bluuebunny/crossref_metadata_2025 huggingface dataset:
Mucinous Syringometaplasia: Case Report and Review of the Literature
Authors: Macías-Alonso Begoña , Solís-Ledesma Guillermo , Sánchez-Tadeo María T. , Jarquin-Guillermo Norma E. , Velázquez-Espinosa Oscar A. , Sangüeza Omar P.
Published: July 2022

Mucinous syringometaplasia is a rare and poorly recognized entity that usually presents as a warty tumor in acral regions. It is more frequent in men, and the age of presentation is variable. Typically, it has been reported as a solitary lesion with a warty appearance that occasionally can drain serous material. The affected sites include head, neck, breast, acral regions, and buttocks. The evolution over time is variable. The pathogenesis has not been elucidated. Diagnosis is established through histopathology, the characteristic feature is an epidermal invagination, which creates a structure similar to a “pore” at the dermal level. The clinical differential diagnosis is mainly with a viral wart, but it can also resemble basal cell carcinomas and other adnexal tumors. The treatment is surgical, and no recurrences have been reported to date. We describe the case of a 25-year-old woman who presented with a lesion on one of her eyelids. A shave removal of the lesion was performed, and the diagnosis was established by histopathologic examination.
Mechanic Hands/Hiker Feet in a Patient With Amyopathic Dermatomyositis and Interstitial Lung Disease
Authors: Regmi Aayushma , Saab-Chalhoub Mario W. , Speiser Jodi J.
Published: July 2022

A 30-year-old African American woman with a history of interstitial lung disease presented with bilaterally symmetrical, nonpruritic, scaling and fissuring, hyperpigmented, lichenified plaques on her hands and feet. She reported occasional erythema of her face, intermittent erythema, and irritation of her eyes but denied any muscle weakness. A biopsy of the plantar first toe showed hyperkeratosis, striking alternating ortho- and parakeratosis with underlying apoptotic bodies. There was psoriasiform acanthosis without suprapapillary thinning, numerous apoptotic keratinocytes in all layers of the epidermis extending into the corneum that were out of proportion with the minimal interface inflammation. Colloidal iron and Alcian blue stains showed increased dermal mucin deposition. Given the clinical, histopathological, and supportive serological findings (positive anti-KU and anti-SSA), a diagnosis of clinically amyopathic dermatomyositis with mechanic hand/hiker feet (MH/HF) was rendered. The pseudocheckerboard pattern of MH/HF has been previously reported in only 4 patients. The most frequent associations with MH/HF are dermatomyositis and antisynthetase syndrome; however, our patient was negative for antiaminoacyl transfer RNA synthetase antibodies, a required criterion to diagnose antisynthetase syndrome. It is imperative to recognize MH/HF clinically and histopathologically because it may be an early indication of developing dermatomyositis or other connective tissue diseases, which would guide further workup and screening for systemic involvement of the disease, including interstitial lung disease.
Foamy Cell Histiocytosis Is a Diagnostic Pitfall: A Case Report of Xanthomatosis Secondary to Sitosterolemia Mimicking Progressive Nodular Histiocytosis
Authors: Garrido Maria C. , Torres María Penalba , Lorenzo Lucía Garzón , Gil Marco , Milla Carmen Palma , Rodriguez-Peralto Jose Luis , Palencia Pérez Sara I.
Published: July 2022

We report a noteworthy case of a 10-year-old girl who presented with papular and nodular lesions on the skin that were clinically and histologically mistaken for progressive nodular histiocytosis. During the clinical management of the patient, the high lipid levels raised the suspicion of lipid metabolism disease and helped us to make the correct diagnosis of sitosterolemia. In sitosterolemia, proper management such as restriction of plant sterol intake and administration of cholesterol absorption inhibitor can improve prognosis.
The Appropriately Designed TDM Clinical Trial: Endpoints, Pitfalls, and Perspectives
Authors: van Gelder Teun
Published: July 2022

Background:

Appropriately designed clinical trials can provide the evidence needed to broadly implement therapeutic drug monitoring (TDM). In the past 30 years, some stunning successes but also some fascinating failures in demonstrating the benefits of TDM have been observed. Future TDM studies can be designed based on this experience.

Methods:

The manuscript is based on a combination of personal experience and published articles and discusses several aspects of the design and conduct of TDM studies.

Results:

Recommendations are provided to reduce the risk of protocol violations and to maximize the potential impact of a TDM study on clinical practice.

Conclusions:

There are lessons that can be learned from previous experience, and this article gives an overview of potential TDM study designs, endpoints, pitfalls, and perspectives.
Early menopause and a low body mass index are associated with an increased risk of coronary heart disease in Japanese women
Authors: Yamanouchi Keiko , Ohta Tsuyoshi , Konta Tsuneo , Nakamura Fumihiro , Horikawa Shouta , Nakai Nanako , Sakai Kazuyoshi , Fukase Mika , Seino Manabu , Yamatani Hizuru , Watanabe Masafumi , Ueno Yoshiyuki , Nagase Satoru
Published: July 2022

Objective

The primary objective was to investigate the association between early menopause and cardiovascular disease (CVD) prevalence in Japanese women. The secondary objective was to ascertain the association with CVD risk factors.

Methods

In this cross-sectional study, 7,239 naturally menopausal women from the Yamagata Cohort Study who completed an annual health visit and questionnaire between 2009 and 2015 were divided into three groups according to their age at menopause (women experiencing menopause at <45, 45-49 y, and ≥ 50 y). The diagnosis of coronary heart disease (CHD) and stroke were made by self-report, while hypertension, hyperlipidemia, and diabetes mellitus, were diagnosed by vital signs and laboratory parameters. Logistic regression analysis was used to estimate the associations between age at menopause and CVD prevalence and CVD risk factors.

Results

A total of 354 (4.9%) and 156 (2.2%) women reported a history of CHD and stroke, respectively. Women experiencing menopause at <45 years had a higher prevalence of CHD than those experiencing menopause at ≥50 years (OR 1.77, 95% CI 1.07-2.90; P = 0.023). Stroke, hypertension, diabetes mellitus, and hyperlipidemia were equally prevalent among the three groups. Significant interactions were observed between age at menopause and body mass index (BMI) (P = 0.025) and parity (P = 0.025). Among those with a BMI < 18.5 or parity ≥2, women experiencing menopause at <45 years had a significantly higher prevalence of CHD than those experiencing menopause at ≥50 years.

Conclusion

Early menopause and low BMI were associated with CHD in Japanese women.
Dutch Physician’s Perspectives on Diagnosis and Treatment of Waldenström’s Macroglobulinemia Before and After the Implementation of a National Guideline
Authors: Amaador Karima , Kersten Marie José , Minnema Monique C. , Vos Josephine M. I.
Published: July 2022

Waldenström’s macroglobulinemia (WM), a rare low-grade B-cell non-Hodgkin lymphoma (NHL), has a distinct clinical presentation and different treatment-related side effects compared with other NHL. Currently, a wide variety of therapeutic agents are available for the treatment of WM but there is no consensus on optimal treatment in first line and/or at relapse. The aim of this survey was to evaluate the current knowledge and perspectives of hematologists on diagnosis and treatment of WM. Also, we compare these results to a similar survey done before the publication of the first Dutch national guideline, in order to evaluate the impact of the implementation of a national guideline. A link to an online survey was sent out to all registered hematologists and hemato-oncologists in the Netherlands with the request to participate. The survey contained questions regarding the preferred diagnostic and treatment methods in patients with WM as well as treatment goals. We also compared physicians preferred treatment goals to those of patients (as studied in a recent nationwide patient questionnaire). Ninety-five responses (30% response rate) were obtained, out of which 82 (86%) surveys were complete. The respondents most commonly used dexamethasone-rituximab-cyclophosphamide as first-line treatment. For second-line treatment, bendamustine with rituximab and ibrutinib monotherapy were the most frequently applied. Compared with the initial survey, serum IgM M-protein was determined in all cases, MYD88 mutation analysis was currently widely implemented, prevention of an IgM “flare” was uniformly managed by the respondents and use of rituximab-cyclophosphamide-vincristine-prednisone was entirely abandoned. Physicians differed somewhat from patients with regard to most important treatment goals. The approach to diagnostic methods and treatment options in WM was more consistent with international guidelines and was more homogeneous after implementation of the national guideline. These data indicate an increase in knowledge on WM diagnosis and treatment. This may have resulted from implementation of a local guideline or the global rise in awareness and attention for WM.
EFFECTS OF INTRAVITREAL BEVACIZUMAB THERAPY ON GLOMERULAR FILTRATION RATES IN PATIENTS TREATED FOR PROLIFERATIVE DIABETIC RETINOPATHY
Authors: Camp David A. , Price David A. , Neiweem Ashley E. , Jusufbegovic Denis
Published: July 2022

Purpose:

To assess whether the repeated use of intravitreal bevacizumab injections in treatment of proliferative diabetic retinopathy is associated with a long-term decline in the glomerular filtration rate (GFR).

Methods:

Three hundred charts were retrospectively reviewed, of which 60 patients met the criteria for inclusion. The criteria were as follows: reception of at least one bevacizumab injection, baseline GFR before initial bevacizumab injection, and end GFR 6 to 24 months after baseline. Analysis controlled for time between baseline and end GFR measurements, blood pressure, hemoglobin A1C, race, sex, age, and use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Significance testing was performed with step-wise multiple linear regression. The significance threshold was 5%, and all tests were two-sided.

Results:

Patients received a range of 1 to 17 injections (average 3.6). The average baseline GFR was 76 ± 38 mL/minute, and the end GFR was 63 ± 39 mL/min. The number of injections patients received was not associated with end GFR (P = 0.72), GFR reduction (P = 0.88), or percent GFR reduction (P = 0.49).

Conclusion:

Increased number of intravitreal bevacizumab injections at therapeutic dosage was not associated with reduced GFR in patients with proliferative diabetic retinopathy. This study supports that intravitreal antivascular endothelial growth factor agents are renally safe.
NODULAR EPIRETINAL MÜLLER CELL GLIOSIS IN THE FOVEA
Authors: Jung Jesse J. , Zeng Anne , Komati Rahul , Mackin Anna G. , Skondra Dimitra , Yonekawa Yoshihiro , Fineman Mitchell S. , Ezon Isaac , Rofagha Soraya , Hoang Quan V.
Published: July 2022

Purpose:

The purpose of this study was to report the findings of a hyperreflective nodular epiretinal gliosis observed with optical coherence tomography presumed to be due to subclinical hyaloidal traction causing Mϋller cell cone gliosis.

Methods:

Retrospective, observational case series.

Results:

Six eyes of six patients (mean age: 57 years, range 35–81 years) presented with a nodular epiretinal gliosis and had an average follow-up interval of 26 months (range 1–82 months). The mean baseline best-corrected visual acuity was 0.25 ± 0.17 (Snellen equivalent 20/38.3 ± 16.9). Fundus photography demonstrated a yellowish lesion overlying the fovea. Optical coherence tomography imaging revealed a hyperreflective preretinal lesion with a mean vertical length of 267 μm (range 185–497) and a mean greatest linear diameter of 312 µm (range 124–640). There was no vitreoretinal abnormality including vitreomacular traction or epiretinal membrane noted in any eye, and two of six eyes displayed a definitive posterior vitreous detachment. These nodules may have occurred before and persisted even after a posterior vitreous detachment or may have been acquired after the posterior vitreous detachment. The nodules typically remained stable with minimal change although in one eye, a posterior vitreous detachment occurred 6 months after initial presentation and lifted the gliosis off of the retinal surface where it remained attached to the posterior hyaloid.

Conclusion:

Foveal nodular epiretinal gliosis may occur due to subclinical hyaloidal traction on the Müller cell cone even without obvious vitreoretinal interface abnormality on optical coherence tomography.
Delphi study to define core clinical outcomes for inclusion in a complex regional pain syndrome international research registry and data bank
Authors: Llewellyn Alison , Buckle Lisa , Grieve Sharon , Birklein Frank , Brunner Florian , Goebel Andreas , Harden R. Norman , Bruehl Stephen , Vaughan-Spickers Nicole , Connett Robyn , McCabe Candida
Published: July 2022

Complex regional pain syndrome (CRPS) clinical trials have historically captured a diverse range of outcomes. A minimum set of CRPS patient-reported outcomes has been agreed for inclusion in a future CRPS international clinical research registry and data bank. This study aimed to identify a complementary set of core clinical outcomes. Clinicians and researchers from the international CRPS community informed the content of a 2-round electronic Delphi study. Participation was invited from members of the International Association for the Study of Pain CRPS Special Interest Group and the International Research Consortium for CRPS. In round 1, participants rated the relevance of 59 clinical outcomes in relation to the question “What is the clinical presentation and course of CRPS, and what factors influence it?” (1 = not relevant and 9 = highly relevant). In round 2, participants rerated each outcome in the light of the round 1 median scores. The criterion for consensus was median score ≥7, agreed by 75% of respondents. The core study team considered the feasibility of data collection of each identified outcome in agreeing final selections. Sixty respondents completed both survey rounds, with responses broadly consistent across professions. Nine outcomes met the consensus criterion. Final outcomes recommended for inclusion in the core clinical set were record of medications, presence of posttraumatic stress disorder, extent of allodynia, and skin temperature difference between limbs. Study findings provide robust recommendations for core clinical outcome data fields in the future CPRS international clinical research registry. Alongside patient-reported outcomes, these data will enable a better understanding of CRPS.
Update on vitamin C administration in critical illness
Authors: Fujii Tomoko , Lankadeva Yugeesh R. , Bellomo Rinaldo
Published: July 2022

Purpose of review

Several studies have recently explored the effects of intravenous vitamin C in sepsis. We aimed to summarize their findings to provide perspectives for future research.

Recent findings

Sepsis trials examined 6 g/day of intravenous vitamin C with or without the thiamine and/or hydrocortisone compared with placebo or hydrocortisone. Network meta-analysis reported that intravenous vitamin C, thiamine, hydrocortisone, or combinations of these drugs was not proven to reduce long-term mortality. However, the component network meta-analysis suggested an association of high-dose (>6 g/day) and very-high dose vitamin C (>12 g/day) and decreased mortality but with low certainty. The preclinical investigations have, however, advanced to much higher doses of intravenous vitamin C therapy since a scoping review on harm reported that mega-doses of intravenous vitamin C (50–100 g/day) had been administered without any conclusive adverse effects. In a Gram-negative sheep model, renal tissue hypoperfusion was reversed, followed by improvements in kidney function when a mega-dose of vitamin C (150 g/day equivalent) was administered.

The effect of intravenous vitamin C in critically ill patients has yet to be determined and might be dose-dependent. Clinical studies of very high or mega doses of vitamin C are justified by preclinical data.
Challenges and advances in nutrition for the critically ill child
Authors: Albert Ben D. , Martinez Enid E.
Published: July 2022

Purpose of review

Malnutrition remains prevalent in critically ill children and is associated with worse clinical outcomes. Conversely, nutrition provision has been associated with improved survival. Nutritional challenges must be addressed to guide best nutrition practices for the critically ill child. In this narrative review, we summarize findings from research published between July 2020 and January 2022 on nutrition in critically ill children. Findings from these articles build on previous work to guide next steps in both research and clinical practice in this cohort.

Recent findings

A comprehensive literature review was performed. We identified the following common themes for research published between July 2020 and January 2022-metabolism, enteral nutrition, including timing, dosing, protein prescription and delivery in special populations, gastrointestinal function, and enteral nutrition adjunctive therapies.

Research continues to support early initiation and advancement of enteral nutrition. Achieving nutritional adequacy is challenging, but research associated with the timing and dosing of enteral nutrition, alternative methods of enteral nutrition delivery and the use of adjuncts are expanding our understanding of best practices for this cohort. Areas for further research continue to be the use of measured energy requirements, protein dosing and inclusion of functional outcomes to assess the benefit of nutritional interventions.
Protein metabolism in critical illness
Authors: Chapple Lee-anne S. , van Gassel Rob J.J. , Rooyackers Olav
Published: July 2022

Purpose of review

Critically ill patients experience skeletal muscle wasting that may contribute to the profound functional deficits in those that survive the initial injury. Augmented protein delivery has the potential to attenuate muscle loss, yet the ability for dietary protein to improve patient outcomes is reliant on effective protein metabolism. This review will discuss the recent literature on protein delivery and digestion, amino acid absorption, and muscle protein synthesis (MPS) in critically ill adults.

Recent findings

Critically ill patients are prescribed protein doses similar to international recommendations, yet actual delivery remains inadequate. The majority of trials that have achieved higher protein doses have observed no effect on muscle mass, strength or function. Critically ill patients have been observed to have minimal deficits in protein digestion and amino acid absorption when delivery bypasses the stomach, yet postprandial MPS is impaired. However, the literature is limited due to the complexities in the direct measurement of protein handling.

Postprandial MPS is impaired in critically ill patients and may exacerbate muscle wasting experienced by these patients. Studies in critically ill patients require assessment not only of protein delivery, but also utilization prior to implementation of augmented protein doses.
Insulin resistance in children
Authors: Mainieri Francesca , Tagi Veronica Maria , Chiarelli Francesco
Published: July 2022

Purpose of review

Insulin resistance (IR) is a clinical condition due to the decline in the efficiency of insulin promoting glucose uptake and utilization. The aim of this review is to provide an overview of the current knowledge on IR in children, focusing on its physiopathology, the most appropriate methods of measurement of IR, the assessment of risk factors, the effects of IR in children, and finally giving indications on screening and treatment.

Recent findings

IR has evolved more and more to be a global public health problem associated with several chronic metabolic diseases.

Detecting a correct measurement method and specific risk predictors, in order to reduce the incidence of IR, represents a challenging goal.
A Systematic Review and Meta-Analysis of the Association Between Periodontal Disease and Severe Mental Illness
Authors: Cai Vickie , Peng Ng Chee , Zhao Jenny , Siskind Dan , Kisely Steve
Published: July 2022

Background

Periodontal disease represents a global public health concern, with a disproportionate burden being borne by vulnerable populations. One such group is people with severe mental illness (SMI), and this study examined whether periodontal health is poorer in people with SMI than the general population.

Methods

We conducted a systematic search for studies published before March 2021 on the periodontal health of people with SMI using the following databases: PubMed, PsycINFO, EMBASE, China National Knowledge Infrastructure, and Chongqing VIP. Outcomes were periodontitis, periodontal disease, and shallow and deep periodontal pockets. Results were compared with the general population.

Results

Seventeen studies had sufficient data for a random-effects meta-analysis, consisting of 4404 psychiatric patients and 95,411 controls. SMI was associated with an increased prevalence of periodontitis (odds ratio = 1.97, 95% confidence interval [CI] = 1.15–3.35) compared with the general population. People with SMI had 4.28 the odds of having periodontal disease compared with controls (95% CI = 2.54–7.21). They also had 3.65 the odds of shallow pockets (95% CI = 1.80–7.42) and 2.76 the odds of deep pockets (95% CI = 1.10–6.93).

Conclusions

Our findings highlight the increased prevalence and severity of periodontal disease in people with SMI. Oral health is often considered the gateway to overall health and should be a public health priority for this population.
The Relationship Between Family Socioeconomic Status and Adolescent Sleep and Diurnal Cortisol
Authors: Rocha Sarah , Almeida David M. , Chiang Jessica J. , Cole Steve W. , Irwin Michael R. , Seeman Teresa , Fuligni Andrew J.
Published: July 2022

Objective

This study aimed to investigate the associations between indices of family socioeconomic status and sleep during adolescence and to examine whether measures of hypothalamic-pituitary-adrenal (HPA) axis functioning mediate the observed associations.

Methods

A total of 350 ethnically diverse adolescents (57% female; mean [standard deviation] agewave 1 = 16.4 [0.7] years) completed a three-wave longitudinal study in which sleep and cortisol data were collected at 2-year time intervals. Sleep duration, latency, and variability were assessed via actigraphy during a period of 8 days per study wave. Salivary cortisol was collected across 3 days per study wave to assess cortisol diurnal slope, area under the curve, and the cortisol awakening response. Adolescents’ caregivers reported their education levels, family income, and economic hardship.

Results

A greater family income-to-needs ratio was associated with longer adolescent sleep duration (b = 2.90, p = .023), whereas greater parental education was associated with shorter sleep duration (b = −3.70, p = .030), less sleep latency (b = −0.74, p = .016), and less variability across days (b = −2.06, p = .010). Diurnal cortisol slope statistically mediated the association of parental education with sleep duration (b = −0.48, 95% confidence interval = −1.099 to −0.042), but not the association of income-to-needs ratio with sleep duration.

Conclusions

Findings suggest that parental education and family resources may have unique impacts upon sleep and HPA axis functioning during the period of adolescence. Future research is needed to examine family and behavioral factors that may underlie socioeconomic status associations with adolescent sleep and HPA axis functioning.
Harms and Contributors of Leaving Against Medical Advice in Patients With Infective Endocarditis
Authors: Mishra Ajay Kumar , Abraham Benson M. , Sahu Kamal K. , George Anu A. , Sargent Jennifer , Kranis Mark J. , George Susan V. , Abraham George M.
Published: July 2022

Introduction

Patients leaving against medical advice (AMA) are commonly encountered in hospital medicine. The problem is prevalent worldwide and across all fields of medicine. A retrospective study of 47,583 patients reported a 3.3% AMA rate in 2015.

Objectives

In this retrospective study, we aimed (1) to study the demographic, clinical, and laboratory parameters of infective endocarditis (IE) patients leaving AMA. We also compared (2) the various risk factors and outcomes of these patients with IE patients who completed treatment.

Results

A total of 111 patients diagnosed with IE were recruited for 36 months. Of the 74 patients with available details, 32 patients (29%) left AMA during their treatment. The mean age of patients leaving AMA was 39, and among those who left AMA, 66% were females. As compared with patients completing therapy, patients leaving AMA tend to have higher comorbidities, including injection drug use (68.1% versus 31.9%), prior IE (83.3% versus 16.7%), and chronic hepatitis C (72.4% versus 27.8%). Rates of consumption of substances of abuse were higher among those who left AMA. Patients leaving AMA also had higher psychiatric comorbidities (63% versus 37.5%), history of leaving AMA (70.5% versus 29.5%), and consumption of more than 2 substances of abuse. Morbidity was higher in patients leaving AMA. There was a statistically significant association between the development of distal embolus (P < 0.001), the need for recurrent admissions (P = 0.002), recurrent bacteremia (P < 0.001), developing new embolus (P < 0.001), and overall morbidity (P = 0.002) among IE patients leaving AMA.

Conclusions

Infective endocarditis patients leaving AMA tend to be younger females. These patients have prior comorbidities of injection drug use, prior IE, multiple psychiatric comorbidities, drug use, and multiple socioeconomic issues. Patients leaving AMA tend to develop further non–Central nervous system embolic events, recurrent bacteremia, and require frequent admissions. Morbidity in these patients was higher.
Long-term Clinical and Patient-Reported Outcomes After Transversus Abdominis Release With Permanent Synthetic Mesh: A Single Center Analysis of 1203 Patients
Authors: Zolin Samuel J. , Krpata David M. , Petro Clayton C. , Prabhu Ajita S. , Rosenblatt Steven , Rosen Samantha , Thompson Reid , Fafaj Aldo , Thomas Jonah D. , Huang Li-Ching , Rosen Michael J.
Published: July 2022

Objective:

We aimed to report long-term clinical and patient-reported outcomes of transversus abdominis release (TAR) with permanent synthetic mesh performed in a high-volume abdominal wall reconstruction practice.

Summary Background Data:

Despite increasing utilization of TAR in abdominal wall reconstruction, long-term clinical and patient-reported outcomes remain uncertain.

Methods:

Prospectively collected registry data from the Cleveland Clinic Center for Abdominal Core Health were analyzed retrospectively. Patients undergoing elective, open VHR with TAR and permanent synthetic mesh implantation between August 2014 and March 2020 with 30-day clinical and ≥1 year clinical or patient-reported outcome follow-up were included. Outcomes included composite hernia recurrence, characterized by patient-reported bulges and recurrent hernias noted on physical exam or imaging, as well as hernia-specific quality of life and pain.

Results:

A total of 1203 patients were included. Median age was 60 years [interquartile range (IQR): 52–67], median body mass index was 32 kg/m2 (IQR: 28–36), median hernia width was 15 cm (IQR: 12–19), and 57% of hernias were recurrent. Fascial reapproximation was achieved in 92%. At a median follow-up of 2 years (IQR: 1–4), the overall composite hernia recurrence rate was 26%, with sensitivity analysis yielding best-case and worst-case estimates of 5% and 28%, respectively. Patients experienced improved hernia-specific quality of life and pain regardless of recurrence outcome; however, those who did not recur experienced more substantial improvement.

Conclusions:

TAR with permanent synthetic mesh remains a valuable, versatile technique; however, surgeon and patient expectations should be tempered regarding long-term durability. Despite a high rate of recurrence, patients experience measurable improvements in quality of life.
Lymph Node Ratio Improves Prediction of Overall Survival in Esophageal Cancer Patients Receiving Neoadjuvant Chemoradiotherapy: A National Cancer Database Analysis
Authors: Zhang Yajie , Cao Yuqin , Zhang Jiahao , Huang Maosheng , Roy Pascal , Huang Binhao , Yang Hong , Rong Yi , Chen Yuping , Zhu Chengchu , Fang Wentao , Yu Zhentao , Mao Weimin , Xiang Jiaqing , Han Yongtao , Lin Jules , Zhang Jie , Fu Jianhua , He Jie , Li Hecheng
Published: July 2022

Objective:

This study aimed to propose a revised ypN (r-ypN) classification based on lymph node ratio (LNR) and to examine its prognostic value in postneoadjuvant esophageal cancer.

Background:

A new postneoadjuvant pathologic (ypTNM) staging classification has been introduced for esophageal cancer. However, the ypN classification currently defined by the number of positive lymph nodes is influenced by the extent of lymphadenectomy.

Methods:

Data on 7195 esophageal cancer patients receiving neoadjuvant chemoradiation were extracted from the National Cancer Database (NCDB). Four r-ypN stages were defined by 3 LNR thresholds (0%, 10%, and 20% using X-tile software). A revised ypTNM (r-ypTNM) classification was developed by solely changing N categories. Kaplan-Meier method and Cox proportional hazards models were used for survival analyses. Akaike information criterion (AIC) and Harrell’s concordance index (C-index) were used to compare the predictive performance of the current and the revised classification. External validation was performed using an independent cohort from the NEOCRTEC5010 clinical trial.

Results:

Both ypN (P<0.001) and r-ypN (P<0.001) were independent prognostic factors of overall survival (OS) for esophageal cancer patients. Kaplan-Meier curves demonstrated a better discrimination with r-ypN than ypN categories. Within each ypN category (except ypN3), OS was significantly different comparing r-ypN strata; however, there were no differences between ypN strata within each r-ypN category (except r-ypN3). r-ypN (AIC: 60752 vs 60782; C-index: 0.591 vs 0.587) and r-ypTNM (AIC: 60623 vs 60628; C-index: 0.613 vs 0.610) showed better predictive performance than the current staging system, with a lower AIC (better calibration) and higher C-index (improved discrimination). This advantage was also confirmed by external validation using the NEOCRTEC5010 cohort.

Conclusions:

LNR showed better performance than ypN in predicting OS of esophageal cancer patients after neoadjuvant chemoradiation and may be an improvement on the current staging system.
Operative Team Familiarity and Specialization at an Academic Medical Center
Authors: Witmer Hunter D.D. , Keçeli Çağla , Morris-Levenson Joshua A. , Dhiman Ankit , Kratochvil Amber , Matthews Jeffrey B. , Adelman Dan , Turaga Kiran K.
Published: July 2022

Objective:

To propose a framework for quantification of surgical team familiarity.

Background:

Operating room (OR) teamwork quality is associated with familiarity among team members and their individual specialization. We describe novel measures of OR team familiarity and specialty experience.

Methods:

Surgeon-scrub (SS) and surgeon-circulator (SC) teaming scores, defined as the pair’s proportion of interactions relative to the surgeon’s total cases in the preceding 6 months were calculated between 2017 and 2021 at an academic medical center. Nurse service-line (SL) experience scores were defined as the proportion of a nurse’s cases performed within the given specialty. SS, SC, and nurse-SL scores were analyzed by specialty, case urgency, robotic approach, and surgeon academic rank. Two-sample Kolmogorov-Smirnov tests were used to determine heterogeneity between distributions.

Results:

A total of 37,364 operations involving 150 attending surgeons and 222 nurses were analyzed. Median SS and SC scores were 0.08 (interquartile range: 0.03–0.19) and 0.06 (interquartile range: 0.03–0.13), respectively. Higher margin SLs, senior faculty rank, elective, and robotic cases were associated with greater SS, SC, and nurse-SL scores (P<0.001).

Conclusions:

These novel measures of teaming and specialization illustrate the low levels of OR team familiarity and objectively highlight differences that necessitate a deliberate evaluation of current OR scheduling practices.
Characterizing outbreak vulnerability in a stochasticSISmodel with an external disease reservoir
Authors: Nieddu Garrett T. , Forgoston Eric , Billings Lora
Published: July 2022

In this article, we take a mathematical approach to the study of population-level disease spread, performing a quantitative and qualitative investigation of anSISκmodel which is a susceptible-infectious-susceptible (SIS) model with exposure to an external disease reservoir. The external reservoir is non-dynamic, and exposure from the external reservoir is assumed to be proportional to the size of the susceptible population. The full stochastic system is modelled using a master equation formalism. A constant population size assumption allows us to solve for the stationary probability distribution, which is then used to investigate the predicted disease prevalence under a variety of conditions. By using this approach, we quantify outbreak vulnerability by performing the sensitivity analysis of disease prevalence to changing population characteristics. In addition, the shape of the probability density function is used to understand where, in parameter space, there is a transition from disease free, to disease present, and to a disease endemic system state. Finally, we use Kullback–Leibler divergence to compare our semi-analytical results for theSISκmodel with more complex susceptible-infectious-recovered (SIR) and susceptible-exposed-infectious-recovered (SEIR) models.
Deeply subwavelength giant monopole elastodynamic metacluster resonators
Authors: Cotterill Philip A. , Nigro David , Parnell William J.
Published: July 2022

The giant monopole resonance is a well-known phenomenon, employed to tune the dynamic response of composite materials comprising voids in an elastic matrix which has a bulk modulus much greater than its shear modulus, e.g. elastomers. This low frequency resonance (e.g.

λ
p

/

a
≈
100

for standard elastomers, where

λ
p

and

a

are the compressional wavelength and void radius, respectively) has motivated acoustic material design over many decades, exploiting the subwavelength regime. Despite this widespread use, the manner by which the resonance arising from voids in close proximity is affected by their interaction is not understood. Here, we illustrate that for planar elastodynamics (circular cylindrical voids), coupling due to near-field shear significantly modifies the monopole (compressional) resonant response. We show that by modifying the number and configuration of voids in a metacluster, the directionality, scattering amplitude and resonant frequency can be tailored and tuned. Perhaps most notably, metaclusters deliver a lower frequency resonance than a single void. For example, two touching voids deliver a reduction in resonant frequency of almost 16% compared with a single void of the same volume. Combined with other resonators, such metaclusters can be used as meta-atoms in the design of elastic materials with exotic dynamic material properties.
Not just females: the socio-ecology of social interactions between spider monkey males
Authors: Saldaña-Sánchez Amor Aline , Schaffner Colleen M. , Smith-Aguilar Sandra , Aureli Filippo
Published: July 2022

Male–male relationships are mostly characterized by competition. However, males also cooperate with one another if socio-ecological conditions are suitable. Due to their male philopatry, the need for cooperation in home range defence and high degree of fission–fusion dynamics, spider monkeys provide an opportunity to investigate how male–male interactions are associated with socio-ecological factors, such as the presence of potentially receptive females, the degree of food availability and the likelihood of home range defence. We tested predictions about changes in social interactions between wild spider monkey males in relation to these factors. First, males did not change their interaction patterns when potentially receptive females were in the subgroup compared to when they were absent. Second, males tended to be less tolerant of one another when feeding, but spent more time grooming, in contact and proximity with one another when food availability was lower than when it was higher. Third, males exchanged fewer embraces, spent less time grooming, in proximity and in contact with one another, and spent more time vigilant at the home range boundary area than at other locations. Our findings contribute to the understanding of social flexibility and the importance of considering males in socio-ecological models of any group-living species.
Descending neuron population dynamics during odor-evoked and spontaneous limb-dependent behaviors
Authors: Aymanns Florian , Chen Chin-Lin , Ramdya Pavan
Published: July 2022

Deciphering how the brain regulates motor circuits to control complex behaviors is an important, long-standing challenge in neuroscience. In the fly, Drosophila melanogaster, this is accomplished by a population of ∼ 1100 descending neurons (DNs). Activating only a few DNs is known to be sufficient to drive complex behaviors like walking and grooming. However, what additional role the larger population of DNs plays during natural behaviors remains largely unknown. For example, they may modulate core behavioral commands, or comprise parallel pathways that are engaged depending on sensory context. We evaluated these possibilities by recording populations of nearly 100 DNs in individual tethered flies while they generated limb-dependent behaviors. We found that the largest fraction of recorded DNs encode walking while fewer are active during head grooming and resting. A large fraction of walk-encoding DNs encode turning and far fewer weakly encode speed. Although odor context does not determine which behavior-encoding DNs are recruited, a few DNs encode odors rather than behaviors. Lastly, we illustrate how one can identify individual neurons from DN population recordings by analyzing their spatial, functional, and morphological properties. These results set the stage for a comprehensive, population-level understanding of how the brain’s descending signals regulate complex motor behaviors.
Neopterin level can be measured by intraocular liquid biopsy
Authors: Kuvbachieva-Benarrosh Anelia , Nefzaoui Chaker , Quadrio Isabelle , Remignon Charles-Henry , Jullian Eric , Perret-Liaudet Armand
Published: July 2022

Robust intraocular markers are needed in clinical practice for several inflammatory ophthalmological conditions in addition to advanced imaging, histology and immunohistochemistry tests in order to assure reliable diagnosis. Neopterin (NPt) is produced by activated lymphocyte T cells and is known to increase within the CNS in proinflammatory or early infectious states. This study aimed to measure intraocular NPt in aqueous liquid following intraocular liquid biopsy using standard methods. We enrolled 20 healthy patients without known inflammatory history or medication underdoing cataract surgery and analyzed samples for 19 out of 20. NPt level was measured below 1,9 nmol/l in 16 patients (84 %) and less than 3 nmol/l in 94,74%. Given the first time that NPt is measured in intraocular liquids we compared with the established reference limits within the CSF. These findings suggest that NPt could serve as a potential additional signature in ophthalmological conditions to differentiate between any or proinflammatory intraocular state, as well in follow-up.
The size of myocardial infarction and peri-infarction edema are not major determinants of diastolic impairment after acute myocardial infarction
Authors: Sundqvist Martin G , Verouhis Dinos , Sörensson Peder , Henareh Loghman , Persson Jonas , Saleh Nawzad , Settergren Magnus , Witt Nils , Böhm Felix , Pernow John , Tornvall Per , Ugander Martin
Published: July 2022

Aims

Diastolic dysfunction after myocardial infarction (MI) is a marker of poor prognosis. The relationship between myocardial infarction size (IS), myocardial edema, and diastolic dysfunction is poorly understood, both in the acute phase, and in the development of diastolic dysfunction in the follow-up setting. Using a mechanistic approach could potentially add insights.

Methods and results

Patients underwent cardiovascular magnetic resonance (CMR) imaging and echocardiography including mechanistic analysis using the parameterized diastolic filling method within 4-7 days (acute) and 6 months after a first acute anterior MI (n=74). Linear regression modeling of echocardiographic diastolic parameters using CMR IS with and without inclusion of the myocardium at risk (MAR) and model comparisons with likelihood ratio tests were performed. Diastolic parameters at 6 months follow-up were modelled using final IS. For most parameters there was no association with acute IS, except for deceleration time (R2=0.24, p<0.001), left atrial volume index (R2=0.13, p=0.01) and the mechanistic stiffness parameter (R2=0.21, p<0.001). Adding MAR improved only the e′ model (adjusted R2 increase: 0.08, p=0.02). At 6 months follow-up, final IS was only associated with viscoelastic energy loss (R2=0.22, p=0.001).

Conclusion

In acute MI, both IS and MAR are related to diastolic function but only to a limited extent. At 6 months after infarction, increasing IS is related to less viscoelastic energy loss, albeit also to a limited extent. The relationship between IS and diastolic dysfunction seems to be mediated by mechanisms beyond simply the spatial extent of ischemia or infarction.
Debriefing to improve interprofessional teamwork in the operating room: a systematic review
Authors: Skegg Emma , McElroy Canice , Mudgway Mercedes , Hamill James
Published: July 2022

Purpose

Debriefing has been pivotal in medical simulation training but its application to the real-world operating room environment has been challenging. We reviewed the literature on routine surgical debriefing with special reference to its implementation, barriers, and effectiveness.

Design

Descriptive systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Methods

Inclusion criteria were papers pertaining to debriefing in routine surgical practice. Excluded were papers reporting simulation training. We searched Google Scholar, CINAHL, Web of Science Core Collection, PsychINFO, Medline, Embase, and ProQuest Theses & Dissertations Global. The last search was performed on 14 March 2022. Quality was assessed on a 21-point checklist adapted from a standard reporting guideline. Synthesis was descriptive.

Findings

The search process resulted in 19 papers. Publication date ranged from 2007 – 2022. Study methods included surveys, interviews, and analysis of administrative data. Five papers involved a specific intervention. Quality scores ranged from 12 – 19 out of 21. On synthesis, we identified five topics: explanations of how debriefing had been implemented; the value of coaching and audit; the learning dimensions of debriefing, both team learning and quality improvement at the organizational level; the effect of debriefing on patient safety or the organization’s culture; and barriers to debriefing.

Conclusions

Debriefing is valuable for team learning, efficiency, patient safety, and psychological safety. Successful implementation programs were characterized by strong commitment from management and support by frontline workers. Integration with administrative quality and safety processes, and information feedback to frontline workers are fundamental to successful debriefing programs.
Weight cycling induces innate immune memory in adipose tissue macrophages
Authors: Caslin Heather L. , Cottam Matthew A. , Piñon Jacqueline M. , Boney Likem Y. , Hasty Alyssa H.
Published: July 2022

Weight loss improves obesity-associated diabetes risk. However, most individuals regain weight, which worsens the risk of developing diabetes and cardiovascular disease. We previously reported that male mice retain obesity-associated immunological changes even after weight loss, suggesting that immune cells may remember the state of obesity. Therefore, we hypothesized that cycles of weight gain and loss, otherwise known as weight cycling, can induce innate memory in adipose macrophages. We first treated bone marrow derived macrophages in a culture model of innate immune memory. Priming the cells with palmitic acid or adipose tissue conditioned media increased maximal glycolysis, oxidative phosphorylation, and increased LPS-induced TNFα and IL-6 production. While weight loss improved glucose tolerance, adipose macrophages retained elevated LPS-induced cytokine production. In a model of weight cycling, adipose macrophages had elevated metabolism and secreted higher levels of basal TNFα. Together, these data suggest that obesity and subsequent weight loss can prime adipose macrophages for enhanced inflammation upon weight regain. This innate immune memory response may contribute to worsened glucose tolerance following weight cycling.
Single-cell transcriptional landscape of peripheral immunity and biomarkers for human sporadic amyotrophic lateral sclerosis patients
Authors: Ma Albert Ziye , Kirk Brian D. , Yan Deyu , Zhang Mingchao , Yao Jing , Dai Xiaomin , Lu Lingdan , Wang Qinghua , Ying Weihai , Han Yan
Published: July 2022

Sporadic amyotrophic lateral sclerosis (ALS) is a fatal adult-onset neurodegenerative disease with unknown causes and few treatment options. Here we report the first multi-dimensional single-cell landscape of the peripheral blood mononuclear cell samples from seven ALS patients representing three distinct disease stages: Early, Mid and Late. Our multipronged analyses revealed the over-activation of immune cells especially in the Mid and Late ALS stages, which is characterized by the increased cytotoxic CD8+effector cells, expanded TCR clonotypes, upregulated oxidative phosphorylation and ribosomal genes across many cell types. More importantly, the current study discovered novel genes strongly correlated with ALS conditions, such asFOXO1andTGFBR2responsible for the aberrant T cell activation, andXBP1andSPIBaccountable for excessive oxidative stress. We further identified 60 genes that distinguished ALS patients from healthy donors with an unprecedented accuracy of 93% against an independent cohort of 792 specimens. Our findings provide new molecular and cellular insights into the mechanisms of ALS onset and progression, and offer novel strategies for accurate diagnosis and potential therapeutic development.