of the interaction, but defense-related genes were mostly upregulated in the MR genotype. At the early stage, a large set of genes was activated in both genotypes, including those involved in cell wall organization, signaling, hormonal pathways, transcription factors, oxidative stress and putative resistance gene analogs. Later, most of the previously activated defense mechanisms were no longer expressed in the S genotype. There was an increased expression of genes encoding proteins involved in hormonal signaling pathways (salicylic acid and gibberellin-related), protein kinases, transcription factors and oxidative stress in MR. However, a decreased expression of genes involved in signaling mediated by calcium and oxidative stress occurred in S, indicating susceptibility. The repertoire of genes identified herein will facilitate research in plant-nematode interactions, with possible applications for the improvement of the common bean.
An International Consensus on Evaluation and Management of Idiopathic Genu Valgum: A Modified Delphi Survey
Authors: Ranade Ashish S. , Oka Gauri A. , Belthur Mohan V. , Shah Hitesh , Herman Martin J. , Fernandes James A. , Hamdy Reggie , Hailer Yasmin D. , Canavese Federico , Monsell Fergal , Gelfer Yael , Eastwood Deborah M , Huser Aaron , Laine Jennifer , McCarthy James , Aroojis Alaric , Cooper Anthony , Barr Alejandro , Herman Mare Pieter , Hosny Gamal A. , Kishan Shyam , Marangoz Salih , Moreno Grangeiro Patricia , Møller-Madsen Bjarne , Nunn Timothy , Shah Maulin
Published: February 2025

Background:

Idiopathic genu valgum beyond physiological limits may require treatment, which is based on age, growth remaining, and the magnitude of the deformity. There is no consensus on clinical, or radiologic evaluation, indications, and management of idiopathic genu valgum, which can range from observation to surgical treatment using various modalities. If available, such guidelines will help surgeons offer optimal treatment to their patients. The aim of our study was to establish an expert consensus on the evaluation and treatment of idiopathic genu valgum.

Methods:

An international panel of 29 pediatric orthopaedic surgeons from 17 countries with clinical and research experience in the management of limb deformity participated in a modified Delphi survey. Surgeons were provided with patient and deformity characteristics and voted on 46 statements on history, clinical examination, radiographic evaluation, and treatment options for idiopathic genu valgum in round 1. Consensus was defined as when statements received ≥70% votes. Statements that were important but received <70% votes were reworded for clarity in round 2 (n=13).

Results:

Consensus was achieved for 28/46 statements and included obtaining a full-length standing radiograph of the lower extremities and measuring joint orientation angles. Participants did not agree to offer surgical treatment based only on the intermalleolar distance. They recommended surgical treatment if the mechanical axis falls in zone 2 or beyond on the lateral side and using guided growth by tension-band plating when the growth remaining is at least 2 years. The panel agreed on performing common peroneal nerve decompression for specific indications such as acute, opening wedge osteotomy of >20 degrees, but not for gradual correction. Consensus was not reached for indications and methods of bone age assessment, treatment when growth remaining is <1 year, indications for implant removal after guided growth in younger children, and the type of osteotomy for acute deformity correction.

Conclusions:

We have generated consensus statements to guide the management of idiopathic genu valgum. Statements that lack consensus are areas for future multicenter research.

Level of Evidence:

Level V.
Immune-metabolic shifts in acute liver failure caused by HEV infection during pregnancy and their association with obstetric outcomes
Authors: Saxena Anoushka , Minal﻿  , Pahwa Prabhjyoti , Maras Jaswinder Singh , Siddiqui Hamda , Sevak Jayesh Kumar , Mala Yedla Manikya﻿ , Tyagi Shakun , Sarin Shiv K. , Trehanpati Nirupama
Published: February 2025

Background:

Hepatitis-E virus (﻿HEV)-induced liver failure during pregnancy leads to maternal and fetal complications. This study investigates the HEV-associated metabolomic and immunological changes to elucidate the worsening of obstetric outcomes in patients with acute liver failure (ALF) due to HEV.

Methods:

Pregnant women with (i) acute viral hepatitis, IgM HEV positive (AVH-E, n = 31, Gr.I), (ii) acute liver failure (ALF-E, n = 15, Gr.II), (iii) acute hepatitis but negative for viral infections (non-HEV, n = 30, Gr.III), and healthy (HC, n = 21, Gr.IV) were evaluated at delivery for plasma untargeted metabolomics, cytokine, and immune profiling.

Results:

AVH-E and ALF-E (Gr.I, II) showed elevated TNF-α, IL-1β, IL-9, IL-22, and IL-33 compared to HC. In addition, in ALF-E, IFN-γ and IL-12p70 were decreased, but MIP-1α, fractalkine, SDF-1α, IL-22, and IL-33 were increased compared to AVH-E. Both AVH-E and ALF-E had decreased choline, sn-glycero-3-phosphocholine, O-palmitoyl-r-carnitine, and increased taurocholic acid. However, patients with ALF-E had a 2–5-fold decline in these metabolites with raised taurochenodeoxycholic acid. ALF-E showed increased naive T/B cells, decreased CD4, CD8 Tcm, Tem, and plasmablasts, compared to AVH-E contributing to higher failed inductions, preterm births, maternal complications like eclampsia, disseminated intravascular coagulation, preterm premature rupture of membranes, small-for-gestational-age infants, higher rates of intrauterine death, abortion, and mortality.

Conclusions:

HEV infection reduces choline, phosphocholine, and palmitoyl carnitine, enhancing inflammation in ALF-E, while increasing taurocholic and taurochenodeoxycholic acids impairs the immune response. These factors together likely contribute to severe obstetric complications, including higher failed inductions, intrauterine death, and maternal and fetal mortality in ALF-E.
Sharing insight or blowing smoke? The case for descriptive patient representatives on community health center boards
Authors: Patel Amanda S. , Steele Clarissa R. , Beaver Gregory R.
Published: February 2025

Background

Community health centers (CHCs) receive federal grant money to reduce health care disparities. To be eligible, at least 51% of their board members must be descriptively representative patients (i.e., truly represent the population served by the clinic). However, research paints an unclear picture of how these patients influence board effectiveness.

Purpose

The aim of this study was to investigate the impact of descriptively representative patients on board conversations contributing to the board's effectiveness.

Methodology/Approach

Two studies were conducted. Study 1 involved 23 semistructured interviews, observations of six board meetings, and five discussions with subject matter experts to examine the impact of descriptively representative patients on conversations that contribute to board effectiveness. Study 2 was a two-wave survey administered to 177 CHC chief executive or operating officers to investigate the impact of descriptively representative patients on the relationship between volubility (i.e., the amount of talking within a group) and board effectiveness.

Results

Study 1 revealed that although representative patients provided valuable insights, there was skepticism about their ability to contribute effectively, leading some to circumvent the requirement for such members. Additionally, we found that descriptively representative patients influence two key mechanisms—participative decision making and pointless discussion—through which conversations influence board effectiveness. In Study 2, we discovered that increased descriptive patient representation can mitigate the negative impact of volubility on pointless discussion and, in turn, enhance board effectiveness.

Conclusion

Descriptive patient representatives are valuable members of CHC boards, and the information they provide can keep conversations more focused.

Practice Implications

CHC boards should not underestimate the value of truly representative patients. The Health Resources and Services Administration, which provides grants to CHCs, should be aware of efforts to circumvent the requirement for descriptive patient representation on CHC boards.
Anatomical and Functional Outcomes of Heavy Silicone Oil (Oxane® HD and Densiron® 68) in Complex Primary Rhegmatogenous Retinal Detachment
Authors: Ermiş Serhat , Özal Ece , Karapapak Murat , Peker Ömer Faruk , Özal Sadık Altan
Published: February 2025

Purpose:

To evaluate the efficacy of heavy silicone oils (HSO) as endotamponades in the repair of primary complex rhegmatogenous retinal detachment (RRD).

Methods:

This retrospective, single-centre, non-randomised study included 82 eyes of 82 patients with primary macular-off RRD associated with inferior proliferative vitreoretinopathy. Each eye was treated with one of two HSO tamponades: Oxane® HD or Densiron® 68. Study outcomes were primary and final success rates, final logMAR gain and postoperative complications. The final outcome was based on 12-month follow-up.

Results:

Of the 82 eyes, 45 were treated with Oxane HD and 37 with Densiron 68. There were no significant differences in demographic and clinical characteristics between the groups. The primary and final surgical success rates were 66.6% and 75.7% for Oxane HD and 75.6% and 81% for Densiron 68, respectively; these differences were not statistically significant. In addition, the final logMAR gain was 0.36 ± 0.51 (median 0.2) in the Oxane HD group and 0.57 ± 0.58 (median 0.5) in the Densiron 68 group (p = 0.027). Complication rates were similar between groups (p > 0.05).

Conclusions:

Our study suggests that HSOs may be an effective alternative for suitable patients in primary complex RRD cases, demonstrating high anatomical success and a low adverse event profile.
Prophylactic Laser Retinopexy and Scleral Buckle Placement for Retinal Detachment Prevention in Pierson Syndrome: A Retrospective, Case Series Study
Authors: Sather Richard N. , Jiao George , Moon Jade Y. , Quiram Polly
Published: February 2025

Purpose:

To report the impact of prophylactic 360° laser retinopexy and scleral buckle placement for retinal detachment (RD) prophylaxis in patients affected by Pierson syndrome (PS).

Method:

This retrospective case series included 11 PS patients (2015–2024), analyzing demographic data, ophthalmological exams, and genetic testing. Prophylactic interventions were compared with post-RD surgical interventions based on RD occurrence and timing. A one-sample proportion test evaluated outcome differences.

Results:

This study of 11 PS patients evaluated the effectiveness of prophylactic 360° laser retinopexy and scleral buckle (SB) placement. Ten patients carried the LAMB2 c.440A>G mutation and had associated findings of thyroid and renal disease. All retinal detachments (RDs) were combined tractional retinal detachment (TRD) and rhegmatogenous retinal detachment (RRD) due to posterior tears. Eight eyes with TRD-RRD were actively treated with laser retinopexy and SB; six (75%) experienced re-detachments. In contrast, seven eyes with TRD-RRD were treated prophylactically, with 86.6% of eyes treated with laser retinopexy and 100% of those receiving additional SB placement maintaining retinal integrity over an average follow-up of 3.4 years. Prophylactically treated eyes had significantly fewer RD recurrences compared to those treated surgically after RD onset (p < 0.01), highlighting the benefits of early combined intervention in PS.

Conclusion:

This study's results suggest a potential role for prophylactic laser retinopexy and subsequent scleral buckle placement to prevent RD among patients with a confirmed diagnosis of Pierson syndrome.
Persistent macular hole and cystoid macular edema treated with pars plana vitrectomy after failure with topical therapy
Authors: Rohowetz Landon J. , Flynn Harry W.
Published: February 2025

Purpose:

To report a patient with a persistent macular hole and cystoid macular edema (CME) successfully treated with pars plana vitrectomy and internal limiting membrane peeling after failed topical therapy.

Methods:

Case report

Results:

A 70-year-old male presented with a history of decreased vision in the right eye for 3-4 months. Best-corrected visual acuity at the initial examination was 20/80 in the right eye and 20/30 in the left. Optical coherence tomography demonstrated vitreomacular traction with a full-thickness macular hole and prominent CME in the right eye. He was started on topical prednisolone acetate and ketorolac. The width of the hole initially decreased but eventually returned to baseline size despite continued topical therapy. Conservative management with topical therapy was continued in accordance with the patient’s preferences. He later underwent phacoemulsification 20 months after presentation without significant improvement in visual acuity. Pars plana vitrectomy with internal limiting membrane peeling and C3F8 tamponade was ultimately performed 2 years after initial presentation. Postoperatively, the macular hole was closed and visual acuity improved to 20/40 at 3 months.

Conclusion:

Macular holes with significant CME may close with topical therapy alone. In persistent or recalcitrant cases, delayed surgical intervention to close the macular hole can be successful even at 2 years.
Warfarin Versus Non–Vitamin K Inhibitor Medications and Cognitive Disease Progression in Atrial Fibrillation
Authors: Wood Kathryn A. , Ko Yi-An , Han Feier , Thunell Johanna , Zissimopoulos Julie , Wharton Whitney
Published: February 2025

Background

Atrial fibrillation (AF) is associated with cognitive decline. Use of oral anticoagulant (OAC) medications offers a lower risk of dementia, but it is unclear whether differences exist between types of OAC agents.

Objective

This was a secondary analysis to explore whether the progression from normal cognition to mild cognitive impairment to dementia differs between adults with AF on warfarin versus non–vitamin K inhibitor medications (NOACs) using data extracted from the National Alzheimer's Coordinating Center clinical case series.

Methods

Subjects with AF on OACs, having normal cognition and no stroke at baseline, and at least 1 follow-up visit were included. OAC usage was calculated based on follow-up time and reported previous OAC use. Continuation ratio models (with subject-specific random intercepts) were used to examine the association between OAC type and cognitive diagnosis controlling for cognitive diagnosis from previous visit.

Results

Among 1475 eligible participants, 478 reported taking warfarin (n = 396) or NOACs (n = 82) at baseline (mean age of 79 years, 51% females, 84% non-Hispanic White). The median follow-up time was 4 years (interquartile range, 2–7). About 63% continued using either warfarin or NOACs, 44% switched from warfarin to NOACs, and 2% switched from NOACs to warfarin. After adjusting for age, sex, education, race, and cardiovascular clinical comorbidities, no significant association was found between OAC type and cognitive decline (P = .14).

Conclusions

We found similar risks of cognitive decline between those on NOACs or warfarin. Future studies should consider effects of age, length of time from AF diagnosis, and OAC adherence on this risk.
AI-driven evidence synthesis: data extraction of randomized controlled trials with large language models
Authors: Liu Jiayi , Lai Honghao , Zhao Weilong , Huang Jiajie , Xia Danni , Liu Hui , Luo Xufei , Wang Bingyi , Pan Bei , Hou Liangying , Chen Yaolong , Ge Long
Published: February 2025

The advancement of large language models (LLMs) presents promising opportunities to enhance evidence synthesis efficiency, particularly in data extraction processes, yet existing prompts for data extraction remain limited, focusing primarily on commonly used items without accommodating diverse extraction needs. This research letter developed structured prompts for LLMs and evaluated their feasibility in extracting data from randomized controlled trials (RCTs). Using Claude (Claude-2) as the platform, we designed comprehensive structured prompts comprising 58 items across six Cochrane Handbook domains and tested them on 10 randomly selected RCTs from published Cochrane reviews. The results demonstrated high accuracy with an overall correct rate of 94.77% (95% CI: 93.66% to 95.73%), with domain-specific performance ranging from 77.97% to 100%. The extraction process proved efficient, requiring only 88 seconds per RCT. These findings substantiate the feasibility and potential value of LLMs in evidence synthesis when guided by structured prompts, marking a significant advancement in systematic review methodology.
Exercise-based cardiac rehabilitation for patients with coronary artery operation: a systematic review and meta-analysis based on current randomized controlled trials
Authors: Shi Yan , Xu Huiqing , Dong Jige
Published: February 2025

Background:

Currently, exercise-based cardiac rehabilitation (CR) has been given increasing interest for its potentially beneficial effects on the health related quality of life (HRQoL) and outcomes of patients with coronary heart disease (CHD). The aim of this study was to evaluate the effect of exercise-based CR on patients after coronary artery bypass graſt (CABG) and percutaneous coronary interventions (PCI).

Methods:

We searched PubMed, Embase, Cochrane Library and Web of Science from inception to 1 December 2023 for relevant studies that evaluated the effect of exercise-based CR on patients after CABG and PCI. Our primary outcomes included the mortality, complications, hospital admissions and HRQoL between patients receiving exercise-based CR and usual care. All statistical analyses were performed using the standard statistical procedures provided in Review Manager 5.2 and Stata 12.0.

Results:

We finally indicated and included 25 randomized controlled trials (RCTs) with 4106 participants for the present analysis. Our pooled results indicated that, compared to usual care, exercise-based CR did not increasing the all-cause (RR 0.84; 95% CI 0.54 ‒ 1.31) and cardiovascular (RR 0.98; 95% CI 0.38 ‒ 2.54) mortality for patients after coronary artery operation. Similarly, exercise-based CR had equal effect on coronary artery complications for patients after coronary artery surgery, including CABG (RR 0.60; 95% CI 0.32 ‒ 1.15) and PCI (RR 0.92; 95% CI 0.55 ‒ 1.54). It was indicated that exercise-based CR significantly reduced the incidence of myocardial infarction (MI) by half with a RR of 0.50 (95% CI 0.28 ‒ 0.90). In addition, exercise-based CR also significantly reduced all-cause hospital admissions with a RR of 0.74 (95% CI 0.62 ‒ 0.88). Compared with usual care, exercise-based CR obviously improved HRQoL of patients after coronary artery operation evaluated with SF-36 summary scores (SMD 0.24; 95% CI 0.11 ‒ 0.38) and SF-36 8 domains (SMD 0.35; 95% CI 0.24 ‒ 0.46) respectively.

Conclusions:

Our analysis indicated that exercise-based CR had significant effect on the improvement of HRQoL of patients after coronary artery operation without increasing the mortality or incidence of re-intervention with operation.
Comparison of Outcomes for Emergency Medical Services–Transported Infants With Suspected Brief Resolved Unexplained Events Before and After the Coronavirus Disease 2019 Pandemic
Authors: Toy Jake , Bhargava Rishi , Lowe Calvin G. , Pham Phung K. , Shepard Nishelle , Aboudiab Myrna , Saidinejad Mohsen , Chow Jessica , Chang Todd P. , Altergott Caroline , Rai Ekra , Claudius Ilene , Moriel Gabriela , Conser Ellie , Gausche-Hill Marianne
Published: February 2025

Objectives:

This study compares care-seeking behavior, care delivery, and outcomes for infants with suspected brief resolved unexplained events (BRUEs) who were treated by emergency medical services (EMS) and emergency department clinicians before and after the onset of the coronavirus disease 2019 (COVID-19) pandemic and stay-at-home mandates.

Methods:

This multicenter, retrospective observational study uses prehospital and hospital data on EMS-treated infants (age ≤12 months) with a primary paramedic impression of BRUE. We evaluated interventions, management, and outcomes, including transports and admissions, before (April 2019 to February 2020) and after (April 2020 to February 2021) the start of the pandemic and stay-at-home mandates in March 2020. We also characterized longitudinal trends in transports and hospital admissions for BRUE infants between July 2017 and February 2021. Data were analyzed using descriptive statistics and interrupted time series modeling.

Results:

There were no significant differences in demographic characteristics or infant presentations before and after the beginning of the pandemic and stay-at-home mandates. We noted an increase in transports during the before period, but transports plateaued in the after period. There was no significant difference in admissions between the before and after periods.

Conclusions:

For EMS-treated infants with paramedic-suspected BRUE, presentations and hospital admissions were similar before and after the beginning of the COVID-19 pandemic and stay-at-home mandates. There was a longitudinal increase in EMS transports for infants with suspected BRUE before the COVID-19 pandemic and stay-at-home mandates, which then leveled off in the after period.
Buccinator myomucosal neurovascular Island flap: anatomic cadaveric study and clinical experience.
Authors: Bassiri Gharb Bahar , DeLeonibus Anthony , Kotha Vikas S. , Figueroa Brian A. , Rezaei Majid , Maasarani Samantha , Sinclair Nicholas , Rampazzo Antonio
Published: February 2025

BACKGROUND:

Utilization of peninsular buccal flaps for primary cleft palate repair is well-documented in the literature. However, there is no report on the application of an island flap for primary cleft palate repair. This study aims to reveal the clinical application of an axial neurovascular propeller buccinator myomucosal flap.

METHODS:

An anatomical study was performed by injection into the buccal pedicle of twenty-two fresh hemifacial cadavers. Additionally, we analyzed palatal healing and flap outcomes in twenty-five primary cleft palate reconstructions utilizing thirty-six pedicled propeller flaps.

RESULTS:

Cadaver study: the mean buccal artery diameter was 1±0.3 mm, the neurovascular pedicle entered the flap 11.4±2.9 mm anterior to the pterygomandibular raphe (1/6 th the length of the flap), and the buccal artery advanced inside the flap as much as 66.8%±6.0% of the total flap length. Clinical experience: all reconstructions were performed using a modified Furlow palatoplasty. Mean age of patients was 15.3 months and mean maximum cleft width was 11.7 mm. Eleven cases utilized bilateral flaps. The flap always reached the contralateral pillar, and the buccal nerve was always preserved. 11.11% flaps (4/36) underwent scar revision, and 5.56% flaps (2/36) were lost. Follow-up period was 11.3 months.

CONCLUSION:

This study suggests the utilization of axial neurovascular pedicled propeller buccinator myomucosal flaps is a safe and reliable option in primary cleft palate reconstruction. Our anatomical dissections and clinical outcomes reveal the consistent and robust nature of buccal neurovascular pedicle, and our modified surgical technique allows for preservation of the buccal nerve.
The Modified Frailty Index Predicts Outcomes in Immediate Implant-Based Breast Reconstruction
Authors: Danko Dora , Ash Makenna E. , Losken Albert , Thompson Peter W.
Published: February 2025

Background

Risk stratification is a crucial tool to help in surgical planning and counseling. Historically, this has been measured by age, BMI, smoking status, or medical comorbidities. Frailty, the combined burden of the patient's comorbidities and risk factors, has gained traction as a method of combining disparate risk factors into one number. The modified 5-factor frailty index (mFI-5) is simple to calculate and takes only moments to assign a risk level to a patient.

Objectives

This study aimed to study the application and efficacy of the mFI-5 as a measurement of operative risk in immediate breast reconstruction.

Methods

A total of 650 patients undergoing breast reconstruction at our institution were identified. Patients were divided into 5 mFI-5 groups based on their associated comorbidities. Surgical outcomes were compared using the χ2 or Fisher exact tests for categorical variables and t tests for continuous variables.

Results

There were 452 patients stratified into the mFI-5 0 group, 155 patients into the mFI-5 1 group, 40 patients into the mFI-5 2 group, and 3 patients into the mFI-5 3 group. There were no patients in our cohort in either the mFI-5 4 or 5 groups. In comparison of the mFI-5 0 group to 1 group, there was a significant difference in postoperative day of infection (32.06 vs. 21.5 days. respectively; P = 0.049). When comparing to the mFI-5 2 group, there was a significant difference in overall complications on univariate analysis (P = 0.012), minor infections on univariate and multivariate analysis (P = 0.050 and P < 0.001), seroma formation on univariate analysis (P = 0.017), hematoma formation (P < 0.001), return to OR (P < 0.001), and replaced implant (P < 0.001) on multivariate analysis. When comparing the mFI-5 1 group to the mFI-5 2 group, there was a significant difference between overall complications on both univariate and multivariate analyses (P = 0.012 and P = 0.041) and minor infections on univariate analysis (P = 0.032).

Conclusions

The modified 5-factor frailty index is effective in predicting increased complication risks seen after IBR and may be helpful for surgeons when counseling patients and assessing overall operative risk.
Urogynecology Research Is Underrepresented in Top Obstetrics and Gynecology Journals
Authors: Saleeb Monica , Muluk Sruthi , Wood Nicole , Sappenfield Elisabeth , Tunitsky-Bitton Elena
Published: February 2025

Importance

Patients with urogynecologic conditions commonly present to general gynecology practices. Consequently, it is imperative that journals for obstetrics and gynecology (OBGYN) represent topics pertinent to comprehensive women’s health, including urogynecology topics.

Objective

The aim of the study was to analyze the prevalence of urogynecology research compared to other topics in top OBGYN journals.

Study Design

This was a retrospective review of all papers published in top OBGYN-focused journals from 2000 to 2023. The publicly available PubMed package in R was used to extract papers. Stata, a statistical software package, was used to develop an algorithm searching for key words concerning urogynecology, obstetrics, benign gynecology, gynecologic oncology, and reproductive endocrinology and infertility. The algorithm was tested and cross-validated via manual review of papers published in 1999 to determine whether identified key words were accurate in determining paper content. The algorithm was modified with additional key words and revalidated based on this initial analysis.

Results

Validation of the algorithm using all 1999 publications from several top OBGYN journals found a 93.48% accuracy for correct identification and classification of papers. Analysis was performed for 81,174 articles between 2000 and 2023. An average of 6.64% of publications focused on urogynecology topics. In contrast, 41.42% of publications concerned obstetrics, 33.9% on other benign gynecology, 41.9% on gynecologic oncology, and 24.7% on reproductive endocrinology and infertility.

Conclusions

This study reveals consistent underrepresentation of urogynecology topics in leading OBGYN journals. Given that generalist gynecologists may not subscribe to subspecialty journals, this study underscores the need for the inclusion of urogynecologic research in OBGYN journals.
Complex optical vortex knots
Authors: Bode Benjamin
Published: February 2025

The curves of zero intensity of a complex optical field can form knots and links: optical vortex knots. Both theoretical constructions and experiments have so far been restricted to the very small families of torus knots or lemniscate knots. Here we describe a mathematical construction that presumably allows us to generate optical vortices in the shape of any given knot or link. We support this claim by producing for every knot

K

in the knot table up to 8 crossings a complex field

Ψ

:

R

3

→

C

that satisfies the paraxial wave equation and whose zeros have a connected component in the shape of

K

. These fields thus describe optical beams in the paraxial regime with knotted optical vortices that go far beyond previously known examples.
Accelerated Metabolomic Aging and Its Association with Social Determinants of Health in Multiple Sclerosis
Authors: Siavoshi Fatemeh , Noroozi Rezvan , Chang Gina , Schoeps Vinicius A. , Smith Matthew D. , Briggs Farren B.S. , Graves Jennifer S. , Waubant Emmanuelle , Mowry Ellen M. , Calabresi Peter A. , Bhargava Pavan , Fitzgerald Kathryn C
Published: February 2025

Biological age (BA), shaped by genetics, lifestyle, and environmental exposures, reflects physiological changes and mediates the effects of social determinants of health (SDoH) in diseases other than multiple sclerosis (MS). We investigated BA acceleration through metabolic profiling in people with MS (PwMS) and its association with SDoH, measured by the area deprivation index. Accelerated BA was observed in PwMS compared to healthy controls in independent adult and pediatric-onset MS cohorts. Greater social deprivation correlated with greater BA acceleration in PwMS. These findings highlight BA as a potential mediator linking SDoH to MS outcomes and a target to reduce health disparities.
Acute exercise rewires the proteomic landscape of human immune cells
Authors: Walzik David , Joisten Niklas , Metcalfe Alan J , Proschinger Sebastian , Schenk Alexander , Wenzel Charlotte , Henneberg Alessa L. , Schneider Martin , Calderazzo Silvia , Groll Andreas , Watzl Carsten , Opitz Christiane A. , Helm Dominic , Zimmer Philipp
Published: February 2025

Exercise-driven alterations of the immune system are a key mechanism in the prevention and treatment of various diseases. Here, we performed mass spectrometry-based proteomics analysis on peripheral blood mononuclear cells (PBMCs) at a depth of >6000 proteins. Comparing time– and workload-matched high-intensity interval exercise (HIIE) and moderate-intensity continuous exercise (MICE) we discover versatile changes in the proteomic makeup of PBMCs and reveal profound alterations related to effector function and immune cell activation pathways within one hour after exercise. These changes were more pronounced after HIIE compared to MICE and occurred despite identical immune cell mobilization patterns between the two exercise conditions. We further identify an immunoproteomic signature that effectively predicts cardiorespiratory fitness. This study provides a reliable data resource that expands our knowledge on how exercise modulates the immune system, and delivers biological evidence supporting the WHO 2020 guidelines, which highlight exercise intensity as a relevant factor to maintain health.