bluuebunny/crossref_metadata_2025_split huggingface dataset:
Varying levels of natural light intensity affect the phyto-biochemical compounds, antioxidant indices and genes involved in the monoterpene biosynthetic pathway of Origanum majorana L.
Authors: Hashemifar Zahra , Sanjarian Forough , Naghdi Badi Hassanali , Mehrafarin Ali 
Published: October 2024

Abstract
Background
Light is a critical environmental factor in plants, encompassing two vital aspects: intensity and quality. To assess the influence of different light intensities on Origanum majorana L., pots containing the herb were subjected to four levels of light intensity: 20, 50, 70, and 100% natural light. After a 60-day treatment period, the plants were evaluated for metabolite production, including total sugar content, protein, dry weight, antioxidant indices, expression of monoterpenes biosynthesis genes, and essential oil compounds. The experimental design followed a randomized complete blocks format, and statistical analysis of variance was conducted.

Results
The results indicated a correlation between increased light intensity and elevated total sugar and protein content, which contributed to improved plant dry weight. The highest levels of hydrogen peroxide and malondialdehyde (MDA) were observed under 100% light intensity. Catalase and superoxide dismutase enzymes exhibited increased activity, with a 4.23-fold and 2.14-fold increase, respectively, under full light. In contrast, peroxidase and polyphenol oxidase enzyme activities decreased by 3.29-fold and 3.24-fold, respectively. As light intensity increases, the expression level of the 1-deoxy-D-xylulose 5-phosphate reductoisomerase (DXR) gene increases. However, beyond a light intensity of 70%, the DXR gene expression level decreased. Furthermore, the expression levels of the cytochrome P450 genes CYP71D178 and CYP71D179 exhibited an increasing trend in response to elevated light intensity. Essential oil content increased from 0.02 to 0.5% until reaching 70% light intensity. However, with further increases in light intensity, the essential oil content decreased by 54 to 0.23%.

Conclusions
These findings emphasize the importance of balancing plant growth promotion and stress management under different light conditions. The research suggests that sweet marjoram plants thrive best in unshaded open spaces, resulting in maximum biomass. However, essential oil production decreases under the same conditions. For farmers in areas with an average light intensity of approximately 1700 µmol m−2s−1, it is recommended to cultivate sweet marjoram in shade-free fields to optimize biomass and essential oil production. Towards the end of the growth cycle, it is advisable to use shades that allow 70% of light to pass through. The specific duration of shade implementation can be further explored in future research.
Severe co-infection caused by difficult-to-diagnose hypermucoviscous Klebsiella pneumoniae K1-ST82 in a patient with COVID-19: a case report
Authors: Itoga Masamichi , Hayashi Wataru , Kayama Shizuo , Yu Liansheng , Sugawara Yo , Kimura Masahiko , Hanada Hiroyuki , Tasaka Sadatomo , Sugai Motoyuki 
Published: October 2024

Abstract
Background
Co-infection with Klebsiella pneumoniae presents a significant concern in hospitalized patients with coronavirus disease (COVID-19), increasing the risk of severe disease progression. Hypervirulent (hv) and hypermucoviscous (hm) K. pneumoniae (Kp) has gained prominence in Asia due to its capacity to cause invasive community-acquired infections. However, recognition of hvKp/hmKp co-infections in the context of COVID-19 remains limited. We report a severe case of rapidly progressing co-infection with hmKp exhibiting “difficult-to-diagnose” phenotypes in a hospitalized patient with COVID-19.

Case presentation
A 61-year-old woman with COVID-19 initially exhibited mild symptoms resembling the common cold. However, her condition rapidly deteriorated over 7 days, leading to hospital admission with the development of dyspnea. The patient required supplemental oxygen, antibiotic treatment, and mechanical ventilation. Gram-negative bacteria with atypical phenotypes were isolated from alveolar lavage fluid and blood cultures. Both strains formed small, glossy, non-lactose-fermenting colonies on clinically relevant media and were susceptible to ampicillin. Conventional biochemical tests failed to identify the Enterobacteriales strains owing to the urease-negative phenotype. Consequently, the identification of K. pneumoniae was difficult until matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) analysis was performed. A positive string test indicated mucoviscosity, but with variability in the material used for stretching colonies. Whole-genome sequencing performed on the MiSeq and GridION platforms revealed the blood-derived strain JARB-RN-0063 as belonging to serotype K1 and sequence type (ST) 82. The hvKp-associated genes rmpA and iroCD were located on a 5.0-Mb chromosome, and iucABCD-iutA was identified on a 217.9-kb IncFIB(K)/IncR-type plasmid. Therefore, JARB-RN-0063 was genetically classified as hvKp with a Kleborate virulence score of 3. The intrinsic penicillinase gene blaSHV was defective owing to an IS1F element insertion, resulting in the strain being atypically susceptible to ampicillin.

Conclusions
This is the first case of severe COVID-19-associated co-infection with a difficult-to-diagnose K. penummoniae strain. Notably, co-infection by the hmKp K1-ST82 clone exhibited atypical phenotypes, including stunted growth, non-lactose fermentation, urease-negative reaction, ampicillin susceptibility, and abnormal mucoviscosity, posing diagnostic challenges for clinical laboratories and impedes the identification of hvKp/hmKp. Delayed identification may worsen patient outcomes, highlighting the need for increased clinical awareness of such difficult-to-diagnose clones to prevent deterioration.
A comparison of operating room toric placement tools: CALLISTO eye vs. e Wavetec AnalyzOR (CORTCO)
Authors: Scott Maria C. 
Published: October 2024

Abstract
Background
To evaluate procedure times for two cataract planning systems (ZEISS CALLISTO eye and the Wavetec AnalyzOR) in predicting residual astigmatism (prediction error) and other visual outcomes in patients with corneal astigmatism (maximum allowable up to 3.0D) at postoperative month 1.

Methods
This was a prospective, single center, parallel treatment group, bilateral and unilateral, randomized, 1-month study on patients scheduled to undergo routine, small-incision cataract surgery with a toric intraocular lens implantation. Both groups underwent preop measurements with the IOLMaster 700 (Zeiss, Jena, Germany) and surgery with the LenSx device (Alcon). Lens selection in the CALLISTO eye group was based on Zeiss VERACITY Surgery Planner (a web-based tool) and on the Wavetec AnalyzOR component of the ORA system (a real-time intraoperative aberrometer) for those eyes in the ORA group. All procedure and intraoperative times were measured with a stopwatch. Postoperative visual outcomes were evaluated between 1 and 2 months after surgery.

Results
There were 23 eyes in the CALLISTO group and 28 eyes in the ORA group. The mean surgical time for the CALLISTO group was 28.09 ± 1.72 min compared to 34.41 ± 1.52 min for the ORA group (P = 0.01). Toric lens placement mean time in the CALLISTO group was 2.47 ± 0.34 min compared to 3.88 ± 0.29 min in the ORA group (P = 0.0034). At month 1 postoperatively, the manifest refractive spherical error (MRSE) in the CALLISTO eye group 0.022 ± 0.388 diopters (D) compared to -0.174 ± 0.322 D in the ORA group; these were not statistically different. There was a higher percentage (75%) of eyes with an MRSE within 0.25D in the ORA group compared to the CALLISTO eye group (56.5%); at all other levels outcomes were numerically higher in the CALLISTO eye group.

Conclusions
Less surgical time was needed when using the CALLISTO eye than the ORA when performing cataract surgery with toric lens implantation. There were similar visual outcomes between the groups and no statistical differences.
Social norms and social opportunities: a qualitative study of influences on tobacco use among urban adolescent girls in Ghana
Authors: Aryee Lois N.A. , Flanagan Sara V. , Trupe Lydia , Yucel Morgan , Smith Jana 
Published: October 2024

Abstract
Background
Tobacco use is a global public health threat and a leading preventable cause of death in the world. While cigarette use among youth has been decreasing in high-income countries, low- and middle-income countries have contrastingly high rates of adolescent smoking. In Ghana, smoking prevalence is lower than in other parts of the African continent and more common among men than women; however the gender gap in tobacco use among adolescents has narrowed, with shisha use among girls recently surpassing boys. These trends toward increased relative use among adolescent girls are a cause for concern and highlight the need for interventions to prevent and/or reduce tobacco use in this population.

Methods
We conducted in-depth interviews with girls aged 13–20 (n = 148) and their parents (n = 7) in Ghana’s largest two cities – Accra and Kumasi, to explore the physical, social, and psychological context underlying smoking perceptions and behavior.

Results
We identified 11 key insights into influences on smoking behavior, organized into the broader themes of perceptions of smoking, environmental factors, and internal factors. Findings underscore that perceptions around smoking are very much driven by girls’ social world, which is generally small and parent-centric for non-smokers at younger ages but can start to expand as girls get farther along in school or leave school entirely. After what may have been a sheltered adolescence, many older girls in Ghana look for ways to express their independence in decision-making and a few may use their developing agency to rationalize limited or infrequent tobacco use if they perceive the benefits to them outweigh the potential consequences.

Conclusions
Our findings highlight strong social influences on girls’ perceptions, exposure to opportunities, and decision-making in ways that can often be protective against smoking, particularly at younger ages, but may also leave girls unprepared to manage challenging situations later in life. Understanding this context in Ghana will be important for any future programming aiming to prevent smoking initiation among adolescents.
Management and outcomes in pulmonary arterial hypertension patients with sepsis
Authors: Flynn Spencer , Chen Haidee , Kerbel Russell , Gupta Summer , Jasuja Sonia , Saggar Rajan , Channick Richard , Sherman Alexander 
Published: October 2024

Abstract
Background
Sepsis is a common cause of death in patients with pulmonary arterial hypertension (PAH). Treatment requires careful fluid management and hemodynamic support. This study compares patients with or without PAH presenting with sepsis with a focus on initial fluid resuscitation.

Methods
This retrospective analysis compared adults with and without PAH admitted for sepsis at two academic hospitals between 2013 and 2022. Prior PAH diagnosis was verified by review of right heart catheterization data and sepsis present on admission was verified by chart review. Demographics, vital signs, laboratory values, imaging results, treatment approaches, and all-cause mortality data were obtained. Controls were propensity score weighted by age, sex, and Charlson Comorbidity index. Logistic regression models controlling for age and Charlson comorbidity indices were used to examine factors associated with survival.

Results
Thirty patients admitted for sepsis with pre-existing PAH were compared to 96 matched controls. Controls received significantly more fluids at 24 h compared to PAH patients (median 0 mL v. 1216 mL, p < 0.001), while PAH patients were more likely to receive vasoactive medications (23.3% vs. 8.3%, p = 0.037). At 30 days, 7 PAH patients (23.3%) and 13 control patients (13.5%) had died (p = 0.376). PAH patients that received more fluids had decreased mortality (OR 0.31, 95% CI 0.11–0.92, p = 0.03) and patients who received fluids had shorter mean time to antibiotics (2.3 h v. 6.5 h, p = 0.04), although decreased time to antibiotics was not associated with mortality. Patients who received no fluids more often had previously identified right ventricular systolic dysfunction (62.5% v. 28.6%, p = 0.136).

Conclusion
Patients with PAH and sepsis have high mortality and receive different treatments than controls, with more reliance on vasopressors and less on fluid resuscitation. PAH patients who received less fluids had higher mortality and those who received no fluids had a longer time to receiving antibiotics, indicating a potential delay in recognizing sepsis. Timely recognition of sepsis and dynamic decision-making around fluid resuscitation remains critical in this high-risk population.
The effect of empagliflozin on circulating endothelial progenitor cells in patients with diabetes and stable coronary artery disease
Authors: Hershenson Roy , Nardi-Agmon Inbar , Leshem-Lev Dorit , Kornowski Ran , Eisen Alon 
Published: October 2024

Abstract
Background
Diabetes mellitus (DM) is associated with premature atherosclerotic disease, coronary artery disease (CAD) and chronic heart failure (HF), leading to increased morbidity and mortality. Sodium-Glucose Co-transporter 2 Inhibitors (SGLT2i) exhibit cardioprotective benefits beyond glucose lowering, reducing the risk of major cardiovascular events (MACE) and HF hospitalizations in patients with DM and CAD. Endothelial progenitor cells (EPCs) are bone marrow-derived cells involved in vascular repair, mobilized in response to vascular injury. The number and function of circulating EPCs (cEPCs) are negatively affected by cardiovascular risk factors, including DM. This study aimed to examine the response of cEPCs to SGLT2i treatment in DM patients with stable CAD.

Methods
A prospective single-center study included patients with DM and stable CAD who were started on an SGLT2i (empagliflozin). Peripheral blood samples were collected at baseline, 1 month, and 3 months to evaluate cEPC levels and function by flow cytometry, immunohistochemistry and MTT assays.

Results
Eighteen patients were included in the study (median age 73, (IQR 69, 77) years, 67% male). After 1 month of treatment with empagliflozin, there was no significant change in cEPCs level or function. However, following 3 months of treatment, a significant increase was observed both in cell levels (CD34(+)/VEGFR-2(+): from 0.49% (IQR 0.32, 0.64) to 1.58% (IQR 0.93, 1.82), p = 0.0006; CD133(+)/VEGFR-2(+): from 0.38% (IQR 0.27, 0.6) to 0.82% (IQR 0.7, 1.95), p = 0.0001) and in cell function (from 0.25 CFUs (IQR 0, 0.5) at baseline, to 2 CFUs (IQR 1, 2) at 3 months, p = 0.0012).

Conclusions
Empagliflozin treatment in patients with DM and stable CAD increases cEPC levels and function, implying a cardioprotective mechanism. These findings highlight the potential of SGLT2i in treating cardiovascular diseases, warranting further research to explore these effects and their long-term implications.

Graphical Abstract
Aripiprazole once-monthly for the treatment of adult patients with earlier-stage bipolar I disorder: a post hoc analysis of data from a double-blind, placebo-controlled, 52-week randomized withdrawal trial
Authors: Bell Lynum Karimah S. , Castro Christine F. , Zhang Zhen , Patel Mehul , Tohen Mauricio 
Published: October 2024

Abstract
Background
Increased awareness of the factors contributing to the diagnostic disparities seen in bipolar disorder between individuals of different heritage is needed to achieve equity in diagnosis and treatment. One such inequity is the provision of earlier treatment. Earlier treatment of patients diagnosed with bipolar disorder may prolong time to recurrence of mood episodes and reduce functional impairment and other poor outcomes associated with disease progression. The aim of this post hoc analysis was to study the efficacy and safety of long-acting injectable aripiprazole once-monthly 400 mg (AOM 400) in patients with earlier-stage bipolar I disorder (BP-I). Data from a 52-week multicenter, double-blind, placebo-controlled, randomized withdrawal trial of AOM 400 versus placebo in patients with BP‑I (NCT01567527) were analyzed. Those patients in the lowest quartiles for age (18–≤32 years; n = 70) or disease duration (0.13–≤4.6 years; n = 67) at baseline were categorized with earlier-stage BP-I. The primary endpoint was time from randomization to recurrence of any mood episode. Other endpoints included proportion of patients with recurrence of any mood episode, and change from baseline in Young Mania Rating Scale (YMRS) and Montgomery–Åsberg Depression Rating Scale (MADRS) total scores.

Results
Maintenance treatment with AOM 400 significantly delayed time to recurrence of any mood episode versus placebo in patients aged 18–≤32 years (hazard ratio [HR]: 2.46 [95% confidence interval (CI) 1.09, 5.55]; p = 0.0251) or with disease duration 0.13–≤4.6 years (HR: 3.21 [95% CI 1.35, 7.65]; p = 0.005). This was largely driven by a lower proportion of patients in the AOM 400 group with YMRS total score ≥15 or clinical worsening. Changes from baseline in MADRS total score in both earlier-stage groups indicated AOM 400 did not worsen depression versus placebo. The safety profile of AOM 400 was consistent with the original study. Note that the original study included patients who had previously been stabilized on AOM 400 monotherapy, which may have enriched the population with patients who respond to and tolerate AOM 400.

Conclusions
In this post hoc analysis, AOM 400 prolonged time to recurrence of any mood episode versus placebo in earlier-stage BP-I. These findings support early initiation of maintenance treatment with AOM 400.
Nephroprotective role of resveratrol in renal ischemia-reperfusion injury: a preclinical study in Sprague-Dawley rats
Authors: Alaasam Elaf R. , Janabi Ali M. , Al-Buthabhak Karrar M. , Almudhafar Rihab H. , Hadi Najah R. , Alexiou Athanasios , Papadakis Marios , Abo-El Fetoh Mohammed E. , Fouad Dalia , El-Saber Batiha Gaber 
Published: October 2024

Abstract
Background
Renal ischemia-reperfusion injury (IRI) is a significant contributor to renal dysfunction, acute kidney injury (AKI), and associated morbidity and mortality. Resveratrol, a polyphenol and phytoalexin, is known for its anti-inflammatory, antioxidant, and anti-cancer properties. This study investigates the nephroprotective potential of resveratrol in a rat model of renal IRI.

Materials and methods
Twenty-eight male Sprague-Dawley rats were divided into four groups: Sham, IRI, DMSO, and Resveratrol. The Sham group underwent identical procedures without renal pedicle clamping, while the IRI group experienced 30 min of ischemia followed by 2 h of reperfusion. The DMSO group received dimethyl sulfoxide (DMSO) intraperitoneally 30 min before ischemia, and the Resveratrol group received 30 mg/kg resveratrol intraperitoneally 30 min before ischemia. Biochemical parameters (Urea, creatinine, IL-1β, NF-κβ, SOD, GSH, Bcl-2, and caspase-3) and histopathological changes were assessed.

Results
IRI caused a substantial increase in serum creatinine, Urea, IL-1β, NF-κβ, and caspase-3 levels, while simultaneously decreasing SOD, GSH, and Bcl-2 levels. Resveratrol treatment mitigated these effects by lowering inflammatory and apoptotic markers, enhancing antioxidant defenses, and improving histological outcomes.

Conclusion
Resveratrol demonstrates significant nephroprotective effects in renal IRI, primarily through its antioxidant, anti-inflammatory, and anti-apoptotic properties.
Left inguinal dedifferentiated liposarcoma and primary unclassified sarcoma of the left lung as synchronous multiple sarcomas: a case report
Authors: Kobayashi Masao , Satomi Hidetoshi , Chikaraishi Hisaya , Samejima Hironobu , Horiguchi Julian , Kanzaki Ryu , Maniwa Tomohiro , Honma Keiichiro , Okami Jiro 
Published: October 2024

Abstract
Background
Pulmonary nodules in patients with soft tissue sarcomas are likely pulmonary metastases, whereas synchronous primary pulmonary sarcomas are rare. Without surgery, determining whether a solitary pulmonary nodule is a primary or metastatic nodule is difficult. Herein, we report a rare case of a primary pulmonary sarcoma that presented synchronously with a primary dedifferentiated liposarcoma.

Case presentation
A 77-year-old man presented to another hospital with left inguinal swelling and a suspected recurrent inguinal hernia. Computed tomography revealed a left inguinal mass and pure-solid nodule in the left lung and the patient was referred to our hospital for detailed examination and treatment. The inguinal mass was pathologically diagnosed as a dedifferentiated liposarcoma using needle biopsy, whereas bronchoscopic biopsy revealed histological findings suggestive of a sarcoma; however, the primary site could not be determined. Positron emission tomography–computed tomography revealed no high-accumulation lesions except for the two sarcomas. We decided to perform surgery on both sarcomas for diagnostic and curative purposes. The surgical specimens showed that the two sarcomas were different. Based on the immunohistochemical staining findings of MDM2, a left inguinal dedifferentiated liposarcoma and primary pulmonary unclassified sarcoma were diagnosed. The patient displayed no evidence of recurrence 1 year after surgery.

Conclusions
We encountered a rare case of synchronous multiple primary sarcomas, one presenting in the lung and the other in the soft tissue. Surgery was required to achieve a definitive diagnosis for the patient, who achieved disease-free survival at 1 year. This case suggests that proactive resection of pulmonary nodules in patients with soft tissue sarcomas may be feasible as a diagnostic treatment if complete resection is achieved.
Unsupervised machine learning identifies distinct phenotypes in cardiac complications of pediatric patients treated with anthracyclines
Authors: Jacquemyn Xander , Chinni Bhargava K. , Barnes Benjamin T. , Rao Sruti , Kutty Shelby , Manlhiot Cedric 
Published: October 2024

Abstract
Background
Anthracyclines are essential in pediatric cancer treatment, but patients are at risk cancer therapy-related cardiac dysfunction (CTRCD). Standardized definitions by the International Cardio-Oncology Society (IC-OS) aim to enhance precision in risk assessment.

Objectives
Categorize distinct phenotypes among pediatric patients undergoing anthracycline chemotherapy using unsupervised machine learning.

Methods
Pediatric cancer patients undergoing anthracycline chemotherapy at our institution were retrospectively included. Clinical and echocardiographic data at baseline, along with follow-up data, were collected from patient records. Unsupervised machine learning was performed, involving dimensionality reduction using principal component analysis and K-means clustering to identify different phenotypic clusters. Identified phenogroups were analyzed for associations with CTRCD, defined following contemporary IC-OS definitions, and hypertensive response.

Results
A total of 187 patients (63.1% male, median age 15.5 years [10.4–18.7]) were included and received anthracycline chemotherapy with a median treatment duration of 0.66 years [0.35–1.92]. Median follow-up duration was 2.78 years [1.31–4.21]. Four phenogroups were identified with following distribution: Cluster 0 (32.6%, n = 61), Cluster 1 (13.9%, n = 26), Cluster 2 (24.6%, n = 46), and Cluster 3 (28.9%, n = 54). Cluster 0 showed the highest risk of moderate CTRCD (HR: 3.10 [95% CI: 1.18–8.16], P = 0.022) compared to other clusters. Cluster 3 demonstrated a protective effect against hypertensive response (HR: 0.30 [95% CI: 0.13– 0.67], P = 0.003) after excluding baseline hypertensive patients. Longitudinal assessments revealed differences in global longitudinal strain and systolic blood pressure among phenogroups.

Conclusions
Unsupervised machine learning identified distinct phenogroups among pediatric cancer patients undergoing anthracycline chemotherapy, offering potential for personalized risk assessment.