bluuebunny/crossref_metadata_2025 huggingface dataset:
At5g63290 does not encode coproporphyrinogen III oxidase
Authors: Ji Wenjuan , Wang Huijuan , An Ning , Zhou Xuan , Wen Bingxiao , Grimm Bernhard , Liu Zhenhua
Published: January 2025

At5g63290 is not responsible for the decarboxylation of coproporphyrinogen III, prompting a revision of the tetrapyrrole biosynthesis pathway in Arabidopsis thaliana.
Effect of laparoscopic cholecystectomy on plasma levels of EETs, arachidonic acids derived lipid mediators
Authors: Sarı İsmail , Bolat Hacı , Özmen Esma , Köse Burcu , Ayan Durmuş
Published: January 2025

Background

Epoxyeicosatrienoic acids (EETs) are closely associated with lipoprotein metabolism, and changes in lipid profiles potentially affect their levels and functions. Given the alterations in lipid metabolism after cholecystectomy, this study aimed to investigate the levels of four EET regioisomers (free and esterified) and lipid profiles in patients with cholelithiasis after laparoscopic cholecystectomy (LC) and explore correlations between these parameters.

Methods

This prospective study involved 40 patients with symptomatic cholelithiasis who underwent LC. Plasma EETs and serum total cholesterol, triglyceride, high-density lipoprotein (HDL), very low-density lipoprotein, low-density lipoprotein, and body mass index (BMI) values were determined preoperatively and after 6 months of LC.

Results

After LC, triglyceride and very low-density lipoprotein levels increased while TC decreased. BMI values increased significantly after the operation. Despite plasma EET levels decreasing remarkably after surgery, this change did not reach statistical significance. A significant correlation was observed between preoperative levels of 8,9- and 11,12-EET and pre-and post-operative HDL. There was a significant negative correlation between the EET levels measured before and after surgery and the change in BMI values.

Conclusions

In this study, we observed significant changes in lipid profile 6 months after LC. While HDL, low-density lipoprotein, and EET levels showed a decreasing trend post-surgery, this change was not statistically significant. This trend and their significant correlations may indicate a complex relationship between HDL and EET metabolism. In addition, the negative correlation between EET levels and BMI changes highlights the need for further research to elucidate the metabolic impact and weight regulation of EETs after LC.
Becoming authentic: A social conception of the self
Authors: Mortimer Samuel A
Published: January 2025

Two approaches to authenticity have gained currency in the recent analytic philosophical literature. The first takes authenticity to be a property of how people act (authentic agency). The second takes it to be a property of who people are (authentic self). This paper motivates both views, then argues that there is a dependency between the two: the exercise of authentic agency depends on the possession of an authentic self, while the possession of an authentic self relies on the prior exercise of authentic agency. On a particular, individualist conception of the self, this leads to a paradox. This paradox is resolved if one instead adopts a social conception of the self, according to which the self is partially ontologically constituted by other agents (a ‘we’, rather than an ‘I’).
What is the dual Ginzburg-Landau theory for holographic superconductors?
Authors: Natsuume Makoto
Published: January 2025

Holographic superconductors are holographic duals of superconductors. Macroscopically, a superconductor should be described by the Ginzburg-Landau (GL) theory. There is ample evidence that the holographic superconductors are described by the standard GL theory, but the exact form of the dual GL theory is little known. We identify the dual GL theory for a class of bulk 5-dimensional holographic superconductors, where numerical coefficients are obtained exactly.
Investigating Ultralow-Emittance Nanobeam Formation Using a Coulomb Crystal
Authors: Yuri Yosuke , Miyawaki Nobumasa , Hosaka Kouichi , Ishii Yasuyuki , Hosoya Seiji , Kashiwagi Hirotsugu , Ito Kiyokazu , Okamoto Hiromi , Narumi Kazumasa
Published: January 2025

Ultraprecise single-ion irradiation is of practical interest for the application of research and development of quantum materials and devices. To achieve this, a single-ion irradiation system, consisting of a linear Paul trap (LPT) and electrostatic bipotential lenses, is being developed at Takasaki Institute for Advanced Quantum Science, National Institutes for Quantum Science and Technology. In this paper, we conduct detailed multiparticle simulations on the controlled ejection of single ions from a two-component Coulomb crystal generated in the LPT, followed by the bipotential lens for strong focusing and acceleration of ejected cold ions, to investigate the feasibility of nanobeam formation. Two different schemes, which employ any of a string, planar, or shell crystal, are considered for selective single-ion ejection from the LPT. The present numerical results show that, in both ion ejection schemes, silicon ions sympathetically cooled through laser-cooled calcium ions can be ejected selectively from the LPT with an ultralow-emittance of the order of 10−15 m·rad or less and focused below 10 nm on the target after bipotential acceleration to 100 keV. The ion dynamics and focusing characteristics of the lens system are discussed.
Chemoprevention strategies for precancerous gastric lesions beyond Helicobacter pylori eradication
Authors: Zhang Tai , Tang Xudong
Published: January 2025

Gastric cancer (GC) is a significant global health challenge, particularly in high-incidence regions like East Asia. Despite improvements in screening and treatment, the progressive nature of precancerous lesions—such as atrophic gastritis, intestinal metaplasia and dysplasia—necessitates effective prevention strategies. This review evaluates the role of chemoprevention in GC, focusing on agents designed to target these precancerous lesions. The interventions examined include nonsteroidal anti-inflammatory drugs (NSAIDs), COX-2 inhibitors, antioxidants, vitamins, folic acid, bioactive compounds, traditional herbal medicines and emerging agents like metformin. Additionally, the potential of oxygen radical scavengers, anti-inflammatory agents and pathway-specific inhibitors is explored. While promising, the clinical effectiveness of these agents varies, and significant challenges remain in translating preclinical successes into clinical practice. Large-scale clinical trials are essential to validate these strategies and determine their role in GC prevention, particularly for high-risk populations. Integrating chemoprevention with existing GC management protocols may offer a more comprehensive approach to reducing GC incidence and improving outcomes.
Artificial intelligence model for automatic 3-dimensional reconstruction of ossicular chain and bony labyrinth from high-resolution CT
Authors: Xie Mingwei , Wang Haonan , Yang Zehong , Gao Ming , Shi Guangzi , Liao Xingnan , Luo Zhongqiang , Li Xiaomeng , Shen Jun
Published: January 2025

Background

Three-dimensional (3D) reconstruction of ossicular chain and bony labyrinth based on temporal bone high-resolution CT (HRCT) is useful for diagnosis and treatment guidance of middle and inner ear diseases. However, these structures are small and irregular, making manual reconstruction time-consuming.

Purpose

To develop and validate an artificial intelligence (AI) model based on semisupervised learning for automated 3D reconstruction of ossicular chain and bony labyrinth on HRCT images.

Methods

HRCT images from 304 ears of 152 consecutive patients retrospectively collected from a single center were randomly divided into training (246 ears), validation (28 ears), and internal test (30 ears) cohorts for model development. A novel semisupervised ear bone segmentation framework was used to train the AI model, and its performance was evaluated by Dice similarity coefficients. The trained algorithm was applied to a temporally independent test dataset of 30 ears of 15 patients from the same center for comparison with manual 3D reconstruction for processing time, target volume, and visual assessment of segmentation.

Results

The AI model demonstrated a Dice score of 0.948 (95% CI, 0.940-0.955) for the internal and 0.979 (95% CI, 0.973-0.986) for the temporally independent test sets. In the latter dataset, the AI model required 2% or less processing time of manual 3D reconstruction for each ear (17.7 seconds ± 10.1 vs 1080.5 seconds ± 149.8; P < .001) and had an accuracy comparable to human experts in the volume and visual assessment of segmentation targets (P = .237-1.000). In a subgroup analysis, the model achieved accurate segmentation (Dice scores of 0.98-0.99) across various diseases (eg, otitis media, mastoiditis, otosclerosis, middle and inner ear malformations, Ménière disease).

Conclusion

The AI model enables robust, efficient and accurate 3D reconstruction for the small structures such as ossicular chain and bony labyrinth on HRCT images.
Exercising self-control increases responsivity to hedonic and eudaimonic rewards
Authors: Huang Chengli , Zhou Zhiwei , Angus Douglas J , Sedikides Constantine , Kelley Nicholas J
Published: January 2025

The reward responsivity hypothesis of self-control proposes that irrespective of self-control success, exercising self-control is aversive and engenders negative affect. To countermand this discomfort, reward-seeking behavior may be amplified after bouts of self-control, bringing individuals back to a mildly positive baseline state. Previous studies indicated that effort—an integral component of self-control—can increase reward responsivity. We sought to test and extend the reward responsivity hypothesis by asking if exercising self-control increases a neural marker of reward responsivity [Reward Positivity (RewP)] differentially for hedonic rewards or eudaimonic rewards. We instructed participants (N = 114) to complete a speeded reaction time task where they exercised self-control (incongruent Stroop trials) or not (congruent Stroop trials) and then had the opportunity to win money for themselves (hedonic rewards) or a charity (eudaimonic rewards) while electroencephalography was recorded. Consistent with the reward responsivity hypothesis, participants evinced a larger RewP after exercising self-control (vs. not exercising self-control). Participants also showed a larger RewP for hedonic over eudaimonic rewards. Self-control and reward type did not interactively modulate RewP, suggesting that self-control increases reward responsivity in a domain-general manner. The findings provide a neurophysiological mechanism for the reward responsivity hypothesis of self-control and promise to revitalize the relevant literature.
Spatiotemporal analysis of visceral leishmaniasis in Belo Horizonte, Brazil: a historical perspective (1994–2018)
Authors: Lopes Carla M D , Cardoso Diogo T , Bezerra Juliana M T , de Araújo Giovanna R , Carneiro Mariângela , Morais Maria H F , Barbosa David S
Published: January 2025

Background

In the Americas, visceral leishmaniasis (VL) results from the zoonotic transmission of Leishmania infantum. VL has a high occurrence rate in the Metropolitan Region of Belo Horizonte (BH), Minas Gerais, Brazil, and has rapidly spread throughout the municipality since it was first recorded in 1994. This research analysed a historical perspective over 25 y of human VL occurrence in BH.

Methods

An ecological study of reported human VL occurrence from January 1994 to December 2018 in BH was performed. Epidemiological indicators and changes in the spatiotemporal transmission patterns of human VL were analysed throughout the study period.

Results

The average annual incidence of human VL was 3.20 cases per 100 000 inhabitants over the study period. The case fatality rate ranged from 7% to 21%. The proportion of VL/human immunodeficiency virus coinfection was >20% in the years 2012, 2015 and 2018. Human VL was introduced into BH through the East and Northeast regions, expanding to other areas. The coverage areas of the São Miguel Arcanjo and Cafezal health centres (both in the Centro-Sul region of the city) as well as other areas in the Northeast, Northwest, Pampulha, Venda Nova, North, and East regions of the city presented higher relative risks for human VL occurrence.

Conclusions

The study contributes to a better understanding of the disease's epidemiological profile and identifies priority areas for developing control and monitoring actions.
Efficacy and crop safety of Miravis Prime for the control of Fusarium wilt in greenhouse grown cucumber in Davis, CA, 2023
Authors: Watson Dean Campbell , Del Castillo Munera Johanna
Published: January 2025

Fusarium wilt of cucumber, caused by Fusarium oxysporum f. sp. cucumerinum, is a significant disease impacting field and greenhouse cucumber production. Symptoms include leaf yellowing, stunting, wilting, vascular discoloration and plant death. This report evaluates the efficacy of Miravis Prime at controlling Fusarium wilt of cucumber in greenhouse-grown container plants. This trial was conducted on five-week-old transplants of Cucumis sativus ‘Tyria F1’ at the University of California-Davis in the Fall of 2023. Results from this trial will provide more disease management options to control Fusarium wilt on greenhouse-grown cucumbers.
Evaluation of Fungicide Spray Programs with Differential Application Timing to Manage Cercospora Leaf Spot in a Highly Tolerant Sugar Beet Variety in Northwest Minnesota, 2024
Authors: Lien Austin Kyle , Chanda Ashok Kumar
Published: January 2025

Cercospora leaf spot (CLS), caused by Cercospora beticola, is among the most devastating foliar diseases of sugar beet worldwide. Symptoms include small, circular, tan to brown spots that coalesce into large necrotic lesions when infection is severe, leading to reduced plant vigor and sucrose accumulation in the roots. In this study, we evaluated the efficacy of fungicide spray programs with emphasis on the timing of the initial fungicide application and subsequent intervals for management of CLS. The trial was conducted in 2024 in Crookston, MN on a highly tolerant sugar beet variety (Beta vulgaris ‘Crystal 260RR’). Results from this trial will help sugar beet growers make informed decisions on fungicide spray programs for managing this disease.
Genome‐wide transcriptome differences associated with perceived discrimination in an urban, community‐dwelling middle‐aged cohort
Authors: Pacheco Natasha L. , Noren Hooten Nicole , Wu Sharon F. , Mensah‐Bonsu Maame , Zhang Yongqing , Chitrala Kumaraswamy Naidu , De Supriyo , Mode Nicolle A. , Ezike Ngozi , Beatty Moody Danielle L. , Zonderman Alan B. , Evans Michele K.
Published: January 2025

Discrimination is a social adversity that is linked to several age‐related outcomes. However, the molecular drivers of these observations are poorly understood. Social adverse factors are associated with proinflammatory and interferon gene expression, but little is known about whether additional genes are associated with discrimination among both African American and White adults. In this study, we examined how perceived discrimination in African American and White adults was associated with genome‐wide transcriptome differences using RNA sequencing. Perceived discrimination was measured based on responses to self‐reported lifetime discrimination and racial discrimination. Differential gene expression and pathway analysis were conducted in a cohort (N = 59) stratified by race, sex, and overall discrimination level. We found 28 significantly differentially expressed genes associated with race among those reporting high discrimination. Several of the upregulated genes for African American versus White adults reporting discrimination were related to immune function IGLV2‐11, S100B, IGKV3‐20, and IGKV4‐1; the most significantly downregulated genes were associated with immune modulation and cancer, LUCAT1, THBS1, and ARPIN. The most enriched gene ontology biological process between African American and White men reporting high discrimination was the regulation of cytokine biosynthetic processes. The immune response biological process was significantly lower for African American women compared to White women reporting high discrimination. Discrimination was associated with the expression of small nucleolar RNAs, long noncoding RNAs, and microRNAs associated with energy homeostasis, cancer, and actin. Understanding the pathways through which adverse social factors like discrimination are associated with gene expression is crucial in advancing knowledge of age‐related health disparities.
Serial Total Bile Acid Measurements in Intrahepatic Cholestasis of Pregnancy
Authors: Sarker Minhazur R. , Ramos Gladys A. , Ferrara Lauren , Debolt Chelsea A.
Published: January 2025

Although peak serum total bile acid (TBA) levels guide management of intrahepatic cholestasis of pregnancy (ICP), whether ICP progresses in severity and when or how to assess bile acid levels serially remains unclear. We conducted a secondary analysis of a single-institution retrospective cohort study to assess bile acid trends across pregnancy among individuals diagnosed with ICP and to evaluate whether there was progression to higher ICP severity. We defined ICP severity as mild (peak TBA less than 40 micromol/L), moderate (peak TBA between 40 and 100 micromol/L), or severe (peak TBA 100 micromol/L or greater). Among the 1,188 patients with ICP in our cohort, 354 (29.8%) had repeat bile acid level measurements. Of those patients, 88 (24.9%) progressed to higher ICP severity that may have resulted in changes to delivery timing. Further studies are needed to determine whether serial assessment of bile acid levels with potential reclassification of ICP severity improves outcomes.
Analysis of Delirium Risk Assessment Tools for Prediction of Postoperative Delirium Following Lumbar Spinal Fusion
Authors: Singh Manjot , Sahhar Maxwell , Nassar Joseph E. , Farias Michael J. , Rasquinha Rhea , Kim Jinseong , Diebo Bassel G. , Daniels Alan H.
Published: January 2025

Study Design.

Retrospective cohort study.

Objective.

Evaluate the utility of Delirium Risk Assessment Score (DRAS), Delirium Risk Assessment Tool (DRAT), and Delirium Elderly At-Risk (DEAR) in patients undergoing posterior lumbar interbody fusions.

Background.

Surgical interventions can place patients at risk for postoperative delirium (POD), an acute and often severe cognitive impairment associated with poor outcomes. However, common risk assessment tools have not been validated in patients undergoing spine surgery.

Methods.

Adults who underwent posterior lumbar fusion were queried using PearlDiver. Baseline demographics, comorbidities, and delirium occurrence within 7 days of surgery were extracted. Delirium risk scores were calculated using DRAS (15 points total; threshold 5 points), DRAT (8 points total; threshold 3 points), and DEAR (5 points total; threshold 2 points) scales. Receiver operating characteristic (ROC) curves were generated, and optimal risk scores maximizing Youden’s Index were established for each measure.

Results.

Among 37,119 patients, 70 patients (0.2%) developed POD. The mean age was 60.1 y, 56.6% were female, and mean Charlson Comorbidity Index (CCI) was 2.1. POD patients had lower mean age and percent female sex, but higher mean CCI and percent medical comorbidities (all P<0.05). ROC curve analyses revealed that a DRAS score of 5 (Sensitivity=62.9%, Specificity=63.9%), DRAT score of 3 (Sensitivity=31.4%, Specificity=81.0%), and DEAR score of 2 (Sensitivity=40.0%, Specificity=82.9%) maximized the Youden’s Index value. Patients above these thresholds were 6.0, 2.0, and 3.2 times more likely to develop POD after posterior lumbar fusion, respectively.

Conclusion.

Delirium risk assessments tools were found to be useful in stratifying patients at high risk of POD following posterior lumbar fusion. Specifically, patients above the pre-defined thresholds were 2 to 6 times more likely to develop delirium postoperatively. Careful stratification of patients’ risk of delirium using highly sensitive and specific tools like DRAS may guide preoperative surgical planning and postoperative management plans.

Level of Evidence.

IV.
Long-term Outcomes After Minimally Invasive Ventral Rectopexy for Rectal Prolapse Using Biologic Graft Prosthesis: A 15-Year Retrospective Cohort Study
Authors: Lonne Michael L. R. , Cao Amy M. Y. , Jenkin Ashley , Convie Liam J. , Stevenson Grant E , Moloney Jayson M. , Stevenson Andrew R. L.
Published: January 2025

BACKGROUND:

Minimally invasive ventral rectopexy has widely become the preferred prolapse procedure. However there have been recent concerns regarding the safety of permanent synthetic mesh in the pelvis. Biologic grafts have also been commonly used as an alternative prosthesis, but data on their safety and the longevity of the prolapse repair have been lacking.

OBJECTIVE:

To assess the short and long-term safety and efficacy of biologic grafts in minimally invasive ventral rectopexy.

DESIGN:

Retrospective cohort study using data from a prospectively collected database.

SETTINGS:

Single surgeon at a single tertiary hospital in Australia.

PATIENTS:

There were 366 patients with minimum 6 months follow-up undergoing minimally invasive ventral rectopexy using a biologic graft between January 1, 2008, and October 5, 2023.

MAIN OUTCOME MEASURES:

Overall recurrence, complications and functional outcomes.

RESULTS:

A total of 57 patients (15.6%, n = 57) experienced a recurrence during the study period, with a median follow up time of 35.5 months (range, 6-183 months). Of these, 17 (4.6%) were full thickness recurrence. The Kaplan-Meier estimates of the overall 1-, 3-, and 5-year recurrence rates were 2.0%, 6.0% and 16.0% respectively. There was no statistically significant difference in recurrence for patients who presented with a full thickness prolapse compared to those with other indications (16.8% vs 14.2%, p=0.29). Overall, there were a total of 34 complications which occurred in 29 (7.9%) patients. 19 patients (5.2%) required a return to theatre. There were no graft related complications or long-term pelvic pain. 98% of patients had symptomatic improvement and were satisfied with their outcome.

LIMITATIONS:

Retrospective study and generalizability of the results from single surgeon experience. Late recurrences may have been missed.

CONCLUSIONS:

Minimally invasive ventral rectopexy using a biological graft is both safe and effective, offering acceptable short- and long-term recurrence rates and overall complications with no graft related morbidity. See Video.
Extracorporeal Life Support Organization 2024 Guideline for Early Rehabilitation or Mobilization of Adult Patients on Extracorporeal Membrane Oxygenation
Authors: Ramsey Stephen , Shehatta Ahmed Labib , Ramanathan Kollengode , Shekar Kiran , Brodie Daniel , Diaz Rodrigo , Roberts Abigail , Cruz Sherene , Hodgson Carol , Zakhary Bishoy
Published: January 2025

Disclaimer:

This Extracorporeal Life Support Organization guideline describes early rehabilitation or mobilization of patients on extracorporeal membrane oxygenation (ECMO). The guideline describes useful and safe practices put together by an international interprofessional team with extensive experience in the field of ECMO and ECMO rehabilitation or mobilization. The guideline is not intended to define the delivery of care or substitute sound clinical judgment. The guideline is subject to regular revision as new scientific evidence becomes available.
Noncardiac chest computerized tomography scan as a predictor for plaque presence in coronary artery
Authors: Regev-Avraham Zipi , Rozenfeld Ina , Hussein Osamah , Sharabi-Nov Adi , Halabi Majdi
Published: January 2025

Background

Coronary artery calcium, a marker of coronary atherosclerosis, is often identified on noncoronary chest computed tomography (CT). We wanted to evaluate the correlation between the presence of coronary plaques in coronary artery catheterization and coronary calcifications as shown in noncardiac chest CT.

Methods

A retrospective case–control study consisting of cases (N = 63) and controls (N = 29), aged 18–70 years old, residing in northern Israel and treated in the Intensive Cardiac Care Unit of Ziv Medical Center, between January 2020 and November 2022. All participants underwent coronary catheterization and noncoronary CT scans in the 5 years before the catheterization procedure. Data were taken from the participants’ electronic files while considering the potential of cardiovascular risk factors.

Results

The 92 participants had a mean age of 60.1 ± 10.3 years old. Multivariate logistic regression adjusted to age, sex, and hyperlipidemia showed that calcified coronary artery as shown on a previous noncardiac CT scan was positively and significantly associated with increasing risk of coronary plaque as presented in coronary catheterization: odds ratio = 5.93 (95% confidence interval: 1.85–19.07, P < 0.01) and was also associated with male sex who were more likely to have plaque on coronary catheterization than females: odds ratio = 3.77 (95% confidence interval: 1.29–11.32, P < 0.05).

Conclusion

Coronary calcifications on a previous noncoronary CT scan and sex are positively and significantly associated with coronary plaque risk as present in coronary catheterization. Coronary evaluation on CT scans is important for early detection of coronary disease. Early treatment can avoid coronary disease complications and increase patient survival.
Evaluation of Proposed New Measures for the Hospital CAHPS Survey
Authors: Elliott Marc N. , Beckett Megan K. , Hambarsoomian Katrin , Lehrman William G. , Giordano Laura A. , Goldstein Elizabeth , Brown Julie
Published: January 2025

Background:

Since its 2006 launch, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has become the most used hospital patient experience survey, included in public reporting and accountability systems. Responding to emerging evidence of possible gaps in survey content, the Centers for Medicare & Medicaid Services undertook extensive efforts to develop and test new HCAHPS measures.

Objectives:

Describe the development and testing of new HCAHPS measures.

Research Design:

Activities supporting the development and refinement of survey items and measures included 4 patient focus groups, 27 cognitive interviews, and a 12-member technical expert panel. Psychometric testing of proposed survey items and measures used data from a 2021 large-scale randomized experiment.

Results:

Patient focus groups, cognitive testing, psychometric analyses, and a technical expert panel supported the addition of 2 new multi-item measures (Care Coordination and Restfulness of Hospital Environment), a new single-item measure (Information about Symptoms), and the placement of one current HCAHPS item (Quietness) within one of the new composite measures. All proposed measures had strong psychometric properties, including good construct validity and hospital-level reliabilities that ranged from 0.73 for the Information about Symptoms standalone measure to 0.87 for Restfulness of Hospital Environment. Cronbach alpha for the 3 new or modified composite measures ranged from 0.74 to 0.76.

Conclusions:

The new content would broaden HCAHPS by adding new aspects of care that are important to patients. The public reporting of the new measures and their role in payment may support hospital quality improvement efforts.
A case of obstructive shock and transient ischemic attack from intracardiac metastasis of non-small cell lung cancer (NSCLC)
Authors: Chenna Venkata Sai Harshabhargav , Olaniyi Seyi , Arowolo Seun Adeola , Varghese Jeffrin John , Khan Misbah Kamal , Tabassum Sara , Balushi Jubran Al , Alameddine Selim , Kaur Parvinder
Published: January 2025

Introduction:

Cancer-associated stroke (CAS) is a serious complication in cancer patients, particularly those with lung cancer. This case highlights a 76-year-old male with metastatic squamous cell carcinoma of the lung who developed obstructive shock and a transient ischemic attack (TIA) due to intracardiac metastasis.

Case presentation:

The patient, with a history of coronary artery disease, chronic atrial fibrillation, and obstructive sleep apnea, was diagnosed with stage IIIB squamous cell carcinoma of the lung. Imaging revealed a tumor thrombus in the left atrium, extending from the right lower lobe of the lung via the pulmonary vein. The patient presented with hemodynamic instability and a fall. A TIA with right facial droop and left pronator drift developed, which resolved within six hours. Given his poor performance status (ECOG 3), he was started on palliative radiation therapy and discharged to hospice care.

Clinical discussion:

Intracardiac metastasis is a rare complication of lung cancer, leading to severe hemodynamic issues and neurological events like stroke. In this case, the tumor thrombus caused obstructive shock and increased the risk of ischemic stroke. Cancer-associated stroke is more common in patients with thoracic malignancies, underscoring the need for a multidisciplinary approach to manage these complex cases.

Conclusion:

This case highlights the importance of early recognition and a multidisciplinary approach in managing cancer-associated strokes, particularly in patients with advanced lung cancer. Palliative care is essential for symptom management and improving quality of life. Further research is needed to explore targeted treatments for cancer-associated thrombosis.
Unraveling the resurgence of syphilis: a deep dive into the epidemic sweeping across the United States; a mini review
Authors: Fatima Zainab , Ahmad Bilal , Abdullah Muhammad , Suheb Mahammed Khan , Naaz Farheen , Akilimali Aymar
Published: January 2025

Syphilis, a resurging public health concern in the United States, has witnessed a staggering rise in cases over the past decade. This highly contagious sexually transmitted infection caused by Treponema pallidum presents significant challenges due to its infectious nature and potential for severe complications. Despite the successful syphilis elimination plan launched in the early 2000s, which showed a decline in syphilis cases in highly funded states, syphilis has rapidly reemerged, with incidence rates steadily climbing across many states. Transmitted through sexual contact and vertically from infected mothers to babies, syphilis progresses through distinct stages, each with varying symptoms and complications. Despite modern treatment availability such as the antibiotic benzathine penicillin G, cases often go undiagnosed until severe complications arise. Neurovascular and cardiovascular issues can result from untreated syphilis. The resurgence of syphilis is evident across demographics, with men, particularly men who have sex with men, and certain racial groups being disproportionately affected. Additionally, congenital syphilis cases have surged, leading to serious adverse outcomes for newborns. Public health initiatives must prioritize education, outreach, and preventive services tailored to high-risk populations. Partner notification, aided by technological advancements, is crucial for controlling transmission. Laboratories play a vital role in surveillance and disease monitoring. In conclusion, tackling syphilis resurgence demands a multifaceted approach addressing social, economic, and health care disparities. By implementing comprehensive public health strategies including enhanced screening and public awareness campaigns, the burden of syphilis and its associated adverse outcomes can be mitigated, safeguarding public health in the United States.
Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of alignment accuracy and clinical outcomes
Authors: Mostafa Omar , Malik Maymunah , Qayum Kaif , Ishaq Usman , Khan Abdul Muhaymin , Wasim Abdus Samee , Alsoud Zain , Quraishi Sohail
Published: January 2025

Background:

Robotic-assisted total knee arthroplasty (RA-TKA) has emerged as an alternative to conventional TKA (C-TKA), aiming to improve surgical precision and patient outcomes. This systematic review and meta-analysis study compares the efficacy of RA-TKA versus C-TKA.

Methods:

A comprehensive search of five databases (PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane Library) was conducted. We included all published randomized controlled trials (RCTs) from inception to August 2024. Meta-analysis was done using RevMan 5.4 package.

Results:

Twenty-one RCTs involving 2692 patients were involved. RA-TKA demonstrated significantly lower mechanical alignment outlier rates (risk ratio = 0.33, 95% confidence interval (CI)[0.19, 0.59], P = 0.0002) and less deviation from neutral mechanical axis (mean difference, MD = −0.93° [−1.20, −0.66], P < 0.00001) compared to C-TKA. No significant differences were found in WOMAC or Oxford Knee Scores at various follow-up points. RA-TKA was associated with longer operative times (MD = 19.94 minutes [9.2, 30.68], P = 0.0003) but showed no significant difference in intraoperative blood loss. Postoperative Knee Society Scores were slightly higher in the RA-TKA group (MD = 1.03 [0.50, 1.57], P = 0.0002).

Conclusion:

RA-TKA offers improved mechanical alignment accuracy compared to C-TKA but does not demonstrate superior short to medium-term functional outcomes. The technology is associated with longer operative times. These findings suggest that while RA-TKA may enhance surgical precision, its clinical benefits and cost-effectiveness require further evaluation, particularly in long-term studies.
Quadricuspid aortic valve in an asymptomatic young adult: a case report
Authors: Karki Parag , KC Sharada , Bastakoti Aashish , Khatiwada Abhikanta
Published: January 2025

Introduction:

Quadricuspid aortic valve (QAV) is a rare congenital heart disease, ranking behind bicuspid and unicuspid aortic valves in terms of the incidence of congenital aortic valve abnormalities. When symptoms are present, they are typically related to aortic regurgitation, manifesting as shortness of breath, nocturnal dyspnea, and palpitations, or aortic stenosis, which presents with exertional dyspnea, angina, or syncope.

Case presentation:

We present the case of an asymptomatic male, diagnosed with a QAV during a routine examination. Despite the absence of clinical symptoms, a thorough general physical examination, including cardiac auscultation, revealed signs suggestive of valvular abnormality. The diagnosis was confirmed via transthoracic echocardiography.

Clinical discussion:

For QAV, the diagnostic process typically includes transthoracic echocardiography, which allows for initial confirmation of the valve morphology. In addition, computed tomography (CT) coronary angiography provides detailed information on valvular morphology and helps identify any associated coronary stenosis. In cases of QAV, a CT aortogram is also crucial to assess potential aortic root dilation, a known complication of this congenital anomaly.

Conclusion:

This case emphasizes the importance of routine physical examination in diagnosing rare congenital heart conditions like QAV, even in asymptomatic individuals. Early diagnosis and appropriate imaging are essential for timely management, particularly in preventing the progression of associated complications such as aortic regurgitation or root dilation.
Detecting ectopic thymus in thymoma-associated myasthenia gravis through flow cytometry analysis of CD3mediumTCRvβmediumCD4+CD8+ T cells and its clinical significance
Authors: Ao Yongqiang , Deng Jie , Jiang Jiahao , Yao Min , Gao Jian , Wang Shuai , Jin Chun , Liu Qiuyue , Zhai Yunze , Du Fengxue , Zhang Yu , Zhang Juan , Zheng Yuejuan , Ren Jiazi , Yu Zuoren , Shen Yunli , Ke Aiwu , Cao Yongbing , Wang Haikun , Ding Jianyong
Published: January 2025

Background:

Traditional histological methods for identifying ectopic thymus (ET) have significant limitations including high risk of false negatives. This study aims to evaluate the effectiveness of flow cytometry in detecting ETs in patients undergoing total thymectomy.

Methods:

We analyzed 864 samples from 103 patients using flow cytometry and hematoxylin and eosin (H&E) staining. ETs were identified by the presence of CD3mediumTCRvβmediumCD4+CD8+ T cells in flow cytometry or Hassall’s corpuscles in H&E staining.

Results:

In the discovery set, flow cytometry detected ETs in 69.2% of samples, compared to 23.6% by histological methods. The validation set showed a higher incidence of ETs in myasthenia gravis (MG) patients than in non-MG patients (73.5% vs. 58.0%, P < 0.0001) and in those with thymic epithelial tumors versus normal thymus (68.1% vs. 58.1%, P = 0.0088). MG patients exhibited a higher prevalence of active ETs, characterized by a high proportion of CD4+CD8+ T cells, indicating robust thymopoiesis, compared to those without MG (P = 0.0001). Specific regions, such as the left cervical root, areas along the right and left phrenic nerves, and the left innominate vein, showed significantly higher activity (P < 0.05). Additionally, ETs were more frequently found in the cervical region than in the mediastinum (75.0% vs. 60.8%, P = 0.0012), and in patients aged 40 years or younger compared to those older than 40 years (73.0% vs. 60.6%, P = 0.0027).

Conclusions:

Flow cytometry is a viable alternative for ET detection, providing a novel distribution map that enhances surgical decision-making in MG treatment.
Efficacy and safety of ketorolac and dexamethasone for preventing renal colic post stent removal: a randomized triple-blind, placebo-controlled clinical trial
Authors: Mahmoudiandehkordi Shaghayegh , Morovatshoar Reza , Hadipour Pedram , Fooladi Sarabi Shahnaz , Fadaei Mahta , Ansari Abtin , Farhadi-Shahi Mohammad , Noroozi Mohammadreza
Published: January 2025

Background:

Renal colic following stent removal post-ureteroscopy is a significant clinical issue. This study aims to evaluate the efficacy and safety of intramuscular ketorolac and dexamethasone in preventing renal colic after stent removal.

Methods:

A randomized, triple-blind, placebo-controlled clinical trial was conducted with 147 patients. Participants were allocated to three groups: ketorolac only, ketorolac plus dexamethasone, and placebo. The primary outcome was the visual analog scale (VAS) score for pain, assessed at 1- and 7-days post-stent removal. Secondary outcomes included opioid use, emergency department visits, renal colic symptoms, and missed workdays.

Results:

The combination group (ketorolac and dexamethasone) demonstrated significantly lower VAS scores at 24 hours compared to the placebo group (2.95 vs. 4.30, P = 0.008). Additionally, this group had fewer emergency department visits (2.0% vs. 22.4%, P = 0.010) and lower incidences of subjective renal colic (2.0% vs. 20.4%, P = 0.017). No significant differences were observed at 7 days post-stent removal.

Conclusion:

Intramuscular ketorolac and dexamethasone significantly reduce pain and related complications following stent removal, providing an effective alternative to opioid analgesics.
Impact of Biodegradable Stent on Pancreatic Leakage After Pancreatoduodenectomy – Systematic Review
Authors: Farooqui Waqas , Tschuor Christoph , Storkholm Jan Henrik , Krohn Paul Suno , Hansen Carsten Palnæs , Burgdorf Stefan Kobbelgaard
Published: January 2025

Purpose:

Postoperative pancreatic fistula (POPF) is a serious complication following pancreatoduodenectomy, due to the risk of complications related to the leak. Intraoperative internal and external stenting of the pancreaticojejunostomy, have been used as a prophylactic measure with mixed results and with a risk of complications. Biodegradable stents could be a potential way to avoid complications associated with traditional stents and reduce the risk of pancreatic leaks and fistulas.

Methods:

A systematic review was conducted to investigate the effectiveness of biodegradable stents in reducing POPF after pancreatoduodenectomy. Studies using biodegradable stents and reporting the incidence of POPF were included. Reviews, case reports, and non-English studies were excluded.

Results:

Eight observational studies with a total of 155 patients were included. A meta-analysis was conducted, and the pooled incidence of POPF was around 7% (18 out 155 patients). Apart from one study (comparing biodegradable stent to regular stent), there were no comparator groups. Using ROBINS-I tool to assess the risk of bias, there was overall a moderate risk of bias.

Conclusion:

Biodegradable stents may be associated with lower risk of POPF. However, the observational design of the studies, the risk of bias and sample sizes, reduced the significance of the results. Well-designed randomized controlled trials are needed to assess the effectiveness.
Complex orbitocranial penetrating injury-managed through neuroplastic surgery – a rare case report and review of literature
Authors: Udhay Priti , Sathyabal Varsha Coimbatore , Kodeeswaran Om Saran , M Kodeeswaran , Priyadharshan K.P. , Chaurasia Bipin
Published: January 2025

Introduction and importance:

Orbitocranial penetrating injuries (OPI) are uncommon types of head injuries, accounting for about 0.04% of all head injuries. Foreign bodies penetrating the orbit and cranium cause fractures, leading to ophthalmic and neurological manifestations. These require a specialized treatment approach that mainly depends on the foreign body type, extent of injury, and potential complications. Management involves foreign body removal, reconstruction, and infection control.

Case details:

We discuss a case of a 25-year-old male who presented with a penetrating cranio-orbital injury caused by a wooden stick through the left eye. The transorbital-transcranial wooden foreign body penetrated the orbital roof and temporal bone causing displacement of the orbital contents and extended intracranially into the temporal region. The management was done by a multidisciplinary approach consisting of a team of neurosurgeons and oculoplastic surgeons by extracting the foreign body and reconstruction.

Clinical discussion:

No sound literature on the management of OPI by neuroplastic surgery is available.

Conclusion:

This article highlights the importance of neuroplastic surgery for reconstructing complex fractures involving the cranio-orbital and craniofacial regions for improving patient outcomes, and preventing potential complications. This could potentially revolutionize the management of complex craniofacial abnormalities and a new era for neuro-reconstructive care.
Genetic factors and management strategies in aortic health: a literature review of inherited aortopathy
Authors: Elendu Chukwuka , Nzeako Tochukwu R. , Nwachukwu Nwachukwu O. , Akpa Kenneth N. , Omiko Raymond A. , Ayobami-Ojo Petra S. , Orji Uguru W. , Nwankwo Vivian C. , Amaefule Kingsley C. , Chima Chiamaka S. , Chika Nwafor W. , Olukorode John O. , Oloyede Praise O. , Falade David M. , Fayemi Temiloluwa E. , Ezeamaku-Humphrey Chisom P. , Vansh Roshni R. , Enaholo Tobechukwu M.O. , Anukam Lordsfavour I. , Chukwuneke Osita M.
Published: January 2025

Inherited aortopathies, including Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome, are genetic disorders characterized by structural abnormalities of the aorta that predispose individuals to life-threatening complications like aneurysms and dissections. These conditions result from mutations in genes essential for maintaining aortic wall integrity, such as FBN1, TGFBR1, and COL3A1, affecting extracellular matrix components and the transforming growth factor-beta (TGF-β) pathway. Marfan syndrome has a prevalence of approximately 1 in 5000, while Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome are rarer, with estimated prevalences of 1 in 100 000 and 1 in 20 000, respectively. Familial thoracic aortic aneurysms and dissections (FTAAD), linked to mutations in genes like ACTA2 and MYH11, highlight the genetic heterogeneity of aortopathies. Management strategies focus on early diagnosis, risk stratification, regular imaging, lifestyle modifications, and timely surgical intervention. Advances in genetic testing and targeted therapies offer promise for personalized care. However, challenges such as genetic heterogeneity, incomplete penetrance, and variability in disease progression limit effective management. Limitations in current research include heterogeneity among studies, which complicates meta-analyses and consensus building. Future directions include exploring novel genetic interventions, optimizing treatment timing, and addressing psychosocial impacts to enhance patient outcomes. By addressing gaps in knowledge and integrating patient-reported outcomes, this study underscores the importance of a multidisciplinary approach to managing inherited aortopathies and improving the quality of life for affected individuals.
Intradiploic epidermoid cyst in a 15-year-old female: a rare case report
Authors: Reshad Payenda Ahmad , Zubair Maimoona , Ahmed Nazmin , Khan Adnan , Dad Khan Waseem , Siddiqui Saad , Hasan Masroor , Shafiq Shabna , Chaurasia Bipin
Published: January 2025

Introduction and importance:

Intradiploic epidermoid cysts are rare, benign, slow-growing lesions that originate from the inclusion of ectodermal elements during the closure of the neural tube. This article reports a case of a rare, benign intradiploic epidermoid cyst.

Case presentation:

A 15-year-old female patient had a cystic swelling located in the occipital region, caused the patient to experience a progressively enlarging swelling and intense headaches. It was diagnosed as intradiploic epidermoid cyst on MRI. Surgery was done and removed. Postoperative outcomes were very good.

Clinical discussion:

Intradiploic epidermoid cysts are quite rare. Although these cysts usually happen because of this ectoderm inclusion, the patient’s history of falling raises questions about whether trauma could have caused it too. We really need more research to see if there’s a connection between injuries & these types of cysts.

Conclusion:

The importance of prompt diagnosis and appropriate surgical intervention is necessary while highlighting the rarity of these lesions and their potential traumatic origin.
Serum metabolic profiling analysis of chronic gastritis and gastric cancer by untargeted metabolomics
Authors: Afzal Hadiya , Shaukat Ayesha , Ul Haq Muhammad Zain , Khaliq Nawal , Zahid Maha , Shakeel Laiba , Wasay Zuberi Muhammad Abdul , Akilimali Aymar
Published: January 2025

Chronic gastritis (CG), particularly when associated with Helicobacter pylori (H. pylori) infection, is a significant precursor to gastric cancer (GC), a leading cause of cancer-related deaths worldwide. The persistent inflammation in CG, driven by factors such as H. pylori, induces oxidative stress and DNA damage in gastric epithelial cells, which can lead to malignant transformation. Atrophic gastritis, a form of CG, can be categorized into autoimmune and H. pylori-associated types, both of which increase the risk of GC development, particularly when compounded by external factors like smoking and dietary habits. This manuscript explores the pathophysiological mechanisms underlying CG and its progression to GC, highlighting the critical role of metabolomics in advancing our understanding of these processes. Metabolomics, the comprehensive study of metabolites, offers a novel approach to identifying biomarkers that could facilitate early detection and improve the accuracy of GC diagnosis and prognosis. The analysis of metabolic alterations, particularly in glucose, lipid, and amino acid metabolism, reveals distinct biochemical pathways associated with the progression from benign gastritis to malignancy. Integrating metabolomic profiling with traditional diagnostic methods can revolutionize GC management, enabling more personalized treatment strategies and improving clinical outcomes. However, significant challenges remain, including the need to validate biomarkers across diverse populations and standardize metabolomic techniques. Future research should address these challenges to fully realize the potential of metabolomics in early GC detection and treatment, ultimately aiming to reduce the global burden of this deadly disease.