bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing the hemodynamic changes, bleeding, and surgeon’s satisfaction during rhinoplasty surgery by use of two drugs, labetalol and dexmedetomidine added to anesthetic technique: a randomized clinical trial
Authors: Radman Masoud , Mousavi Nila , Jadidi Fatemeh , Ayoobi Fatemeh
Published: July 2024

Background:

Rhinoplasty is a common surgery in the world. Bleeding is a common concern during rhinoplasty. Hemodynamic stability and quality of view of the surgical field help to achieve the best results. The aim was to compare the effect of two drugs, dexmedetomidine and labetalol, on the amount of bleeding and satisfaction with rhinoplasty surgery.

Methods:

A cross-sectional descriptive study includes candidates for rhinoplasty surgery, referring to Moradi Hospital in Rafsanjan. Twenty patients were assigned to each group (dexmedetomidine and labetalol) based on the entry and exit criteria. Systolic and diastolic blood pressures and mean arterial pressure were measured before, 20 minutes after complete anesthesia, and the start of rhinoplasty surgery. All patients were operated by the same surgeon using the same technique. The surgeon’s level of satisfaction indicated with the field of vision is given as follows: good, moderate, and poor.

Results:

The study was performed on 40 subjects in two groups (n = 20), of which 14 (35 %) were male and 26 (65 %) were female. The results presented statistically significant differences in mean osteotomy systolic blood pressure (P = 0.018), osteotomy diastolic blood pressure (P = 0.015), mean osteotomy arterial pressure (P = 0.002), after 20 minutes heart rate (P < 0.001), and osteotomy heart rate (P = 0.001) between two groups. Furthermore, significant differences were observed regarding systolic blood pressure (P = 0.015), mean arterial pressure (P = 0.03), and heart rate (P < 0.001) after controlling for the effect of the group.

Conclusions:

The labetalol is the preferred option for controlling hypotension that provides better surgical field visibility compared to dexmedetomidine in rhinoplasty surgery.
Psychological General Well-being, Cognitive Failure, and Inflammation Biomarkers Among Workers 4 Months After a Mild/Asymptomatic SARS-CoV-2 Infection
Authors: Stufano Angela , Lucchese Guglielmo , Schino Valentina , Plantone Domenico , de Maria Luigi , Vimercati Luigi , Floel Agnes , Iavicoli Ivo , Lovreglio Piero
Published: July 2024

Objective

To investigate the relationship between cognitive complaints, systemic inflammatory biomarkers, and psychological general well-being (PGWB) after mild/asymptomatic SARS-CoV-2 infection, according to the presence of long COVID and work tasks.

Methods

University employees and metal workers were recruited in a cross-sectional study 4 months after SARS-CoV-2 infection to assess cognitive impairment, individual PGWB index, inflammatory biomarkers, namely platelet-lymphocyte, neutrophil-lymphocyte, and lymphocyte-monocyte ratios, and the presence of long COVID symptoms.

Results

A significant increase in the levels of inflammatory biomarkers was observed in subjects with long COVID. Furthermore, the PGWB index was influenced by long COVID symptoms and subjective cognitive and depressive symptoms, but not by work activity.

Conclusions

In occupational settings, it is crucial to detect the presence of long COVID symptoms and systemic inflammation early, as they may be associated with lower PGWB.
Cardiorespiratory Fitness Associates Negatively With Arterial Stiffness in a Cohort of Industrial Workers Followed Up for 4 Years
Authors: Skogstad Marit , Skare Øivind , Mamen Asgeir , Zardin Erika , Sirnes Per Anton
Published: July 2024

Objective

Previously, we have found increased carotid-to-femoral pulse wave velocity (cfPWV) among shift workers compared to day workers in industry, and a decline in maximal oxygen uptake (V̇O2max) in all 86 workers.

Methods

Utilizing all available measurements in 2018, 2021, and 2022, this study investigated associations between V̇O2max and measures of arterial stiffness. Using a mixed model approach, we analyzed the cross-sectional association between all V̇O2max (outcome) and measures of arterial stiffness (covariates).

Results

We observed a significant association between V̇O2max and cfPWV of −1.59 (95% confidence interval [CI], −3.03 to −0.16), and between augmentation pressure (AP) and augmentation index (Aix) of −0.32 (95% CI, −0.58 to −0.06) and −0.12 (95% CI, –0.23 to −0.005), respectively.

Conclusions

We found a significant negative association between cardiorespiratory fitness and measures of arterial stiffness. The former and present results pose challenges for shift workers' future macrovascular and microvascular health.
Comparative Analysis of Upper Limb Impairment Rating Processes in the American Medical Association Guides Sixth Edition 2024 Versus 2008
Authors: Melhorn J. Mark , Gelinas Barry , Martin Douglas W. , Hegmann Kurt T. , Thiese Matthew S.
Published: July 2024

Objectives

The aims of the study are to evaluate how upper limb impairment ratings are affected by updates to the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) Sixth Edition 2024 compared with the AMA Guides Sixth Edition 2008 and to investigate potential correlations with judicial, legislative, and economic factors.

Methods

Two expert evaluators reviewed 31 upper limb clinical vignettes from the 2008 and 2024 versions. The impairment ratings for each version were compared.

Results

After following the impairment ratings steps in each version, the results for 2024 showed no significant differences when compared with the impairment ratings generated using 2008 methods (Cohen’s kappa = 1.00).

Conclusions

The updated AMA Guides Sixth Edition 2024 with improved, transparent processes and enhanced diagnosis-based impairment tables provides efficiency while retaining the accuracy, validity, and reliability of past versions of the AMA Guides.
Duration of surgical antibiotic prophylaxis and surgical site infection in orthopaedic surgery: a prospective cohort study
Authors: Yang Zhenbang , Wang Yuchuan , Wang Zhongzheng , Li Junyong , Du Pei , Meng Hongyu , Zhao Kuo , Zhang Junzhe , Li Ming , Jin Zhucheng , Peng Ziheng , Ye Dandan , Ding Kai , Lv Hongzhi , Wang Juan , Xing Xin , Song Zhaohui , Chen Wei , Zhu Yanbin , Zhang Yingze
Published: July 2024

Background:

The optimal duration for surgical antibiotic prophylaxis (SAP) for preventing surgical site infection (SSI) in orthopaedic surgeries remains poorly supported by high-level evidence. This study aimed to assess the association between SAP duration and the occurrence of SSI within one year postoperatively.

Methods:

This prospective cohort study was based on the database from Surgical Site Infection Surveillance and Improvement Project (SISIP) of a tertiary orthopaedic university hospital from October 2014 to December 2020. The main outcome was SSI, defined according to the CDC/NHSN criteria, determined by a review of index hospitalization medical records, microbiology laboratory reports, and readmission records for SSI treatment within one year after discharge. Adjusted generalized additive models (GAMs) were performed to assess the relationships between SAP duration and SSI, determine the cut-off point of SAP duration, and estimate the relative contribution of each included variable across the overall cohort and the three subgroups (open fracture, closed fracture, and non-traumatic group). Multivariable logistic regression models were used to estimate the association between prolonging SAP duration based on the cut-off point and SSI.

Results:

There were 37 046 patients (55.1% male) included, with an overall SSI incidence of 2.35% (871/37 046). In adjusted GAMs, no statistically significant relationships were observed in the overall cohort and open or closed group (P>0.05), but a non-linear relationship was exhibited in the non-traumatic group (P=0.03); the cut-off point was 2.4 days for the overall cohort and 3.6 days (open), 2.6 days (closed), 1.1 days (non-trauma) for three subgroups. In adjusted logistic regression, prolonging SAP duration did not demonstrate a statistically significant protective effect in overall cohort (aOR=0.868; 95% CI, 0.746–1.011) and three groups (open: aOR=0.867; 95% CI, 0.668–1.124; closed: aOR=0.925; 95% CI, 0.754–1.135; non-trauma: aOR=1.184; 95% CI, 0.832–1.683). The relative contribution ranks of SAP duration were 21st overall among 34 factors, 14th for open fractures, 28th for closed fractures, and 3rd for the non-traumatic group among 33 factors.

Conclusion:

Prolonged postoperative SAP duration has no protective effect against SSI in orthopaedic surgery. Our findings support current guidelines against the practice of continuing SAP postoperatively.
Oncological survival in pancreatic head ductal carcinoma: hybrid minimally invasive versus open pancreatoduodenectomy – a single centre analysis
Authors: Lettner Johannes D. , Kuesters Simon , Fichtner-Feigl Stefan , Biesel Esther A. , Chikhladze Sophia , Wittel Uwe A.
Published: July 2024

Background:

Surgery remains the only curative treatment option for pancreatic head cancer. Laparoscopic surgical techniques are increasingly used, in line with the development of visceral surgery as a whole. The success of surgery is measured by the oncological outcome. Aim of this study is to evaluate the oncological outcome and survival after laparoscopic assisted resection of the pancreatic head compared to open surgery for ductal adenocarcinoma.

Materials and methods:

Data were collected in a prospectively maintained database. Perioperative and oncological outcomes of 182 laparoscopic pancreatic head resections for ductal carcinoma were compared with 585 open pancreatic head resections. The laparoscopic procedures were performed between 2010 and 2022, the open procedures between 2002 and 2022.

Results:

Laparoscopic procedure was significantly superior in terms of intraoperative blood loss (575 vs. 600 ml, P=0.021) and operative time (413 vs. 427 min, P=0.033). Tumor size (25 vs. 27 mm, P=0.028), need for portal vein resection (P=0.009) and blood transfusion (P=0.004) were significantly greater in the open group (P=0.009). The resection margin remained negative significantly more often in the laparoscopic group (159 [87%] vs. 449 [77%], P<0.001). There was no difference in postoperative mortality and morbidity. Postoperative survival at 5 years was significantly better in the laparoscopic group (37 vs. 15%, P<0.001).

Conclusions:

In our cohort, patients who underwent hybrid laparoscopic resection of pancreatic head cancer showed a significantly improved oncological outcome. Most of these effects are due to selection bias, which is not captured by the clinical parameters used to date. Our results highlight the need for additional prognostic factors in pancreatic cancer.
The role of adjuvant chemotherapy after radical surgery in patients with lymph node-positive bladder cancer or locally advanced (pT3, pT4a) bladder cancer: a meta-analysis and systematic review
Authors: Chen CaiXia , Wang ChongJian , Huang HaoTian , Li HongYuan , Wen Zhi , Liu Yang , Yang Xue-song
Published: July 2024

Purpose:

This study aims to evaluate the impact of adjuvant chemotherapy (AC) on survival outcomes in patients with lymph node-positive bladder cancer or locally advanced (pT3, pT4a) bladder cancer after surgery. The authors also seek to identify which patients with pN+ bladder cancer are most likely to benefit from AC after radical cystectomy (RC).

Methods:

The authors searched databases including Embase, PubMed, Cochrane, and ClinicalTrials.gov to identify relevant literature published in English up to February 2024. The authors used Stata to compare various parameters. The study has been registered in PROSPERO.

Results:

A total of 21 studies were analyzed, including 1 randomized controlled trial, 6 prospective studies, and 14 retrospective studies, encompassing 12 888 patients. The meta-analysis showed that for patients with lymph node-positive bladder cancer, the AC group had higher overall survival (OS) [I
2=58.2%, hazard ratio (HR) 0.69; 95% CI: 0.57–0.83; P=0.019] and recurrence-free survival (I
2=66.6%, HR 0.71; 95% CI: 0.57–0.89; P=0.006) compared to the RC group. For patients with pT3 and pT4a bladder cancer, the AC group had higher OS (I
2=57.3%, HR 0.77; 95% CI: 0.67–0.89; P=0.022) and cancer-specific survival (I
2=47.2%, HR 0.75; 95% CI: 0.64–0.88; P=0.0048) compared to the RC group. At the same time, according to the different chemotherapy regimens, the authors divided the cisplatin-based chemotherapy regimen and carboplatin-based chemotherapy or other regimens into two subgroups for analysis, and found that the OS (I
2=41.4%, HR 0.64; 95% CI: 0.51–0.80; P=0.000) was better than carboplatin and other chemotherapy regimens (I
2=64.1%, HR 0.77; 95% CI: 069–0.86; P=0.000); lymph node density was found to be an independent predictor of OS (HR=1.6; 95% CI: 1.31–1.95; P=0.0000).

Conclusion:

This study found that postoperative AC improves OS, cancer-specific survival, and recurrence-free survival in patients with pT3, pT4a. It was also confirmed that cisplatin-based chemotherapy regimen was more beneficial for patients with bladder cancer; and lymph node-positive bladder cancer. Additionally, our analysis revealed that patients with lymph node-positive bladder cancer benefit more from postoperative AC. It was further demonstrated that cisplatin-based chemotherapy regimens are more beneficial than other regimens for patients with locally advanced bladder cancer.
Treatment of posterolateral tibial plateau fractures: a narrative review and therapeutic strategy
Authors: Liu Chen-Dong , Hu Sun-Jun , Chang Shi-Min , Du Shou-Chao , Chu Yong-Qian , Qi Yi-Ming , Li Hao-Tao , Mao Wei
Published: July 2024

The posterolateral tibial plateau is crucial for maintaining knee stability during flexion, and fractures in this area often involve ligament and meniscus injuries, necessitating effective management. However, treating posterolateral tibial plateau fractures (PLF) poses significant challenges due to the complex anatomy. Therefore, this review aims to explore contemporary concepts of PLF, from identification to fixation, and proposes a comprehensive treatment strategy. In this article, the authors detail the injury mechanisms, fracture morphology, PLF classification systems, surgical approaches, and techniques for open reduction and internal fixation (ORIF) as well as arthroscopic-assisted internal fixation (ARIF). The findings indicate that PLF is typically caused by flexion-valgus forces, resulting in depression or split-depression patterns. For isolated PLF, the supra-fibular head approach is often preferable, whereas posterior approaches are more suitable for combined fractures. Additionally, innovative plates, particularly the horizontal belt plate, have shown satisfactory outcomes in treating PLF. Currently, the ‘bicondylar four-quadrant’ concept is widely used for assessing and managing the tibial plateau fractures involving PLF, forming the cornerstone of the comprehensive treatment strategy. Despite challenges in surgical exposure and implant placement, ORIF remains the mainstream treatment for PLF, benefiting significantly from the supra-fibular head approach and the horizontal belt plate. Furthermore, ARIF has proven effective by providing enhanced visualization and surgical precision in managing PLF, emerging as a promising technique.
Assessing and evaluating the impact of operative vision compromise (OViC) on surgeons’ practice: a qualitative study
Authors: Nabeel Ahmad , Al-Sabah Salman , Al-Ghanim Khalifa , Al-Roumi Dalal , Al-Basri Dana , Ziyab Ali , Ashrafian Hutan
Published: July 2024

Background:

Assessing the effects of compromised vision in laparoscopic and robotic procedures is crucial to understanding its impact on surgical practice and patient safety. Our aim was to examine the impact of operative vision compromise (OViC) on surgeons’ practice.

Methods:

Intraoperative workload was qualitatively assessed using the NASA-TLX score. Participants included internationally trained surgeons performing laparoscopic sleeve gastrectomy (LSG) procedures. Video recordings of LSG procedures were quantitatively analyzed to assess OViC event frequency and duration to determine their influence on procedural time and surgical flow in a secondary care center. Surgeons’ views on OViC were assessed using a custom survey. Cost analysis of basic expenditures was performed.

Results:

Among 109 participants, the overall NASA-TLX score for OViC was 71.7, indicating a high workload. Out of 81 LSG procedures, 77 experienced at least one lens fouling episode, resulting in 471 OViC events, including 371 lens cleaning occurrences. Significant positive correlations were found between total procedure time and several OViC variables. Compromised vision accounted for 19.3% of total operative time. Lens cleaning constituted 2.5% of the total operative time. In nine (11%) cases, lens cleaning added an average of 7 min per procedure, with the most severe case adding 15 min of operative time. The majority of surgeons (94%) found OViC to impair their performance and compromise patient safety, with 61% reporting witnessing surgical errors or complications directly attributable to OViC.

Conclusions:

OViC was linked to increased procedure time, surgical flow disruptions, elevated surgeon workload, cognitive burden, and frustration, and potential patient safety concerns. These findings emphasize the need for innovative solutions to mitigate OViC, thereby potentially minimizing errors and enhancing operative outcomes.
Associations of biological age accelerations and genetic risk with incident endometrial cancer: a prospective analysis in UK Biobank
Authors: Yang Ziye , Shen Yufei , Zhang Tongtong , Tang Xiaolin , Mao Rui
Published: July 2024

Background:

Endometrial cancer (EC) is one of the gynecologic malignancy cancer with increasing incidence and mortality rates, partly due to aging populations and genetic risks. This study explores the associations between biological age accelerations (BAA) and risk of incident EC and assesses the joint effect of genetic factors and BAA.

Materials and methods:

Based on the UK Biobank cohort, 132 315 women participants were included for primary analysis and 124 119 white participants for genetic risk analysis. Biological age (BA) was calculated using the Klemera-Doubal (KDM) and PhenoAge method based on clinical biomarkers. The authors calculated two metrics for BAA (including KDM residual and PhenoAge residual) using residual analysis, comparing them against chronological age. The risk of incident EC was evaluated using multivariable Cox proportional-hazards models, adjusting for relevant covariates. Polygenic risk scores (PRS) were computed from known EC-associated SNPs.

Results:

Both KDM and PhenoAge residual, were significantly associated with increased EC risk. In fully adjusted models, the highest tertile of KDM and PhenoAge residual was significantly associated with incident EC compared with the lowest group, with HRs of 1.278 (P=0.0044) and 1.424 (P<0.0001), repectively. The population-attributable fractions were 7.84% for KDM residual (P=0.0044), 9.78% for PhenoAge residual (P=0.0005), and 8.47% for genetic risk (P=0.0005). Additionally, joint associations of BAA and genetic risk with incident EC was evaluated. Compared with low genetic risk and low BAA, high genetic risk and high BAA was significantly associated with the incidence of EC with HRs of up to 2.172 (95% CI: 1.592–2.963) for KDM and 2.226 (95% CI: 1.640–3.022) for PhenoAge. Overall, higher levels of PhenoAge residual were consistently associated with an increased risk of incident EC, regardless of genetic risk.

Conclusion:

BAA and genetics both enhance the risk of incident EC. The effect of the PhenoAge residual is greater than that of the investigated genes, which in turn is greater than that of the KDM residual. These findings highlight the importance of considering both BAA and genetic factors in EC prevention.
Dilation Outcomes for Transgender and Nonbinary Patients Following Gender-Affirming Vaginoplasty in a US County Safety-Net System
Authors: Kvach Elizabeth , O’Connell Ryan , Sairafi Shereen , Holland Krystyna , Wittmer Nancy
Published: July 2024

Purpose:

The study purpose was to report neovaginal dilation outcomes and identify factors associated with pain, dilation discontinuation, and sexual function for transgender individuals who underwent gender-affirming vaginoplasty.

Methods:

A retrospective cohort study design was employed of transgender patients 18 years or older undergoing full-depth vaginoplasty and pelvic floor physical therapy (PFPT) between May 2018 and April 2021 at a safety-net hospital through medical record review and an online survey developed with a patient advisory board. Exclusion criterion was minimal-depth vaginoplasty or loss to follow-up.

Results:

In total, 137 patients included underwent full-depth vaginoplasty (46.7% survey response rate) 796.2 days (mean) postoperatively. Patients received 4.3 PFPT visits, with the last visit 12.4 weeks postoperatively (mean). Ninety patients (64.3%) achieved the 2 widest dilators, and 68 patients dilated to a depth of 5.5 inches or more (49.6%). The mean progression time between dilators was 5 weeks. Twenty-nine patients (21.2%) had pain preventing dilation, associated with minor or any surgical complication (OR = 5.7; 95% CI, 1.3-25.0) and posttraumatic stress disorder (P = .01), and had more PFPT visits for longer postoperatively than those without pain (P = .03). Nineteen respondents (32.2%) reported not dilating and were younger (P = .02), more likely to be lesbian, pansexual, or asexual (P = .01), and experienced depression (P = .01). Forty-four respondents (77.2%) were sexually active in the past 6 months, which was not associated with pain during dilation. However, respondents self-reporting dilation pain had greater dissatisfaction with their sex life (P = .02).

Discussion:

Patient dilation practices following vaginoplasty differ from protocols recommended by surgeons. Dilation goals should be adapted to individual patient characteristics and needs.
The Development and Content Validity of the Fremantle Perineal Awareness Questionnaire (FrePAQ) for Use in People With Persistent Perineal Pain
Authors: Hardy Amanda , Campbell Leigh , Jones Carol , Vandyken Carolyn , Bond Jilly , Moss Penny , Smith Anne , Wand Benedict , Thompson Judith
Published: July 2024

Background:

Altered body awareness and perception comprise a common feature of persistent pain. The Fremantle Back Awareness Questionnaire (FreBAQ) was developed to assess body awareness and perception in people with back pain. There is no tool to measure these changes in people with persistent perineal pain.

Objective:

To develop the Fremantle Perineal Awareness Questionnaire (FrePAQ) to assess body awareness and perception in people with persistent perineal pain. To evaluate content validity using a qualitative survey.

Study Design:

Modified electronic Delphi and cross-sectional qualitative online survey.

Methods:

A focus group developed a draft questionnaire from the preexisting FreBAQ. A preliminary FrePAQ was developed through 3 Delphi rounds of anonymous voting by a panel of 14 experts. A qualitative survey was completed by individuals with persistent perineal pain to evaluate the comprehensiveness, comprehensibility, and relevance of the preliminary questionnaire. Responses were thematically analyzed, and demographic data were summarized descriptively.

Results:

Fourteen panel participants completed the Delphi study, with consensus achieved on a 9-item questionnaire after 3 rounds. One hundred thirty-five participants with persistent perineal pain completed the round 1 validation survey. Changes were made to the introduction and 7 items. A new group of 53 participants completed round 2, resulting in final changes to the introduction and 2 of the 9 items.

Conclusions:

An expert consensus was achieved in the wording of a new questionnaire aimed at assessing body awareness and perception in people with persistent perineal pain, which demonstrated acceptable content validity.
Hemorrhoids, Anorectal Symptoms, and Related Risk Factors in Pregnancy and the Postpartum Period: A Follow-up Study
Authors: Gülören Gülbala , Çınar Gamze Nalan , Baran Emine , Gürşen Ceren , Uzelpasacı Esra , Özgül Serap , Beksaç Kemal , Fadıloglu Erdem , Aydın Emine , Tanacan Atakan , Akbayrak Turkan , Beksaç Mehmet Sinan
Published: July 2024

Purpose:

To investigate the presence of hemorrhoids and anorectal signs/symptoms and to identify various risk factors including anthropometric/musculoskeletal contributors associated with hemorrhoids in pregnancy and the postpartum period.

Background:

Pregnancy and the postpartum period may predispose women to develop hemorrhoids and anorectal symptoms because of hormonal and musculoskeletal changes.

Methods:

Fifty-one pregnant women with no history of anorectal disease were included in the study. The occurrence of hemorrhoids and other anorectal signs/symptoms was examined at 4 different times: first, second, and third trimesters, and postpartum 6th week. The Rome III criteria and the Bristol Stool Scale were used to confirm the presence of constipation and to determine stool type, respectively. Waist and hip circumference (as anthropometric contributors), bi-iliac and bitrochanteric width (as diameter measurements), diastasis recti abdominis, joint hypermobility, and lumbar lordosis (as musculoskeletal contributors) were evaluated. Personal, demographic, and clinical characteristics of the patients as well as postpartum period information were also recorded.

Results:

Hemorrhoids, perianal discomfort, perianal pain, and protrusion were significantly more frequent at postpartum than at the first trimester (P < .008). According to the multivariate analysis, body mass index, the presence of constipation, joint hypermobility, and birth weight were significant determinants of hemorrhoids at the third trimester and postpartum (odds ratio = 1.25-2.67).

Conclusions:

Body mass index, constipation, joint hypermobility, and increased birth weight of the newborn were potential risk factors for the development of hemorrhoids during pregnancy and postpartum. Hemorrhoids and anorectal complaints should be kept in mind and managed to increase the quality of life during pregnancy and the postpartum period.
A 3-Year Retrospective Review of Complex Suicides With a Review of the Literature
Authors: Paredes Rivera Alexandra , Dramé Awa Sarr , Knight Laura D.
Published: July 2024

Complex suicide is defined as death by the intentional use of more than 1 method to end one's life. Complex suicides can fit into the planned or premeditated category, where 2 or more methods are used simultaneously or in close succession, or unplanned, the use of 2 or more methods, in which the first method attempted fails (often because it is too unpleasant or painful), and another method is employed subsequently that is successful.

A retrospective review of 3 years of suicide fatalities examined by the Washoe County Regional Medical Examiner's Office in Reno, Nevada, was conducted. A total of 725 suicide cases dated from April 1, 2020, to April 1, 2023, were reviewed, including autopsy, toxicology, and scene investigation reports. Among the 725 suicide cases reviewed, 19 cases (2.62%) of complex suicide were identified. Of those cases, 17 employed 2 methods, and 2 cases employed 3 methods. No cases were identified with >3 methods.

In the 19 complex suicides that were identified, gender, age, marital status, military service, sexual orientation, religion, race, occupation, incident location, suicide note, suicidal ideation history, past suicide attempt, psychiatric disorders, and motive for suicide were examined in addition to methods used.
Three Deaths Associated With Facial and Upper Airway Burns Related to Oxygen Use
Authors: Hinton Cassidy A. , Prahlow Joseph A. , Shattuck Brandy , Tart Anna
Published: July 2024

Despite the implementation of numerous strategies to prevent unintentional burns, fire-related thermal injuries remain a significant source of morbidity and mortality. Unfortunately, fires that occur in the setting of medical oxygen do so despite many safeguards and warnings that accompany oxygen therapy. Oxygen-related accidental fires can occur both within the home and medical settings, and burns associated with these events tend to produce injuries of the face and upper airways. Thermal burns of the face and upper airway are of particular concern because of the vital respiratory function of these anatomic structures, and may initially appear minor, but due to the inhalational injury mechanism, can contribute to death. In this report, three deaths associated with accidental oxygen therapy-related facial/upper airway burns are reported, one occurring during surgery, and two occurring during home-oxygen use.
Caseous Calcification of the Mitral Annulus
Authors: Jorgenson Kyla M. , McMullen Phillip D. , Goldman Bruce I. , Jacob-Leonce Marisa
Published: July 2024

Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification (MAC) usually described as an antemortem finding. We report a case of sudden cardiac arrest in a 39-year-old male with end-stage renal disease undergoing hemodialysis with a history of Fabry disease by kidney biopsy. Autopsy revealed significant circumferential annular calcification in both mitral and aortic valves with a caseous gross appearance. Histologically, these areas consisted of amorphous basophilic material accompanied by a surrounding granulomatous-appearing infiltrate. Von Kossa staining on non-decalcified tissue revealed strong positive staining, confirming CCMA diagnosis. While identifiable, the atrioventricular node was displaced and distorted by caseous deposits. Toluidine blue staining of myocardium showed osmophilic accumulations, and electron microscopy (EM) showed myeloid/zebra bodies, consistent with Fabry disease. We posit that Fabry disease leads to end-stage kidney disease, altering calcium phosphate metabolism, a proposed mechanism for CCMA. This case highlights the multifactorial nature of sudden cardiac death in decedents with various structural cardiac changes and potential renal-disease–induced electrolyte imbalances. We aim to bring awareness to this rare entity, its potential role in a sudden cardiac death, and to highlight the need to use non-decalcified tissue when staining for calcium to establish the diagnosis.
Association Between Cardiovascular Disease and Death by Anaphylaxis
Authors: Garland Jack , Smith Peter , Tse Rexson , Ong Beng , Milne Nathan
Published: July 2024

Despite its severity, anaphylaxis carries a low mortality rate of less than 1%, making the cohort seen in the forensic pathology setting a small and unique subset of the majority of cases of anaphylaxis in the community. Clinically, cardiovascular disease has been recognized as a risk factor for fatal anaphylaxis; however, there is scant forensic pathology research investigating this risk factor, whereas autopsy textbooks emphasize physical respiratory changes seen in the broader clinical cohort. This 20-year retrospective study examined all fatal anaphylactic deaths in the state of Queensland, Australia, to document the underlying disease of the cases, tryptase levels, triggers, and postmortem findings. Our study found that cardiovascular disease was prevalent in 83.3% of cases of fatal anaphylaxis. Although asthma was prevalent in food-related fatal anaphylaxis (60%) in our cohort, it was poorly represented overall (28%), in contrast to clinical research. Additionally, only 43% of cases showed respiratory changes that were greater than mild. Our findings emphasize the difference between the clinical and postmortem anaphylaxis cohorts, and provide autopsy evidence of a potential role of cardiovascular disease in fatal anaphylaxis.
Sudden Death Due to Necrotizing Fasciitis After Routine Cervical Radiofrequency Ablation Treatment
Authors: Trivedi Ravi , deJong Joyce L. , Hansma Patrick A.
Published: July 2024

Cervical facet joint neurotomy, also known as cervical radiofrequency ablation (RFA) or cervical facet rhizotomy, is a medical procedure aimed at alleviating chronic neck pain caused by issues related to the cervical facet joints through ablation of neurons (J Pain Res 2021;14:2807–2831). Although generally safe, adverse events can occur. Infection is a rare consequence of this procedure. Most injection-site infections related to cervical RFA occur spontaneously and resolve with oral antibiotics without sequelae (World Neurosurg 2018;111:e644–e648). We report a case in which a cervical RFA injection resulted in the development of necrotizing fasciitis and ultimately death. To our knowledge, this has not been previously reported and is the first documented fatality due to infectious sequelae of a cervical RFA procedure.
Malaria in pregnancy: baby steps
Authors: Rogerson Stephen J. , Aitken Elizabeth H.
Published: July 2024

Purpose of review

Malaria threatens pregnant women and their babies, particularly in Africa.

Recent findings

This century, the number of women at risk of malaria in pregnancy has decreased globally, apart from in Africa, where it has increased. Low and sub microscopic infections are increasingly documented but remain hard to diagnose with current point-of-care tests, and their contribution to morbidity and transmission are unclear. Artemether-lumefantrine has been endorsed for treatment in first trimester, but many women attend antenatal clinics later in pregnancy, and reaching high-risk young, first-time mothers is particularly difficult. Small-for-gestational-age babies frequently result from malaria, which affects the placenta's development and its functions such as nutrient transport. Resistance to continues to increase to sulphadoxine-pyrimethamine, the mainstay of intermittent preventive treatment in pregnancy. The alternative, dihydroartemisinin-piperaquine controls malaria better, but does not improve pregnancy outcomes, suggesting that sulphadoxine-pyrimethamine may have nonmalarial effects including improving gut function or reducing dangerous inflammation. Understanding of how the malaria parasite uses the VAR2CSA protein to bind to its placental receptor is increasing, informing the search for a vaccine to prevent pregnancy malaria.

Progress in several areas increases optimism that improved prevention and control of malaria in pregnancy is possible, but obstacles remain.
Trends in Top Surgery Patient Characteristics, Wound Complications, and CPT Code Use by Plastic Surgeons
Authors: Park John B. , Adebagbo Oluwaseun D. , Escobar-Domingo Maria J. , Rahmani Benjamin , Tobin Micaela , Yamin Mohammed , Lee Daniela , Fanning James E. , Prospero Matthew , Cauley Ryan P.
Published: July 2024

Background

Gender-affirming top surgery is becoming increasingly common, with greater diversity in the patients receiving top surgery. The purpose of this study was to examine national trends in patient demographics, characteristics, wound complication rates, and concurrent procedures in patients receiving gender-affirming top surgeries.

Methods

Patients with gender dysphoria who underwent breast procedures, including mastectomy, mastopexy, breast augmentation, or breast reduction by a plastic surgeon between 2013 and 2022, were identified from the American College of Surgeons National Surgical Quality Improvement Program database. These procedures were considered to be gender-affirming “top surgery.” Univariate analyses were performed to examine trend changes in the patient population and types of additional procedures performed over the last decade.

Results

There was a 38-fold increase in the number of patients who received top surgery during the most recent years compared to the first 2 years of the decade. Significantly more individuals receiving top surgery in recent years were nonbinary (P < 0.01). There was a significant decrease in percentage of active smokers (P < 0.01) while there was an increase in percentage of patients with diabetes (P = 0.03). While there was a significant increase in the number of obese patients receiving top surgery (P < 0.01), there were no differences in postoperative wound complications between the years. Significantly more patients received additional procedures (P < 0.01) and had about a 9-fold increase in distinct number of additional CPT codes from 2013–2014 to 2021–2022.

Conclusions

Our study found that there has been (1) a significant increase in the number of top surgery patients from 2013 to 2022 overall and (2) a particular increase in patients with preoperative comorbidities, such as a higher body mass index and diabetes. Understanding current and evolving trends in patients undergoing surgical treatment for gender dysphoria can inform individualized care plans that best serve the needs of patients and optimize overall outcomes.
Advancement-Rotation–Modified Z-plasty Technique to Prevent Notching in Congenital Cleft Earlobe Repair
Authors: Rajesh Madhovarshinii , Mendonca Derek Amith
Published: July 2024

The surgical correction of congenital cleft earlobes poses a unique set of challenges in achieving optimal aesthetic outcomes. While various surgical techniques have been proposed, most of them result in the appearance of irregularity and asymmetry of the earlobe. This paper presents a modification to the traditional Z-plasty technique that prevents the postoperative appearance of notching of the earlobe. Our technique achieves this by creating 2 flaps, a medial-advancement flap and a lateral-rotation flap, that are surgically constructed in a manner that ensures the posterior earlobe is directly attached to the mandibular cheek subcutaneous tissue as opposed to adjacent to it to render the appearance of a more natural-looking and volume-sufficient earlobe. The exact technique involved is discussed further in this paper, with supporting case-based examples to demonstrate its efficacy in enhancing overall aesthetic outcomes.
MICK (Mobile Integrated Cognitive Kit) App for Concussion Assessment in a Youth Ice Hockey League
Authors: Hyman Sara , Blacker Mason , Bell Carter A. , Balcer Marc J. , Joseph Binu , Galetta Steven L. , Balcer Laura J. , Grossman Scott N.
Published: July 2024

Background:

Visual symptoms are common after concussion. Rapid automatized naming (RAN) tasks are simple performance measures that demonstrate worse time scores in the setting of acute or more remote injury.

Methods:

We evaluated the capacity for the Mobile Universal Lexicon Evaluation System (MULES) and Staggered Uneven Number (SUN) testing to be feasibly administered during preseason testing in a cohort of youth ice hockey athletes using a novel computerized app, the Mobile Integrated Cognitive Kit (MICK). Participants from a youth hockey league underwent preseason testing.

Results:

Among 60 participants, the median age was 13 years (range 6–17). The median best time for the MULES was 49.8 seconds (range = 34.2–141.0) and the median best time for the SUN was 70.1 (range = 36.6–200.0). As is characteristic of timed performance measures, there were learning effects between the first and second trials for both the MULES (median improvement = 10.6 seconds, range = −32.3 to 92.0, P < 0.001, Wilcoxon signed-rank test) and SUN (median improvement = 2.4 seconds, range= −8.0 to 15.1, P = 0.001, Wilcoxon signed-rank test). Age was a predictor of best baseline times, with longer (worse) times for younger participants for MULES (P < 0.001, r

s
= −0.67) and SUN (P < 0.001, r

s
= −0.54 Spearman rank correlation). Degrees of learning effect did not vary with age (P > 0.05, r

s
= −0.2).

Conclusions:

Vision-based RAN tasks, such as the MULES and SUN, can be feasibly administered using the MICK app during preseason baseline testing in youth sports teams. The results suggest that more frequent baseline tests are necessary for preadolescent athletes because of the relation of RAN task performance to age.
Two distinct host-parasite associations mediate seasonal ecosystem linkages
Authors: Asakura Hinako , Futamura Ryo , Moriyama Senri , Iida Satoko , Araki Koume , Ayumi Masato , Kumikawa Shoji , Matsuoka Yuichi , Takahashi Taro , Uchida Jiro , Kishida Osamu , Sato Takuya
Published: July 2024

Nematomorph parasites manipulate terrestrial arthropods to enter streams where the parasites reproduce. These manipulated arthropods become a substantial prey subsidy for stream salmonids, causing cross-ecosystem energy flow. Diverse nematomorph–arthropod associations underlie the energy flow, but it remains unknown whether they can mediate the magnitude and temporal attributes of the energy flow. Here, we investigated whether distinct phylogenetic groups of nematomorphs manipulate different arthropod hosts and mediate seasonal prey subsidy for stream salmonids. The results of our molecular-based diagnoses show that
Gordionus
and
Gordius
nematomorphs infected ground beetle and orthopteran hosts, respectively. The presumable ground beetle hosts subsidized salmonid individuals in spring, whereas the presumable orthopteran hosts did so in autumn. Maintaining the two distinct nematomorph–arthropod associations thus resulted in the parasite-mediated prey subsidy in both spring and autumn in the study streams. Manipulative parasites are common, and often associated with a range of host lineages, suggesting that similar effects of phylogenetic variation in host–parasite associations on energy flow might be widespread in nature.
A three-dimensional lattice-free agent-based model of intracellular ice formation and propagation and intercellular mechanics in liver tissues
Authors: Amiri Fatemeh , Benson James D.
Published: July 2024

A successful cryopreservation of tissues and organs is crucial for medical procedures and drug development acceleration. However, there are only a few instances of successful tissue cryopreservation. One of the main obstacles to successful cryopreservation is intracellular ice damage. Understanding how ice spreads can accelerate protocol development and enable model-based decision-making. Previous models of intracellular ice formation in individual cells have been extended to one-cell-wide arrays to establish the theory of intercellular ice propagation in tissues. The current lattice-based ice propagation models do not account for intercellular forces resulting from cell solidification, which could lead to mechanical disruption of tissue structures during freezing. Moreover, these models have not been expanded to include more realistic tissue architectures. In this article, we discuss the development and validation of a stochastic model for the formation and propagation of ice in small tissues using lattice-free agent-based model. We have improved the existing model by incorporating the mechanical effects of water crystallization within cells. Using information from previous research, we have also created a new model that accounts for ice growth in tissue slabs, spheroids and hepatocyte discs. Our model demonstrates that individual cell freezing can have mechanical consequences and is consistent with earlier findings.
Multiscale homogenization for dual porosity time-dependent Darcy–Brinkman/Darcy coupling and its application to the lymph node
Authors: Girelli A. , Giantesio G. , Musesti A. , Penta R.
Published: July 2024

We study the coupling between time-dependent Darcy–Brinkman and the Darcy equations at the
microscale
subjected to inhomogeneous body forces and initial conditions to describe a double porosity problem. We derive the homogenized governing equations for this problem using the asymptotic homogenization technique, and as macroscopic results, we obtain a coupling between two Darcy equations, one of which with memory effects, with mass exchange between phases. The memory effects are a consequence of considering the time dependence in the Darcy–Brinkman equation, and they allow us to study in more detail the role of time in the problem under consideration. After the formulation of the model, we solve it in a simplified setting and we use it to describe the movement of fluid within a vascularized lymph node.
Warming sea surface temperatures are linked to lower shorebird migratory fuel loads
Authors: Lagassé Benjamin J. , Breed Greg A.
Published: July 2024

Warming sea surface temperatures (SSTs) are altering the biological structure of intertidal wetlands at a global scale, with potentially serious physiological and demographic consequences for migratory shorebird populations that depend on intertidal sites. The effects of mediating factors, such as age-related foraging skill, in shaping the consequences of warming SSTs on shorebird populations, however, remain largely unknown. Using morphological measurements of Dunlin fuelling for a >3000 km transoceanic migration, we assessed the influence of climatic conditions and age on individuals’ migratory fuel loads and performance. We found that juveniles were often at risk of exhausting their fuel loads en route to primary wintering grounds, especially following high June SSTs in the previous year; the lagged nature of which suggests SSTs acted on juvenile loads by altering the availability of critical prey. Up to 45% fewer juveniles may have reached wintering grounds via a non-stop flight under recent high SSTs compared to the long-term trend. Adults, by contrast, were highly capable of reaching wintering grounds in non-stop flight across years. Our findings suggest that juveniles were disproportionately impacted by apparent SST-related declines in critical prey, and illustrate a general mechanism by which climate change may shape migratory shorebird populations worldwide.
Experimental studies of confined detonations of plasticized high explosives in inert and reactive atmospheres
Authors: Farrimond D. G. , Woolford S. , Barr A. D. , Lodge T. , Tyas A. , Waddoups R. , Clarke S. D. , Rigby S. E. , Hobbs M. J. , Willmott J. R. , Whittaker M. , Pope D. J. , Handy M.
Published: July 2024

When explosives detonate in a confined space, repeated boundary reflections result in complex shock interactions and the formation of a uniform quasi-static pressure (QSP). For fuel-rich explosives, mixing of partially oxidized detonation products with an oxygen-rich atmosphere results in a further energy release through rapid secondary combustion or ‘afterburn’. While empirical formulae and thermochemical modelling approaches have been developed to predict QSP, a lack of high-fidelity experimental data means questions remain around the deterministic quality of confined explosions, and the magnitude and mechanisms of afterburn reactions. This article presents experimental data for RDX- and PETN-based plastic explosives, demonstrating the high repeatability of the QSP generated in a sealed chamber using pressure transducers and high-speed infrared thermometry. Detonations in air, nitrogen and argon atmospheres are used to identify the contribution of afterburn to total QSP, to estimate the duration of afterburn reactions and to speculate on the flame temperature associated with this mechanism. Computational fluid dynamic modelling of the experiments was also able to accurately predict these effects. Understanding and quantifying explosions in complex environments are critical for the design of effective protective structures: the mechanisms described here provide a significant step towards the development of fast-running engineering models for internal blast events.