bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of heparin on venom-induced consumption coagulopathy: a meta-analysis of randomized controlled trials
Authors: Huang Yu-Ning , Chang Wei-Chuan , Lin Yun-Kuan 
Published: January 2025

Abstract
Venom-induced consumption coagulopathy (VICC) is a serious complication of snakebites, potentially leading to life-threatening bleeding. Despite efforts to determine effective treatments other than antivenom, such as heparin, the evidence supporting their use remains insufficient. Therefore, this study aimed to perform a systematic review, meta-analysis and trial sequential analysis (TSA) to examine the effects of heparin on VICC. On 11 August 2024, a systematic search for randomized controlled trials (RCTs) investigating the effects of heparin on VICC was conducted using eight online databases. Six RCTs were included in this study. The meta-analysis revealed that heparin did not significantly reduce the mortality rate (risk ratio, 0.65; 95% CI 0.39 to 1.10). Additionally, the meta-analysis showed no significant differences in various clinical outcomes between the heparin group and control group. The TSA indicated insufficient evidence to conclude the effects of heparin on VICC mortality, and a sample size of 741 patients may be needed for further RCTs. In conclusion, our findings indicate that heparin may not significantly affect VICC outcomes. Although the current evidence is inconclusive because of the limited sample size, it highlights the need for future trials to provide more precise insights.
Evaluation of the immunogenicity of a DNA vaccine for Leishmania major based on the Leishmania-activated C kinase antigen using calcium phosphate and chitosan adjuvants
Authors: Gharaei Abdolaziz , Rahdar Mahmoud , Jorjani Oghlniaz , Saberi Sedigheh , Beiromvand Molouk , Feiz-Haddad Mohammad Hossein 
Published: January 2025

Abstract

Background
Leishmaniasis represents a significant parasitic disease with global health implications, and the development of an affordable and effective vaccine could provide a valuable solution. This study aimed to evaluate the immunogenicity of a DNA vaccine targeting Leishmania major specifically based on the Leishmania-activated C kinase (LACK) antigen, utilizing calcium phosphate nanoparticles (CaPNs) and chitosan nanoparticles (ChitNs) as adjuvants.

Methods
Seventy female BALB/c mice, aged 4–6 wk and weighing 20–22 g, were selected and divided into five groups, each consisting of 14 mice. The first group received the plasmid LACK vaccine (pcDN3+LACK), the second group received the pcDN3+LACK vaccine with the CaPN adjuvant (pcDN3+LACK+CaPN), the third group received the pcDN3+LACK vaccine with the ChitN adjuvant (pcDN3+LACK+ChitN), the fourth group was administered phosphate-buffered saline as a negative control and the fifth group did not receive any vaccine, serving as a positive control. The vaccination program involved two intramuscular injections at 3-wk intervals. Three weeks following the final vaccination, the mice were challenged with wild-type L. major promastigotes via intradermal injection at the base of their tails. Clinical signs and lesion sizes were evaluated biweekly using Vernier calipers. Immune responses, including levels of interferon-gamma (IFN-γ) and interleukin-4 (IL-4), were assessed using ELISA.

Results
The groups receiving pcDN3+LACK+ChitN, pcDN3+LACK+CaPN and pcDN3+LACK exhibited the highest increases in IFN-γ titers and the most significant reductions in IL-4 titers. Furthermore, lesion sizes associated with Leishmania infection were reduced in the vaccinated groups, with the most favorable outcomes observed in the pcDN3+LACK+ChitN group.

Conclusions
These findings suggest that vaccination utilizing the LACK antigen in conjunction with CaPN and ChitN adjuvants may represent an effective strategy for the control of cutaneous leishmaniasis.
An orphan viral genome with unclear evolutionary status sheds light on a distinct lineage of flavi-like viruses infecting plants
Authors: Xu Zhongtian , Zheng Luping , Gao Fangluan , Li Yiyuan , Sun Zongtao , Chen Jianping , Zhang Chuanxi , Li Junmin , Wang Xifeng 
Published: January 2025

Abstract
Advancements in high-throughput sequencing and associated bioinformatics methods have significantly expanded the RNA virus repertoire, including novel viruses with highly divergent genomes encoding “orphan” proteins that apparently lack homologous sequences. This absence of homologs in routine sequence similarity search complicates their taxonomic classification and raises a fundamental question: Do these orphan viral genomes represent bona ide viruses? In 2022, an orphan viral genome encoding a large polyprotein was identified in alfalfa (Medicago sativa) and thrips (Frankliniella occidentalis), and named Snake River alfalfa virus (SRAV). SRAV was initially proposed as an uncommon flavi-like virus identified in a plant host distantly related to family Flaviviridae. Subsequently, another research group showed its common occurrence in alfalfa but challenged its taxonomic position, suggesting it belongs to the family Endornaviridae. In this study, a large-scale analysis of 77 publicly available small RNA datasets indicates that SRAV could be detected across various tissues and cultivars of alfalfa, and has a broad geographical distribution. Moreover, profiles of the SRAV-derived small interfering RNAs (vsiRNAs) exhibited typical characteristics of viruses in plant hosts. The evolutionary analysis suggests that SRAV represents a unique class of plant-hosted flavi-like viruses with an unusual genome organization and evolutionary status, distinct from previously identified flavi-like viruses documented to infect plants. The latter shows a close evolutionary relationship to flavi-like viruses primarily found in plant-feeding invertebrates and lacks evidence of triggering host RNA interference (RNAi) responses so far. Moreover, mining the transcriptome shotgun assembly (TSA) database identified two novel viral sequences with a similar genome organization and evolutionary status to SRAV. In summary, our study resolves the disagreement regarding the taxonomic status of SRAV and suggests the potential existence of two distinct clades of plant-hosted flavi-like viruses with independent evolutionary origins. Furthermore, our research provides the first evidence of plant-hosted flavi-like viruses triggering the host’s RNAi antiviral response. The widespread occurrence of SRAV underscores its potential ecological significance in alfalfa, a crop of substantial economic importance.
Nonintubated video-assisted thoracic surgery: myth or reality?
Authors: Piccioni Federico , Rosboch Giulio Luca 
Published: January 2025

Purpose of review
This review discusses nonintubated video-assisted thoracic surgery (NIVATS) by presenting its physiological, technical aspects and recent clinical data from the literature.

Recent findings
In the last two decades, NIVATS has gained traction as an alternative to traditional intubated thoracic surgery, offering potential benefits in terms of reduced complications, faster recovery times, and improved patient satisfaction. Several approaches to this technique have been described in the literature, mainly divided into the awake patient technique (awake-NIVATS) and the asleep patient technique (asleep-NIVATS). The availability of various sedatives, numerous devices to ensure good oxygenation, and the countless loco-regional techniques available today for pain control in the thoracic region offer the possibility to develop many anesthesia protocols in this context. Numerous studies have already shown that NIVATS is feasible and safe with proper patient selection and adequate collaboration of the surgical team. Some studies have also shown that NIVATS may improve patient outcomes, but the evidence is still limited.

Summary
Literature has demonstrated the feasibility of NIVATS and suggest that it can improve patient outcomes. High-quality international randomized multicenter studies comparing NIVATS and intubated video-assisted thoracic surgery are necessary for a strong comprehension to clarify whether it can be a technique that can guarantee safety and improve the perioperative course of patients.
Nerve Fiber Layer Schisis in Coats Disease
Authors: Burt Spencer S , Bayhaqi Yakub , Ni Shuibin , Jian Yifan , Campbell J. Peter , Young Benjamin K 
Published: January 2025

Purpose:
To describe two cases of pediatric patients with Coats disease who developed nerve fiber layer (NFL) schisis.

Methods:
Observational case series.

Results:
Two male pediatric patients, ages 2 and 14, who were being treated for Coats disease were found to have NFL schisis on optical coherence tomography. Both were treated with panretinal photocoagulation (PRP) and indirect laser. The 14-year-old patient has had recurrent disease with a most recent visual acuity of 20/80+1 in the affected eye. The 2-year-old patient continues to be followed after receiving two rounds of PRP, followed by two rounds of superotemporal laser.

Conclusion:
Nerve fiber layer schisis is a rare manifestation of Coats disease.
Epstein-Barr Virus-Associated Frosted Branch Angiitis: A Case Report and Brief Review
Authors: Cao Angela A. , Curran Christian D. , Diaz Pedro Monsalve , Hause Emily , Koozekanani Dara , Johnson Max R. , Armbrust Karen R. 
Published: January 2025

Purpose:
To report the clinical presentation, treatment course, and outcome of a case of bilateral frosted branch angiitis (FBA) and neuroretinitis associated with acute Epstein-Barr virus (EBV) infection in a pediatric patient with Turner Syndrome.

Methods:
Case report with multimodal ocular imaging and extensive systemic workup.

Results:
A 16-year-old female with Turner syndrome presented with acute bilateral vision loss, hearing loss, and ataxia. Ocular examination showed bilateral extensive perivascular sheathing, optic disc edema, and macular exudates. Fluorescein angiography showed focal retinal ischemia and late optic disc leakage in both eyes. Macular optical coherence tomography was remarkable for intraretinal and subretinal fluid with scattered hyperreflective foci in both eyes. MRI brain and orbits showed a supratentorial T2 signal without enhancement, consistent with inactive vasculopathy. Results of a broad systemic workup were notable only for elevated EBV viral capsid antigen IgM with undetectable EBV viral capsid antigen IgG. After treatment with intravenous methylprednisolone followed by oral prednisone, the patient’s best corrected visual acuity in both eyes improved from 20/200 to 20/20.

Conclusion:
Ocular symptoms and imaging biomarkers in this case of EBV-associated FBA resolved after high-dose systemic corticosteroid monotherapy. Although treatment with antiviral medications is reported in other FBA cases associated with acute EBV infection, this case underscores the treatable nature of this disease without antivirals, the use of which are not supported by the broader literature for EBV infection or post-viral inflammation.
Hypertension Self-Management Among African American Adults
Authors: Sharma Dhruvangi P. , Aycock Dawn M. , Kelley Susan J. , Gaillard Trudy 
Published: January 2025

Hypertension disproportionately affects African Americans, and adequate blood pressure (BP) control remains a challenge. Self-management of hypertension is critical for improving BP control and reducing hypertension-related morbidities.

Objectives
The objective of this study is to describe hypertension self-management (HTN-SM) behaviors and the relationship between HTN-SM and self-reported BP in middle- to older-aged African American adults.

Methods
A cross-sectional correctional design was used, and African Americans 45 years and older were recruited through flyers. Data were collected using self-report surveys, including the Self-Care of Hypertension Inventory, administered via Qualtrics or by telephone interviews.

Results
Participants (N = 142) had a mean age of 63.04 years (SD = 12.0 years). One hundred sixteen (82%) were female and had lived with hypertension for 13.7 years (SD = 11.1 years). For those who could recall their most recent BP (n = 99, 70%), the average systolic BP was 133 (SD = 13.4) and diastolic BP was 80 (SD = 10.7). Thirty-six (36%) participants had BP readings considered stage 2 hypertension (ie, ≥140/90 mm Hg), and 37 (37%) had readings ≥130/80 mm Hg, considered stage 1 hypertension. The mean hypertension self-care maintenance score used to assess HTN-SM was 58.14 ± 16.67; 28% had adequate scores (≥70). Medication adherence, keeping healthcare provider appointments, and eating fruits and vegetables were the most frequent behaviors, whereas asking for low salt, low fat foods, and exercising were the least frequent. Higher hypertension self-care maintenance scores were significantly associated with lower BP readings.

Conclusions
A significant portion of participants had BP considered “uncontrolled” and low self-care maintenance scores. Facilitating HTN-SM is critical for lowering BP; therefore, assessment of HTN-SM is recommended for understanding potential barriers.
Moral Distress Consultation Services: Insights From Unit- and Organizational-Level Leaders
Authors: Amos Vanessa , Whitehead Phyllis , Epstein Beth 
Published: January 2025

Goal:
The objective of this study was to better understand how healthcare systems’ unit- and system-level leaders perceive and experience moral distress consultation services, including their utility, efficacy, and sustainability.

Methods:
A multimethod design was conducted in tandem across two academic medical centers with longstanding and active moral distress consultation services. Moral distress data for healthcare providers participating in moral distress consultation were collected. The authors also conducted interviews about moral distress consultation with unit and organizational leaders using a semistructured interview format. They analyzed interview transcripts using both inductive and deductive coding strategies. Relevant themes and categories were then transferred onto a thematic map for final analysis.

Principal Findings:
Twenty moral distress consults (10 at each institution) were held during the five-month study period. The mean reported moral distress score for all preconsult participants (n = 52) was 6.9 (SD = 2.5), with scores ranging from 0 to 10. In the combined presurvey and postsurvey group (n = 22), the mean moral distress score was 5.9 (SD = 2.2) prior to the consult and 5.3 (SD = 2.7) after the consult. Participants indicated that moral distress causes were primarily team-level-focused prior to moral distress consultation and system-level-focused after consultation. As consult data were collected, eight unit- and system-level leaders were interviewed. Leaders described moral distress consultation as valuable and empowering to unit-based staff. They endorsed the service’s ability to create safe spaces for open communication about morally distressing events. Leaders also suggested the need for more diverse professional representation (outside of nursing) among consultants and participants, as well as more transparent and consistent education plans related to the service, not only to increase leaders’ knowledge and awareness of moral distress, but also to increase the visibility of the consult service, both within and outside the organization. Finally, leadership teams valued qualitative accounts of morally distressing events from staff.

Practical Applications:
Addressing moral distress requires intentional and systemic collaboration, including open communication between moral distress consultation leaders, participants, and unit- and system-level leadership teams. Transparent education plans, broad professional representation, and flexible success measures—including both quantitative and qualitative metrics—are necessary and should be considered for any current or developing moral distress consultation services.
Expert Consensus on an Exercise Prescription Framework for Older People Living With HIV in a South African Setting—A Delphi Study
Authors: Chetty Levin , Cobbing Saul , Chetty Verusia 
Published: January 2025

Abstract
Well-established, regular exercise interventions for older people living with HIV (OPLWH) are beneficial. However, the fundamental principles of exercise prescription for this population have not been sufficiently explored. An expert panel of health care professionals engaged in a modified Delphi technique to explore their perceptions of, and gain their consensus on, an exercise prescription framework for OPLWH in a resource-poor South African setting. A high level of agreement among participants was determined using a priori threshold of 80% agreement and an interquartile range of ≤ 1. Expert consensus was reached on a structured, multifaceted exercise prescription and also fundamental principles, such as multidisciplinary engagement and team collaboration, pre-exercise health screening, and exercise supervision. These were viewed as necessary components of a framework to improve the integration of exercise rehabilitation in the treatment, care, and support for OPLWH.
Association of quantitative flow ratio with in-stent restenosis in patients with unstable angina undergoing percutaneous coronary intervention
Authors: Liu Dongchao , Xue Zheng , Qi Jingxian , Yin Liang , Duan Bing , Gao Bulang , Mi Jie 
Published: January 2025

Objective
To investigate the association of post–percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) with in-stent restenosis (ISR) in patients with unstable angina.

Materials and methods
Patients treated with PCI and follow-up for ISR were divided into a poor QFR group (QFR < 0.91) and a good QFR group with (QFR ≥ 0.91). All clinical data were analyzed.

Results
Among 143 patients enrolled, 57 (39.9%) patients were in the poor QFR group and 86 (60.1%) in the good QFR group. After stenting, the stenosis was decreased to 0 from ≥80% before PCI. At 10-month follow-up, the incidence of ISR in the good QFR group was 6.9%, significantly lower than 33.9% in the poor QFR group (P < 0.05). QFR < 0.91 was a significant (P = 0.002) risk factor for ISR, 4.25 times that of patients with QFR ≥ 0.91. After adjusting for age and sex, the risk of developing ISR in patients with poor QFR was 4.51 times that in patients with good QFR [95% confidence interval (CI): 1.76–11.54, P = 0.002], and QFR < 0.91 (adjusted risk ratio: 6.57, 95% CI: 2.45–17.60, P < 0.001) and diabetes (adjusted risk ratio: 7.23, 95% CI: 2.81–18.60, P < 0.001) were two independent risk factors for ISR.

Conclusion
A positive linear relationship exists between QFR and ISR after adjusting for age and sex, and poor QFR < 0.91 after PCI is a significant independent risk factor for ISR among unstable angina patients undergoing PCI.
Evaluation of Phoenix Sepsis Score Criteria: Exploratory Analysis of Characteristics and Outcomes in an Emergency Transport PICU Cohort From the United Kingdom, 2014–2016
Authors: Carter Michael J. , Hageman Joshua , Feinstein Yael , Herberg Jethro , Kaforou Myrsini , Peters Mark J. , Nadel Simon , Edmonds Naomi , Pathan Nazima , Levin Michael , Ramnarayan Padmanabhan 
Published: January 2025

Objectives:
To assess characteristics and outcomes of children with suspected or confirmed infection requiring emergency transport and PICU admission and to explore the association between the 2024 Phoenix Sepsis Score (PSS) criteria and mortality.

Design:
Retrospective analysis of curated data from a 2014–2016 multicenter cohort study.

Setting:
PICU admission following emergency transport in South East England, United Kingdom, from April 2014 to December 2016.

Patients:
Children 0–16 years old (n = 663) of whom 444 (67%) had suspected or confirmed infection.

Interventions:
None.

Measurements and Main Results:
The PSS was calculated as a sum of four individual organ subscores (respiratory, cardiovascular, neurological, and coagulation) using the worst values during transport (i.e., from referral until the time of PICU admission). A score cutoff of greater than or equal to 2 points was used to define sepsis; and septic shock was defined as sepsis plus 1 or more cardiovascular subscore points. Sepsis occurred in 260 of 444 children (58.6%) with suspected or confirmed infection, with septic shock occurring in 177 of 260 (68.1%) of those with sepsis. A PSS score greater than or equal to 2 points occurred in 37 of 67 bronchiolitis cases, 19 of 35 meningoencephalitis cases, 30 of 47 pneumonia/empyema cases, 38 of 46 septic/toxic shock cases, nine of 15 severe sepsis cases, and 58 of 118 definite viral infections. Overall, 14 of 444 children died (3.2%). There were 12 deaths in the 260 children with PSS greater than or equal to 2, and two deaths in the 184 children with PSS less than 2 (4.6% vs. 1.1%; absolute difference, 3.5%; 95% CI, 0.1–6.9%; p = 0.04).

Conclusions:
In 2014–2016, over half of the critically ill children undergoing emergency transport to PICU with presumed or confirmed infection, and meeting retrospectively applied PSS criteria for sepsis, had a range of clinical diagnoses including bronchiolitis, meningoencephalitis, and pneumonia/empyema. Furthermore, the PSS criteria for categorization of sepsis and septic shock were associated with outcome and may be of value in future risk-stratification in clinical trials.
Demographic and clinical factors associated with functional changes in Long-Covid
Authors: Mazer Barbara , Feldman Debbie Ehrmann 
Published: January 2025

ABSTRACT
Many people experience symptoms months or years following COVID-19 infection. The impact of these symptoms on daily functioning and factors associated with functional decline are not well understood. This study aimed to describe functional changes among persons with Long-Covid and explore associated sociodemographic and clinical factors. 2764 adults who tested positive for COVID-19 were recruited at >12 weeks after diagnosis. Participants responded to an electronic survey [Newcastle Post-COVID Syndrome Questionnaire (symptoms); COVID-19 Yorkshire Rehabilitation Screen (activities; perceived global health, mobility, personal care, daily activities)]. 37.8% were classified as having Long-Covid based on the positive response to “Are you still troubled by symptoms?”. The majority of them reported a decline in global health, mobility, and participation in daily activities. Common changes in function included fatigue, breathlessness upon climbing stairs and when dressing, decline in participation in usual activities, anxiety, pain/discomfort, and reduced concentration. Having COVID-19 > 1 year prior was associated with change in perceived global health (OR = 1.5). Being infected >12 months prior (OR = 1.5), hospitalized for COVID-19 (OR = 2.2-2.4), >1 chronic comorbid conditions (OR = 1.6), and obesity (OR = 1.6) were associated with functional decline. Many of those infected with COVID-19 experience long-lasting symptoms impacting daily functioning. Multidisciplinary medical and rehabilitation services are needed to help improve recovery and maximize functioning.