bluuebunny/crossref_metadata_2025_split huggingface dataset:
miR-361-3p overexpression promotes apoptosis and inflammation by regulating the USP49/IκBα/NF-κB pathway to aggravate sepsis-induced myocardial injury
Authors: Geng Huan , Qi Luyao , You Lijiao , Feng Wentao , Yang Xiaofang , Lei Ming 
Published: November 2024

Abstract

Background
Sepsis is a major cause of in-hospital death, particularly in the intensive care unit. A huge amount of effort has been put into identifying reliable biomarkers to improve the prognosis of patients with sepsis. Among the numerous candidates, microRNAs have attracted attention because of their promising prognostic value. Multiple miRNAs have been suggested to play vital roles in manipulating the nuclear factor-kappa B (NF-κB) pathway, a key factor involved in sepsis. In this study, we attempted to elucidate the potential functions of miR-361-3p in sepsis-induced myocardial injury in vivo and in vitro.

Methods
A sepsis model was established by cecal ligation and puncture (CLP) in rats and by lipopolysaccharide (LPS) in H9c2 cells. The functions of miR-361-3p were revealed by assessing the level of biomarkers of myocardial injury and inflammation by Enzyme-linked immunosorbent assay, as well as the apoptosis by terminal deoxynucleotidyl transferase dUTP nick-end labeling staining and flow cytometry. Binding of miR-361-3p and the 3′ untranslated region of ubiquitin-specific peptidase 49 (Usp49) was revealed by Dual luciferase reporter gene assay. The interaction of USP49 and its downstream target NF-κB inhibitor alpha (IκBα) was revealed by Co-immunoprecipitation and western blot analysis.

Results
miR-361-3p antagomir inhibited myocardial injury and inflammation in CLP-induced rats, as evidenced by a decrease in the serum levels of cardiac troponin I, creatine kinase-MB, interleukin-1 beta (IL-1β), IL-6, and tumor necrosis factor-alpha and cell apoptosis. However, miR-361-3p agomir aggravated sepsis-induced myocardial injury. Moreover, miR-361-3p inhibition induced the inhibition of LPS-induced apoptosis and inflammation in H9c2 cells. miR-361-3p could inhibit the expression of Usp49 by binding to its 3′ untranslated region. Furthermore, we demonstrated that Usp49 binds to IκBα and mediates its deubiquitination, leading to the stabilization of IκBα, which results in the cytoplasmic accumulation of NF-κB and eventually the suppression of NF-κB activity.

Conclusion
Taken together, our data demonstrate that miR-361-3p overexpression promotes apoptosis and inflammation by regulating the USP49/IκBα/NF-κB pathway to aggravate sepsis-induced myocardial injury.
The dynamics of household sanitation services and faeco-oral diseases externalities in Osun State, southwest Nigeria
Authors: Aluko O O 
Published: November 2024

Abstract

Background
Maintaining human dignity through sanitation is a perennial challenge and highlights the externalities of sanitation and hygiene services (SHS). In Nigeria, 23.2% practise open defecation, and 45.5% use basic sanitation services, although conventional sewerage systems are rare. This study determines SHS and their predictors in the context of local governance in southwest Nigeria.

Methods
The cross-sectional study applied a five-stage sampling technique and elicited information from 542 respondents using a validated semistructured questionnaire. The study results are presented by descriptive and inferential statistics.

Results
The mean age of respondents was 48.2±0.8 y. Of these, 64.2% were homeowners, and 40.0% were in the lower wealth quartiles. While 76.9% of respondents had access to toilets, only 16.6% and 18.1% benefitted from safely managed and basic sanitation services, respectively, with 21.2% practising open defecation. Open defecation (42.6%) was prevalent primarily in the Ayedaade local government area (LGA), while safely managed sanitation services (27.6%) and limited sanitation services (54.1%) were predominant in the Olorunda and Ilesa-West LGAs. The predictors influencing household sanitation services included residence, ethnicity and wealth.

Conclusions
There were significant inequalities in sanitation access and critical infrastructure, and sanitation quality gaps exist among respondents. The prevalence of open defecation was high, and there was variation in access to sanitation services across different LGAs.
Neuroimmune signalling pathways in chronic rhinosinusitis with nasal polyps
Authors: Jama Guled M. , Kariyawasam Harsha H. 
Published: November 2024

Purpose of review
To evaluate the role of neuroimmune signalling pathways in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP).

Recent findings
The sinonasal mucosa is densely infiltrated by immune cells and neuronal structures that share an intimate spatial relationship within tissue compartments. Together, such neuroimmune units play a critical role in airway defence and homeostatic function. CRSwNP is primarily driven by a type 2 immune endotype in the majority of patients. So far, central and peripheral neuronal mechanisms that promote, regulate and enhance immune responses have not been investigated to any detail within this disease group. Neurogenic inflammation, mediated by neuropeptides such as substance P and calcitonin gene-related peptide (CGRP), has been shown to modulate immune responses. Emerging evidence now suggests a bidirectional communication between immune cells and neurons, with inflammatory cytokines directly activating sensory neurons and influencing their function alongside the nervous system directly modulating immune cells.

Summary
The complex interplay between epithelial cells, immune cells and neurons in CRSwNP presents both challenges and opportunities for therapeutic intervention. Understanding these neuroimmune interactions not only provides valuable insights into the pathogenesis of CRSwNP but also may open up new avenues for therapeutic strategies targeting both the inflammatory and neuronal components of the disease.
Clinical Outcomes of Revision Lumbar Fusion in the Aging Population
Authors: Narayanan Rajkishen , Tarawneh Omar H. , Dalton Jonathan , Oris Robert J. , Miller Mark , Pohl Nicholas B. , Issa Tariq Z. , Meade Matthew , Opara Olivia , Berthiaume Emily , Lee Yunsoo , Reddy Yashas , Bowen Grace , Lightsey Harry , Kaye Ian D. , Kurd Mark F. , Canseco Jose A. , Hilibrand Alan S. , Vaccaro Alexander R. , Kepler Christopher K. , Schroeder Gregory D. 
Published: November 2024

Study Design.
Retrospective Cohort

Objective.
To examine the profile of older patients undergoing revision lumbar fusion and to evaluate the impact that advancing age may have on outcomes following revision lumbar fusion.

Summary of Background Data.
The proportion of older patients undergoing revision lumbar fusion is increasing, however, the benefit of revision lumbar fusion in an aging demographic is not well documented.

Methods.
Patients aged 55+ who underwent revision lumbar between 2011 and 2022 were included and were stratified into age groups: 55-64, 65-74, and 75+. Primary outcomes consisted of postoperative emergency department (ED) visits, 30- and 90-day readmissions, all-cause reoperations, and the need for secondary revisions. Secondary outcomes included patient-reported outcome measures (PROMs) obtained preoperatively, and at three months and one year postoperatively.

Results.
A total of 914 patients were included: 55-64 years (n=512, mean: 61.1 years), 65-74 years (n=296, mean:69.1 years), and 75+ (n=106, mean:78.9 years). Adjacent segment disease as a revision indication significantly increased with age(P=0.001). A circumferential approach was used most (N=200, 39.7%) in patients 55-64, while a posterior-only approach was used in 86.3% of patients 75+(P<0.001). Levels decompressed increased with age, from 1.67 in the youngest group to 2.04 in the oldest (P<0.001). The number of levels fused showed no significant difference (P=0.068). 90-day readmissions and the need for secondary revisions did not vary by age. Age groups were not independently associated with ΔPROMs at one year, but the oldest groups continued to experience improvement in PROMs in line with their younger counterparts.

Conclusion.
Patients 75 years and older derive similar benefits from revision lumbar fusion compared to their younger counterparts with no increased risk of ED visits, readmissions, or reoperations. Clinicians should be advised that there remains significant value in revising older patients when indicated.

Level of Evidence.
3
Caregiving
Authors: Hermanns Melinda , Greer Danice 
Published: November 2024

ABSTRACT:
Caregiving is a fundamental nursing role. However, when providing care to parents, the nurse experiences caregiving in a completely different way. The stresses and challenges the nurse experiences can be used to support others in similar caregiving experiences. In this article, caregiver role strain is discussed, and spiritual interventions are offered along with insight into the physical, mental, and emotional requirements of caregiving.
Mpox Keratouveitis: A Clinical Analysis of Host Immune Responses
Authors: Carrubba Steven , Jennings Erin , Guttha Samyuktha , Ostrovsky Ann , Sperber Laurence , Haberman Ilyse , Goyal Himani 
Published: November 2024

Purpose:
To describe 2 patients with mpox keratouveitis and evaluate their contrasting clinical phenotypes in the context of baseline immune function.

Methods:
Both patients were subject to longitudinal care by providers at our institution. Qualitative polymerase chain reaction (PCR) analysis was used to confirm their diagnoses, and interval slit-lamp photography was used to document their clinical progression. For case 2, histologic analysis was performed on a corneal biopsy specimen.

Results:
Case 1 describes a 31-year-old immunocompetent man with cutaneous mpox who developed a unilateral keratouveitis after a cutaneous lesion of the ipsilateral eyelid. His keratitis resolved over 1 week with application of trifluridine eye drops. An anterior uveitis persisted but resolved by 2 weeks after treatment with topical prednisolone and oral tecovirimat. Case 2 describes a 27-year-old man with HIV and a declining CD4+ count who was coinfected with monkeypox virus. Over 3 months, he developed a progressive unilateral keratouveitis that resulted in corneal melt requiring tectonic keratoplasty to preserve globe integrity. On histology, the patient's corneal biopsy specimen was devoid of lymphocytes.

Conclusions:
Contrary to immunocompetent patients, individuals with profound cell-mediated immunodeficiencies may be unable to mount sufficient lymphocytic responses in corneal tissue to contain mpox lesions. A progressive keratouveitis can develop, leading to corneal melt with an atypical local immune signature. The clinical and histologic phenotype of the cornea in this scenario is analogous to progressive vaccinia of the skin, a rare clinical entity that develops after smallpox vaccination of immunocompromised hosts.
Viral and immune predictors of HIV posttreatment control
Authors: Mesquita Flavio S. , Li Yijia , Li Jonathan Z. 
Published: November 2024

Purpose of review
This review focuses on the viral and immune factors influencing HIV posttreatment control (PTC), a rare condition where individuals maintain viral suppression after discontinuing antiretroviral therapy (ART).

Recent findings
Studies demonstrate that early ART initiation leads to smaller HIV reservoirs and delayed viral rebound in PTCs. Virologically, PTCs harbor smaller HIV reservoirs and show lower levels of reservoir transcriptional activity compared with posttreatment noncontrollers. Immunologically, PTCs exhibit distinct T-cell dynamics, with reduced CD4+ and CD8+ T-cell activation and exhaustion, enhanced natural killer (NK) cell activity, and enhanced proliferative responses of HIV-specific CD8+ T cells post-ART interruption. Additionally, humoral immunity, particularly the development of autologous neutralizing antibodies (aNAbs), plays a role in viral control, though broadly neutralizing antibodies (bnAbs) are rare.

Summary
The mechanisms behind posttreatment control are multifactorial, involving virological and immunological factors. Early ART initiation, a smaller and less transcriptionally active HIV reservoir, and immune responses including proliferative T-cell activity and NK cell function are key contributors to achieving ART-free HIV remission.
Use of long-acting injectable cabotegravir/rilpivirine in people with HIV and adherence challenges
Authors: Christopoulos Katerina A. , Hickey Matthew D. , Rana Aadia 
Published: November 2024

Purpose of review
Recent changes in US Department of Health and Human Services and International AIDS Society USA guidelines now endorse use of long-acting injectable cabotegravir and rilpivirine (LA-CAB/RPV) in people with HIV (PWH) who have adherence challenges, including those with viremia. We sought to summarize clinical trial and real-world study data on outcomes and implementation strategies, highlight key unanswered questions, and provide recommendations for best practices.

Recent findings
Studies of LA-CAB/RPV in PWH with adherence challenges demonstrate excellent virologic outcomes, although the rate of virologic failure is higher than that in registrational trials conducted in PWH with stable viral suppression. However, viral suppression is attainable on alternate antiretroviral regimen, including those that employ lenacapavir, another long-acting injectable antiretroviral drug, even after virologic failure on LA-CAB/RPV. Successful implementation strategies for long-acting programs include centralized multidisciplinary clinic teams (ideally with pharmacist/pharmacy technician involvement), small incentives to promote patient retention on injections, allowing for drop-in injections, outreach after late injections, and partnerships with home nursing, street medicine, and harm reduction sites.

Summary
Creating programs that can support PWH with adherence challenges, their providers, and their clinics to use LA-CAB/RPV in service of sustained viral suppression is an urgent priority, particularly for PWH with CD4+ cell count <200 cells/mm3.
What Are the Perceived and Experienced Barriers to Health Care Access for Low-Income, Rural Communities of Color in the Southern United States?
Authors: Blackburn Christine Crudo 
Published: November 2024

Objective:
Examines the perceived and experienced barriers to healthcare access for low-income, rural communities of color in the Southern United States.

Design:
This study used focus groups to examine barriers to healthcare access in each community. The transcripts from the focus groups were analyzed using thematic analysis and description-focused coding in MAXQDA 2022© software to determine the barriers that were common across all four communities of study.

Setting:
One community in Louisiana, one community in Mississippi, one community in Alabama, and one community in South Carolina (total of 4 communities).

Participants:
37 adults participated in the study.

Results:
Three primary themes were identified: 1) long distances to hospitals and clinics prevent people from seeking and receiving healthcare; 2) people will not access healthcare out of a fear that they are sick; and 3) medical costs after insurance are a deterrent to accessing healthcare and medications.

Conclusions:
Fear associated with finding out that they are sick is a significant obstacle for participants to access healthcare. The study also confirms previous research findings that distance and medical costs are a major barrier to healthcare access. Importantly, the findings regarding distance demonstrate a lack of acceptance for local health services rather than a lack of availability, suggesting that a lack of acceptance creates a perceived lack of availability and need to travel for care.
Corneal scar after ulcer in a young patient demanding visual restoration in a timely fashion treated with PTK + topo-guided PRK
Authors: Santhiago Marcony R. , Morgado Claudia R. , Koo Ellen , Iyer Geetha , Srinivasan Bhaskar , Berrospi Ruben , Ghanem Ramon 
Published: November 2024

A 23-year-old woman was referred for low visual acuity in the left eye after a corneal ulcer associated with contact lens use 2 years previously. The patient had a history of contact lens use, reported use of antibiotic eye drops with improvement of infection, and subsequent scarring. There were no comorbidities. The manifest refraction was −3.25 −2.25 × 180 (20/20) in the right eye and was −2.00 esf −2.00 × 165 (20/80) in the left eye. The patient demands a solution in a reasonable time because of the need for functional vision and possible restoration of her binocular functions.
The slitlamp examination revealed a corneal scar partially affecting the visual axis (Figure 1

JOURNAL/jcrs/04.03/02158034-202412000-00016/figure1/v/2025-01-16T220450Z/r/image-tiff

). Corneal topography revealed an irregular pattern and spectral-domain optical coherence tomography (OCT) examinations revealed scarring in the anterior stroma (Figures 2 and 3

JOURNAL/jcrs/04.03/02158034-202412000-00016/figure2/v/2025-01-16T220450Z/r/image-tiff

JOURNAL/jcrs/04.03/02158034-202412000-00016/figure3/v/2025-01-16T220450Z/r/image-tiff

).
Given the patient's refraction, corneal scar, and visual demands, would you perform photorefractive keratectomy (PRK) treatment to correct ametropia and partially remove the anterior stroma? Would you perform excimer laser treatment for therapeutic purposes guided by topography? Would you opt for a 2-stage treatment, regularizing the cornea with neutral phototherapeutic keratectomy (PTK) or PRK treatment guided by topography and then correcting the ametropia? Considering the OTC maps, would you perform a femtosecond laser-assisted anterior lamellar keratoplasty (FALK), deep anterior lamellar keratoplasty (DALK), or even penetrating keratoplasty? Would you consider any other surgical step to prevent delayed cornea healing-persistent epithelial defect?
Complementary, integrative, and standard rehabilitative therapies in a military population with chronic predominantly musculoskeletal pain: a pragmatic clinical trial with SMART design
Authors: Flynn Diane M. , Ransom Jeffrey C. , Steffen Alana D. , Orr Kira P. , McQuinn Honor M. , Snow Tyler J. , Burke Larisa A. , Wi Dahee , Doorenbos Ardith Z. 
Published: November 2024

Abstract
There is growing acceptance for combining complementary and integrative health (CIH) therapies with standard rehabilitative care (SRC) for chronic pain management, yet little evidence on the best sequence of therapies. We investigated whether starting with CIH therapies or SRC is more effective in reducing pain impact. Participants were 280 service members with predominantly (88%) musculoskeletal chronic pain referred to an interdisciplinary pain management center who were randomized to a twice weekly program of either CIH therapies (n = 140) or SRC (n = 140) for the 3-week first stage of treatment. The composition of a second 3-week treatment stage depended upon response to the first stage. The primary outcome measure was the impact score (range 8-50) from the NIH Task Force on Research Standards for Chronic Low-Back Pain. Outcomes were measured after 3 and 6 weeks of treatment and at 3- and 6-month follow-ups. Most participants were men (76.8%) and mean age was 34.7 years (SD 8.0). At end of stage 1, pain impact decreased significantly more in the CIH group (29.8 points [SD 7.2] at baseline to 26.3 points [SD 7.9], change of −3.3 points [95% confidence interval, −4.2 to −2.5]) than in the SRC group (30.8 [SD 7.6] to 29.4 [SD 7.8], change of −0.9 points [95% confidence interval, −1.8 to −0.1]; P < 0.001). No significant between-group differences were observed after 6 weeks of treatment nor at 3- or 6-month follow-ups. Complementary and integrative health therapies may provide earlier improvement in pain impact than SRC, but this difference is not sustained.
Depression and Quality of Life in Patients With Chronic Kidney Disease: A Mediation Analysis of Handgrip Strength and Demoralization
Authors: LEE Szu-Ying , FANG Yu-Wei , LIU Chieh-Yu 
Published: November 2024

ABSTRACT

Background
Chronic kidney disease (CKD) is a progressive disease impacting the physical function and mental health of sufferers. Depression is known to negatively impact quality of life, whereas handgrip strength and demoralization are important factors affecting physical and mental health. Lower handgrip strength has been associated with sarcopenia and higher risk of hospitalization in patients and higher workloads for nurse caregivers. Few studies have investigated the complex relations among these factors in patients with CKD.

Purpose
This study was designed to investigate the mediating effects of grip strength and demoralization on the relationship between depression and quality of life in patients with CKD.

Methods
Two hundred fifty patients with CKD comprised the study sample. The hypotheses were tested using the PROCESS macro.

Results
Depression was found to be negatively associated with handgrip strength and quality of life but positively associated with demoralization. The results indicate that both handgrip strength and demoralization mediate the association between depression and quality of life. Moreover, the results of multiple mediation model analysis showed handgrip strength and demoralization both play important roles in the link between depression and quality of life.

Conclusions
The results of this study indicate that handgrip strength and demoralization mediate the relationship between depression and quality of life in patients with CKD. Thus, increasing handgrip strength and decreasing demoralization levels may mitigate the impact of depression on quality of life. Therefore, nurses should better appreciate the importance of handgrip strength for patients with CKD and evaluate handgrip strength. Nurses should also develop physical and mental interventions to increase handgrip strength and decrease demoralization.
Advances in achieving lung and diaphragm-protective ventilation
Authors: van den Berg Maarten J.W. , Heunks Leo , Doorduin Jonne 
Published: November 2024

Purpose of review
Mechanical ventilation may have adverse effects on diaphragm and lung function. Lung- and diaphragm-protective ventilation is an approach that challenges the clinician to facilitate physiological respiratory efforts, while maintaining minimal lung stress and strain. Here, we discuss the latest advances in monitoring and interventions to achieve lung- and diaphragm protective ventilation.

Recent findings
Noninvasive ventilator maneuvers (P0.1, airway occlusion pressure, pressure-muscle index) can accurately detect low and excessive respiratory efforts and high lung stress. Additional monitoring techniques include esophageal manometry, ultrasound, electrical activity of the diaphragm, and electrical impedance tomography. Recent trials demonstrate that a systematic approach to titrating inspiratory support and sedation facilitates lung- and diaphragm protective ventilation. Titration of positive-end expiratory pressure and, if available, veno-venous extracorporeal membrane oxygenation sweep gas flow may further modulate neural respiratory drive and effort to facilitate lung- and diaphragm protective ventilation.

Summary
Achieving lung- and diaphragm-protective ventilation may require more than a single intervention; it demands a comprehensive understanding of the (neuro)physiology of breathing and mechanical ventilation, along with the application of a series of interventions under close monitoring. We suggest a bedside-approach to achieve lung- and diaphragm protective ventilation targets.