bluuebunny/crossref_metadata_2025 huggingface dataset:
Two cases of concurrent carcinoma showing thymus-like differentiation (CASTLE) coexisting with papillary thyroid carcinoma
Authors: Zhao Qi , Bian Xuehai
Published: September 2023

Carcinoma showing thymus-like differentiation (CASTLE), which emerges within the thyroid gland or the adjacent soft tissues of the neck, is a rare malignant neoplasm found globally. The occurrence of CASTLE in conjunction with papillary thyroid carcinoma is an even more infrequent phenomenon. The ensuing sections elaborate upon the clinical attributes characteristic of CASTLE.
Incidental intraoperative finding of jejunal neuroendocrine tumors during elective ventral hernia repair
Authors: Reed Gasinee , Kim David , Hayes Kelsey , Wirz Richard
Published: September 2023

Neuroendocrine tumors (NETs) constitute ~0.5% of all diagnosed malignancies. In our case, a 72-year-old male, who was asymptomatic aside from mild left lower abdominal pain, was scheduled for elective ventral hernia repair, evident on computed tomography. The laparoscopic ventral hernia repair necessitated the conversion to laparotomy due to extensive adhesions and the incorporation of surgical mesh into the small bowel wall. The patient suffered from delayed small bowel injury resulting in the second emergent laparotomy when numerous calcified lesions were incidentally noted in the small bowel wall. Pathology confirmed Grade 1 well-differentiated NETs of the jejunum. This case highlights the importance of considering NETs as part of a differential diagnosis in patients with nonspecific symptoms and negative imaging studies. This case also emphasizes the importance of early detection of this rare pathology to improve prognosis and outcome.
Epenthesis and vowel intrusion in Central Dhofari Mehri
Authors: Watson Janet C E , Lourido Gisela Tomé , al-Mahri Abdullah
Published: September 2023

The paper discusses epenthesis and vowel intrusion in the Central Dhofari variety of Mehri, one of six endangered Modern South Arabian languages indigenous to southern Arabia. Mehri is spoken by members of the Mahrah tribe in southern Oman, eastern Yemen, parts of southern and eastern Saudi Arabia and in communities in parts of the Gulf and East Africa. The estimated number of Mehri speakers is between 100,000–180,000. Following Hall (2006), this study distinguishes between two types of inserted vowels: epenthetic vowels, which repair illicit syllable structures, and intrusive vowels, which transition between consonants. The paper examines how the properties of epenthetic and intrusive vowels as proposed by Hall relate to Mehri.
Verbal system and poetics in the works of Yehuda Ha-Lewi
Authors: Gryczan Barbara
Published: September 2023

The article analyzes the verbal system in the Hebrew language of Yehuda Ha-Lewi, which is (and was) represented solely by poetry. It points at Ha-Lewi’s poetics, as the central factor shaping his language, whose verbal forms were ascribed additional poetic functions. It aims to define grammatical units and rhetorical techniques which, combined, were used by Ha-Lewi to create his unique poetic style and linguistic system coherent, though seemingly mimicking Biblical Hebrew. Due to the uniqueness of the corpus of the language and the fact that the rhetorical functions were to a large extent ascribed to grammatical forms, in order to define them most accurately, I apply the discursive-pragmatic approach. This method has allowed to outline the matrix of Ha-Lewi’s verbal system and define its innovative features.
Tellurium emission line in kilonova AT 2017gfo
Authors: Hotokezaka Kenta , Tanaka Masaomi , Kato Daiji , Gaigalas Gediminas
Published: September 2023

The late-time spectra of the kilonova AT 2017gfo associated with GW170817 exhibit a strong emission line feature at $2.1\, {\rm \mu m}$. The line structure develops with time and there is no blueshifted absorption feature in the spectra, suggesting that this emission line feature is produced by electron collision excitation. We attribute the emission line to a fine structure line of Tellurium (Te) III, which is one of the most abundant elements in the second r-process peak. By using a synthetic spectral modelling including fine structure emission lines with the solar r-process abundance pattern beyond the first r-process peak, i.e. atomic mass numbers A ≳ 88, we demonstrate that [Te iii] $2.10\, \rm \mu m$ is indeed expected to be the strongest emission line in the near infrared region. We estimate that the required mass of Te iii is ∼10−3 M⊙, corresponding to the merger ejecta of 0.05 M⊙, which is in agreement with the mass estimated from the kilonova light curve.
A cautionary lesson from Gaia systematics: the mono-metallic globular cluster NGC 5904
Authors: Bianchini Paolo , Mastrobuono-Battisti Alessandra
Published: September 2023

The study of the chemistry of the stellar populations in globular clusters (GCs) is a fundamental task to unveil their formation in the high-redshift universe and to reconstruct the build-up of our Galaxy. Using metallicity estimates from BP/RP low-resolution Gaia DR3 spectra, a recent work presented the surprizing detection of two stellar populations with distinct metallicities in the stellar stream of the GC NGC 5904, otherwise considered a mono-metallic system. The presence of these two populations, with [Fe/H] ∼ −1.4 and [Fe/H] ∼ −2.0 dex, was taken as the evidence of a merger origin of the cluster. In this Letter, using the same data set complemented by new robust metallicity estimates, we carry out a detailed analysis of the metallicity distribution of stars belonging both to the cluster and to its stellar stream, explicitly focusing on the subtle effects of data systematics. We demonstrate that the population at [Fe/H] ∼ −2.0 dex is a data artefact due to error systematics, affecting especially faint stars. The new higher quality metallicity sample corroborates this finding, and it indicates the presence of only one population of stars with metallicity of [Fe/H] ∼ −1.3 dex, in agreement with previous literature studies. We, therefore, conclude that both NGC 5904 and its stellar stream are mono-metallic systems, and emphasize the need of carefully examining systematic effects in large and complex data.
Unmodificated stepless regulation of CRISPR/Cas12a multi-performance
Authors: Zhao Rong , Luo Wang , Wu You , Zhang Li , Liu Xin , Li Junjie , Yang Yujun , Wang Li , Wang Luojia , Han Xiaole , Wang Zhongzhong , Zhang Jianhong , Lv Ke , Chen Tingmei , Xie Guoming
Published: September 2023

As CRISPR technology is promoted to more fine-divided molecular biology applications, its inherent performance finds it increasingly difficult to cope with diverse needs in these different fields, and how to more accurately control the performance has become a key issue to develop CRISPR technology to a new stage. Herein, we propose a CRISPR/Cas12a regulation strategy based on the powerful programmability of nucleic acid nanotechnology. Unlike previous difficult and rigid regulation of core components Cas nuclease and crRNA, only a simple switch of different external RNA accessories is required to change the reaction kinetics or thermodynamics, thereby finely and almost steplessly regulating multi-performance of CRISPR/Cas12a including activity, speed, specificity, compatibility, programmability and sensitivity. In particular, the significantly improved specificity is expected to mark advance the accuracy of molecular detection and the safety of gene editing. In addition, this strategy was applied to regulate the delayed activation of Cas12a, overcoming the compatibility problem of the one-pot assay without any physical separation or external stimulation, and demonstrating great potential for fine-grained control of CRISPR. This simple but powerful CRISPR regulation strategy without any component modification has pioneering flexibility and versatility, and will unlock the potential for deeper applications of CRISPR technology in many finely divided fields.
A suspected case of Lyme disease causing complete heart block
Authors: Isha Shahin , Sharma Rohan , Hannon Rachel M , Sanghavi Devang K
Published: September 2023

Carditis is a rare complication of Lyme disease and usually presents in the early dissemination phase, several weeks after exposure to a tick bite. Conduction abnormalities are the most common manifestation of Lyme carditis. The presentation can vary from atrioventricular conduction delay (first-degree atrioventricular conduction block) to life-threatening situations, such as a complete heart block. Although such manifestations occur late, our case report describes an interesting case where the patient developed a complete heart block in the setting of acute Lyme disease. An elevated IgM with negative IgG Lyme serology titer, an unusual finding, initially led us to face a diagnostic dilemma. Our suspicion of a tick bite was affirmed when we detected a positive titer for Babesia microti, an organism carried by the same tick and a common co-infection with Lyme disease. The patient improved with antibiotic therapy and temporary pacemaker support during the initial few days of admission.
Carotidynia presenting as an atypical cause of unilateral neck pain in the emergency department
Authors: Baig Muhammad Akbar , Asad Sadia
Published: September 2023

Carotidynia is a rare presentation of atypical neck and face pain, which is due to inflammation around the carotid artery. Symptoms can get aggravated by head and neck movements, jaw movements and deglutition. It is usually a self- limiting illness, and it is treated conservatively with analgesics. Because of it is rarity, and partly due to physician’s lack of understanding, it remains underdiagnosed. Our case report aims to shed light on the importance of how its diagnosis cannot be missed.
Treatment of pediatric antimuscarinic delirium with oral rivastigmine
Authors: Yakey Brandtly , Vohra Varun , Martin Amarilis , King Andrew M
Published: September 2023

Antimuscarinic drug toxicity is a common pediatric emergency, which produces central and peripheral symptoms. Treatment of agitation and hyperactive antimuscarinic delirium, with first-line agents like cholinesterase inhibitors or benzodiazepines, is imperative to prevent severe toxicity. Intravenous physostigmine salicylate is a cholinesterase inhibitor that is commonly used to treat central antimuscarinic delirium. Its chemical structure facilitates crossing of the blood–brain barrier. Overlapping nationwide physostigmine and benzodiazepine shortages have prompted consideration of therapeutic alternatives. Rivastigmine is a long-acting cholinesterase inhibitor with a similar chemical structure to physostigmine. It represents a potential therapeutic option for antimuscarinic delirium. Rivastigmine offers potential benefits over physostigmine including a longer duration of action, slower rate of central nervous system penetration, more favorable side effect profile, and availability in multiple formulations. A paucity of literature exists describing the use of rivastigmine for central antimuscarinic delirium. We describe the effective use of oral rivastigmine in a child with central antimuscarinic delirium.
Development and External Validation of Individualized Prediction Models for Pain Intensity Outcomes in Patients With Neck Pain, Low Back Pain, or Both in Primary Care Settings
Authors: Archer Lucinda , Snell Kym I E , Stynes Siobhán , Axén Iben , Dunn Kate M , Foster Nadine E , Wynne-Jones Gwenllian , van der Windt Daniëlle A , Hill Jonathan C
Published: September 2023

Objective

The purpose of this study was to develop and externally validate multivariable prediction models for future pain intensity outcomes to inform targeted interventions for patients with neck or low back pain in primary care settings.

Methods

Model development data were obtained from a group of 679 adults with neck or low back pain who consulted a participating United Kingdom general practice. Predictors included self-report items regarding pain severity and impact from the STarT MSK Tool. Pain intensity at 2 and 6 months was modeled separately for continuous and dichotomized outcomes using linear and logistic regression, respectively. External validation of all models was conducted in a separate group of 586 patients recruited from a similar population with patients’ predictor information collected both at point of consultation and 2 to 4 weeks later using self-report questionnaires. Calibration and discrimination of the models were assessed separately using STarT MSK Tool data from both time points to assess differences in predictive performance.

Results

Pain intensity and patients reporting their condition would last a long time contributed most to predictions of future pain intensity conditional on other variables. On external validation, models were reasonably well calibrated on average when using tool measurements taken 2 to 4 weeks after consultation (calibration slope = 0.848 [95% CI = 0.767 to 0.928] for 2-month pain intensity score), but performance was poor using point-of-consultation tool data (calibration slope for 2-month pain intensity score of 0.650 [95% CI = 0.549 to 0.750]).

Conclusion

Model predictive accuracy was good when predictors were measured 2 to 4 weeks after primary care consultation, but poor when measured at the point of consultation. Future research will explore whether additional, nonmodifiable predictors improve point-of-consultation predictive performance.

Impact

External validation demonstrated that these individualized prediction models were not sufficiently accurate to recommend their use in clinical practice. Further research is required to improve performance through inclusion of additional nonmodifiable risk factors.
Utility of the capabilities, opportunities, motivations model for understanding changes in behavior
Authors: Armitage Christopher J , Keyworth Chris , Gartland Nicola , Coleman Anna , Fishwick David , Johnson Sheena , van Tongeren Martie
Published: September 2023

Background

Wearing face coverings to prevent airborne viral transmission has at times been legally mandated, followed by periods when rules were relaxed. The present study tracks changes in face covering and the impacts on people’s perceptions of their capabilities, opportunities and motivations.

Methods

Three-wave survey. At wave 1 (25 January–6 February 2022), 10 622 UK adults reported: (a) sociodemographic characteristics; (b) face covering in work, public transport and indoor leisure settings and (c) capabilities, opportunities and motivations. Measures were repeated 1–18 March 2022 and 20 May–6 June 2022. Data were analyzed descriptively, within-participants analysis of covariance (ANCOVA) and multiple linear regression.

Results

Face covering decreased over time as rules around the wearing of face coverings relaxed. Perceptions of capabilities, opportunities and motivations to wear face coverings were consistently associated with the actual wearing of face coverings, with marked decreases in motivations over time.

Conclusions

Decreases in motivations seem to explain best the reasons for declining levels of face covering. Further work is required to develop interventions to change people’s motivations and promote the wearing of face coverings, should they be required in the future.
Measuring Total Carbon Pricing
Authors: Agnolucci Paolo , Fischer Carolyn , Heine Dirk , Montes de Oca Leon Mariza , Pryor Joseph , Patroni Kathleen , Hallegatte Stéphane
Published: September 2023

While countries increasingly commit to pricing greenhouse gases directly through carbon taxes or emissions trading systems, indirect forms of carbon pricing—such as fuel excise taxes and fuel subsidy reforms—remain important factors affecting the mitigation incentives in an economy. Taken together, how can policy makers think about the overall price signal for carbon emissions and the incentive it creates? We develop a methodology for calculating a total carbon price applied to carbon emissions in a sector, a fuel, or the whole economy. We recognize that rarely is a single carbon price applied across an economy; many direct carbon pricing instruments target specific sectors or even fuels, much like indirect taxes on fossil fuels; and carbon and fuel taxes can be substituted for one another. Tracking progress on carbon pricing thus requires following both kinds of price interventions, their coverage, and specific exemptions. This inclusive total carbon pricing measure can facilitate progress in discussions on minimum carbon price commitments and inform assessments of the pricing of carbon embodied in traded goods. Calculations across 142 countries from 1991 to 2021 indicate that although direct carbon pricing now covers roughly one-quarter of global emissions, the global total carbon price is not that much higher than it was in 1994 when the United Nations Framework Convention on Climate Change entered into force. Indirect carbon pricing still comprises the lion's share of the global total carbon price, and it has stagnated. Taking these policy measures into account reveals that many developing countries—particularly net fuel importers—contribute substantially to global carbon pricing. Tackling fuel subsidy reform and pricing coal and natural gas emissions more fully would have a profound effect on aligning carbon prices across countries and sectors and with their climate costs.
Modeling the Airborne Inoculum of Polystigma amygdalinum to Optimize Fungicide Programs Against Almond Red Leaf Blotch
Authors: Pons-Solé Gemma , Torguet Laura , Marimon Neus , Miarnau Xavier , Lázaro Elena , Vicent Antonio , Luque Jordi
Published: September 2023

Red leaf blotch (RLB) of almond, caused by the ascomycete Polystigma amygdalinum, is a severe foliar disease endemic in the Mediterranean Basin and Middle East. Airborne ascospores of P. amygdalinum were monitored from 2019 to 2021 in two almond orchards in Lleida, Spain, and a Bayesian beta regression was used to model its seasonal dynamics. The selected model incorporated accumulated degree-days (ADD), ADD considering both vapor pressure deficit and rainfall as fixed effects, and a random effect for the year and location. The performance of the model was evaluated in 2022 to optimize RLB fungicide programs by comparing the use of model predictions and action thresholds with the standard program. Two variants were additionally considered in each program to set the frequency between applications, based on (i) a fixed frequency of 21 days or (ii) specific meteorological criteria (spraying within 7 days after rainfalls greater than 10 mm, with daily mean temperatures between 10 and 20°C, and with a minimum frequency of 21 days between applications). Programs were evaluated in terms of RLB incidence and number of applications. The program based on the model with periodic fungicide applications was similarly effective as the standard program, resulting only in a 2.6% higher RLB incidence but with fewer applications (three to four, compared with seven in the standard program). When setting the frequency between applications by using the meteorological criteria, a higher reduction in the number of applications (two to three) was observed, while RLB incidence increased by roughly 16% in both programs. Therefore, the model developed in this study may represent a valuable tool toward a more sustainable fungicide schedule for the control of almond RLB in northeast Spain.
Pathway to Independence Awards (K99/R00): Funding Dynamics and Prediction of Future National Institutes of Health Research Project Funding
Authors: Gillen Kelly M. , Markowitz Daniel M. , Long Patricia , Villegas-Estrada Adriel , Anglon Gabriela , Chang Eileen , Gupta Ajay
Published: September 2023

Purpose

The authors used the National Institutes of Health (NIH) RePORTER (Research Portfolio Online Reporting Tools) to evaluate funding trends and historic NIH investment increase in the K99 award pathway and examine whether R00 to R01 or R21 achievement time correlated with the future success of an early-stage NIH-funded investigator.

Method

All K99 awards and funding data in this study were limited to all clinical departments. The authors identified all researchers and awards through a K99 search from fiscal years (FYs) 2007 to 2022 across all clinical departments and investigated trends in K99 awards and funding from NIH FYs 2007 to 2022. They generated an R00 data set and analyzed the K99 to R00 achievement statistics from FYs 2007 to 2022. The authors aggregated NIH annual data files for FYs 2007 to 2021 to generate a master data file of all R01 and R21 awards. They linked R01 and R21 award data to the researcher previously identified through the K99 search and focused on the connection between K99/R00 awardees and subsequent R01 or R21 awards.

Results

From FY 2008 to FY 2022, the NIH K99 budget increased 127.0%, whereas the NIH program-level budget increased 17.3%. A principal investigator’s mean funding per year significantly decreased as time from R00 to R01 or R21 increased (P < .001); 7 of 15 comparisons differed significantly (2 at P < .01 and 5 at P < .001).

Conclusions

NIH investment in the K99 award pathway has substantially outpaced the NIH program-level budget increase, and there is a strong association between mean funding per year since the start of the R00 phase and time from R00 to R01 or R21. This analysis may be useful to clinical departments as they evaluate selecting new and retaining current biomedical scientists for independent research positions.
Baseline High-Sensitivity C-Reactive Protein as a Predictor of Adverse Clinical Events in Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Meta-Analysis
Authors: Yang Shanshan , Pan Yuxiang , Zheng Wan
Published: September 2023

Inflammation in patients with coronary artery disease (CAD) has been linked to adverse clinical outcomes. A useful biomarker for measuring inflammation levels, high-sensitivity C-reactive protein (hs-CRP) in the blood can be used to detect the presence of low-grade inflammation. This study sought to assess the predictive value of baseline hs-CRP levels for adverse clinical events in CAD patients undergoing percutaneous coronary intervention (PCI). To investigate this topic, a meta-analysis was performed. We conducted a systematic search of PubMed, Embase, and the Cochrane Library for original articles reporting the correlation between hs-CRP levels and adverse clinical events in CAD patients undergoing PCI. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and conducted a meta-analysis by extracting relevant data. Our pooled calculations yielded hazard ratios or odds ratios with 95% confidence intervals. A total of 28 studies comprising 60544 patients were included in this analysis. High baseline hs-CRP levels predicted increased risk for major adverse cardiac events (P = 0.037), major adverse cardiac and cerebrovascular events (P = 0.020), all-cause mortality (P = 0.001), cardiovascular mortality (P < 0.001), death and/or myocardial infarction (P = 0.017) in patients, as well as restenosis (P < 0.001). However, there was no association between elevated baseline hs-CRP levels and thrombosis. In conclusion, in CAD patients undergoing PCI, baseline hs-CRP levels are reliable predictors of major adverse cardiac events, major adverse cardiac and cerebrovascular events, all-cause mortality, cardiovascular mortality, death and/or myocardial infarction, and restenosis. Therefore, hs-CRP can effectively assist in prognosis determination for CAD patients undergoing PCI.
Evaluating the Health of the Work Environment and the Perception of New Nurses During the Transition to Practice in Critical Care
Authors: Gellner Paula , DiLibero Justin , Griffin Annette
Published: September 2023

Background

New nurses are the major source of hiring for most hospitals. They fill vacancies left by seasoned nurses creating an experience-complexity gap. Turnover among new-graduate nurses is as high as 85% in the first 2 years.

Objectives

The purpose of this study was to provide a deeper understanding of the factors contributing to turnover. The specific aims were (1) to better understand novice nurses' perceptions of their transition to critical-care practice and (2) to describe all eligible critical-care nurses' perceptions of a healthy work environment.

Methods

A quantitative descriptive design was used. Data were collected over 3 weeks in February 2022 from novice nurses (n = 12) who completed the Casey-Fink Nurse Experience Survey and from novice and experienced nurses (n = 47) who completed the American Association of Critical-Care Nurses' Healthy Work Environment Assessment Tool. Data were analyzed using descriptive statistics.

Results

Respondents to the Casey-Fink Nurse Experience Survey (n = 12) indicated feeling well supported by family, friends, and preceptors, although they felt less positive about prioritizing care, organizing patient needs, and recommending changes to the plan of care. The overall mean score on the Health Work Environment Assessment Tool was 2.99 (n = 47), indicating the need for improvement. Responses varied by unit, years of experience, and certification status.

Conclusion

This study contributes to the evolving body of nursing knowledge and has provided a more detailed understanding of the health of the work environment and perceptions of new nurses during the transition to practice.
Grief Support and Coping Mechanism Mediate the Effect of Grief on Burnout Among Intensive Care Unit Nurses
Authors: Jit Singh Gurbinder Kaur , Low Wah Yun , Abdullah Khatijah Lim
Published: September 2023

Background

Patients' death caused the intensive care unit (ICU) nurses to grieve, which led to their burnout. Intensive care unit nurses use various coping mechanisms and need support to overcome grief.

Objective

The aim of this study was to identify the mediation effects of coping mechanisms and grief support on the impact of grief on burnout.

Method

This cross-sectional study among 660 ICU nurses from 9 hospitals used 4 self-reported instruments to collect data, apart from the sociodemographic and employment-related variables. A final model was developed through structural equation modeling after establishing the construct validities of the measures through confirmatory factor analysis.

Results

The representation of ICU nurses from each hospital was greater than 50%, with the majority being female (90.8%) with a mean age of 27.27 years. Most nurses perceived the absence of grief, low burnout, and moderate to low grief support. The nurses use various coping mechanisms. Grief support significantly mediated the relationship between grief and burnout using a bootstrapping method with a mediation strength using the variance counted for (VAF) of 34.95%. The final model fit indices with acceptable values validated the direct and indirect relationships of grief, grief support, and coping mechanisms on burnout.

Discussion

The significant influence of grief support in mediating the effect of grief on burnout is an important finding. The nursing and hospital management can use this finding to provide grief support to ICU nurses, enhance the grief support resources, and promote future studies to test the model's validity and applicability to health care professionals who frequently face patients' death.
Effectiveness of Trachomatous Trichiasis Case-identification Approaches in Ethiopia
Authors: Diallo Alpha Oumar , Bayissasse Belay , Sisay Alemayehu , Seyum Dawit , Weaver Jerusha , Munoz Beatriz , Merbs Shannath L. , Gower Emily W.
Published: September 2023

Background:

Trachoma control programs use multiple approaches to identify individuals with trachomatous trichiasis (TT). Evidence is limited regarding which approaches are most effective and cost-efficient.

Methods:

We evaluated the effectiveness of two TT case-identification approaches in Ethiopia: community mobilization to encourage self-referral for centralized screening and house-to-house screenings conducted by case finders. We compared the number of true cases found per 1000 population and costs associated with case identification under each approach, stratified by villages that received one or multiple screening visits.

Results:

We conducted screenings in 396 villages. In villages receiving one house-to-house visit, case finders identified 14,229 suspected cases, of whom 10,513 (73.9%) presented for TT confirmation. A median of 17.2% (interquartile range [IQR]: 9.1%–27.8%) of those presenting truly had TT (positive predictive value). In single-visit villages, the community mobilization approach yielded higher rates of confirmed cases than the house-to-house approach (1.5 [IQR: 1.1, 2.6] vs. 1.1 [IQR: 0.5, 1.9] cases per 1000 population), and the median cost of identifying a TT case was less ($5.59 vs. $31.18) using community mobilization than house-to-house. In multiple-visit villages, additional screening visits increased the median rate of confirmed cases to 2.5 per 1000 population in community mobilization villages, but the rate remained unchanged in house-to-house villages.

Conclusions:

Community mobilization-based TT case finding had a higher yield than house-to-house, at a substantially lower cost. Future research should examine whether additional tools to aid case finders in their diagnosis increases case-finding efficiency and accuracy and whether TT prevalence and surgical program duration impact case-finding success.
High Summer Temperatures and Heat Stroke Mortality in Spain
Authors: Tobías Aurelio , Madaniyazi Lina , Gasparrini Antonio , Armstrong Ben
Published: September 2023

Background:

Heat stroke is a significant cause of mortality in response to high summer temperatures. There is limited evidence on the pattern and magnitude of the association between temperature and heat stroke mortality. We examined this association in Spain, using data from a 27-year follow-up period.

Methods:

We used a space-time-stratified case–crossover design. We analyzed data using conditional quasi-Poisson regression with distributed lag nonlinear models.

Results:

Spain recorded a total of 285 heat stroke deaths between 1990 and 2016. Heat stroke deaths occurred in 6% of the days in the summer months. The mean temperature was, on average, 5 °C higher on days when a heat stroke was recorded than on days without heat stroke deaths. The overall relative risk was 1.74 (95% confidence interval = 1.54, 1.96) for a 1 °C rise in mean temperature above the threshold of 16 °C, at which a heat stroke death was first recorded. We observed lagged effects as long as 10 days.

Conclusions:

Although heat stroke represents a small fraction of total heat-attributable mortality during the summer, it is strongly associated with high temperatures, providing an immediately visible warning of heat-related risk.
Nonselective beta-blockers may lead to stage 2 acute kidney injury and waitlist mortality in child class C cirrhosis
Authors: Lai Mason , Fenton Cynthia , Ge Jin , Rubin Jessica , Lai Jennifer C. , Cullaro Giuseppe
Published: September 2023

Background and Aims:

Nonselective beta-blockers (NSBB) protect patients with compensated cirrhosis; however, it is unclear if NSBB is associated with acute kidney injury (AKI) in patients with decompensated cirrhosis. We aimed to determine if the use of NSBB was associated with an increased risk of stage II AKI or greater and waitlist mortality (WLM) among patients with decompensated cirrhosis awaiting liver transplant stratified by cirrhosis severity.

Methods:

Included were 1816 outpatients listed for liver transplantation at UCSF from June 2012 to April 2022. Our primary outcome was stage 2 AKI (>200% increase in serum creatinine). Our secondary outcome was WLM (all-cause mortality). Our primary exposure was the use of any NSBB derived using natural language processing of clinical notes. Multivariable Cox proportional hazards models with time-dependent variables were used to determine the HR of NSBB use on stage 2 AKI and WLM, stratified by Child-Pugh Score.

Results:

The average age of the cohort was 58 years old, with 35% identifying as female. In multivariable time-dependent models, NSBB use was associated with 1.53 × (95 CI 1.19–1.97) the hazard of stage 2 AKI in the cohort overall and 1.80 × (95 CI 1.26–2.57) among those with Child C cirrhosis, respectively. Similarly, NSBB use was associated with 1.30 × (95 CI 1.07–1.59) and 1.45 × (95 CI 1.03–2.03) the hazard of WLM, overall and in Child C, respectively. NSBB use was not significantly associated with AKI nor WLM among those with Child A.

Conclusion:

NSBB use is associated with Stage 2 AKI and WLM in patients awaiting liver transplantation and Child C cirrhosis. These data suggest cautious use of NSBBs in patients in this population.
Time trends in mortality and life expectancy in 22,658 patients hospitalized with alcohol-associated cirrhosis: A nationwide cohort study
Authors: Wester Axel , Shang Ying , Stål Per , Hagström Hannes
Published: September 2023

Background:

The management of alcohol-associated cirrhosis has improved in the last decades, but whether the prognosis has changed over time is uncertain. We aimed to assess time trends in mortality and life expectancy in patients hospitalized with alcohol-associated cirrhosis.

Methods:

In this population-based cohort study, we used the Swedish national population and health registers to identify all patients with a first episode of in-hospital alcohol-associated cirrhosis from 1969 to 2019 (n = 22,658). Time trends in 1-year mortality were assessed with multivariable Cox regression. A flexible parametric model was fitted to evaluate loss in life expectancy.

Results:

Crude mortality was similar in the 2010s and 1980s (unadjusted HR = 1.00, 95% CI = 0.93–1.08, ptrend = 0.767). However, when adjusting for baseline characteristics, mortality was lower in the 2010s than in the 1980s (adjusted HR = 0.74, 95% CI = 0.68–0.80), including both liver- and nonliver-related mortalities. These results were consistent in men but not in women, where only nonliver mortality had decreased. The average loss in life expectancy for patients with alcohol-associated cirrhosis compared with the general population was similar throughout the study period (in the 2010s: 14.3 y shorter (95% CI = 13.7–14.9) in men and 15.8 years shorter (95% CI = 14.9–16.7) in women).

Conclusion:

Mortality in patients hospitalized with alcohol-associated cirrhosis has improved somewhat when accounting for baseline characteristics, but the loss in life expectancy remains substantial. This underscores the need for new therapeutic options and health policy interventions to further improve the dismal prognosis and life expectancy of patients with alcohol-associated cirrhosis.
Characterization of Rheum palmatum mitochondrial genome and comparative analysis among Caryophyllales species
Authors: Gao Longlong , Hao Lijun , Xu Wenjie , Xin Tianyi , Song Chi , Lin Yulin , Zhu Lingping , Song Jingyuan
Published: September 2023

Objective:

This work aimed to report the first complete mitochondrial genome (mitogenome) of Rheum palmatum, summarize the features of Caryophyllales mitogenomes, and to reveal the potential of utilizing the mitogenomes of R. palmatum and other Caryophyllales species for inferring phylogenetic relationships and species identification.

Methods:

Both Illumina short reads and PacBio HiFi reads were utilized to obtain a complete mitogenome of R. palmatum. A variety of bioinformatics tools were employed to characterize the R. palmatum mitogenome, compare the reported mitogenomes in Caryophyllales and conduct phylogenetic analysis.

Results:

The mitogenome of R. palmatum was assembled into a single master circle of 302,993 bp, encoding 35 known protein-coding genes, 18 transfer RNA genes, and three ribosome RNA genes. A total of 249 long repeats and 49 simple sequence repeats were identified in this mitogenome. The sizes of mitogenomes in Caryophyllales varied from 253 kb to 11.3 Mb. Among them, 23 mitogenomes were circular molecules, one was linear, and one consisted of relaxed circles, linear molecules, and supercoiled DNA. Out of the total mitogenomes, 11 were single-chromosome structure, whereas the remaining 14 were multi-chromosomal organizations. The phylogenetic analysis is consistent with both the Engler system (1964) and the Angiosperm Phylogeny Group III system.

Conclusions:

We obtained the first mitogenome of R. palmatum, which consists of a master circle. Mitogenomes in Caryophyllales have variable genome sizes and structures even within the same species. Circular molecules are still the dominant pattern in Caryophyllales. Single-chromosome mitogenomes account for nearly a half of all the mitogenomes in Caryophyllales, in contrast to previous studies. It is feasible to utilize mitochondrial genomes for inferring phylogenetic relationships and conducting species identification.
From drusen to type 3 macular neovascularization
Authors: Bousquet Elodie , Santina Ahmad , Corradetti Giulia , Sacconi Riccardo , Ramtohul Prithvi , Bijon Jacques , Somisetty Swathi , Voichanski Shilo , Querques Giuseppe , Sadda SriniVas , Freund K. Bailey , Sarraf David
Published: September 2023

Purpose:

To investigate the imaging features preceding the occurrence of type 3 (T3) macular neovascularization (MNV) using tracked spectral-domain optical coherence tomography (SD-OCT).

Method:

From a cohort of eyes with T3 MNV and ≥ 12 months of prior tracked SD-OCT, T3 lesions that developed above soft drusen were selected for OCT analysis. Retinal imaging findings at the location where type T3 MNV occurred were analyzed at each follow-up until the onset of T3 MNV. The following OCT parameters were assessed: drusen size (height and width), outer nuclear layer (ONL)/ Henle fiber layer (HFL) thickness at the drusen apex, and the presence of intraretinal hyperreflective foci (HRF), retinal pigment epithelium (RPE) disruption, incomplete RPE and outer retina atrophy (iRORA), and complete RORA (cRORA).

Results:

From a cohort of 31 eyes with T3 MNV, T3 lesions developed above soft drusen in 20 eyes (64.5%). Drusen showed progressive growth (p<0.001) associated with ONL/HFL (p<0.001) thinning prior to T3 MNV. The following OCT features were identified preceding the occurrence of T3 MNV, typically at the apex of the drusenoid lesion: disruption of the external limiting membrane (ELM)/ellipsoid zone (EZ) and/or the RPE, HRF, and iRORA/cRORA.

Conclusion:

Our results demonstrate specific anatomic alterations preceding the occurrence of T3 MNV that most commonly originates above soft drusen. Drusen growth, reduced ONL/HFL thickness, and RPE atrophy at the drusen apex precede the development of T3 MNV. Identifying these OCT features should warrant close monitoring for identification of T3 MNV which can benefit from prompt intravitreal anti-VEGF therapy.
A CASE OF ELSCHNIG SPOTS OBSERVED USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AFTER STENTING FOR INTERNAL CAROTID ARTERY DISSECTION
Authors: Saito Kazuma , Uchida Yuto , Tokui Shunsuke , Akiyama Hideo
Published: September 2023

Purpose:

We report the case of a 28-year-old man who developed Elschnig spots after stenting for an internal carotid artery dissection using optical coherence tomography angiography.

Methods:

This was a case report.

Results:

The patient developed a visual field defect in the left eye immediately after endovascular stenting for left internal carotid artery dissection. Fundus examination revealed white lesions and numerous mottled orange–red lesions in the posterior pole and midperiphery of the left eye. Indocyanine green angiography revealed mottled hypofluorescein areas in the early and late stages, coinciding with the orange–red lesions. Optical coherence tomography angiography showed flow void areas in the choriocapillaris layer, consistent with the orange–red lesions, which were diagnosed as Elschnig spots associated with choroidal circulatory failure. The spots disappeared approximately 2 months after surgery, and the flow void on optical coherence tomography angiography also disappeared.

Conclusion:

We report a case of Elschnig spots associated with transient choroidal circulatory failure after stenting for internal carotid artery dissection. Optical coherence tomography angiography detected improved circulation at the level of the choriocapillaris with the disappearance of Elschnig spots.
PROGRESSION OF CHOROIDAL THICKNESS ON ENHANCED DEPTH IMAGING-OPTICAL COHERENCE TOMOGRAPHY AS THE FIRST SIGN OF ORBITAL LYMPHOMA
Authors: Vela José Ignacio , Giró-Rosa Marta , García-Vilaró Marta , Loscos-Giménez Irene , Rego-Lorca Daniela , Schwember Philipp
Published: September 2023

Purpose:

To present an orbital extranodal marginal zone B-cell lymphoma (mucosa-associated lymphoid tissue lymphoma) with increased choroidal thickness as the first diagnostic sign.

Methods:

A patient presented with mild blurred vision in the left eye. Progressively increased choroidal thickness was demonstrated by enhanced depth imaging–optical coherence tomography and ocular ultrasound-confirmed diffuse choroidal effusion. Orbital MRI revealed a well-circumscribed intraconal orbital mass surrounding the optic nerve and molding around the globe. An orbital biopsy of the lesion with subsequent histologic and immunohistochemical analyses demonstrated mucosa-associated lymphoid tissue lymphoma.

Results:

After initial treatment with rituximab without improvement, the patient received orbital radiotherapy (36 Gy in 20 sessions). A reduction in choroidal thickness was observed during follow-up visits. Congestion of the choroidal vasculature and choroidal infiltration by the lymphoma are discussed as possible causative mechanisms.

Conclusion:

Enhanced depth imaging–optical coherence tomography can be a helpful tool to detect the presence of orbital lymphoid tumors in contact with the globe and to monitor response to therapy.
Occupational Pregnancy Discrimination Is Associated With Negative Health Impacts for Pregnant Persons and Their Children
Authors: Borrowman Jaclyn Dziewior , Krumboltz Raegan , Jones Melissa , Whitaker Kara M.
Published: September 2023

Objective

The aim of the study is to examine associations between occupational pregnancy discrimination, maternal, and child health.

Methods

A nationwide sample of individuals currently in their third trimester of pregnancy who worked full-time (>35 hr/wk) were recruited. Surveys were completed during the third trimester and 6 weeks postpartum.

Results

Respondents (N = 183) were mostly White (57.9%), had at least a bachelor’s degree (60.8%), and worked 40.3 hr/wk. Occupational pregnancy discrimination increased the odds of clinically significant depressive/anxiety symptoms by 8% and 17%, respectively (odds ratio = 1.1, 95% confidence interval: 1.0–1.1; odds ratio = 1.2, 95% confidence interval: 1.1–1.2). Discrimination was also associated with postpartum depression occurrence (P = 0.02). Social support level mitigated the association between pregnancy discrimination, depressive symptoms (β = 2.1, P < 0.01), and anxiety symptoms (β = 7.25, P < 0.01).

Conclusions

Poorer mental health during and after pregnancy was associated with occupational pregnancy discrimination but effects were mitigated by social support.
Neurosurgical application of pineal region tumor resection with 3D 4K exoscopy via infratentorial approach: a retrospective cohort study
Authors: Hua Wei , Zhang Xin , Wang Qijun , Qiu Tianming , Yang Zixiao , Wang Xiaowen , Xu Hao , Zhang Jinsen , Yu Guo , Fu Minjie , Chen Liang , Zhu Wei , Mao Ying
Published: September 2023

Background:

The pineal region tumors are challenging for neurosurgeons and can lead to secondary hydrocephalus. The advent of the exoscope has provided clinical interventions with high image quality and an ergonomic system for pineal region tumor operations. In this study, we describe the exoscopic approach used to facilitate the surgical resection of pineal region tumors and relieve hydrocephalus.

Materials and Methods:

In this retrospective cohort study, we consecutively reviewed clinical and radiological data of 25 patients with pineal region lesions who underwent three-dimensional exoscopic tumor resection at a single center.

Results:

The patient cohort consisted of 16 males and 9 females, with an average age of 34.6 years (range, 6-62 years; 8 cases aged ≤18). Pathological examination confirmed eight pineal gland tumors, four gliomas, nine germ cell neoplasms, two ependymomas, and two metastatic tumors. Preoperative hydrocephalus was present in 23 patients. Prior to tumor resection, external ventricular drainage (EVD) with Ommaya reservoir implantation was performed in 17 patients. Two patients received preoperative endoscopic third ventriculostomy (ETV), and five patients received a ventriculoperitoneal (VP) shunt, including one who received both procedures. Gross total resection was achieved in 19 patients (76%) in the “head-up” park bench position using the exoscope. Eight patients (31.6%) with third ventricle invasion received subtotal resection, mainly in glioma cases, which was higher than those without invasion (0%), but not statistically significant (P=0.278, Fisher’s exact test). No new neurological dysfunction was observed after surgery. Two patients (8%) developed intracranial and pulmonary infections, and two patients (8%) suffered from pneumothorax. Hydrocephalus was significantly relieved in all patients postoperatively, and four patients with relapse hydrocephalus were cured during the long-term follow-up. Postoperative adjuvant management was recommended for indicated patients, and a mean follow-up of 24.8±14.3 months showed a satisfied outcome.

Conclusion:

The exoscope is a useful tool for pineal region tumor resection and hydrocephalus relief, particularly with posterior third ventricle invasion, as total resection could be achieved without obvious complication. The special superiority of exoscope for indicated pineal region tumors should be highlighted.
Venous thromboembolism prophylaxis practices for patients with sickle cell disease prior to and during the COVID-19 pandemic
Authors: Davila Jennifer , Mitchell William B. , Morrone Kerry , Silver Ellen J. , Minniti Caterina P. , Billett Henny H. , Desai Payal C. , O’Brien Sarah H. , Manwani Deepa
Published: September 2023

Patients with sickle cell disease (SCD) are predisposed to a hypercoagulable state due to alterations in the coagulation system. Despite concern for the development of venous thromboembolism (VTE) in this population, there are no standardized guidelines for routine thromboprophylaxis.

The objective of this study was to assess thromboprophylaxis practices of adult and pediatric treaters of SCD before and during the coronavirus disease of 2019 (COVID-19) pandemic.

A cross-sectional electronic survey was distributed to pediatric and adult hematology oncology practitioners through seven SCD-specific interest groups between May 29, 2020, and July 13, 2020.

Of 93 total responses, 14% (N = 13) reported they only treat patients more than 21 years old; 38.7% (N = 36) only treat patients 0–21 years old and 47.3% (N = 44) reported they treat both. Our study showed that before the COVID-19 pandemic, 96% of adult practitioners would recommend pharmacologic thromboprophylaxis, mechanical thromboprophylaxis or both for hospitalized adults with thromboprophylaxis, but only 76% of pediatric treaters would recommend any thromboprophylaxis in hospitalized children (P < 0.0001), with 24% of pediatric treaters choosing no thromboprophylaxis at all.

During the COVID-19 pandemic, pharmacologic thromboprophylaxis specifically was recommended for adults by 94% of treaters and for pediatric patients by 76% of treaters. These findings suggest that despite the lack of evidence-based thromboprophylaxis guidelines in adults and children with thromboprophylaxis, subspecialty treaters routinely provide pharmacologic thromboprophylaxis in their adult patients and will modify their practice in pediatric patients who are considered at a high risk for VTE.