bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bacterial outer membrane vesicles in the fight against cancer
Authors: Meng Yiming , Kong Cuicui , Ma Yushu , Sun Jing , Zhang Guirong 
Published: August 2024

Abstract
Bacterial outer membrane vesicles (OMVs) are diminutive vesicles naturally released by Gram-negative bacteria. These vesicles possess distinctive characteristics that attract attention for their potential use in drug administration and immunotherapy in cancer treatment. Therapeutic medicines may be delivered via OMVs directly to the tumor sites, thereby minimizing exposure to healthy cells and lowering the risk of systemic toxicity. Furthermore, the activation of the immune system by OMVs has been demonstrated to facilitate the recognition and elimination of cancer cells, which makes them a desirable tool for immunotherapy. They can also be genetically modified to carry specific antigens, immunomodulatory compounds, and small interfering RNAs, enhancing the immune response to cancerous cells and silencing genes associated with disease progression. Combining OMVs with other cancer treatments like chemotherapy and radiation has shown promising synergistic effects. This review highlights the crucial role of bacterial OMVs in cancer, emphasizing their potential as vectors for novel cancer targeted therapies. As researchers delve deeper into the complexities of these vesicles and their interactions with tumors, there is a growing sense of optimism that this avenue of study will bring positive outcomes and renewed hope to cancer patients in the foreseeable future.
Generalizability of Heat-related Health Risk Associations Observed in a Large Healthcare Claims Database of Patients with Commercial Health Insurance
Authors: Milando Chad W. , Sun Yuantong , Romitti Yasmin , Nori-Sarma Amruta , Gause Emma L. , Spangler Keith R. , Sue Wing Ian , Wellenius Gregory A. 
Published: August 2024

Background:
Extreme ambient heat is unambiguously associated with a higher risk of illness and death. The Optum Labs Data Warehouse (OLDW), a database of medical claims from US-based patients with commercial or Medicare Advantage health insurance, has been used to quantify heat-related health impacts. Whether results for the insured subpopulation are generalizable to the broader population has, to our knowledge, not been documented. We sought to address this question, for the US population in California from 2012 to 2019.

Methods:
We examined changes in daily rates of emergency department encounters and in-patient hospitalization encounters for all-causes, heat-related outcomes, renal disease, mental/behavioral disorders, cardiovascular disease, and respiratory disease. OLDW was the source of health data for insured individuals in California, and health data for the broader population were gathered from the California Department of Health Care Access and Information. We defined extreme heat exposure as any day in a group of 2 or more days with maximum temperatures exceeding the county-specific 97.5th percentile and used a space-time-stratified case-crossover design to assess and compare the impacts of heat on health.

Results:
Average incidence rates of medical encounters differed by dataset. However, rate ratios for emergency department encounters were similar across datasets for all causes [ratio of incidence rate ratios (rIRR) = 0.989; 95% confidence interval (CI) = 0.969, 1.009], heat-related causes (rIRR = 1.080; 95% CI = 0.999, 1.168), renal disease (rIRR = 0.963; 95% CI = 0.718, 1.292), and mental health disorders (rIRR = 1.098; 95% CI = 1.004, 1.201). Rate ratios for inpatient encounters were also similar.

Conclusions:
This work presents evidence that OLDW can continue to be a resource for estimating the health impacts of extreme heat.
Impact of Microsurgical Reconstruction Timing on the Risk of Free Flap Loss in Acute Burns: Systematic Review and Meta-Analysis
Authors: Alessandri-Bonetti Mario , Kasmirski Julia A. , Liu Hilary Y. , Corcos Alain C. , Ziembicki Jenny A. , Stofman Guy M. , Egro Francesco M. 
Published: August 2024

Background:
Free tissue transfer is usually considered as a last resort in severe burn cases, when skin substitutes and local flaps are not viable options. Prior studies have demonstrated a free flap loss rate ranging from 0% to 44%. The aim of this study is to identify the ideal timing to perform free flap reconstruction in acute burn-related injuries to minimize free flap loss.

Methods:
A systematic review and meta-analysis was performed and reported according to PRISMA guidelines. PubMed, Embase, Web of Science, and Cochrane Library databases were queried. The review protocol was registered on PROSPERO database (CRD42023404478). Three time intervals from day of injury were identified: (1) 0–4 days, (2) 5–21 days, and (3) 22 days–6 weeks. The primary outcome was total free flap loss.

Results:
A total of 17 articles met inclusion criteria. The analysis included 275 free flaps performed in 260 patients (88% men, 12% women) affected by acute burn injuries. The pooled prevalence of free flap failure in the three time intervals (0–4 days, 5–21 days, and 22 days–6 weeks) were 7.32% [95% confidence interval (CI): 2.38%–20.37%], 16.55% (95% CI: 11.35%–23.51%), and 6.74% (95% CI: 3.06%–14.20%), respectively.

Conclusions:
Free flap reconstruction carries a high risk of failure in patients with acute burn. However, timing of the reconstruction appears to influence surgical outcomes. Free flap reconstruction performed between 5 and 21 days from burn injury had a trend toward higher flap loss rates and should be discouraged.
Knot Security 101: A Comprehensive Practical Review to Optimal Knot Configuration, Pulling Direction, Throw Count, and Tail Length
Authors: Bushong Elizabeth E. , Janis Jeffrey E. 
Published: August 2024

Background:
Knots are the weakest structural point in a suture line and inevitably weaken almost all suture materials. This practical review critically evaluates the factors, such as suture material properties, gauge, configuration, throw count, and tail length, that affect knot security.

Methods:
A PubMed search between the years 1934 and 2023 identified relevant studies that addressed factors relating to knot security. Studies that investigated knots and sutures solely used in laparoscopic and arthroscopic surgery were excluded. Knot configurations assessed were the Aberdeen, sliding, square, and surgeon’s.

Results:
Eighty-six articles were included in this review article and demonstrated that knot security varies greatly between suture materials and gauge. Knot security also varies by configuration, throw count, conditions, tail length, and stitch type. Throw count differs by knot configuration, with the Aberdeen knot being most secure with three throws and one to two turns compared with three to five throws for surgeon’s and square knots. The optimal tail length was 3 mm.

Conclusions:
This practical review demonstrates that there are significant differences in knot security based on a variety of factors. It is challenging to propose an ideal knot because most studies did not evaluate knot security using a broad variety of suture materials, gauges, and throws for each of the most common knots. Although this review article demonstrated several applicable findings, additional robust studies are needed to simplify proposals.
PARS PLANA VITRECTOMY FOR THE TREATMENT OF VITREOUS AMYLOID IN PATIENTS WITH HEREDITARY TRANSTHYRETIN AMYLOIDOSIS
Authors: Marques João Heitor , Morais Inês , Coelho João , Severo Milton , Menéres Maria João , Beirão João Melo 
Published: August 2024

Purpose:
To describe a series of patients with hereditary transthyretin amyloidosis with vitreous amyloid and to study the efficacy and safety of pars plana vitrectomy for its treatment.

Methods:
Retrospective study of 266 patients with hereditary transthyretin amyloidosis because of Val30Met mutation submitted to pars plana vitrectomy for vitreous amyloid, with a minimum of 3-month follow-up. Indications for surgery were disabling myodesopsia or two lines loss in visual acuity. Only the first operated eye was considered for analysis.

Results:
Male patients were operated at younger age (51.0 vs. 53.6, P < 0.001). Best-corrected visual acuity improved from 0.38 to 0.89 (decimal scale, P < 0.001). Preoperative glaucoma was associated with lower gain in visual acuity (P < 0.001). During the follow-up, 69%, 22%, and 1% developed new-onset glaucoma, retinal angiopathy, or retinal detachment, respectively, and 36% required cataract surgery. Pars plana vitrectomy was also required in the fellow eye in 57%. Hereditary transthyretin amyloidosis–related death occurred in 27%, 9.3 (95% confidence interval 8.0 to 10.7) years after pars plana vitrectomy.

Conclusion:
Vitreous opacities are frequently the first symptomatic manifestation of ocular amyloidosis. Moreover, they may be a marker of mortality. Vitrectomy is a safe and effective treatment, but these patients require long-term follow-up to monitor the development or worsening of glaucoma or retinal angiopathy.
Paenibacillus lautus: A new foe in endogenous endophthalmitis
Authors: Joshi Aditi , Rao Chetan , Majumder Parthopratim Dutta , Anand A. R. 
Published: August 2024

Purpose:
To discuss the diagnosis and management of a rare case of endogenous endophthalmitis (EE) caused by Paenibacillus lautus mimicking granulomatous uveitis in a child, highlighting the use of 16S rRNA gene amplicon sequencing as an accurate method to identify rare pathogens.

Method:
A retrospective chart review of the clinical presentation, microbiologic workup—including microscopy, culture, antibiotic susceptibility, and polymerase chain reaction for pathogen DNA of clinical samples—and the clinical management of the case were recorded.

Result:
A 13-year-old boy presented with decreased vision in the right eye for one month. On examination, he had uveitis with hypopyon and complicated cataract. The case underwent an anterior chamber tap followed by vitrectomy and lensectomy. The culture of the vitreous aspirate grew Gram-variable bacilli that could not be identified by conventional microbiological techniques. However, PCR-based sequencing of the 16S rRNA gene was performed, and the bacterium was identified as P. lautus. The patient subsequently developed rhegmatogenous retinal detachment, for which he underwent endo laser photocoagulation and oil tamponade. Four months later, silicone oil was removed, and an intraocular lens was implanted. At six weeks follow-up, the retina remained well attached, and intraocular pressure was maintained.

Conclusion:

P. lautus can cause EE and mimic granulomatous uveitis. Techniques such as 16S rRNA gene sequencing can significantly facilitate aetiological diagnosis in cases where conventional methods fail.
Efficacy and Safety of Antibiotics for the Treatment of Relapsing Fever: A Systematic Review and Network Meta-analysis
Authors: Gao Li , Wu Xinya , Liu Meixiao , Fan Yuxin , Chen Jingjing , Yang Jiaru , Ma Weijie , Zhong Lei , Peng Li , Wu Hanxin , Kong Jing , Li Bingxue , Dong Yan , Ma Weijiang , Liu Aihua , Bao Fukai 
Published: August 2024

Abstract
Relapsing fever is an acute infectious disease caused by a variety of relapsing fever-associated spirochetes, for which no optimal treatment has been developed. The purposes of this study were to compare the efficacy and safety of commonly used antibiotics for the treatment of relapsing fever using a network meta-analysis approach and to explore the advantages of each drug based on the current evidence. This study examined nine published studies involving 1416 patients with relapsing fever treated with penicillin, erythromycin, tetracycline, doxycycline, minocycline or chloramphenicol. The odds ratio (OR) and 95% confidence interval (CI) were used as influence indices for discontinuous data, and the efficacy and safety of drugs were ranked by the surface under the cumulative ranking (SUCRA) curve. The primary outcomes of this study were mortality and cure rates, and the secondary outcomes were the rates of Jarisch-Herxheimer reaction and relapse. Erythromycin (SUCRA, 84.5%) was the most effective antibiotic for reducing mortality, whereas tetracycline was the most effective antibiotic for improving the cure rate (SUCRA, 69.3%) and reducing the relapse rate (SUCRA, 79.7%), and minocycline (SUCRA, 66.4%) was the most effective antibiotic for reducing Jarisch-Herxheimer reactions. In addition, our network meta-analysis showed that tetracycline is superior to penicillin for improving the cure rate (OR, 5.91; 95% CI, 2.21–15.81) and reducing the relapse rate (OR, 0.16; 95% CI, 0.04–0.67).
TBK1 p.Y153Qfs*9 variant may be associated with young-onset, rapidly progressive amyotrophic lateral sclerosis through a haploinsufficiency mechanism
Authors: Fang Shih-Yu , Tsai Pei-Chien , Jih Kang-Yang , Hsu Fang-Chi , Liao Yi-Chu , Yang Chih-Chao , Lee Yi-Chung 
Published: August 2024

Background:

TBK1 variants have been implicated in the pathogenesis of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia spectrum disorder. The current study elucidated the clinical and molecular genetic features of a novel TBK1 variant identified in a patient with young-onset, rapidly progressive ALS.

Methods:
The coding regions of TBK1, SOD1, TARDBP, and FUS were genetically analyzed using Sanger sequencing. Repeat-primed polymerase chain reaction (PCR) was used to survey the GGGGCC repeat in C9ORF72. The study participant underwent a comprehensive clinical evaluation. The functional effects of the TBK1 variant were analyzed through in vitro transfection studies.

Results:
We identified a novel frameshift truncating TBK1 variant, c.456_457delGT (p.Y153Qfs*9), in a man with ALS. The disease initially manifested as right hand weakness at the age of 39 years but progressed rapidly, with the revised ALS Functional Rating Scale score declining at an average monthly rate of 1.92 points in the first year after diagnosis. The patient had no cognitive dysfunction. However, Technetium-99m single photon emission tomography indicated hypoperfusion in his bilateral superior and middle frontal cortices. In vitro studies revealed that the p.Y153Qfs*9 variant resulted in a truncated TBK1 protein product, reduced TBK1 protein expression, loss of kinase function, reduced interaction with optineurin, and impaired dimerization.

Conclusion:
The heterozygous TBK1 p.Y153Qfs*9 variant may be associated with young-onset, rapidly progressive ALS through a haploinsufficiency mechanism.
The Nature of Employment in a High Socioeconomic Hardship Community
Authors: Bonney Tessa , Rospenda Kathleen M. , Chaudhry Aeysha , Forst Linda , Conroy Lorraine M. , Holloway Adlaide , Berumen Teresa , Castaneda Dolores , Castaneda Yvette , Gonzalez Sylvia , Hebert-Beirne Jeni 
Published: August 2024

Objectives
This cross-sectional survey aimed to examine employment characteristics and their associations with employment precarity in two high socioeconomic hardship Chicago neighborhoods.

Methods
We used a community-based participatory approach to develop and administer a survey to residents who perceived their work situations to be precarious.

Results
A total of 489 residents were surveyed. Responses were skewed toward the most precarious work situations, with the majority of respondents employed outside of a traditional arrangement. Those in the highest precarity category were most likely to identify as Latinx and born outside of the United States. Unstable, low-quality employment conditions were nearly all significantly associated with highest precarity work situations.

Conclusions
Precarious employment is an important predictor of other employment conditions, and characterizing these at a hyperlocal level allows for a nuanced understanding of work as a determinant of health.
Evaluation of Air Consumption Efficiency in Structural Firefighters
Authors: Langford Emily L. , Bergstrom Haley C. , Lanham Sarah N. , Eastman Alyssa Q. , Best Stuart , Ma Xin , Abel Mark G. 
Published: August 2024

Objective
This study examines variability in air consumption (AC) between firefighters (FF) working at a standardized pace, evaluates the relationship between air consumption efficiency (ACE) and work economy, identifies parameters associated with ACE, and explores the relationship between ACE and self-paced work rate.

Methods
FF completed randomized trials of an air consumption drill at a standardized pace while breathing through a self-contained breathing apparatus and a gas analyzer. A subsample completed another trial at a self-selected pace.

Results
The average AC variability (±1 standard deviation) was ~3.1 min of cylinder usage (13.7%). AC was positively associated with work economy and numerous physiological and anthropometric outcomes. No relationship was found between ACE and self-paced air consumption drill time.

Conclusions
FF working at higher internal strain demonstrated poorer ACE. Improving metabolic tolerance may extend the self-contained breathing apparatus' functional duration to enhance productivity and safety.
Feasibility of Cryobiopsy Specimen Retrieval Through Standard Guide Sheath for Peripheral Pulmonary Lesions Without Bronchoscope Removal
Authors: Kho Sze Shyang , Tan Shirin Hui , Nyanti Larry Ellee , Chai Chan Sin , Ismail Adam Malik , Tie Siew Teck 
Published: August 2024

Background:
Transbronchial cryobiopsy is a promising technique for biopsy of peripheral pulmonary lesions (PPL). However, cryobiopsy specimen retrieval can pose problems due to the risk of bleeding during the blind period when the bronchoscope and cryoprobe are removed en bloc. Artificial airways and prophylactic balloon placement are risk-reducing measures, but the latter is challenging in upper lobe PPL. Specimen retrieval through standard guide sheath (GS) system without the need for bronchoscope removal may now be feasible with the ultrathin cryoprobe.

Methods:
Retrospective review of radial endobronchial ultrasound (rEBUS)-guided transbronchial cryobiopsy for PPL cases in which cryobiopsy specimen was retrieved through the GS over a 6-month period.

Results:
Twenty patients were included with an overall median age of 66.50 (IQR: 53.0 to 76.7). The median procedural time was 30 (IQR: 25.0 to 33.7) minutes. Median target size was 3.20 (IQR: 2.17 to 4.84) cm with 85% of lesions demonstrated “within” rEBUS orientation. Overall technical feasibility was 85% with median cryoactivation of 4.0 (IQR: 3.0 to 4.0) seconds. No specimen was retrieved in 3 patients. The diagnostic yield for forceps and cryobiopsy was 70% and 60%, respectively, and the combined diagnostic yield was 85% (P<0.01 vs. forceps biopsy). Median aggregate size for forceps and cryobiopsy was 8.0 (IQR: 5.3 to 10.0) and 4.5 (IQR: 2.3 to 7.0) mm respectively (P<0.01). No pneumothorax was reported and mild self-limiting bleeding was encountered in 30% of cases.

Conclusion:
Retrieval of cryoprobe through standard GS appears to be a safe and feasible method that can simplify the transbronchial cryobiopsy procedure and complement forceps biopsy in specific cases.
Curved Spine: The Shape of Spine in Taoist Body Diagrams and Its Influence on Medical Body Diagrams
Authors: ZHANG Xinyue , ZHANG Shujian 
Published: August 2024

Abstract
From the early Taoist diagrams of the human body to the end of the Qing dynasty and the beginning of the Republic of China, Taoists exaggerated and deformed the human spine in a shape-shifting manner. It is likely that medical practitioners were influenced by this style of representation, and there are also numerous diagrams of the human body with the curved spine in the lateral-view diagrams of viscera and Ming Tang Tu (明堂图 Acupuncture and Moxibustion Chart), which constantly show the human torso in an elliptical “egg shape”. No later than the Ming dynasty, medical practitioners began to depict the actual physiological spinal curve of the human body. By the Qing dynasty, the depiction of the spinal curve in medical diagrams of the human figure showed a tendency to part ways with the Taoist freehand style of the previous generation. Although the representation of the curve of the spine was very crude, later medical images of the human body at least gradually straightened the spine and no longer depicted it in a shape-shifting manner. However, the curved spine in Taoist diagrams of the human body continued to exist, and the presentation of the curved spine never changed. This way of depicting its appearance, which is very different from reality, is shaped by Taoism’s special way of perceiving and viewing the body, and may also contain another form of truth.
The effects of gaze stability exercises on balance, gait ability, and fall efficacy in patients with chronic stroke: A 2-week follow-up from a randomized controlled trial
Authors: Cui Zhe , Tang Ying-Ying , Lee Myoung-Ho , Kim Myoung-Kwon 
Published: August 2024

Background:
This study aimed to examine the effect of gaze stability exercises on balance, gait ability, and fall efficacy in patients with chronic stroke, as well as to investigate whether any observed effects were maintained 2 weeks later.

Methods:
In this experiment, 30 chronic stroke patients were selected. The patients were randomly divided into 3 groups (10 patients in each group). All patients in the 3 groups performed basic neurodevelopmental treatment. Group 1 performed balance exercises accompanied by gaze stability exercises. Group 2 performed gaze stability exercises, and group 3 performed balance exercises. Each exercise program for 40 minutes 3 times a week for 4 weeks. After the intervention period, the patient’s balance, gait ability, and fall efficacy were measured again. In order to know whether the training effect is maintained, a 2-week follow-up test was conducted after the training.

Results:
The results of this study showed that there was a significant improve in balance (overall stability index, limit of stability test, and Berg Balance Scale), gait ability (gait velocity, cadence, step time and step length, Timed Up and Go [TUG] test), and fall efficacy over the different time within the 3 groups. The effect was observed to be maintained in follow-up tests after 2 weeks. In the comparison among 3 groups, the overall stability index, limit of stability test in the balance test and the gait velocity, cadence, step time, step length and Timed Up and Go test in the gait test all showed statistically significant differences, and the other items did not have significant differences. In most of the assessments, group 1 that used balance exercise combined with gaze stability exercise showed a better improvement than the other 2 groups.

Conclusion:
As a result, for stroke patients, gaze stability exercise is an effective arbitration method to improve balance and gait ability and fall efficacy. With balance exercise combined with gaze stability exercise, a greater effect can be seen than with gaze stability exercise or balance exercise alone. Thus, this combination exercise program can be recommended as effective.