bluuebunny/crossref_metadata_2025 huggingface dataset:
International institutions in global tax governance
Authors: Stewart Miranda
Published: January 2025

Tax law and governance have long been understood as quintessential elements of national sovereignty. Today, there appears to be an expansion of global tax governance through the work of a diverse array of international institutions. This article identifies the ‘who’ of global tax governance, ‘what’ they are engaged in, and ‘how’ they seek to go about it. Mapping the international institutions engaged in taxation is a necessary step in analysing the origins, activities, and future direction of this new field of multilateral activity.
Control of industrially relevant microbial isolates by antimicrobial agents: Implications for sugar factories
Authors: Bruni Gillian O , Terrell Evan , Klasson K Thomas , Qi Yunci
Published: January 2025

Microbial isolates from sugar crop processing facilities were tested for sensitivity to several industrial antimicrobial agents to determine optimal dosing. Hydritreat 2216 showed broad-spectrum activity against all bacterial isolates as well as Saccharomyces cerevisiae. Sodium hypochlorite showed broad-spectrum activity against all isolates, but at much higher effective concentrations. Hops BetaStab XL was effective against Gram-positive isolates. Magna Cide D minimum inhibitory concentration was lowest for S. cerevisiae and Zymomonas mobilis but was less effective against Gram-positive bacterial strains. Based on laboratory experiments, factory losses of sucrose from a single microbial species in the absence of antimicrobials could range from 0.13 to 0.52 kg of sucrose per tonne of cane. Additional improvements in sugar yield are anticipated from agents with broad-spectrum activity. A cost analysis was conducted considering sucrose savings due to antimicrobial application to provide estimates for break-even costs, which ranged from approximately $0.50 to $2.00/L for a given antimicrobial agent.

One-Sentence Summary

Application of antimicrobial agents at minimal inhibitory doses for microbes results in optimal inhibition of microbial growth and sucrose consumption.
A rare huge retroperitoneal accessory spleen mimicking right-sided sarcoma in a female patient: case report and review
Authors: Al-Thani Hassan , El-Menyar Ayman , Ata Yaser M , Afifeh Lana Abu , Alatasi Sali , Telfah Hussam , Al-Sulaiti Maryam , Tabeb AbdelHakem
Published: January 2025

Detecting retroperitoneal accessory spleen (AS) requires a high index of suspicion for proper and timely diagnosis. The AS can be found near the hilum of the spleen or wholly or partially embedded in the pancreatic tail, stomach, bowel, mesentery walls, or even in the pelvis. Left-sided retroperitoneal AS is common compared to the right-sided retroperitoneal location, which is very rare. The diagnosis of AS is not common preoperatively when investigating a mass in the other abdominal regions, and the surgical resection can thoroughly confirm the diagnosis. The management of AS is surgical excision through open, laparoscopic, or robotic-assisted techniques, depending on the patient status, the size and location of the mass, and the available treatment modality in the hospital. Here, we described a rare case presentation of a huge right retroperitoneal mass (AS) that was initially suspected as sarcoma and managed by laparotomy resection.
Challenges in diagnosis and treatment of fascioliasis in a non-endemic country
Authors: Dor Shira , Cohen-Poradosu Ronit , Hochstein David , Grossman Tamar , Mathiesen Inger , Saed Rashed , Green Hefziba , Amitai Michal , Schwartz Eli , Leshem Eyal
Published: January 2025

A returned traveller from Asia presented with prolonged fever, abdominal pain, and eosinophilia. Abdominal CT revealed hypodense lesions of the liver. Fascioliasis was clinically suspected. Serology and triclabendazole are unavailable in Israel; therefore, empiric treatment with nitazoxanide and transfer to Denmark for definitive serodiagnosis and triclabendazole treatment was necessary.
Root system ideotypes: what is the potential for breeding drought-tolerant grapevine rootstocks?
Authors: Bernardo Sara , Marguerit Elisa , Ollat Nathalie , Gambetta Gregory A , Saint Cast Clément , de Miguel Marina
Published: January 2025

Adaptation to drought is one of the most important challenges for agriculture. The root system, along with its integration with the soil, is fundamental in conferring drought tolerance. At the same time, it is extremely challenging to study. The result is that investigations aimed at increasing crop drought tolerance have mainly focused on above-ground traits, especially for perennial species. In this review, we explore the root trait syndromes that would constitute drought-tolerant ideotypes, taking the example of grapevine as a model perennial grafted plant. We introduce and discuss the complexity of root trait interactions across different spatial and temporal scales considering their diversity, plasticity, and possible trade-offs. Finally, we review future approaches for discovering hidden root trait syndromes conferring drought tolerance, such as state-of-the-art root phenotyping technologies, the use of modeling as a tool to upscale root traits to the field, and new strategies to link genes to phenotypes. Together these integrated approaches can improve the breeding of drought-tolerant grapevine rootstocks.
A new quantitative reverse transcription PCR assay to improve the routine diagnosis of paracoccidioidomycosis
Authors: Marques de Macedo Priscila , Sturny-Leclère Aude , Hamane Samia , Pautet Thierry , Rodrigues Anderson Messias , Freitas Dayvison Francis Saraiva , Valle Antonio Carlos Francesconi do , Zancopé-Oliveira Rosely Maria , Almeida-Paes Rodrigo , Alanio Alexandre
Published: January 2025

Paracoccidioides are dimorphic fungal pathogens and the etiological agents of paracoccidioidomycosis (PCM). This severe systemic mycosis is restricted to Latin America, where it has been historically endemic. Currently, PCM presents the fewest diagnostic tools available when compared to other endemic mycoses. The main PCM diagnostic methods also have limitations. Molecular methods using different protocols have been proposed, but are restricted to a few regions. An analytical transversal study was conducted to evaluate a new molecular tool using specimens from patients diagnosed with PCM at a reference center for endemic mycoses in Rio de Janeiro, Brazil. After whole nucleic acid (WNA) extraction, RT-qPCR was performed in two independent simplex reactions, targeting the mitochondrial small subunit ribosomal RNA genes of Paracoccidioides brasiliensis and Paracoccidioides lutzii. Additionally, WNAs from all PCM-related Paracoccidioides species and from 114 other fungal strains, as well as from samples obtained from patients diagnosed with other endemic mycoses and tuberculosis, were also tested for specificity. The RT-qPCR targeting P. brasiliensis successfully amplified genetic material from all tested Paracoccidioides species but not P. lutzii, which is why a specific RT-qPCR was designed. The RT-qPCR efficiency was 1.95 (95%) with 100% analytical specificity for both targets. All included PCM clinical samples were positive (100% sensitivity) for P. brasiliensis, and all yielded negative for P. lutzii. Additionally, all samples collected from patients with other diseases were negative, reinforcing the assay’s specificity. In conclusion, this study proposes a new accurate tool to cover gaps, contributing to the molecular diagnosis of this neglected disease.
Machine learning-based identification of Gaia astrometric exoplanet orbits
Authors: Sahlmann Johannes , Gómez Pablo
Published: January 2025

The third Gaia data release (DR3) contains ∼170 000 astrometric orbit solutions of two-body systems located within ∼500 pc of the Sun. Determining component masses in these systems, in particular of stars hosting exoplanets, usually hinges on incorporating complementary observations in addition to the astrometry, e.g. spectroscopy and radial velocities. Several Gaia DR3 two-body systems with exoplanet, brown-dwarf, stellar, and black hole components have been confirmed in this way. We developed an alternative machine learning approach that uses only the Gaia DR3 orbital solutions with the aim of identifying the best candidates for exoplanets and brown-dwarf companions. Based on confirmed substellar companions in the literature, we use semisupervised anomaly detection methods in combination with extreme gradient boosting and random forest classifiers to determine likely low-mass outliers in the population of non-single sources. We employ and study feature importance to investigate the method’s plausibility and produced a list of 20 best candidates, of which two are exoplanet candidates and another five are either very massive brown dwarfs or very low mass stars. Three candidates, including one initial exoplanet candidate, correspond to false-positive solutions where longer-period binary star motion was fitted with a biased shorter-period orbit. We highlight nine candidates with brown-dwarf companions for preferential follow-up. The companion around the Sun-like star G 15-6 could be confirmed as a genuine brown dwarf using external radial-velocity data. This new approach is a powerful complement to the traditional identification methods for substellar companions among Gaia astrometric orbits. It is particularly relevant in the context of Gaia DR4 and its expected exoplanet discovery yield.
The Quasar Feedback Survey: zooming into the origin of radio emission with e-MERLIN
Authors: Njeri Ann , Harrison Chris M , Kharb Preeti , Beswick Robert , Calistro-Rivera Gabriela , Circosta Chiara , Mainieri Vincenzo , Molyneux Stephen , Mullaney James , Sasikumar Silpa
Published: January 2025

We present 6 GHz e-MERLIN observations of 42 $z\lt 0.2$ type 1 and type 2 mostly radio-quiet quasars ($L_{\rm [O\,{\small III}]}\gtrsim 10^{42}$ erg s$^{-1}$; $L_{\rm AGN}\gtrsim 10^{45}$ erg s$^{-1}$) from the Quasar Feedback Survey. The nature and origin of radio emission in these types of sources is typically ambiguous based on all-sky, low-resolution surveys. With e-MERLIN, we investigate radio emission on sub-kiloparsec scales ($\sim$10s–100s pc). We find 37/42 quasars are detected, with a diversity of radio morphologies, including compact cores, knots, and extended jet-like structures, with sizes of 30–540 pc. Based on morphology and brightness temperature, we classify 76 per cent of the quasars as radio-AGN, compared to the $\sim$57 per cent identified as radio-AGN at the $\sim$1–60 kpc scales probed in prior studies. Combining results from e-MERLIN and the Very Large Array, 86 per cent reveal a radio-AGN. On average, $\sim$60 per cent of the total radio flux is resolved away in the e-MERLIN maps, and is likely dominated by jet-driven lobes and outflow-driven shocks. We find no significant differences in measured radio properties between type 1 and type 2 quasars, and estimate sub-relativistic jet speeds of $\sim$0.2–0.3c and modest jet powers of $P_\mathrm{jet} \approx \times 10^{43}$ erg s$^{-1}$ for the few targets, where these measurements were possible. These quasars share characteristics with compact radio-selected populations, and the global radio emission likely traces strong interactions between the AGN (jets/outflows) and their host galaxy ISM from 10s parsec to 10s kiloparsec scales.
Jaccoud’s arthropathy secondary to leprosy
Authors: Viana Izabela Prado , Figueiroa Maria de Lourdes Castro de Oliveira , Argollo Beatriz Paixão , Pinto Gustavo Luiz Behrens , Santiago Mittermayer Barreto
Published: January 2025

Jaccoud’s arthropathy is a deforming, nonerosive form of arthritis initially described in patients with rheumatic fever. However, it has been recently observed more frequently in those with systemic lupus erythematosus. Cases of Jaccoud’s arthropathy have also been described to be associated with other conditions. Herein, we describe the case of a 64-year-old Brazilian man who exhibited Jaccoud’s arthropathy associated with leprosy. To the best of our knowledge, this is the first report on this association.
Dual functional nanoplatforms potentiate osteosarcoma immunotherapy via microenvironment modulation
Authors: Lu Shunyi , Yang Yuqi , Song Zhuorun , Cao Jie , Han Zhihui , Chen Linfu , He Yunfei , Wang Jiayi , Teng Yun , Zhang Zengli , Zou Jun , Ge Jun , Yang Huilin , Cheng Liang
Published: January 2025

Osteosarcoma (OS), a highly aggressive bone tumor, presents significant challenges in terms of effective treatment. We identified that cellular autophagy was impaired within OS by comparing clinical OS samples through bioinformatic analyses and further validated the inhibition of mitochondrial autophagy in OS at the transcriptomic level. Based on this finding, we investigated the therapeutic potential of a dual functional metal nanoplatform (MnSx) to facilitate a transition from the protective effect of low-level autophagy in OS to the killing effect of high-level autophagy in OS. MnSx facilitated intracellular H2S generation via endocytosis, leading to the S-sulfhydration of ubiquitin-specific peptidase 8 (USP8) and subsequent promotion of mitochondrial autophagy in vitro. Additionally, MnSx activated the cyclic guanosine monophosphate–adenosine monophosphate synthase (cGAS)–stimulator of interferon genes (STING) pathway, further enhancing the cellular autophagic response and accelerating tumor cell death. Moreover, it was demonstrated in vivo that MnSx, on the one hand, mediated the activation of tumor autophagy by USP8 via intracellular H2S, while Mn2+ promoted the maturation of dendritic cells, activated cytotoxic T lymphocytes and contributed to tumor eradication. Such tumor killing could be suppressed by the autophagy inhibitor chloroquine. Importantly, synergistic combination therapy with immune checkpoint inhibitors showed promise for achieving complete remission of OS. This study highlights the potential of MnSx as a dual-functional therapeutic platform for OS treatment and offers novel directions for future research in this field.
Exploring Predictors of Treatment Response to GLP-1 Receptor Agonists for Smoking Cessation
Authors: Yammine Luba , de Dios Constanza , Suchting Robert , Green Charles E , Nielsen David A , Walss-Bass Consuelo , Schmitz Joy M
Published: January 2025

Introduction

Understanding predictors of smoking cessation medication efficacy facilitates the ability to enhance treatment effectiveness. In our pilot trial, exenatide, a glucagon-like peptide-1 receptor agonist, adjunct to nicotine patch improved smoking abstinence compared to nicotine patch alone. This secondary analysis explores potential baseline characteristics associated with differential treatment response to exenatide.

Aims and Methods

The parent trial randomized (1:1) 84 smokers with prediabetes and/or overweight to once-weekly placebo or exenatide, 2 mg, subcutaneously. All participants received nicotine patch (21 mg) and brief smoking cessation counseling, with biologically confirmed 7-day point prevalence abstinence at week 6 (end-of-treatment) deemed the primary outcome. Bayesian generalized linear modeling explored differential response to treatment as a function of baseline patient characteristics, including demographic, psychosocial, clinical, smoking-related, and genetic factors. Posterior probability (PP) ≥ 75% that an effect exists was taken as a minimum threshold of evidence in favor of model effects.

Results

Exenatide showed stronger benefit versus placebo in participants who smoked >20 cigarettes per day (PP = 81.7%) and in those without prediabetes (PP = 76.0%) or obesity (PP = 94.4%). Exenatide’s efficacy was observed only in individuals with no/minimal depression symptoms but not in those with symptoms (PP = 91.2%). Finally, exenatide was more efficacious than placebo only in those with the CHRNA rs16969968 GG genotype (PP = 88.6%).

Conclusions

The effect of exenatide on abstinence may be moderated by the number of cigarettes smoked daily, metabolic, psychological, and genetic factors. Larger prospective investigations are needed to confirm and extend these findings.

Implications

Understanding predictors of smoking cessation medication efficacy enhances the ability to improve treatment effectiveness. In our pilot trial, extended-release exenatide, a GLP-1 receptor agonist, adjunct to nicotine patch, improved smoking abstinence in smokers with prediabetes and/or overweight. The current post-hoc analysis found that the effect of exenatide on smoking abstinence may be moderated by the number of cigarettes smoked daily, metabolic, psychological, and genetic factors. Larger investigations are needed to confirm and extend these findings.
Patient Characteristics and Outcomes by Sex and Smoking Status in Pulmonary and Cardiac Rehabilitation
Authors: Gaalema Diann E , Zhang Yu , Howard George , Menson Katherine E
Published: January 2025

Introduction

Those with established symptomatic cardiopulmonary disease should attend secondary prevention programs. Attendance at these programs is known to differ by sex and smoking status, with females and those who smoke being less likely to attend. However, little is known about whether the risk factors of being female and smoking are cumulative, and how outcomes from secondary prevention differ by these subgroups. Accordingly, we sought to examine patient characteristics at entry and outcomes of those attending pulmonary (PR) and cardiac rehabilitation (CR) by sex and smoking status.

Aims and Methods

Data were from patients enrolled in programs participating in a national registry between 2013 and 2021 (PR) or 2012 and 2021 (CR). Variables examined included: age, sex, race, educational attainment, insurance coverage, qualifying diagnosis, BMI, number of PR/CR sessions attended, baseline, and change in, psychosocial (depression and anxiety symptoms) and physical function and fitness measures (6-minute walk distance [6MWD]/metabolic equivalents [METs]).

Results

Analyses included 41 087 PR and 447 921 CR patients. Current smoking was reported in 14.3% (PR) and 8.4% (CR) of patients. Across PR/CR, at baseline, current smoking and female sex were both associated with higher depression scores, lower fitness/function measures, and fewer sessions. Both current smoking and female sex were significantly associated with less improvement in 6MWD, METs, and depression scores within CR.

Conclusions

Both sex and smoking status are important risk factors for those entering secondary prevention programs. Females who smoke have higher risk factors at entry, attend fewer sessions, and, within CR, improve less in fitness/function.

Implications

This study uses large national registries to replicate and expand upon prior findings that both female sex and current smoking are associated with higher-risk profiles when entering secondary prevention programs. Additionally, this study demonstrates that current smoking and female sex are also associated with less improvement during secondary prevention, especially within cardiac rehabilitation.
Preference for HIV Pre-exposure Prophylaxis Access Among Men who Have Sex With Men in China: A Discrete Choice Experiment
Authors: Huang Wenting , Stegmueller Daniel , Sales Jessica M , Mi Guodong , Yu Fei , Liu Yufen , Sullivan Patrick S , Siegler Aaron J , Ong Jason J
Published: January 2025

Background

HIV pre-exposure prophylaxis (PrEP) is highly effective but not widely used by men who have sex with men (MSM; 27%) in China.

Methods

In June 2023, an online cross-sectional survey with a discrete choice experiment (DCE) was distributed to PrEP-eligible MSM in China who were at least 18 years old. The DCE explored attributes of PrEP modality (daily pill, on-demand pill, injections, implants), clinical care model (same-day, 2-visit, telehealth prescription), medication pickup (clinic, community health center, pharmacy, MSM-focused community-based organization, home delivery), enhanced support (self-management, smartphone app, text reminder, anonymous peer support group), and cost.

Results

A total of 1013 MSM completed the survey; the average age was 31 years, and a quarter had used PrEP. The most influential attributes were cost (relative importance: 64.6%), followed by PrEP modality (27.7%), medication pickup (4.0%), enhanced support (3.5%), and clinical care model (0.2%). The most preferred ways to access PrEP were no-cost on-demand pill, medication home delivery, self-management, and telehealth. The predicted uptake of on-demand PrEP was higher than other modalities, increasing from 22% with no subsidy to 79% with full subsidy, holding the other 3 attributes constant.

Conclusions

Chinese MSM have strong preferences regarding accessing PrEP: Low cost is a critical priority, especially important because medication and clinical care are currently entirely unsubsidized in China. Preferences for on-demand PrEP and home delivery indicate methods that the health care system can utilize to best meet the needs of MSM and factors that should be incorporated into future interventions.
Flexible inference in heterogeneous and attributed multilayer networks
Authors: Contisciani Martina , Hobbhahn Marius , Power Eleanor A , Hennig Philipp , De Bacco Caterina
Published: January 2025

Networked datasets can be enriched by different types of information about individual nodes or edges. However, most existing methods for analyzing such datasets struggle to handle the complexity of heterogeneous data, often requiring substantial model-specific analysis. In this article, we develop a probabilistic generative model to perform inference in multilayer networks with arbitrary types of information. Our approach employs a Bayesian framework combined with the Laplace matching technique to ease interpretation of inferred parameters. Furthermore, the algorithmic implementation relies on automatic differentiation, avoiding the need for explicit derivations. This makes our model scalable and flexible to adapt to any combination of input data. We demonstrate the effectiveness of our method in detecting overlapping community structures and performing various prediction tasks on heterogeneous multilayer data, where nodes and edges have different types of attributes. Additionally, we showcase its ability to unveil a variety of patterns in a social support network among villagers in rural India by effectively utilizing all input information in a meaningful way.
Unmasking Mutual Fund Derivative Use
Authors: Kaniel Ron , Wang Pingle
Published: January 2025

Using new SEC data, we study fund derivative use and its impact on performance. Despite small portfolio weights, derivatives contribute largely to fund returns. Contrary to prior research, we find most employ derivatives to amplify, not hedge, equity returns. Using machine learning to classify funds’ derivative strategies reveals high specializations linked to information-related trading, liquidity management, gaining exposure, or hedging motives. Long index derivative users drive the amplification. During COVID-19, these users significantly increased derivative use more than others and shifted strategies, but initially lost on existing positions and then on newly opened short positions when markets unexpectedly rebounded.
Clinical characteristics of primary SS– and overlap SS–associated pulmonary arterial hypertension: a multicentre retrospective study
Authors: Sun Xiaoxuan , Zhang Yixin , Liu Ting , Zhang Hang , Zu Beibei , Zhou Lei , Wang Qiang , Zhang Miaojia
Published: January 2025

Objective

The objective of this study was to explore the clinical characteristics and risk factors for adverse outcomes in patients with SS-associated pulmonary arterial hypertension (SS-PAH).

Methods

A retrospective analysis was conducted on SS-PAH patients diagnosed by right heart catheterization (RHC) between March 2013 and March 2024 across four Chinese medical centres. Patients were categorized into primary SS-PAH (pSS-PAH) and overlap SS-PAH groups, based on the presence of additional autoimmune diseases. We compared clinical and demographic data, echocardiographic and haemodynamic parameters, treatment strategies, and event-free survival between the groups. The statistical analyses included t-tests, Wilcoxon rank-sum tests, χ2 tests, Fisher’s exact tests, and Kaplan–Meier survival analysis.

Results

Overlap SS-PAH was most commonly associated with SLE. Compared with pSS-PAH, overlap SS-PAH patients had a lower proportion categorized as having WHO functional class III–IV, lower pulmonary vascular resistance (PVR), and higher cardiac index. They also showed higher treatment success rates and better event-free survival. However, overlap SS-PAH patients with primary biliary cholangitis (PBC) or autoimmune hepatitis (AIH) had significantly lower 1-year event-free survival rates, older age, and elevated ALP levels.

Conclusion

Overlap SS-PAH generally has a better prognosis than pSS-PAH, with improved exercise capacity and milder haemodynamic abnormalities. However, overlap with PBC/AIH is associated with a poorer prognosis. These findings highlight the heterogeneity of SS-PAH and the need for tailored treatment based on underlying autoimmune conditions.

Trial registration

ClinicalTrials.gov, https://clinicaltrials.gov, NCT05980728.
Analgesic Safety and Efficacy of Perioperative Posterior Cervical Muscle Plane Blocks in Elective Posterior Cervical Spine Surgery
Authors: Weisbrod Luke J. , Ceesay Omar I. , Schmidt Cynthia , Haynatzki Roman , Surdell Daniel L.
Published: January 2025

Objective:

Posterior cervical spine surgery can result in significant discomfort in the postoperative period. Postoperative pain management presents a challenge, particularly in the elderly population that﻿ is more sensitive to adverse effects from analgesia. We compared outcomes after perioperative posterior cervical muscle plane blocks versus patients who received general anesthesia only.

Methods:

MEDLINE, EMBASE, and the Cochrane Library were searched for articles concerning the use of blocks in posterior cervical spinal surgery from January 1, 1974 to December 11, 2023. Data from studies meeting inclusion criteria were analyzed. Fixed-effect and random-effect models were used to establish odds ratios and mean differences with 95% CIs for each outcome.

Results:

The results of the pooled analysis showed that in patients undergoing elective posterior cervical spine surgery, a perioperative posterior cervical muscle plane block resulted in a statistically significant decrease in numerical pain rating scores at 2 hours postoperatively, 12 hours postoperatively, adverse events, and postoperative nausea/vomiting. A preoperative posterior cervical block resulted in a decrease in the duration of surgery, and numerical pain rating scores at 24 hours postoperatively, though not to a level of statistical significance.

Conclusion:

These meta-analyses suggest that perioperative posterior cervical muscle plane blocks are safe and result in improved postoperative analgesic efficacy when compared with controls. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of perioperative posterior cervical blocks for elective posterior cervical spine surgery.
Developing an EEG-based model to predict awakening after cardiac arrest using partial processing with the BIS Engine
Authors: Snider Samuel B. , Molyneaux Bradley J. , Murthy Anarghya , Rademaker Quinn , Rajwani Hafeez , Scirica Benjamin M. , Lee Jong Woo , Connor Christopher
Published: January 2025

Introduction:

Accurate prognostication in comatose survivors of cardiac arrest is a challenging and high-stakes endeavor. We sought to determine whether internal EEG subparameters extracted by the Bispectral Index (BIS) monitor, a device commonly used to estimate depth-of-anesthesia intraoperatively, could be repurposed to predict recovery of consciousness after cardiac arrest.

Methods:

In this retrospective cohort study, we trained a 3-layer neural network to predict recovery of consciousness to the point of command following versus not based on 48 hours of continuous EEG recordings in 315 comatose patients admitted to a single US academic medical center after cardiac arrest (Derivation cohort: N=181; Validation cohort: N=134). Continuous EEGs were partially processed into subparameters using virtualized emulation of the BIS Engine (i.e., the internal software of the BIS monitor) applied to signals from the frontotemporal leads of the standard 10-20 EEG montage. Our model was trained on hourly-averaged measurements of these internal subparameters. We compared this model’s performance to the modified Westhall qualitative EEG scoring framework.

Results:

Maximum prognostic accuracy in the Derivation Cohort was achieved using a network trained on only four BIS subparameters (inverse burst suppression ratio, mean spectral power density, gamma power, and theta/delta power). In a held-out sample of 134 patients, our model outperformed current state-of-the-art qualitative EEG assessment techniques at predicting recovery of consciousness (area under the receiver operating characteristic curve: 0.86, accuracy: 0.87, sensitivity: 0.83, specificity: 0.88, positive predictive value: 0.71, negative predictive value: 0.94). Gamma band power has not been previously reported as a correlate of recovery potential after cardiac arrest.

Conclusions:

In patients comatose after cardiac arrest, four EEG features calculated internally by the BIS Engine were repurposed by a compact neural network to achieve a prognostic accuracy superior to the current clinical qualitative gold-standard, with high sensitivity for recovery. These features hold promise for assessing patients after cardiac arrest.
Association of Subcapsular Liver Hematoma With Preeclampsia, Eclampsia, or Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome
Authors: Chahine Khalil M. , Shepherd Megan C. , Sibai Baha M.
Published: January 2025

OBJECTIVE:

To describe the presentation, outcomes, and management strategies for cases of subcapsular liver hematoma associated with preeclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.

METHODS:

This was a case series of individuals with subcapsular liver hematoma managed at a single level IV center over a 10-year period, from 2013 to 2024. Presenting signs and symptoms, laboratory findings, time of onset, management strategies, acute perinatal and maternal outcomes, and long-term outcomes such as subsequent pregnancies were reviewed in the medical record and recorded. Data were summarized using descriptive statistics, with results reported as means, standard deviations, and ranges. Categorical variables were summarized as counts and percentages.

RESULTS:

There were 13 cases of subcapsular liver hematoma associated with preeclampsia, eclampsia, and HELLP syndrome between 2013 and 2024. In 10 of the 13 pregnancies (76.9%), delivery was preterm. The most common presenting symptoms were epigastric or right upper quadrant pain (53.8%), followed by abdominal distention (38.5%). Diagnosis of subcapsular liver hematoma was made in the antepartum period for six patients and was made in the postpartum for seven patients. The diagnosis was confirmed in all cases by computed tomography. Conservative management with close hemodynamic monitoring and transfusion of blood and blood products was sufficient in 11 (84.6%) patients; two patients underwent surgical exploration. The mean duration of hospital stay was 10 days (range 2–21 days). Maternal complications included pleural effusions, acute kidney injury, and pulmonary edema. There were no maternal deaths. There were four stillbirths and no neonatal deaths. Four people had five subsequent pregnancies; delivery was preterm in all five pregnancies, two pregnancies were complicated by subsequent HELLP syndrome, and one patient developed recurrent subcapsular liver hematoma.

CONCLUSION:

Subcapsular liver hematoma is a rare complication of preeclampsia, eclampsia, and HELLP syndrome that is associated with substantial maternal and perinatal morbidities. Conservative management with hemodynamic monitoring and transfusion of blood and blood products was sufficient for management in the majority of cases. All subsequent pregnancies resulted in preterm births.
Correlation between skin cancer and therapy with anti-IL monoclonal antibodies in patients affected by moderate-to-severe psoriasis: an observational monocentric study
Authors: Manzo Margiotta Flavia , Fidanzi Cristian , Pardossi Simone , Michelucci Alessandra , Granieri Giammarco , Salvia Giorgia , Bevilacqua Matteo , Morganti Riccardo , Panduri Salvatore , Bagnoni Giovanni , Romanelli Marco , Janowska Agata , Dini Valentina
Published: January 2025

Our study aimed to investigate the correlation between skin cancer and anti-interleukin (IL) therapy in patients with moderate-to-severe psoriasis. This was an observational monocentric study in which we enrolled a total of 235 patients in which 127 patients were affected by moderate-to-severe psoriasis and treated with anti-IL monoclonal antibodies (mAbs) for at least 6 months, whereas 108 patients affected by mild psoriasis were treated with topical therapies. Afterward, we performed a dermatologic visit to all the subjects, collecting anamnestic information including risk factors for skin cancer. We examined the skin lesions on their entire body by polarized and nonpolarized dermoscopy. A total of 21 suspicious lesions in the first group and 17 in the second one were removed and histologically analyzed. Twelve (9.4%) cancerous or precancerous lesions were found in the first group: seven (5.5%) basal cell carcinoma (BCC) and five actinic keratosis. The mean time to cancer onset was identified as 22 months after the start of four therapy, with an SD of 18 months, suggesting an earlier onset with respect to the start of therapy in our population. On univariate analysis, age (P = 0.001) and age of psoriasis onset (0.009) were statistically significant. Nine of 17 were skin cancers in the second group. Our study provided real-life evidence of the percentage of patients with skin cancers during therapy with anti-IL mAbs, demonstrating a good safety profile of the investigated drugs.
Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) from contaminated water and risk of childhood cancer in California, 2000–2015
Authors: Binczewski Natalie R. , Morimoto Libby M. , Wiemels Joseph L. , Ma Xiaomei , Metayer Catherine , Vieira Verónica M.
Published: January 2025

Background:

Few studies have investigated associations between per- and polyfluoroalkyl substances (PFAS) and childhood cancers. Detectable levels of PFAS in California water districts were reported in the Third Unregulated Contaminant Monitoring Rule for 2013–2015.

Methods:

Geocoded residences at birth were linked to corresponding water district boundaries for 10,220 California-born children (aged 0–15 years) diagnosed with cancers (2000–2015) and 29,974 healthy controls. A pharmacokinetic model was used to predict average steady-state maternal serum concentrations of perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) from contaminated drinking water. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) per doubling of background exposure were calculated for cancers with at least 90 cases.

Results:

Predicted PFOS and PFOA maternal serum concentrations ranged from background (5 ng/ml PFOS and 2 ng/ml PFOA) to 22.89 ng/ml and 6.66 ng/ml, respectively. There were suggestive associations between PFOS and nonastrocytoma gliomas (n = 268; AOR = 1.26; 95% CI: 0.99, 1.60), acute myeloid leukemia (n = 500; AOR = 1.14; 95% CI: 0.94, 1.39), Wilms tumors (n = 556, AOR = 1.15; 95% CI: 0.96, 1.38), and noncentral system embryonal tumors (n = 2,880; AOR = 1.07; 95% CI: 0.98, 1.17), and between PFOA and non-Hodgkin lymphoma (n = 384; AOR = 1.19; 95% CI: 0.95, 1.49). Among children of Mexico-born mothers, there was increased risk of Wilms tumor (n = 101; AORPFOS = 1.52; 95% CI: 1.06, 2.18; AORPFOA = 1.59, 95% CI: 1.12, 2.24) and noncentral system embryonal tumors (n = 557; AORPFOS = 1.24, 95% CI: 1.03, 1.50; AORPFOA = 1.19, 95% CI: 0.98, 1.45).

Conclusion:

Results suggest associations between predicted prenatal maternal PFAS serum concentrations and some childhood cancers. Future analyses are warranted.
Robotic mitral valve surgery: evolving history, techniques, and training paths
Authors: Hasan Irsa , Amabile Andrea , Tam Derrick Y.
Published: January 2025

Purpose of review

Over the past 25 years, robotic-assisted mitral valve surgery has gained significant recognition because of its potential to minimize patient trauma and improve clinical outcomes. This field has evolved from early efforts in minimally invasive mitral procedures to more refined and technically sophisticated approaches, driven by the need for smaller incisions and reduced recovery times.

Recent findings

This review will delve into the historical evolution of robotic-assisted mitral valve surgery, detailing the technical advancements that have shaped current practices and outlining the essential training pathways for a career as robotic mitral valve surgeon.

The development of robotic systems has marked a turning point, offering surgeons greater precision and dexterity, crucial adjuncts in complex mitral valve repairs.
Investigation of the Ocular Response and Corneal Damage Threshold of Exposure to 28 GHz Quasi-millimeter Wave Exposure
Authors: Kojima Masami , Tasaki Takafumi , Kamijo Toshio , Hada Aki , Suzuki Yukihisa , Kik Alfred , Ikehata Masateru , Sasaki Hiroshi
Published: January 2025

Electromagnetic radiation energy at millimeter wave frequencies, typically 30 GHz to 300 GHz, is ubiquitously used in society in devices for telecommunications; radar and imaging systems for vehicle collision avoidance, security screening, and medical equipment; scientific research tools for spectroscopy; industrial applications for non-destructive testing and precise measurement; and military and defense applications. Understanding the biological effects of this technology is essential. We have been investigating ocular responses and damage thresholds comparing various frequencies using rabbit eyes and dedicated experimental apparatus. In this study we investigated the 28 GHz quasi-millimeter wave band (wavelength: 10.7 mm), a candidate for 5G communication. Similar to millimeter wave frequencies, ocular damage from exposure to 28 GHz for 6 min (400 mW cm−2) included corneal epithelial damage, corneal edema, and opacity. The incident power density threshold, indicating a 50% probability of ocular damage from exposure for 6 min, was found to be 359 mW cm−2 for 28 GHz. Comparing the ocular exposure area for various millimeter wave frequencies (40, 75, 95 GHz) and 28 GHz quasi-millimeter waves using a thermosensitive liquid crystal capsule, we found that for millimeter waves, even at identical incident power densities, the ocular exposure area decreases as the frequency increases (lens effect). However, this lens effect was not observed at 28 GHz, where the entire anterior segment area was exposed to radio waves.
HIV Vulnerability Typologies Among Adolescent Girls and Young Women in Lesotho: A Population-Based, Cross-Sectional, Latent Class Analysis
Authors: Shrader Cho-Hee , Jovanovski Straso , Saito Suzue , Reed Domonique , Ndagije Felix , Greenleaf Abigail
Published: January 2025

Adolescent girls and young women ages 15–29 years (AGYW) living in Lesotho experience a disproportionate HIV burden. Using a household-based national survey in Lesotho, we conducted a three-step latent class analysis to identify typologies of AGYW most vulnerable to HIV infection. We first classified AGYW into HIV vulnerability groups based on self-reported sexual behaviors, then identified associations between typology and HIV diagnosis. HIV vulnerability behaviors included early sexual debut, condomless sex, multiple sexual partners in the past year, sex with partners they do not know the status of or are living with HIV, age disparate sex, use of contraceptives, and having children. Across all age groups, we found that HIV vulnerability typologies could be described as low vulnerability, high vulnerability, and parous. As AGYW age, they engage in more types of higher vulnerability sexual behaviors; interventions to reduce this risk should start at a younger age. Our findings emphasize the importance of implementing and scaling up biomedical strategies such as pre-exposure prophylaxis.
Current approach to diagnosis and management of low-phospholipid associated cholelithiasis syndrome
Authors: Soret Pierre-Antoine , Chazouillères Olivier , Corpechot Christophe
Published: January 2025

Purpose of review

Low phospholipid-associated cholelithiasis (LPAC) syndrome is a rare genetic form of intrahepatic cholesterol lithiasis, affecting mainly young adults. This review describes the recent advances in genetic and clinical characterization, diagnosis and management of LPAC syndrome.

Recent findings

Recent publications report data from several retrospective cohorts. These cohorts describe the main clinical features, the most frequent radiological lesions, complications, the results of biliary endoscopic procedures and the prognosis associated with LPAC syndrome.

LPAC syndrome has been linked to a partial defect in the ATP binding cassette subfamily B member 4 (ABCB4) gene encoding the canalicular phospholipid transporter multidrug resistance protein 3, but this mechanism would explain only half the cases, or even fewer. This syndrome is characterized by the appearance of cholelithiasis at an abnormally early age (before 40) and by the persistence of biliary symptoms after cholecystectomy. The diagnosis is usually confirmed by an ultrasound scan of the liver, which reveals the presence of intrahepatic microlithiasis, as evidenced by comet-tail images or microspots along the intrahepatic bile ducts. Ursodeoxycholic acid, at a daily dose of 5–15 mg/kg, is the reference treatment. If not performed prior to diagnosis, cholecystectomy should be avoided wherever possible. In complicated or refractory forms, endoscopic biliary intervention may be necessary.
Ipsilateral Breast Carcinoma Recurrence
Authors: Fernández-Abad María , Caniego-Casas Tamara , Carretero-Barrio Irene , Calderay-Domínguez Milagros , Saavedra Cristina , Hardisson David , Palacios José , Pérez-Mies Belén
Published: January 2025

Determining whether an ipsilateral breast carcinoma recurrence is a true recurrence or a new primary remains challenging based solely on clinicopathologic features. Algorithms based on these features have estimated that up to 68% of recurrences might be new primaries. However, few studies have analyzed the clonal relationship between primary and secondary carcinomas to establish the true nature of recurrences. This study analyzed 70 breast carcinomas from 33 patients using immunohistochemistry, FISH, and massive parallel sequencing. We compared 35 primary carcinomas with the associated recurrences, identifying 24 (68.6%) as true recurrences, 7 (20%) as new primaries, and 4 (11%) as undetermined. Twenty-eight primary carcinomas were invasive carcinomas (22 of no special type, 5 invasive lobular, and 1 invasive micropapillary carcinoma), and 7 were in situ (6 ductal and 1 lobular). Time to recurrence was longer for new primaries (median 12.8 y) than for true recurrences (median 6.8 y). Among the new primary cases, 6 of 7 (85%) patients had undergone mastectomy as their initial treatment. Clinicopathologic classifications of invasive carcinomas overestimated the number of new primaries (41.6% to 68.6%), partially due to phenotype conversion in 14% of true recurrences. Although 41.7% of recurrences showed private mutations or amplifications relevant to tumor progression, such as PIK3CA, PIK3R1, MAP3K1, AKT1, GATA3, CCND1, MDM4, or T P 5 3; a common mutational progression pattern was not identified. Further studies, including larger series, are necessary to evaluate the prognostic significance of the molecular classification of recurrences.
A Qualitative Assessment of Barriers, Facilitators, and Outcomes in a Simulation-Based Collaborative Quality Improvement Program
Authors: Alletag Michelle J. , Kant Shruti , Van Ittersum Wendy L. , Walls Theresa A. , Montgomery Erin E. , Anderson Hannah L , Mannenbach Mark S. , Auerbach Marc A.
Published: January 2025

Objectives

ImPACTS (Improving Acute Care Through Simulation) is a collaborative simulation-based program partnering pediatric specialty centers (“hubs”) with general emergency departments (GEDs) to improve pediatric acute care. Objective measurements of ImPACTS, such as evaluating Pediatric Readiness Score (PRS) and simulation-based outcome improvements, have been reported previously. Barriers to and facilitators of program involvement and the downstream effects of the program have not been previously described. This study explores these aspects and key drivers for successful collaboration.

Methods

The authors performed open coding of semistructured interviews of hub team members and pediatric emergency care coordinators (PECCs) from community GED “spokes.” We then identified and explored themes within the categories of barriers to, facilitators of, and barrier mitigation strategies for successful partnerships from the perspectives of both groups.

Results

Analysis generated 4 dominant themes: buy-in, communication, personnel, and logistics. Engagement, institutional support, and buy-in of site leaders and individual participants were crucial to successful implementation, without which the programs were not completed or never started. Hubs benefited from project involvement via increased local engagement in pediatric readiness, organizational support, and further buy-in from institutional leadership, allowing for the future continuation of ImPACTS and similar programs. Benefits experienced by GEDs impacted education, pediatric readiness, and clinical and financial partnerships across institutions. Additionally, spoke interviewees cited downstream effects of participation, including increased collaboration and improved relationships with hub sites as being the most impactful.

Conclusion

Understanding the key drivers of all collaborators is instrumental in successfully implementing large-scale educational and quality initiatives like the ImPACTS program.
A National Survey of Caregiver Needs and Experiences When Attending the Emergency Department
Authors: Ali Samina , Rahimi Asa , Rajagopal Manasi , Ma Keon , Yaskina Maryna , Clerc Paul , Stang Antonia , Beer Darcy , Poonai Naveen , Kam April , Principi Tania , Gardner Katie , Wright Bruce , Plint Amy , Gouin Serge , Schreiner Kurt , Scott Shannon D. ,   on behalf of the Pediatric Emergency Research Canada Family Needs study team
Published: January 2025

Objectives

Despite being a frequent entry point of care, it remains unknown if families' needs are being met across pediatric emergency departments (PEDs). Study objectives were to describe caregivers' perceived overall PED experience and needs and to what extent these needs were met.

Methods

This descriptive, cross-sectional survey with medical record review was conducted in 10 Canadian PEDs. Caregivers completed electronic surveys in the PED and within 7 days postvisit. The primary outcome was the degree to which caregivers' overall needs were met in the PED.

Results

A total of 2005 caregivers participated; mean age was 37.8 (standard deviation 7.7) years and 74.3% (1462/1969) were mothers. Mean child age was 5.9 (standard deviation 5.1) years; 51.9% (1040/2003) were male. The median [interquartile range (IQR)] length of stay was 3.9 (2.6–6.1) hours. A total of 22.1% (322/1454) of caregivers reported that their overall needs were not adequately met (Likert scale 1–3/5). The top unmet needs during a PED visit were prompt medical care [20.3% (194/955)], access to practical items [16.8% (160/955)], and effective communication surrounding care [8.7% (83/955)]. Caregiver needs being met were associated with their child's needs being met [odds ratio (OR) 21.2 (13.1–34.2)], child's pain being well managed [OR 3.7 (2.4–5.6)], and satisfaction with overall length of stay [OR 2.6 (1.8–3.8)].

Conclusions

Almost one fourth of caregivers report their overall needs were not fully met. Improving the quality of PED experience through better communication (ie, wait time delays, medical updates) and earlier pain care initiation may improve family experiences while policymakers work nationally to address lengthy wait times.