bluuebunny/crossref_metadata_2025 huggingface dataset:
A Retrospective Analysis of Upper Arm Rejuvenation Surgery in 50 Patients
Authors: Zhu Jinglin , Zhao Fangning , Li Facheng
Published: December 2023

Background

Upper arm aesthetics often suffer from aging effects such as skin laxity and sagging due to collagen and elastin depletion. Fat loss, obesity, and weight fluctuations further exacerbate these issues. Existing classification systems for upper arm excess are complex and have practical limitations.

Objectives

The aim of this study was to develop a more concise and clearer classification of upper arm excess that can guide surgical interventions effectively and assess clinical outcomes.

Methods

Patients undergoing upper arm rejuvenation surgery from January 2020 to January 2023 were categorized as mild, moderate, or severe. Mild cases underwent suction-assisted liposuction (SAL), moderate cases underwent radiofrequency-assisted liposuction combined with SAL, and severe cases underwent brachioplasty combined with SAL. Arm circumferences and BODY-Q questionnaires were collected pre- and postoperatively.

Results

The study included 50 female patients, aged 21 to 49 years. The average follow-up time was 7.5 [2.2] months. Arm circumference reduction rates were 6.8% in mild cases, 15.1% in moderate cases, and 17.3% in severe cases. Regarding the BODY-Q questionnaire for upper arms, the average score increased by 0.9 for mild, 2.1 for moderate, and 2.9 for severe cases. Complications were minimal, including 1 seroma and 2 cases of scar widening.

Conclusions

The revised classification system for upper arm excess proved effective in guiding surgical decisions. Selecting the surgical approach based on severity resulted in satisfactory outcomes based on BODY-Q scores. This system offers a concise, objective, and practical tool for plastic surgeons.

Level of Evidence: 3
Main Factors Influencing Patient Satisfaction After Primary Breast Augmentation: A Prospective Study Based on Patient-Reported Outcome Measures
Authors: Marangi Giovanni Francesco , Savani Luca , Gratteri Marco , Arcari Lucrezia , Segreto Francesco , Cagli Barbara , Cogliandro Annalisa , Vega Raffaella , Mirra Carlo , Persichetti Paolo
Published: December 2023

Background

Primary breast augmentation is one of the most sought-after procedures in cosmetic surgery. It is generally related to a high degree of patient satisfaction, but it is not always obvious which factors have greater influence on patient satisfaction.

Objectives

The aim of this prospective study was to evaluate how anthropometric, psychological, and social parameters, in association with the main surgical variables, influenced patients’ satisfaction with their breasts after surgery.

Methods

Patients undergoing primary breast augmentation between October 2018 and February 2022, who completed a 12-month follow-up without complications, were enrolled in the study. For each patient we recorded: BMI, pinch test (upper pole of the breast), surgical access, implant pocket, implant volume, bra size increase, age, smoking habit, civil status, education level, pregnancies, and psychiatric disorders. Each variable was statistically correlated with patient’s satisfaction, assessed by BREAST-Q questionnaire preoperatively and 12 months postoperatively.

Results

Analyzing the data of the 131 patients, we found 3 factors affecting their satisfaction (P<.05); BMI: underweight patients were less satisfied than normal and overweight patients; pinch test: patients with a pinch test >2 cm were more satisfied; volume of the implant and bra size increase: patients with implant volume <300 cc and a less than 2 bra size increase were less satisfied than patients with larger augmentation.

Conclusions

BMI, pinch test, implant volume, and extent of volumetric enhancement should be taken into careful consideration by the surgeon during preoperative consultation and surgical planning, because they can be critical to patient satisfaction.

Level of Evidence: 3
Utility and Evaluation of Applied Project Management Processes Within a Large Multicountry Health Systems Development Project Conducted During the Coronavirus Disease 2019 (COVID-19) Pandemic
Authors: Kwon Soo Young , Gautam Sanjay , Poudel Kritika , Banneheke Hasini , Ferreira Delfim , Gautam Manish , Hau'ofa Michelle , Mahmood Nashmia , Phommalad Bouahome , Sujan Mohammad Julhas , Yangzom Pema , Joh Hea Sun , Shaw Alina , Dolabella Brooke , Seo Hye Jin , Kim Jong-Hoon , Gallagher Partick , MacWright William R , Poudyal Nimesh , Marks Florian , Holm Marianne
Published: December 2023

The increasing trends in antimicrobial resistance (AMR) continue to pose a significant threat to human health, with grave consequences in low- and middle-income countries. In collaboration with local governments and microbiology laboratories in South Asian and Southeast Asian countries, the Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project worked to identify gaps and expand the volume of existing AMR data to inform decision-makers on how to best strengthen their national AMR surveillance capacity. This article describes overall project management processes and the strategies implemented to address the disruptive impact of the coronavirus disease 2019 (COVID-19) pandemic on the project activities across diverse contexts in different countries. Also, it assesses in-country team's feedback on the conduct of activities and their overall impact on project completion. The strategies employed were tailored to the specific context of each country and included increased communication and collaboration among consortium partners and in-country teams, as well as hiring of additional in-country team members. This paper highlights the importance of local representation and capacities as well as real-time (virtual) engagement with stakeholders, ensuring close monitoring of the local situation and ability to tailor context-specific mitigation strategies to continue project implementation during disruptive external circumstances.
A chromosome-level genome assembly of Agave hybrid NO.11648 provides insights into the CAM photosynthesis
Authors: Yang Ziping , Yang Qian , Liu Qi , Li Xiaolong , Wang Luli , Zhang Yanmei , Ke Zhi , Lu Zhiwei , Shen Huibang , Li Junfeng , Zhou Wenzhao
Published: December 2023

The subfamily Agavoideae comprises crassulacean acid metabolism (CAM), C3, and C4 plants with a young age of speciation and slower mutation accumulation, making it a model crop for studying CAM evolution. However, the genetic mechanism underlying CAM evolution remains unclear because of lacking genomic information. This study assembled the genome of Agave hybrid NO.11648, a constitutive CAM plant belonging to subfamily Agavoideae, at the chromosome level using data generated from high-throughput chromosome conformation capture, Nanopore, and Illumina techniques, resulting in 30 pseudo-chromosomes with a size of 4.87 Gb and scaffold N50 of 186.42 Mb. The genome annotation revealed 58 841 protein-coding genes and 76.91% repetitive sequences, with the dominant repetitive sequences being the I-type repeats (Copia and Gypsy accounting for 18.34% and 13.5% of the genome, respectively). Our findings also provide support for a whole genome duplication event in the lineage leading to A. hybrid, which occurred after its divergence from subfamily Asparagoideae. Moreover, we identified a gene duplication event in the phosphoenolpyruvate carboxylase kinase (PEPCK) gene family and revealed that three PEPCK genes (PEPCK3, PEPCK5, and PEPCK12) were involved in the CAM pathway. More importantly, we identified transcription factors enriched in the circadian rhythm, MAPK signaling, and plant hormone signal pathway that regulate the PEPCK3 expression by analysing the transcriptome and using yeast one-hybrid assays. Our results shed light on CAM evolution and offer an essential resource for the molecular breeding program of Agave spp.
Genomic analysis of fruit size and shape traits in apple: unveiling candidate genes through GWAS analysis
Authors: Dujak Christian , Coleto-Alcudia Veredas , Aranzana Maria José
Published: December 2023

Genomic tools facilitate the efficient selection of improved genetic materials within a breeding program. Here, we focus on two apple fruit quality traits: shape and size. We utilized data from 11 fruit morphology parameters gathered across three years of harvest from 355 genotypes of the apple REFPOP collection, which serves as a representative sample of the genetic variability present in European-cultivated apples. The data were then employed for genome-wide association studies (GWAS) using the FarmCPU and the BLINK models. The analysis identified 59 SNPs associated with fruit size and shape traits (35 with FarmCPU and 45 with BLINK) responsible for 71 QTNs. These QTNs were distributed across all chromosomes except for chromosomes 10 and 15. Thirty-four QTNs, identified by 27 SNPs, were related for size traits, and 37 QTNs, identified by 26 SNPs, were related to shape attributes. The definition of the haploblocks containing the most relevant SNPs served to propose candidate genes, among them the genes of the ovate family protein MdOFP17 and MdOFP4 that were in a 9.7kb haploblock on Chromosome 11. RNA-seq data revealed low or null expression of these genes in the oblong cultivar “Skovfoged” and higher expression in the flat “Grand’mere.” The Gene Ontology enrichment analysis support a role of OFPs and hormones in shape regulation. In conclusion, this comprehensive GWAS analysis of the apple REFPOP collection has revealed promising genetic markers and candidate genes associated with apple fruit shape and size attributes, providing valuable insights that could enhance the efficiency of future breeding programs.
Designing an early selection morphological traits index for reproductive efficiency in Pura Raza Española mares
Authors: Perdomo-González Davinia I , Sánchez-Guerrero María J , Bartolomé Ester , Guedes dos Santos Rute , Molina Antonio , Valera Mercedes
Published: December 2023

The low rate of reproductive efficiency in horses may be linked to the equine industry’s practice of maintaining breeding stock that stands out for its athletic or morphological performance but exhibits poor reproductive efficiency. In this study, the age at first foaling, age at last foaling, interval between first and second foaling, average interval between foaling, foaling number and reproductive efficiency, and their relationship with the morphological records in 19,758 Pura Raza Española (PRE) mares were analyzed. After a partial least squares analysis height at withers, lateral hock angle, dorsal-sternal diameter, perimeter of anterior cannon bone, angle of shoulder, thoracic perimeter, hip-stifle distance, and angle of croup were the most important traits related with reproductive traits in PRE mares. A multivariate animal model with both morphological and reproductive traits was applied, including age, geographical area, coat color, and average stud size in the decade of the mare’s first foaling. The results indicate that reproductive selection is feasible, and is enhanced by the use of morphological traits, given the moderate to high magnitudes of heritability values in both types of traits, which oscillated between 0.1 (interval between first and second foaling) and 0.95 (height at withers). The resulting genetic parameters were used to develop a series of selection indexes based on morphological or morphological and reproductive combination traits to improve reproductive efficiency traits in PRE mares and thus compute the expected genetic response (EGR) for the different strategies. The increase in EGR, when comparing EGR using only reproductive traits as selection criteria vs. using a combined index of both morphological and reproductive traits, oscillated between 4.0% for the age at first foaling to 46.8% for the interval between first and second foaling. In addition, two precocity indexes showed positive EGR when the age at last foaling and the interval between first and second foaling, both with and without morphological traits, were used as selection criteria. Therefore, this analysis reveals that the preselection of reproductive traits based on morphological traits is possible in PRE mares. Ultimately, this knowledge will help breeders achieve genetic progress in reproductive traits, leading to healthier and more successful breeding outcomes in horses.
Depletion of Gsdma1/2/3 alleviates PMA-induced epidermal hyperplasia by inhibiting the EGFR–Stat3/Akt pathway
Authors: Liu Qiyao , Li Manyun , Sun Minli , Xin Ruyue , Wang Yushu , Chen Qin , Gao Xiang , Lin Zhaoyu
Published: December 2023

Homeostasis of the skin barrier is essential for maintaining normal skin function. Gasdermin A (GSDMA) is highly expressed in the skin and associated with many skin diseases, such as melanoma and psoriasis. In mice, GSDMA is encoded by three gene homologues, namely Gsdma1, Gsdma2, and Gsdma3. Although Gsdma3 gain-of-function mutations cause hair loss and skin inflammation, Gsdma3-deficient mice do not show any visible phenotypes in skin and hair structures. To explore the physiological function of GSDMA, we generated conventional Gsdma1/2/3 knockout (KO) mice. These mice showed significantly alleviated epidermal hyperplasia and inflammation induced by phorbol 12-myristate 13-acetate (PMA). Furthermore, the alleviation of epidermal hyperplasia depended on the expression of Gsdma1/2/3 specifically in keratinocytes. Mechanistically, Gsdma1/2/3 depletion downregulated epidermal growth factor receptor (EGFR) ligands, leading to the decreased EGFR–Stat3/Akt signalling. These results demonstrate that depletion of Gsdma1/2/3 alleviates PMA-induced epidermal hyperplasia partially by inhibiting the EGFR–Stat3/Akt pathway.
Characterization of cerebellar amyloid-β deposits in Alzheimer disease
Authors: Lopez Gianluca , Magaki Shino D , Williams Christopher Kazu , Paganini-Hill Annlia , Vinters Harry V
Published: December 2023

Cerebellar amyloid-β (Aβ) plaques are a component of the diagnostic criteria used in Thal staging and ABC scoring for Alzheimer disease (AD) neuropathologic change. However, Aβ deposits in this anatomic compartment are unique and under-characterized; and their relationship with other pathological findings are largely undefined. In 73 cases of pure or mixed AD with an A3 score in the ABC criteria, parenchymal (plaques) and vascular (cerebral amyloid angiopathy [CAA]) cerebellar Aβ-42 deposits were characterized with respect to localization, morphology, density, and intensity. Over 85% of cases demonstrated cerebellar Aβ-42 parenchymal staining that correlated with a Braak stage V-VI/B3 score (p < 0.01). Among the 63 with cerebellar Aβ-42 deposits, a diffuse morphology was observed in 75% of cases, compact without a central dense core in 32%, and compact with a central dense core in 16% (all corresponding to plaques evident on hematoxylin and eosin staining). Cases with Purkinje cell (PC) loss showed higher proportions of PC layer Aβ-42 staining than cases without PC loss (88% vs 44%, p = 0.02), suggesting a link between Aβ-42 deposition and PC damage. Among all 73 cases, CAA was observed in the parenchymal vessels of 19% of cases and in leptomeningeal vessels in 44% of cases.
Data-driven numerical simulation with extended Kalman filtering and long short-term memory networks for highway traffic flow prediction
Authors: Shih Chung-Yu , Chang Chia-Ming , Wu Bo-Fan , Chang Chia-Hui , Hwang Feng-Nan
Published: December 2023

Developing an accurate and reliable computational tool for traffic flow prediction has always been an active research topic in transportation engineering and planning. The available predictive tools generally fall into parametric, nonparametric and PDE-based approaches. In particular, the machine learning methods, such as the long short-term memory (LSTM) networks, belong to the nonparametric methods. This study proposes the data assimilation technique with LSTM for predicting highway traffic flows. The proposed method is developed under the framework of the extended Kalman filter (EKF) algorithm, which consists of two key components: the analysis and prediction steps. As the numerical simulator, a kernel component of the predictive tool, we use an explicit (EX) Godunov’s scheme to discretize the Lighthill–Whitham–Richards model, where the MacNicholas formulation is used as the fundamental relation between the velocity and density. EKF combines LSTM prediction from two perspectives. In practical scenarios, future data at the upstream or downstream boundary points are unavailable. Therefore, the predicted values generated by LSTM are employed to set boundary conditions. Furthermore, two stages in EKF assimilate the LSTM predicted values, known as pseudo-observations, and the observed data in order with background values obtained through numerical simulation and observed data whenever available. This assimilation process aims to obtain a better initial condition for subsequent predictions, resulting in improved accuracy. Based on historical traffic data of the Hsuehshan Tunnel highway in Taiwan, the numerical results demonstrate that our method can effectively reduce the observation error and outperforms three baselines: EX, EKF and LSTM.
Not just a Fairy Tale: Parody, Late Fascism, and Ghedini’s ‘La pulce d’oro’ (1940)
Authors: Campisi Maria Grazia Aurora
Published: December 2023

At first glance, La pulce d’oro (1940), a one-act comic opera by Giorgio Federico Ghedini, might seem at odds with the turmoil of late-fascist Italy on the brink of war. A new opera in 1940 was itself anachronistic: a genre mired in unending crisis, resurfacing now at one of the darkest moments in the nation’s history. However, on closer inspection, La pulce d’oro demonstrates a peculiar timeliness and—in the tradition of Verdi’s Falstaff—offers pertinent insight into its contemporary and much overlooked moment. This article proposes a reading of the relevance of Ghedini’s opera through its twofold use of parody: as a musical technique and as an allegorical means, connecting past and present, fiction and reality, fairy tale and history. Encompassing some of the key cultural currents of the time—neoclassicism, magic realism, and social satire—La pulce d’oro’s parody unexpectedly brings together comic opera and fascism at a moment of cultural and political apotheosis.
La détection et la prise en charge d’une croissance atypique
Authors: Casey Linda , Fenton Tanis R
Published: December 2023

En pédiatrie, il est fondamental d’évaluer la croissance de l’enfant, mais un tableau clinique de plus en plus complexe peut compliquer l’évaluation des profils de croissance. Le présent point de pratique s’appuie sur des études de cas représentatives pour décrire les principaux éléments de l’interprétation des profils de croissance courants et la réponse à privilégier. Le clinicien qui connaît ces profils courants et leur étiologie sera mieux en mesure d’y répondre de manière appropriée et de limiter le risque de sous-diagnostiquer ou de surdiagnostiquer les retards de croissance.
Trustees’ powers—challenging exercises of discretion
Authors: Wilson KC Richard
Published: December 2023

Challenges to exercises of trustees’ fiduciary powers have become a common feature of trust litigation. The recent decision of the Privy Council in Grand View v Wong has provided a framework for these challenges and clarified the law on improper purposes. This article considers the extent to which there is now a coherent set of principles governing the exercise of fiduciary powers and which important questions remain to be answered.
Pedestrian trajectory prediction method based on the Social-LSTM model for vehicle collision
Authors: Han Yong , Lin Xujie , Pan Di , Li Yanting , Su Liang , Thomson Robert , Mizuno Koji
Published: December 2023

Techniques for predicting the trajectory of vulnerable road users are important to the development of perception systems for autonomous vehicles to avoid accidents. The most effective trajectory prediction methods, such as Social-LSTM, are often used to predict pedestrian trajectories in normal passage scenarios. However, they can produce unsatisfactory prediction results and data redundancy, as well as difficulties in predicting trajectories using pixel-based coordinate systems in collision avoidance systems. There is also a lack of validations using real vehicle-to-pedestrian collisions. To address these issues, some insightful approaches to improve the trajectory prediction scheme of Social-LSTM were proposed, such methods included transforming pedestrian trajectory coordinates and converting image coordinates to world coordinates. The YOLOv5 detection model was introduced to reduce target loss and improve prediction accuracy. The DeepSORT algorithm was employed to reduce the number of target transformations in the tracking model. Image Perspective Transformation (IPT) and Direct Linear Transformation (DLT) theories were combined to transform the coordinates to world coordinates, identifying the collision location where the accident could occur. The performance of the proposed method was validated by training tests using MS COCO (Microsoft Common Objects in Context) and ETH/UCY datasets. The results showed that the target detection accuracy was more than 90% and the prediction loss tends to decrease with increasing training steps, with the final loss value less than 1%. The reliability and effectiveness of the improved method were demonstrated by benchmarking system performance to two video recordings of real pedestrian accidents with different lighting conditions.
36th Annual APRN Legislative Update
Authors: Phillips Susanne J.
Published: December 2023

Advanced practice registered nurses (APRNs) across the US continue to remove statutory and regulatory barriers to patients' full access to APRN care. The status of APRN practice in each US state and Washington, D.C. is examined, with any updates to practice authority and reimbursement reported.
Pressure Injury Knowledge and Attitudes of Senior Nursing Students
Authors: Yoltay Hatice Eda , Özşaker Esma
Published: December 2023

OBJECTIVE

To describe the pressure injury (PI) knowledge and attitudes of senior nursing students (SNSs).

METHODS

This study used a descriptive and cross-sectional design. The study population consisted of SNSs involved in a nursing program in the Aegean region of Turkey. The authors collected data using a student information form, the Turkish version of the Attitude towards Pressure Ulcer Prevention instrument, and the Turkish version of the Pressure Ulcer Prevention Knowledge Assessment Instrument.

RESULTS

One hundred seventy SNSs were included; 50% had experience preventing PI, 14.1% had provided care to patients with PIs, and 21.2% had staged PIs. The SNSs’ average PI prevention knowledge score was 13.06 ± 2.94 (50.3% correct), and only 20.5% (n = 35) of the SNSs answered questions at an acceptable proficiency level (60%). The mean Attitude towards Pressure Ulcer Prevention score of the SNSs was 39.38 ± 2.73 (75.7% correct).

CONCLUSIONS

The results of the research indicated that the SNSs’ knowledge about preventing PI was insufficient, although their attitudes toward PI prevention were positive. Because adequate training on PI is important for patient care, students’ knowledge deficiencies regarding PIs should be identified and addressed.
Are Orthopedic Trauma Surgeons Appropriately Compensated for Treating Acetabular Fractures? An analysis of operative times and RVUs
Authors: Chintalapudi Nainisha , Hysong Alexander , Posey Samuel , Hsu Joseph R. , Kempton Laurence , Phelps Kevin D. , Sims Stephen , Karunakar Madhav , Seymour Rachel B. , Medda Suman ,   the Evidence-Based Musculoskeletal Injury and Trauma Collaborative (EMIT)
Published: December 2023

OBJECTIVES:

To evaluate the work RVUs attributed per minute of operative time (wRVU/min) in fixation of acetabular fractures, evaluate surgical factors that influence wRVU/min, and to compare wRVU/min to other procedures.

METHODS:

Design:

Retrospective

Setting:

Level 1 academic center

Patient Selection Criteria:

251 operative acetabular fractures (62 A, B, C) from 2015 – 2021

Outcome Measures and Comparisons:

Work RVU per minute of operative time for each acetabular current procedural terminology (CPT) code. Surgical approach, patient positioning, total room time and surgeon experience were collected. Comparison wRVU/min were collected from the literature.

RESULTS:

The mean wRVU per surgical minute for each CPT code was (1) CPT 27226 (isolated wall fracture): 0.091 wRVU/min, (2) CPT 27227 (isolated column or transverse fracture): 0.120 wRVU/min, (3) CPT 27228 (associated fracture types): 0.120 wRVU/min. Of fractures with single approaches, anterior approaches generated the least wRVU/min (0.091 wRVU/min, p=0.0001). Average non-surgical room time was 82.1 minutes. Surgeon experience ranged from 3 to 26 years with operative time decreasing as surgeon experience increased (p = 0.03). As a comparison, the wRVU/min for primary and revision hip arthroplasty have been reported as 0.26 and 0.249 wRVU/min respectively.

CONCLUSIONS:

The wRVUs allocated per minute of operative time for acetabular fractures is less than half of other reported hip procedures and lowest for isolated wall fractures. There was a significant amount of non-surgical room time that should be accounted for in compensation models. This information should be utilized to ensure that orthopedic trauma surgeons are being appropriately supported for managing these fractures.
LIFETIME AMBIENT ULTRAVIOLET RADIATION EXPOSURE AND INCIDENCE OF AGE-RELATED MACULAR DEGENERATION
Authors: Amari Bouchra , Merle Benedicte M. J. , Korobelnik Jean-François , Delyfer Marie-Noëlle , Boniol Mathieu , Dore Jean-François , Helmer Catherine , Delcourt Cecile , Cougnard-Gregoire Audrey
Published: December 2023

Purpose:

To investigate the link between lifelong exposure to ultraviolet radiation (UVR) and the development of age-related macular degeneration (AMD).

Methods:

The Alienor study is a prospective population-based cohort involving 963 residents of Bordeaux, France, older than 73 years. A subset of 614 participants for advanced AMD and 422 participants for early AMD were included in the analysis. The participants' residential history combined with UVR estimates from the EuroSun satellite were used to estimate the amount of ambient UVR they have been exposed to over their lifetime. Age-related macular degeneration was classified from retinal fundus photographs and spectral domain optical coherence tomography at 2 to 3 years intervals over the 2006 to 2017 period. Associations between cumulative exposure to ultraviolet A, ultraviolet B, and total (total UV) and the incidence of early and advanced AMD were estimated using multivariate Cox models.

Results:

Intermediate quartiles of total UV, ultraviolet A, and ultraviolet B exposures were associated with a higher risk for incident early AMD (Hazard Ratio [HR] =2.01 [95% confidence interval [CI] = 1.27–3.13], HR = 2.20 [95% CI = 1.38–3.50], HR = 1.79 [95% CI = 1.13–2.80], respectively) as compared with the lower quartile. However, this risk did not further increase in the highest quartiles of exposure. None of the three types of UVR exposure was significantly associated with incident advanced AMD.

Conclusion:

Despite an increased risk with intermediate compared with low UVR exposure, our study cannot confirm a dose–response relationship of UVR exposure with early AMD onset.
HIGH MYOPIA IS COMMON IN PATIENTS WITH X-LINKED RETINOPATHIES
Authors: Huang Li , Lai Yanting , Sun Limei , Li Songshan , Ding Xiaoyan
Published: December 2023

Purpose:

High myopia can occur as a single or syndromic condition. The aim of this study was to evaluate the refractive error and myopic maculopathy in patients with X-linked retinopathies.

Methods:

Whole exome sequencing, Sanger sequencing, and comprehensive ocular examinations were performed in patients with X-linked retinopathies.

Results:

A total of 17 patients were recruited, including six with CACNA1F, seven with RPGR, three with NYX, and one with OPN1MW mutations. The diagnoses were congenital stationary night blindness (6), cone–rod dystrophy (4), retinitis pigmentosa (4), achromatopsia (1), Leber congenital amaurosis (1), and myopia (1). Myopia was present in 88.2% patients, and 64.7% patients had high myopia. Gene analysis showed that high myopia was present in 80% patients with CACNA1F, 100% patients with NYX, and 57.1% patients with RPGR mutations. In the ATN classification, 64.7% of the patients were A1T0N0 and 35.3% were A0T0N0. The refractive errors progressed over time, even in patients with congenital stationary night blindness. Two females with heterozygous de novo RPGR mutations presented with retinitis pigmentosa or cone rod dystrophy combined with high myopia.

Conclusion:

High myopia is common in patients with X-linked retinopathies, and myopic maculopathy was only mild atrophy without traction and neovascularization.
Genes as drugs for glaucoma: latest advances
Authors: Borrás Teresa , Stepankoff Michelle , Danias John
Published: December 2023

Purpose of review

To provide the latest advances on the future use of gene therapy for the treatment of glaucoma.

Recent findings

In preclinical studies, a number of genes have been shown to be able to reduce elevated intraocular pressure (IOP), and to exert neuroprotection of the retinal ganglion cells. These genes target various mechanisms of action and include among others: MMP3, PLAT, IκB, GLIS, SIRT, Tie-2, AQP1. Some of these as well as some previously identified genes (MMP3, PLAT, BDNF, C3, TGFβ, MYOC, ANGPTL7) are starting to move onto drug development. At the same time, progress has been made in the methods to deliver and control gene therapeutics (advances in these areas are not covered in this review).

While preclinical efforts continue in several laboratories, an increasing number of start-up and large pharmaceutical companies are working on developing gene therapeutics for glaucoma (Sylentis, Quetera/Astellas, Exhaura, Ikarovec, Genentech, Regeneron, Isarna, Diorasis Therapeutics). Despite the presence of generic medications to treat glaucoma, given the size of the potential world-wide market (∼$7B), it is likely that the number of companies developing glaucoma gene therapies will increase further in the near future.
Megalin Facilitates the Regulation of Mitochondrial Function by Extracellular Cues
Authors: Li Qingtian , Sheikh-Hamad David
Published: December 2023

Megalin (also known as low density lipoprotein-receptor related protein 2 [LRP2]) is a multi-ligand cell-surface endocytic receptor expressed widely; it is important for the uptake of vitamins, nutrients and hormones. We recently reported the discovery of LRP2/megalin in the mitochondria of many cells and organs. Importantly, megalin traffics the mitochondrial intracrines stanniocalcin-1, TGF-β and angiotensin II from the extracellular milieu to the mitochondria. This transport parallels the retrograde early endosome to Golgi pathway and requires the Rab GTPase Rab32 in the mitochondria, megalin associates with sirtuin family of class III histone deacetylases (Sirt3) and stanniocalcin-1 (Stc1), which are important for anti-oxidant defenses. Deletion of megalin impairs mitochondrial respiration and glycolysis. The interaction between stanniocalcin-1 and megalin is mediated by leucines within the signal peptides of the proteins; and this interaction is essential to the stimulation of mitochondrial respiration and glycolysis by stanniocalcin-1. Our findings suggest that megalin facilitates the regulation of mitochondrial function by extracellular cues.
Factors Associated With Educational Completion for Students With Physical Disabilities in Physical Therapist Programs
Authors: Sharp Amanda
Published: December 2023

Introduction.

Few studies have investigated the specific factors associated with educational completion, or graduation, for students with physical disabilities (SWPD) in physical therapist programs.

Review of Literature.

Disability diversity has been at the forefront in nursing and medicine over the past several years with tangible action and research initiatives identified. Similar calls have been made in the physical therapy profession; however, research is needed to frame the scope of the topic. The purpose of this study was to explore the institutional context of where and how education for SWPD occurs and to identify the academic factors associated with educational completion for SWPD in physical therapist programs.

Subjects.

Accredited physical therapist programs in the United States with a history of graduating at least one cohort were invited to participate in a survey. Faculty with experiences working with SWPD were invited for interviews.

Methods.

A conceptual framework was developed based on known educational scholars and on theories specific to the disability community. From the framework, a one-phase convergent mixed-methods study was conducted. Data were collected, analyzed separately, and integrated.

Results.

Institutions with technical standards (TS) updated in the past 5 years were more likely to have admitted SWPD (P = .027). Statistically significant academic factors associated with successful completion of SWPD in physical therapist programs included private institutions over public, having recently updated TS, and having available faculty training on accommodations. Supports including having adaptable perspectives and using multistakeholder collaboration related to SWPD were identified during qualitative analysis. Barriers were grouped as roadblocks and having a fixed mindset.

Discussion/Conclusion.

These findings can be applied across physical therapist programs with a goal to improve disability diversity in the profession. Implications for other health professional programs, ongoing research opportunities, and practice recommendations are provided.
Latest insights into the pathophysiology of bladder pain syndrome/interstitial cystitis
Authors: Tornic Jure , Engeler Daniel
Published: December 2023

Purpose of review

Bladder pain syndrome/interstitial cystitis (BPS/IC) is a common medical problem in both sexes affecting people of all ages. Patients might report overactive bladder symptoms with additional bladder pain at maximum bladder filling, during and after micturition. This review aims to highlight pathophysiological mechanisms associated with this disease.

Recent findings

Latest literature exposes different pathophysiological mechanisms such as impaired urothelial barrier function, alteration of urothelial factors and cytokines, chronic inflammation, vascular lesions, neurogenic inflammation and processes in the central nervous system leading to central sensitization. According to the involved mechanisms, BPS/IC may be arranged in clusters according to the clinical phenotype thus helping in clinical decision-making and treatment. Moreover, patients with BPS/IC suffer from other comorbidities such as fibromyalgia, irritable bowel syndrome, chronic pain and functional syndromes and psychosomatic diseases making the management challenging for medical professionals.

Bladder pain syndrome/interstitial cystitis is a complex heterogeneous medical condition involving different pathomechanisms leading to bladder pain and dysfunction, consequently, impairing quality-of-life in affected individuals. However, these mechanisms are still not fully understood, so that patient treatments often remain unsatisfactory. For this reason, continuing research is important to understand the underlying pathomechanisms to discover biomarkers and treatment targets eventually improving diagnostic and therapeutic measures of BPS/IC.
Fearing the final dose
Authors: Carolan Jennifer A.
Published: December 2023

Nurses caring for patients at the end of life should walk away from their shift knowing that they did their best to keep the patient and their family comfortable, educated, and supported.
Taking the Fear Out of Peer Feedback
Authors: Rodriguez Rebecca , Hambley Catherine , Wisner Kirsten
Published: December 2023

Effective peer feedback is critical for the self-regulation of nursing practice and safe, high-quality care, yet peer feedback conversations can be challenging and anxiety provoking. As current literature revealed no consistent approach, taskforce members designed and implemented an innovative and standardized peer feedback program using brain science to support nurses' skills in speaking up. The new program resulted in an increase in nurses' self-reported willingness to provide peer feedback, and improvements in safety culture and nurse-sensitive quality outcomes.
Are Gender-Affirming Plastic Surgeons Adequately Compensated? An Analysis of Relative Value Units
Authors: Oleru Olachi O. , Seyidova Nargiz , Taub Peter J.
Published: December 2023

Background

Gender-affirming surgery (GAS) has a complicated history within US health care. As GAS procedures and reimbursement availability continue to uptrend, the present study aims to investigate whether compensation is equitable between GAS procedures and general plastic surgery procedures.

Methods

The National Surgical Quality Improvement Program database was queried for all surgeries performed by plastic surgeons from 2016 to 2020. Cases were assigned to the GAS or non-GAS cohort using ICD-10 codes. Duplicate Current Procedural Terminology (CPT) codes were removed for analysis. Operative time, total wRVUs, wRVUs per hour (wRVU/h), reoperation/readmission rate, and number of concurrent procedures were compared between the cohorts.

Results

A total of 132,319 non-GAS and 3,583 GAS were identified. After duplicate CPT removal, 299 cases (21 unique CPTs) remained in the GAS cohort and 20,022 (37 unique CPTs) in the non-GAS cohort. Operative time was higher in the GAS cohort (262.9 vs 120.7 min, P < 0.001), as were total wRVUs (59.4 vs 21.6, P < 0.001). Reoperation/readmission rate (7.0% vs 6.0%) and wRVU/h (15.8 vs 15.1) were not significantly different (all P > 0.05). There was a positive correlation between total operative time and total wRVUs (P < 0.001) and a negative correlation between total operative time and wRVU/h (P < 0.001).

Conclusions

Proportional wRVUs are allocated to gender affirming plastic procedures. However, the RVU scale does not allocate proportional wRVUs to longer operative times for both GAS and general plastic surgeries. Compensation for gender affirming plastic surgeries is higher than that of general plastic surgeries; however, there is no difference in wRVUs per hour on comparison.
Geographic Variability of Genital Gender-Affirming Surgery Centers and Costs of Hospitalization
Authors: Kim Erin J. , Stearns Stephen A. , Bustos Valeria P. , Engmann Toni , Dowlatshahi Arriyan S. , Lee Bernard T. , Cauley Ryan
Published: December 2023

Purpose

The cost of gender-affirming surgery (GAS) is an important component of healthcare accessibility for transgender patients. However, GAS is often prohibitively expensive, particularly as there are inconsistencies in insurance coverages. Variability in hospital costs has been documented for other types of nonplastic surgery procedures; however, this analysis has not been done for GAS. To better understand the financial barriers impairing access to equitable transgender care, this study analyzes the distribution of hospitals that perform genital GAS and the associated costs of inpatient genital GAS.

Methods

This is a study of the 2016–2019 National Inpatient Sample database. Transgender patients undergoing genital GAS were identified using International Classification of Diseases, Tenth Revision, diagnosis and procedure codes, and patients undergoing concurrent chest wall GAS were excluded. Descriptive statistics were done on patient sociodemographic variables, hospital characteristics, and hospitalization costs. χ2 test was used to assess for differences between categorical variables and Mood's median test was used to assess for differences between continuous variable medians.

Results

A total of 3590 weighted genital GAS encounters were identified. The Western region (50.8%) and Northeast (32.3%) performed the greatest proportion of GAS, compared with the Midwest (9.1%) and the South (8.0%) (P < 0.0001). The most common payment source was private insurance (62.8%), followed by public insurance (27.3%). There were significant differences in the variability of median hospital costs across regions (P < 0.0001). The South and Midwest had the greatest median cost for vaginoplasty ($19,935; interquartile range [IQR], $16,162–$23,561; P = 0.0009), while the West had the greatest median cost for phalloplasty ($26,799; IQR, $19,667–$30,826; P = 0.0152). Across both procedures, the Northeast had the lowest median cost ($11,421; IQR, $9155–$13,165 and $10,055; IQR, $9,013–$10,377, respectively).

Conclusions

There is significant regional variability in the number of GAS procedures performed and their associated hospitalization costs. The identified disparities in insurance coverage present an area of possible future improvement to alleviate the financial burden GAS presents to gender-discordant individuals. The variability in cost suggests a need to evaluate variations in care, leading to cost standardization.
Oncological Safety of Autologous Fat Grafting for Breast Reconstruction
Authors: Strong Amy L. , Syrjamaki John D. , Kamdar Neil , Wilkins Edwin G. , Sears Erika D.
Published: December 2023

Background

Autologous fat grafting has become a vital component of breast reconstruction. However, concerns remain regarding the safety of fat grafting after oncological resection and breast reconstruction. The purpose of the study was to evaluate the association of fat grafting after breast reconstruction with metastasis and death in breast cancer patients.

Methods

A retrospective, population-based cohort study was conducted using deidentified claims data from 2001 to 2018 and included privately insured patients with breast cancer who underwent breast reconstruction after surgical resection. Breast reconstruction patients who underwent fat grafting were compared with those not undergoing fat grafting, evaluating metastasis and death up to 15 years after reconstruction. One-to-one propensity score matching was used to account for selection bias on patient risk factors comparing those with and without fat grafting.

Results

A total of 4709 patients were identified who underwent breast reconstruction after lumpectomy or mastectomy, of which 368 subsequently underwent fat grafting. In the propensity score–matched patients, fat grafting was not associated with an increased risk of lymph node metastasis (9.7% fat-grafted vs 11.4% in non–fat-grafted, P = 0.47) or distant metastasis (9.1% fat-grafted vs 10.5% in non–fat-grafted, P = 0.53). There was no increased risk of all-cause mortality after fat grafting for breast reconstruction (3.9% fat-grafted vs 6.6% non–fat-grafted, P = 0.10).

Conclusions

Among breast cancer patients who subsequently underwent fat grafting, compared with no fat grafting, no significant increase was observed in distant metastasis or all-cause mortality. These findings suggest that autologous fat grafting after oncologic resection and reconstruction was not associated with an increased risk of future metastasis or death.
A Simple Scale That Can Be Used to Screen Visceral Obesity
Authors: Bahşi Remzi , Üstüner Evren , Atmiş Volkan , Coşarderelioğlu Çağlar , Mut Sürmeli Deniz , Turgut Tuğba , Selvi Öztorun Hande , Yalçin Ahmet , Varli Murat , Aras Sevgi
Published: December 2023

A possible relationship between the Mini Nutritional Assessment Short Form (MNA-SF) and visceral fat thickness (VFT) in 390 participants 60 years and older was investigated. VFT was measured by ultrasonography as the distance between the inner wall of the rectus abdominis and the anterior abdominal aortic wall. The risk of visceral obesity increased with the increase in MNA-SF values independent of age, gender, diabetes mellitus, and alcohol history (odds ratio = 1.534, 95% CI 1.176–2.002, P = .002). The optimal cut-off point of the MNA-SF to predict visceral obesity was measured as 12.5 (area under the curve = 0.617, 95% CI 0.558–0.676). Our findings suggest that the MNA-SF may be useful in visceral obesity screening.
Association of Food Insecurity With Malnutrition and Cognitive Status in Elderly Referred to Outpatient Clinics of Milad Hospital in Tehran
Authors: Zeifoddini Aida , Qorbani Mostafa , Ataie-Jafari Asal
Published: December 2023

Food insecurity can cause adverse effects on the physical and mental health of the elderly. This study aimed to investigate the association among food insecurity, malnutrition, and cognitive impairment in elderly. To assess malnutrition, cognitive status, and food insecurity, the questionnaires Mini Nutritional Assessment, Mini-Mental State Examination, and the Household Food Insecurity Access Scale were used. There was a significant association between food insecurity and malnutrition (odds ratio [OR] = 5.36; 95% confidence interval [CI], 2.18-13.17; P < .001). The odds of cognitive impairment in the elderly with food insecurity were also more than 4 times higher than those with food security (OR = 4.35; CI, 1.78-10.59; P = .01). Because of the association between food insecurity, malnutrition, and cognitive impairment, food security in the elderly should be considered.
Gas-Bloat Syndrome after Magnetic Sphincter Augmentation: Incidence, Natural History, Risk Factors, and Impact on Surgical Outcomes Over Time
Authors: Eriksson Sven E , Ayazi Shahin , Zheng Ping , Sarici Inanc S , Hannan Zain , Jobe Blair A
Published: December 2023

BACKGROUND:

The notion that gas-bloat syndrome (GBS) after magnetic sphincter augmentation (MSA) is less detrimental has not been substantiated by data. This study aimed to identify the incidence, natural history, risk factors, and impact on outcomes of GBS after MSA.

STUDY DESIGN:

Records of patients who underwent MSA at our institution were reviewed. GBS was defined as a score of 4 or more on the gas bloat–specific item within the GERD health-related quality-of-life (GERD-HRQL) questionnaire. Preoperative clinical and objective testing data were compared between those with and without GBS at 1 year using univariate followed by multivariable analysis. GBS evolution over time and its impact on outcomes were assessed in those with 1- and 2-year follow-up.

RESULTS:

A total of 489 patients underwent MSA. At a mean (SD) follow-up of 12.8 (2.1) months, patient satisfaction was 88.8%, 91.2% discontinued antisecretory medications, and 74.2% achieved DeMeester score normalization.

At 1 year, 13.3% of patients developed GBS, and had worse GERD-HRQL scores and antisecretory medication use and satisfaction (p < 0.0001). DeMeester score normalization was comparable (p = 0.856). Independent predictors of GBS were bloating (odds ratio [OR] 1.8, p = 0.043), GERD-HRQL score greater than 30 (OR 3, p = 0.0010), and MSA size 14 or less beads (OR 2.5, p = 0.004). In a subgroup of 239 patients with 2-year follow-up, 70.4% of patients with GBS at 1 year had resolution by 2 years. The GERD-HRQL total score improved when GBS resolved from 11 (7 to 19) to 7 (4 to 10), p = 0.016. Patients with persistent GBS at 2 years had worse 2-year GERD-HRQL total scores (20 [5 to 31] vs 5 [3 to 12], p = 0.019).

CONCLUSIONS:

GBS affects 13.3% of patients at 1 year after MSA and substantially diminishes outcomes. However, GBS resolves spontaneously with quality-of-life improvement. Patients with preoperative bloating, high GERD-HRQL scores, or small MSA devices are at greatest risk of this complication.