bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evolution of the syrinx of Apodiformes, including the vocal-learning Trochilidae (Aves: Strisores)
Authors: Legendre Lucas J , Rodríguez-Saltos Carlos A , Eliason Chad M , Clarke Julia A 
Published: February 2024

Abstract
The vocal organ of birds, the syrinx, represents a key innovation in the evolutionary history of vertebrate communication. Three major avian clades: passerines, parrots, and hummingbirds, independently acquired both specialized syringeal structures and vocal-production learning, between which a functional relationship has been proposed but remains poorly understood. In hummingbirds, the syrinx has never been studied comparatively alongside non-learning relatives in the parent clade Strisores. Here we describe the anatomy of the syrinx in three swift species using enhanced-contrast computed tomography, which reveals structures previously unreported in the clade. We also tested for correlations between syringeal and acoustic traits in a sample of hummingbirds and swifts using phylogenetically informed regressions. The swift syrinx presents lateral labia located on the first pair of bronchial half-rings, which are present in hummingbirds and may be ancestral to Strisores. The further enlarged lateral labia of hummingbirds are found to be significantly correlated to the reduction in length of their trachea and m. tracheolateralis. Acquisition of intrinsic muscles and loss of the sternotrachealis muscle co-occur with these shifts. We recover a significant negative correlation between tracheal elongation and maximum vocalization frequency, suggesting that tracheal shortening in hummingbirds facilitated the acquisition of high-frequency vocalizing.
Does Medicare Insurance Mitigate Racial/Ethnic Disparities in Access to Lumbar Spinal Surgery When Compared to Commercial Insurance?
Authors: Herrera Michael M. , Tiao Justin , Rosenberg Ashley , Zubizarreta Nicole , Poeran Jashvant , Chaudhary Saad B. 
Published: February 2024

Study Design:
Retrospective cohort study.

Objective:
Compare disparities in lumbar surgical care utilization in Commercially insured versus Medicare patients.

Summary of Background Data:
While disparities in spinal surgery have been previously described, less evidence exists on effective strategies to mitigate them. Theoretically, universal health care coverage under Medicare should improve health care access.

Materials and Methods:
Utilizing National Inpatient Sample data (2003–2018), we included inpatient lumbar discectomy or laminectomy/fusion cases in black, white, or Hispanic patients aged 18–74 years, with Commercial or Medicare insurance. A multivariable Poisson distribution model determined race/ethnicity subgroup-specific rate ratios (RRs) of patients undergoing lumbar surgery compared to their respective population distribution (using US Census data) based on race/ethnicity, region, gender, primary payor, and age (Commercially insured age subgroups: 18–39, 40–54, and 55–64 y; Medicare age subgroup: 65–74 y).

Results:
Of the 2,310,956 lumbar spine procedures included, 88.9%, 6.1%, and 5.0% represented white, black, and Hispanic patients, respectively. Among Commercially insured patients, black and Hispanic (compared to white) patients had lower rates of surgical care utilization; however, these disparities decreased with increasing age: black (RR=0.37, 95% CI: 0.37–0.38) and Hispanic patients (RR=0.53, 95% CI: 0.52–0.54) aged 18–39 years versus black (RR=0.72, 95% CI: 0.71–0.73) and Hispanic patients (RR=0.64, 95% CI: 0.63–0.65) aged 55–64 years. Racial/ethnic disparities persisted in Medicare patients, especially when compared to the neighboring age subgroup that was Commercially insured: black (RR=0.61, 95% CI: 0.60–0.62) and Hispanic patients (RR=0.61, 95% CI: 0.60–0.61) under Medicare.

Conclusions:
Disparities in surgical care utilization among black and Hispanic patients persist regardless of health care coverage, and an expansion of Medicare eligibility alone may not comprehensively address health care disparities.

Level of Evidence:
Level III.
The Burden of Back and Neck Strains and Sprains in Professional Baseball Players
Authors: Makhni Melvin C. , Curriero Frank C. , Yeung Caleb M. , Leung Eric , Kvit Anton , Ahmad Christopher S. , Lehman Ronald A. 
Published: February 2024

Study Design:
A retrospective case series study.

Objective:
To analyze the epidemiology of diagnoses of back and neck strains and sprains among Major League (MLB) and Minor League (MiLB) Baseball players.

Background:
Baseball players perform unique sets of repetitive movements that may predispose to neck and back strains and sprains. Data are lacking concerning the epidemiology of these diagnoses in this population.

Materials and Methods:
De-identified data on neck/back strains and sprains were collected from all MLB and MiLB teams from 2011 to 2016 using the MLB-commissioned Health and Injury Tracking System database. Diagnosis rates of conditions related to cervical, thoracic, and lumbar musculature and their impact on days missed due to injury, player participation, and season or career-ending status were assessed. Injury rates were reported as injuries per 1000 athlete exposures (AEs).

Results:
There were 3447 cases of neck/back strains and sprains in professional baseball players from 2011 to 2016. Seven hundred twenty-one of these occurred in MLB versus 2726 in MiLB. Of injuries 136 were season-ending (26 in MLB, 110 in MiLB); 22 were career-ending (2 in MLB, 20 in MiLB). The total days missed were 39,118 (8838 from MLB and 30,280 from MiLB). Excluding season or career-ending injuries, the mean days missed were 11.8 (12.7 and 11.6 in MLB and MiLB, respectively). The median days missed were 4 (3 and 5 in MLB and MiLB, respectively). Combining MLB and MiLB, the pitcher injury rate was 1.893 per 1000 AEs versus 0.743 per 1000 Aes for other position players (P < 0.0001).

Conclusion:
There was a high incidence of neck/back strains and sprains in MLB and MiLB players, with nearly 40,000 aggregate days missed in our 6-year study period. The median days missed were lower than the mean days missed, indicating rightward outliers. Pitchers had over double the rates of injuries compared with other position players.

Level of Evidence:
Level III.
Home Blood Pressure Monitoring and Its Association With Blood Pressure Control Among Hypertensive Patients With High Cardiovascular Risk in China
Authors: Li Jiaying , Tian Aoxi , Liu Jiamin , Ge Jinzhuo , Peng Yue , Su Xiaoming , Li Jing 
Published: February 2024

Objective:
Home blood pressure monitoring (HBPM) is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension. However, evidence remains scarce about the effectiveness of HBPM use in the real world. This study aimed to examine the associations of HBPM use with blood pressure (BP) control and medication adherence.

Methods:
This prospective cohort study included hypertensive patients with high cardiovascular risk who were aged ≥50 years. At baseline, information about types of BP monitor, frequency of HBPM, perception of anti-hypertensive treatment, and measured office BP were collected. During the 1-year follow-up (visits at 1, 2, 3, 6, and 12 months), information on medication adherence was collected at each visit. The 2 major outcomes were BP control at baseline and medication adherence during the 1-year follow-up. A log-binomial regression model was used to examine the association between frequency of HBPM and outcomes, stratified by the perceptions of anti-hypertensive treatment.

Results:
A total of 5,363 hypertensive patients were included in the analysis. The age was (64.6 ± 7.2) years, and 41.2% (2,208) were female. Of the total patients, 85.9% (4,606) had a home BP monitor and 47.8% (2,564) had an incorrect perception of anti-hypertensive treatment. Overall, 24.2% (1,299) of patients monitored their BP daily, 37.6% (2,015) weekly, 17.3% (926) monthly, and 20.9% (1,123) less than monthly. At baseline, the systolic BP and diastolic BP were (146.6 ± 10.8) mmHg and (81.9 ± 10.6) mmHg, respectively, and 28.5% (1,527) of patients had their BP controlled. Regardless of whether the patients had correct or incorrect perceptions of anti-hypertensive treatment, there is no significant association between HBPM frequency and BP control at baseline. During the 1-year follow-up, 23.9% (1,280) of patients had non-adherence to medications at least once. In patients with an incorrect perception of anti-hypertensive treatment, those monitoring BP most frequently (daily) had the highest non-adherence rate (29.9%, 175/585). Compared with those monitoring their BP less than monthly, patients who monitored their BP daily were more likely not to adhere to anti-hypertensive medications (adjusted relative risk = 1.38, 95% confidence interval: 1.11–1.72, P = 0.004).

Conclusions:
HBPM performance among hypertensive patients in China is, in general, sub-optimal. No association was observed between using HBPM alone and hypertension control, indicating that the effects of HBPM could be conditional. Patients’ misconceptions about anti-hypertensive treatment may impair the role of BP monitoring in achieving medication adherence. Fully incorporating the correct perception of hypertension into the management of hypertensive patients is needed.
Salivary Therapeutic Monitoring of Buprenorphine in Neonates After Maternal Sublingual Dosing Guided by Physiologically Based Pharmacokinetic Modeling
Authors: Alsmadi Mo'tasem M. 
Published: February 2024

Background:
Opioid use disorder (OUD) during pregnancy is associated with high mortality rates and neonatal opioid withdrawal syndrome (NOWS). Buprenorphine, an opioid, is used to treat OUD and NOWS. Buprenorphine active metabolite (norbuprenorphine) can cross the placenta and cause neonatal respiratory depression (EC50 = 35 ng/mL) at high brain extracellular fluid (bECF) levels. Neonatal therapeutic drug monitoring using saliva decreases the likelihood of distress and infections associated with frequent blood sampling.

Methods:
An adult physiologically based pharmacokinetic model for buprenorphine and norbuprenorphine after intravenous and sublingual administration was constructed, vetted, and scaled to newborn and pregnant populations. The pregnancy model predicted that buprenorphine and norbuprenorphine doses would be transplacentally transferred to the newborns. The newborn physiologically based pharmacokinetic model was used to estimate the buprenorphine and norbuprenorphine levels in newborn plasma, bECF, and saliva after these doses.

Results:
After maternal sublingual administration of buprenorphine (4 mg/d), the estimated plasma concentrations of buprenorphine and norbuprenorphine in newborns exceeded the toxicity thresholds for 8 and 24 hours, respectively. However, the norbuprenorphine bECF levels were lower than the respiratory depression threshold. Furthermore, the salivary buprenorphine threshold levels in newborns for buprenorphine analgesia, norbuprenorphine analgesia, and norbuprenorphine hypoventilation were observed to be 22, 2, and 162 ng/mL.

Conclusions:
Using neonatal saliva for buprenorphine therapeutic drug monitoring can facilitate newborn safety during the maternal treatment of OUD using sublingual buprenorphine. Nevertheless, the suitability of using adult values of respiratory depression EC50 for newborns must be confirmed.
Resilience and related factors in caregivers of adult cancer patients: a systematic review
Authors: Mollaei Fereshteh , Sharif Nia Hamid , Pouralizadeh Moluk , Karkhah Samad , Javadi-Pashaki Nazila , Ghorbani Vajargah Pooyan 
Published: February 2024

Background:
This systematic review aimed to investigate resilience and its related factors in caregivers of adult patients with cancer.

Materials and methods:
A systematic search of online electronic databases including Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) was performed using keywords extracted from Medical Subject Headings such as “Psychological Resilience”, “Caregiver”, and “Cancer” from the earliest to 6 June 2023. The quality of the studies included in this review was evaluated using the appraisal tool for cross-sectional studies (AXIS tool).

Results:
A total of 2735 caregivers of cancer patients participated in 15 studies. The majority of the studies found that caregivers of cancer patients had high levels of resilience. Factors related to the resilience of cancer patients’ caregivers included caregivers’ social support, caregivers’ quality of life, patients’ resilience, caregivers’ family function, patients’ performance, caregivers’ age, caregivers’ health status, caregivers’ self-esteem, caregivers post-traumatic growth, caregivers religious, caregivers hope, caregivers positive affect, patients age, patients social support, patients resilience support, patients quality of life, caregivers’ anxiety, caregivers’ depression, caregivers’ burden, caregivers level of education, caregivers financial problem, caregivers memory, caregivers negative affect, caregivers post-traumatic stress disorder, maternal distress, and patients post-traumatic stress disorder.

Conclusion:
Therefore, healthcare administrators and policymakers can enhance the resilience of caregivers and the quality of care they provide by instituting ongoing training initiatives focused on evaluating mental well-being and implementing coping strategies for managing stress and depression.
A rara case of concurrent chromophobe renal cell cancer with lung neuroendocrine tumor: a case report and literature review
Authors: Zeer Zahraa M. M. , Noman Mahmoud , Zeer Almotazbellah M. M. , Mahamid Yamama Hasan , Arafat Hasan , Abomoch Malak , Abu Aqeel Bashir 
Published: February 2024

Introduction:
Multiple primary malignances may be in one organ or in multiple separate organs. They are categorized into synchronous and metachronous according to the time interval between the two malignancies. Multiple risk factors could be attributed to the development of second primary malignancy.

Case Presentation:
we report a case of a 51-year-old male patient with renal cell carcinoma. During his evaluation, he seemed to have a lung mass which revealed to be a carcinoid tumor. As the patient had two primary malignancies, he was managed according to the treatment options for each tumor.

Discussion:
Although multiple primary malignancies (MPM) have been reported increasingly in the past decade, overall incidence is still very rare. Appropriate management and survival depend on distinguishing between dual primary tumors from metastatic disease.

Conclusion:
Multidisciplinary approach is very crucial for diagnosis and management such rare cases.
Effect of an Evaluation Algorithm on CT Utilization in Identifying Appendicitis in Children
Authors: Sikes Kendra L. , Hart Rebecca J. , Feygin Yana , Penrod Cody H. 
Published: February 2024

Objective
Our objective was to determine if there was a significant change in computed tomography (CT) utilization or length of stay (LOS) among patients evaluated for acute appendicitis after implementation of an appendicitis evaluation algorithm.

Methods
We conducted a retrospective chart review of patients aged 3–18 years in an urban, tertiary pediatric emergency department with acute abdominal pain, evaluated for appendicitis. Data were collected for 6 months preimplementation and postimplementation of the evaluation algorithm with a 3-month washout period between September 2018 and November 2019. Main outcomes were rate of CT utilization and LOS preimplementation and postimplementation and were analyzed using χ2 test and Mann-Whitney U test, respectively. Descriptive analysis of demographics was performed, in addition to logistic regression to assess differences between the 2 study periods.

Results
A total of 2872 charts were identified with a chief complaint inclusive of “abdominal pain.” Of these, 1510 met age requirements but did not meet at least 1 inclusion criteria; 229 more were excluded upon chart review for a final study sample of 1133 patients. Of these, 648 (57.2%) were female, 747 (65.9%) were White, and 988 (87.2%) were non-Hispanic. The majority of patients (770, 68%) were discharged home from the emergency department without a diagnosis of acute appendicitis. Neither CT (25.7% to 24.8%; P = 0.794) nor ultrasound (59.5% to 59.7%; P = 1.000) utilization significantly changed postimplementation. Total ED median LOS increased significantly (333.50 to 362.00 minutes; P = 0.011). Significant factors associated with CT utilization included fever, migration of pain, and right lower quadrant tenderness. Significant factors associated with appendicitis diagnosis included right lower quadrant pain, nausea/vomiting, migration of pain, and peritoneal signs.

Conclusions
Overall, the appendicitis evaluation algorithm did not significantly decrease CT utilization or LOS. Equivocal grade 2 or 3 ultrasound finding rates were high, likely leading to higher rates of CT utilization and increasing LOS.
TARGETED STIMULATION OF THE SENSORY AFFERENTS IMPROVES MOTONEURON FUNCTION IN HUMANS WITH A DEGENERATIVE MOTONEURON DISEASE
Authors: Prat-Ortega G. , Ensel S. , Donadio S. , Borda L. , Boos A. , Yadav P. , Verma N. , Ho J. , Frazier-Kim S. , Fields D.P. , Fisher LE , Weber DJ , Duong T. , Weinstein S. , Eliasson M. , Montes J , Chen K.S. , Clemens P , Gerszten P. , Mentis G.Z. , Pirondini E , Friedlander R. M. , Capogrosso M 
Published: February 2024

SUMMARYSpinal Muscular Atrophy (SMA) is an inherited neurodegenerative disease causing motoneuron dysfunction, muscle weakness and early mortality1,2. Three therapies can slow disease progression enabling people to survive albeit with lingering motoneuron dysfunction and severe motor impairments3,4. Here we introduce a neurotechnological approach that improved spinal motoneuron function, muscle strength and walking in three adults with SMA. Starting from preclinical evidence showing that motoneuron dysfunction in SMA originates from the loss of excitatory inputs from primary afferents5,6, we hypothesized that augmentation of sensory neural activity with targeted electrical stimulation could compensate for this loss thereby improving motoneuron function. To test this hypothesis we implanted three adults with SMA with epidural electrodes over the lumbosacral spinal cord to stimulate the sensory axons of the legs7,8. We stimulated participants for 4 weeks 2 hours per day while they executed walking and strength tasks. Remarkably, our neurostimulation regime led to robust improvements in strength, walking and fatigue paralleled by reduced neuronal hyperexcitability, increased sensory inputs and higher motoneuron firing rates. Our data indicate that targeted neurostimulation can reverse degenerative processes of circuit dysfunction thus promoting disease modifying effects in a human neurodegenerative disease.
Novel approach for carbon-wise utilization of lignin-related compounds by synergistically employing anaerobic and aerobic bacteria
Authors: Meriläinen Ella , Efimova Elena , Santala Ville , Santala Suvi 
Published: February 2024

AbstractLignin is a highly abundant but strongly underutilized natural resource that could serve as a sustainable feedstock to produce chemicals by microbial cell factories. However, the production from lignin-related aromatics is hindered by limited substrate range and inefficient catabolism of the production hosts. Particularly, the aerobic demethylation reactions are energy-limited and cause growth inhibition and loss of CO2. Here, we present a novel approach for carbon-wise utilization of lignin-related aromatics by the integration of anaerobic and aerobic metabolisms. In practice, we employed an acetogenic bacteriumAcetobacterium woodiifor anaerobic O-demethylation of aromatic compounds, which distinctively differs from the aerobic demethylation; in the process, the carbon from the methoxyl groups is fixated together with CO2 to form acetate while the aromatic ring remains unchanged. These accessible end-metabolites were then utilized by an aerobic bacteriumAcinetobacter baylyiADP1. Finally, we demonstrated the production of muconic acid from guaiacol, an abundant but inaccessible substrate to most microbes, with a nearly equimolar yield with only a minor genetic engineering and without the need for additional organic carbon source. This study highlights the power of synergistic integration of distinctive metabolic features of bacteria, thus unlocking new opportunities for harnessing microbial cocultures in upgrading challenging feedstocks.
Locomotion-dependent auditory gating to the parietal cortex guides multisensory decisions
Authors: Choi Ilsong , Lee Seung-Hee 
Published: February 2024

AbstractDecision-making in mammals fundamentally relies on integrating multiple sensory inputs, with conflicting information resolved flexibly based on a dominant sensory modality. However, the neural mechanisms underlying state-dependent changes in sensory dominance remain poorly understood. Our study demonstrates that locomotion in mice shifts auditory-dominant decisions toward visual dominance during audiovisual conflicts. Using circuit-specific calcium imaging and optogenetic manipulations, we found that weakened visual representation in the posterior parietal cortex (PPC) leads to auditory-dominant decisions in stationary mice. Prolonged locomotion, however, promotes visual dominance by inhibiting auditory cortical neurons projecting to the PPC (ACPPC). This shift is mediated by secondary motor cortical neurons projecting to the auditory cortex (M2AC), which specifically inhibit ACPPCneurons without affecting auditory cortical projections to the striatum (ACSTR). Our findings reveal the neural circuit mechanisms underlying auditory gating to the association cortex depending on locomotion states, providing insights into the state-dependent changes in sensory dominance during multisensory decision-making.
Circadian rhythms of macrophages are altered by the acidic pH of the tumor microenvironment
Authors: Knudsen-Clark Amelia M. , Mwangi Daniel , Cazarin Juliana , Morris Kristina , Baker Cameron , Hablitz Lauren M. , McCall Matthew N. , Kim Minsoo , Altman Brian J. 
Published: February 2024

AbstractMacrophages are prime therapeutic targets due to their pro-tumorigenic and immunosuppressive functions in tumors, but the varying efficacy of therapeutic approaches targeting macrophages highlights our incomplete understanding of how the tumor microenvironment (TME) can influence regulation of macrophages. The circadian clock is a key internal regulator of macrophage function, but how circadian rhythms of macrophages may be influenced by the tumor microenvironment remains unknown. We found that conditions associated with the TME such as polarizing stimuli, acidic pH, and elevated lactate concentrations can each alter circadian rhythms in macrophages. Circadian rhythms were enhanced in pro-resolution macrophages but suppressed in pro-inflammatory macrophages, and acidic pH had divergent effects on circadian rhythms depending on macrophage phenotype. While cyclic AMP (cAMP) has been reported to play a role in macrophage response to acidic pH, our results indicate that pH-driven changes in circadian rhythms are not mediated solely by the cAMP signaling pathway. Remarkably, clock correlation distance analysis of tumor-associated macrophages (TAMs) revealed evidence of circadian disorder in TAMs. This is the first report providing evidence that circadian rhythms of macrophages are altered within the TME. Our data further suggest that heterogeneity in circadian rhythms at the population level may underlie this circadian disorder. Finally, we sought to determine how circadian regulation of macrophages impacts tumorigenesis, and found that tumor growth was suppressed when macrophages had a functional circadian clock. Our work demonstrates a novel mechanism by which the tumor microenvironment can influence macrophage biology through altering circadian rhythms, and the contribution of circadian rhythms in macrophages to suppressing tumor growth.