bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetes mellitus: association of cystatin C- versus creatinine-based estimated glomerular filtration rate with mortality and cardiovascular events
Authors: He Daijun , Gao Bixia , Wang Jinwei , Yang Chao , Wu Shouling , Chen Shuohua , Li Junjuan , Chen Min , Zhao Ming-Hui , Zhang Luxia
Published: February 2024

Background

To explore the association between the differences between cystatin C- and creatinine-based estimated glomerular filtration rate (eGFRdiff), and the risk of mortality and cardiovascular (CV) events in individuals with diabetes.

Methods

Three prospective cohorts analyzed data from adults with diabetes from the Incident, Development, and Prognosis of Diabetic Kidney Disease (INDEED) study (2016–17 to 2020) in China, the National Health Nutrition Examination Survey (NHANES, 1999–2004 to 2019) in the USA and UK Biobank (UKB, 2006–10 to 2022) in the UK. Baseline eGFRdiff was calculated using both absolute difference between cystatin C- and creatinine-based calculations (eGFRabdiff), and the ratio between them (eGFRrediff). Cox proportional hazards regression models were used to investigate the association between eGFRdiff and outcomes including all-cause mortality and incident CV events.

Results

A total of 8129 individuals from INDEED (aged 60.7 ± 10.0 years), 1634 from NHANES (aged 62.5 ± 14.4 years) and 29 358 from UKB (aged 59.4 ± 7.3 years) were included. At baseline, 43.6%, 32.4% and 42.1% of participants in INDEED, NHANES and UKB, respectively, had an eGFRabdiff value ≥15 mL/min/1.73 m2. During a median follow-up of 3.8 years for INDEED, 15.2 years for NHANES and 13.5 years for UKB, a total of 430, 936 and 6143 deaths and a total of 481, 183 and 5583 CV events occurred, respectively. Each 1-standard deviation higher baseline eGFRabdiff was independently associated with a lower risk of all-cause mortality and CV events, with hazard ratios of 0.77 and 0.82 in INDEED, 0.70 and 0.68 in NHANES, and 0.66 and 0.78 in UKB. Similar results were observed for eGFRrediff.

Conclusions

eGFRdiff represents a marker of adverse events for diabetes among general population. Monitoring both eGFRcys and eGFRcr yields additional prognostic information and has clinical utility in identifying high-risk individuals for mortality and CV events.
Satellite tracking of American Woodcock reveals a gradient of migration strategies
Authors: Clements Sarah J , Berigan Liam A , Fish Alexander C , Darling Rachel L , Roth Amber M , Balkcom Greg , Carpenter Bobbi , Costanzo Gary , Duguay Jeffrey , Filkins Kayleigh , Graham Clayton L , Harvey William , Hook Michael , Howell Douglas L , Maddox Seth , McWilliams Scott , Meyer Shawn W , Nichols Theodore C , Pollard J Bruce , Roy Christian , Sausville David , Slezak Colby , Stiller Josh , Straub Jacob , Tetreault Mathieu , Washington Dawn , Williams Lisa , Blomberg Erik J
Published: February 2024

Diversity in behavior is important for migratory birds in adapting to dynamic environmental and habitat conditions and responding to global change. Migratory behavior can be described by a variety of factors that comprise migration strategies. We characterized variation in migration strategies in American Woodcock (Scolopax minor), a migratory gamebird experiencing long-term population decline, using GPS data from ~300 individuals tracked throughout eastern North America. We classified woodcock migratory movements using a step-length threshold, and calculated characteristics of migration related to distance, path, and stopping events. We then used principal components analysis (PCA) to ordinate variation in migration characteristics along axes that explained different fundamental aspects of migration, and tested effects of body condition, age-sex class, and starting and ending location on PCA results. The PCA did not show evidence for clustering, suggesting a lack of discrete strategies among groups of individuals; rather, woodcock migration strategies existed along continuous gradients driven most heavily by metrics associated with migration distance and duration, departure timing, and stopping behavior. Body condition did not explain variation in migration strategy during the fall or spring, but during spring adult males and young females differed in some characteristics related to migration distance and duration. Starting and ending latitude and longitude, particularly the northernmost point of migration, explained up to 61% of the variation in any one axis of migration strategy. Our results reveal gradients in migration behavior of woodcock, and this variability should increase the resilience of woodcock to future anthropogenic landscape and climate change.
Gene expression and metabolite levels converge in the thermogenic spadix of skunk cabbage
Authors: Tanimoto Haruka , Umekawa Yui , Takahashi Hideyuki , Goto Kota , Ito Kikukatsu
Published: February 2024

The inflorescence (spadix) of skunk cabbage (Symplocarpus renifolius) is strongly thermogenic and can regulate its temperature at around 23 °C even when the ambient temperature drops below freezing. To elucidate the mechanisms underlying developmentally controlled thermogenesis and thermoregulation in skunk cabbage, we conducted a comprehensive transcriptome and metabolome analysis across 3 developmental stages of spadix development. Our RNA-seq analysis revealed distinct groups of expressed genes, with selenium-binding protein 1/methanethiol oxidase (SBP1/MTO) exhibiting the highest levels in thermogenic florets. Notably, the expression of alternative oxidase (AOX) was consistently high from the prethermogenic stage through the thermogenic stage in the florets. Metabolome analysis showed that alterations in nucleotide levels correspond with the developmentally controlled and tissue-specific thermogenesis of skunk cabbage, evident by a substantial increase in AMP levels in thermogenic florets. Our study also reveals that hydrogen sulfide, a product of SBP1/MTO, inhibits cytochrome c oxidase (COX)-mediated mitochondrial respiration, while AOX-mediated respiration remains relatively unaffected. Specifically, at lower temperatures, the inhibitory effect of hydrogen sulfide on COX-mediated respiration increases, promoting a shift toward the dominance of AOX-mediated respiration. Finally, despite the differential regulation of genes and metabolites throughout spadix development, we observed a convergence of gene expression and metabolite accumulation patterns during thermogenesis. This synchrony may play a key role in developmentally regulated thermogenesis. Moreover, such convergence during the thermogenic stage in the spadix may provide a solid molecular basis for thermoregulation in skunk cabbage.
Imprinting but not cytonuclear interactions determines seed size heterosis in Arabidopsis hybrids
Authors: June Viviana , Song Xiaoya , Chen Z Jeffrey
Published: February 2024

The parent-of-origin effect on seeds can result from imprinting (unequal expression of paternal and maternal alleles) or combinational effects between cytoplasmic and nuclear genomes, but their relative contributions remain unknown. To discern these confounding factors, we produced cytoplasmic–nuclear substitution (CNS) lines using recurrent backcrossing in Arabidopsis (Arabidopsis thaliana) ecotypes Col-0 and C24. These CNS lines differed only in the nuclear genome (imprinting) or cytoplasm. The CNS reciprocal hybrids with the same cytoplasm displayed ∼20% seed size difference, whereas the seed size was similar between the reciprocal hybrids with fixed imprinting. Transcriptome analyses in the endosperm of CNS hybrids using laser-capture microdissection identified 104 maternally expressed genes (MEGs) and 90 paternally expressed genes (PEGs). These imprinted genes were involved in pectin catabolism and cell wall modification in the endosperm. Homeodomain Glabrous9 (HDG9), an epiallele and one of 11 cross-specific imprinted genes, affected seed size. In the embryo, there were a handful of imprinted genes in the CNS hybrids but only 1 was expressed at higher levels than in the endosperm. AT4G13495 was found to encode a long-noncoding RNA (lncRNA), but no obvious seed phenotype was observed in lncRNA knockout lines. Nuclear RNA Polymerase D1 (NRPD1), encoding the largest subunit of RNA Pol IV, was involved in the biogenesis of small interfering RNAs. Seed size and embryos were larger in the cross using nrpd1 as the maternal parent than in the reciprocal cross, supporting a role of the maternal NRPD1 allele in seed development. Although limited ecotypes were tested, these results suggest that imprinting and the maternal NRPD1-mediated small RNA pathway play roles in seed size heterosis in plant hybrids.
Binocular rivalry under naturalistic geometry: Evidence from worlds simulated in virtual reality
Authors: Han Shui'er , Blake Randolph , Aubuchon Celine , Tadin Duje
Published: February 2024

Binocular rivalry is a fascinating, widely studied visual phenomenon in which perception alternates between two competing images. This experience, however, is generally restricted to laboratory settings where two irreconcilable images are presented separately to the two eyes, an implausible geometry where two objects occupy the same physical location. Such laboratory experiences are in stark contrast to everyday visual behavior, where rivalry is almost never encountered, casting doubt on whether rivalry is relevant to our understanding of everyday binocular vision. To investigate the external validity of binocular rivalry, we manipulated the geometric plausibility of rival images using a naturalistic, cue-rich, 3D-corridor model created in virtual reality. Rival stimuli were presented in geometrically implausible, semi-plausible, or plausible layouts. Participants tracked rivalry fluctuations in each of these three layouts and for both static and moving rival stimuli. Results revealed significant and canonical binocular rivalry alternations regardless of geometrical plausibility and stimulus type. Rivalry occurred for layouts that mirrored the unnatural geometry used in laboratory studies and for layouts that mimicked real-world occlusion geometry. In a complementary 3D modeling analysis, we show that interocular conflict caused by geometrically plausible occlusion is a common outcome in a visual scene containing multiple objects. Together, our findings demonstrate that binocular rivalry can reliably occur for both geometrically implausible interocular conflicts and conflicts caused by a common form of naturalistic occlusion. Thus, key features of binocular rivalry are not simply laboratory artifacts but generalize to conditions that match the geometry of everyday binocular vision.
On the nature of apparent transient sources on the National Geographic Society–Palomar Observatory Sky Survey glass copy plates
Authors: Hambly N C , Blair A
Published: February 2024

We examine critically recent claims for the presence of above-atmosphere optical transients in publicly available digitized scans of Schmidt telescope photographic plate material derived from the National Geographic Society–Palomar Observatory Sky Survey. We employ the publicly available SuperCOSMOS Sky Survey catalogues to examine statistically the morphology of the sources. We develop a simple, objective, and automated image classification scheme based on a random forest decision tree classifier. We find that the putative transients are likely to be spurious artefacts of the photographic emulsion. We suggest a possible cause of the appearance of these images as resulting from the copying procedure employed to disseminate glass copy survey atlas sets in the era before large-scale digitization programmes.
Antiphospholipid syndrome pathogenesis in 2023: an update of new mechanisms or just a reconsideration of the old ones?
Authors: Raschi Elena , Borghi Maria Orietta , Tedesco Francesco , Meroni Pier Luigi
Published: February 2024

Antibodies against phospholipid (aPL)-binding proteins, in particular, beta 2 glycoprotein I (β2GPI), are diagnostic/classification and pathogenic antibodies in antiphospholipid syndrome (APS). β2GPI-aPL recognize their target on endothelium and trigger a pro-thrombotic phenotype which is amplified by circulating monocytes, platelets and neutrophils. Complement activation is required as supported by the lack of aPL-mediated effects in animal models when the complement cascade is blocked. The final result is a localized clot. A strong generalized inflammatory response is associated with catastrophic APS, the clinical variant characterized by systemic thrombotic microangiopathy. A two-hit hypothesis was suggested to explain why persistent aPL are associated with acute events only when a second hit allows antibody/complement binding by modulating β2GPI tissue presentation. β2GPI/β2GPI-aPL are also responsible for obstetric APS, being the molecule physiologically present in placental/decidual tissues. Additional mechanisms mediated by aPL with different characteristics have been reported, but their diagnostic/prognostic value is still a matter of research.
The impact of antiphospholipid antibodies/antiphospholipid syndrome on systemic lupus erythematosus
Authors: Venturelli Veronica , Abrantes Ana Mafalda , Rahman Anisur , Isenberg David A
Published: February 2024

aPLs are a major determinant of the increased cardiovascular risk in patients with SLE. They adversely affect clinical manifestations, damage accrual and prognosis. Apart from the antibodies included in the 2006 revised classification criteria for APS, other non-classical aPLs might help in identifying SLE patients at increased risk of thrombotic events. The best studied are IgA anti-β2-glycoprotein I, anti-domain I β2-glycoprotein I and aPS-PT. Major organ involvement includes kidney and neuropsychiatric systems. aPL/APS severely impacts pregnancy outcomes. Due to increased thrombotic risk, these patients require aggressive cardiovascular risk factor control. Primary prophylaxis is based on low-dose aspirin in high-risk patients. Warfarin is the gold-standard drug for secondary prophylaxis.
Viewpoint: Lupus anticoagulant detection and interpretation in antiphospholipid syndrome
Authors: Efthymiou Maria , Bertolaccini Maria Laura , Cohen Hannah
Published: February 2024

Lupus anticoagulant (LA) is a well-established risk factor for the clinical manifestations of antiphospholipid syndrome (APS). Accurate LA detection is an essential prerequisite for optimal diagnosis and management of patients with APS or aPL carriers. Variability remains a challenge in LA testing, with reliable detection influenced by multiple factors, including pre-analytical conditions, anticoagulation treatment, choice of tests and procedures performed, as well as interpretation of results, that can lead to false-positives or negatives. A standardised approach to LA testing, following current guidance, based on published data and international consensus, and with attention to detail, is required to underpin accurate detection of LA. Future work should focus on better characterisation of the nature of LA, which may ultimately lead to improved diagnosis and management of patients with APS and aPL carriers. This article reviews current practice and challenges, providing an overview on detection of LA.
Viewpoint: The value of non-criteria antiphospholipid antibodies
Authors: de Laat Bas , Gehlen Rachel , de Groot Philip G
Published: February 2024

In 2006, at a meeting in Sydney, Australia, consensus was reached by an international group of specialists to establish a number of serological criteria that identify patients with a history of thrombosis or pregnancy complications as having antiphospholipid syndrome (APS). These criteria were originally formulated for research purposes and to compare clinical trials in different centres. However, these same criteria are now generally used and accepted for the diagnosis and treatment of patients. The practice of using these criteria for direct patient care requires that these criteria are based on sound scientific evidence. Indeed, for all the autoantibodies that are officially included in the serological criteria, it has been shown that they induce thrombosis and fetal loss when infused into mice. There are also a number of additional autoantibodies that have been identified in these patients but for these antibodies there was not enough evidence to meet the official APS criteria in 2006. Seventeen years have now passed since the consensus meeting, therefore, this review examines whether additional studies performed with these ‘non-criteria’ autoantibodies have provided sufficient results to suggest the inclusion of these autoantibodies in the official serological criteria of APS.
Dating in the Dark: Elevated Substitution Rates in Cave Cockroaches (Blattodea: Nocticolidae) Have Negative Impacts on Molecular Date Estimates
Authors: Kovacs Toby G L , Walker James , Hellemans Simon , Bourguignon Thomas , Tatarnic Nikolai J , McRae Jane M , Ho Simon Y W , Lo Nathan
Published: February 2024

Rates of nucleotide substitution vary substantially across the Tree of Life, with potentially confounding effects on phylogenetic and evolutionary analyses. A large acceleration in mitochondrial substitution rate occurs in the cockroach family Nocticolidae, which predominantly inhabit subterranean environments. To evaluate the impacts of this among-lineage rate heterogeneity on estimates of phylogenetic relationships and evolutionary timescales, we analyzed nuclear ultraconserved elements (UCEs) and mitochondrial genomes from nocticolids and other cockroaches. Substitution rates were substantially elevated in nocticolid lineages compared with other cockroaches, especially in mitochondrial protein-coding genes. This disparity in evolutionary rates is likely to have led to different evolutionary relationships being supported by phylogenetic analyses of mitochondrial genomes and UCE loci. Furthermore, Bayesian dating analyses using relaxed-clock models inferred much deeper divergence times compared with a flexible local clock. Our phylogenetic analysis of UCEs, which is the first genome-scale study to include all 13 major cockroach families, unites Corydiidae and Nocticolidae and places Anaplectidae as the sister lineage to the rest of Blattoidea. We uncover an extraordinary level of genetic divergence in Nocticolidae, including two highly distinct clades that separated ~115 million years ago despite both containing representatives of the genus Nocticola. The results of our study highlight the potential impacts of high among-lineage rate variation on estimates of phylogenetic relationships and evolutionary timescales.
Insect Vector and Reservoir Plant of ‘Fragaria × ananassa’ Phyllody Phytoplasma (16SrXIII-F) in Central Region of Chile
Authors: Cui Weier , Muñoz Valentina , Navarrete Melisa , Cabrera Sebastian , Campodonico Juan , Estrada Mauricio , Zamorano Alan , Fiore Nicola
Published: February 2024

Strawberry phyllody has emerged as a prevalent disease affecting Chilean strawberry in recent years. The causal pathogen, ‘Fragaria × ananassa’ phyllody phytoplasma (StrPh), is categorized within the 16S ribosomal group XIII that is exclusively found in the Americas. In the context of economically significant crops, hemipteran insect vectors and alternative host plants play a pivotal role in their natural dissemination. This study comprehensively examined the key epidemiological facets of StrPh in the central region of Chile: the insect vector and alternative hosts. Through field surveys, we identified an abundance of an insect species, Cixiosoma sp., in an StrPh-infected strawberry field and confirmed its role as a vector of this phytoplasma through subsequent transmission assays. Moreover, we found a spontaneous weed species, Galega officinalis, to be infected with StrPh, raising the possibility of it being a potential alternative host plant for this phytoplasma. StrPh was also detected in cold-stored strawberry runners purchased from a nursery that supplies the local strawberry cultivation, suggesting a potential source of this phytoplasma in Chile. Collectively, these findings provide a significant epidemiological source of StrPh dissemination in central Chile.
Evaluation of Physical Properties of Coated Polydioxanone Threads
Authors: Park EunJi , Jang Tae su , Kim Jae Kyung
Published: February 2024

BACKGROUND

Using a thread for wound closure promotes healing and minimizes contamination by foreign substances. Threads have also been employed in esthetic surgery; however, functional threads that can improve wrinkles and rejuvenate the skin are required.

OBJECTIVE

To evaluate the suitability of polydioxanone threads coated with polyethylene glycol, hyaluronic acid, and amino acids for use in the medical field because such formulations are expected to promote regeneration and collagen synthesis.

MATERIALS AND METHODS

Physical properties (diameter [n = 20], tensile strength [n = 20], strength retention rate [n = 10], and scanning electron microscopy images) and cytotoxicity (3-[4,5-dimethylthiazol-2-yl]–2,5-diphenyltetrazolium bromide and lactate dehydrogenase assays) of polydioxanone threads coated with polyethylene glycol, hyaluronic acid, and amino acids were assessed and compared with those of uncoated polydioxanone threads. Analyses were performed using IBM SPSS Statistics (Statistical significance; p values <.05).

RESULTS

The size standards for tensile strength (≥63.5 N) and diameter (average 0.570–0.610 mm) were met. There were no differences in the physical properties of the coated and uncoated threads; however, the biocompatibility of coated threads was high owing to low cytotoxicity.

CONCLUSION

Threads coated with materials that can promote regeneration are suitable for use in the medical field.
The Impact of a Centralized Plastic Surgery Research Infrastructure on Scholarly Productivity and Output
Authors: Sobti Nikhil , Rhee Ben S. , Soliman Luke , Rao Vinay , Kwan Daniel , Woo Albert S. , Bhatt Reena , Kalliainen Loree , Breuing Karl , Liu Paul
Published: February 2024

Although research and innovation is a key within the field of plastic and reconstructive surgery, the impact of team structure, interpersonal dynamics, and/or standardized infrastructure on scholarly output has been infrequently studied. In this work, we present the formation and implementation of a novel plastic surgery research program that aims to unite previously disparate clinical and translational research efforts at our institution to facilitate critical inquiry. From July 2022 to June 2023, our department launched a pilot research program based on three pillars: (1) formalization of a research curriculum (monthly research meetings for agenda setting and discussion for project honing, formal research leadership for meeting facilitation and workflow regulation), (2) development of a centralized database to compile ongoing research (Google Drive repository to house all ongoing research documents, facilitate real-time editing, and provide resources/templates for assisting in the research process), and (3) bolstering of a core research identity built on mentorship and collaboration (more frequent interactions to shift previously siloed faculty-student mentorship into a robust milieu of intercollaboration). During the first year, we saw an increased number of publications and presentations, as well as robust participation and contribution from faculty, residents, and medical students. Future directions will focus on addressing resource limitation, such as project idea availability and funding, to sustain the success and growth of this novel research infrastructure.
A novel cabazitaxel liposomes modified with ginsenoside Rk1 for cancer targeted therapy
Authors: Huang Dandan , Tang Zhongjie , Pu Xiao , Wang Tianqi , Gao Feiyan , Li Chong
Published: February 2024

Objective:

In this study, we aim to enhance the anti-prostate cancer efficacy of cabazitaxel (CTX) and reduce its immunosuppression and systemic toxicity by developing CTX-loaded liposomes modified with ginsenoside Rk1 (Rk1/CTX-Lip).

Methods:

Physical and chemical properties of Rk1/CTX-Lip were investigated. We evaluated the biological functions of Rk1/CTX-Lip, both in vitro and in vivo. A subcutaneous prostate cancer (RM-1)-bearing mouse model was established to study the efficacy of Rk1/CTX-Lip inhibition in tumors. Simultaneously, a Candida albicans infection model was established in tumor-bearing mice to study the infection-relieving efficacy of Rk1/CTX-Lip. Finally, biocompatibility and in vivo safety of Rk1/CTX-Lip were evaluated.

Results:

We successfully prepared Rk1/CTX-Lip, achieving high CTX encapsulation efficiency (97.24 ± 0.75)% and physical stability. Rk1/CTX-Lip demonstrated evasion of macrophage phagocytosis, effective tumor tissue targeting, and a significant reduction (>50%) in average tumor volume compared with Chol/CTX-Lip. Moreover, it relieved the concurrent infection burden and effectively regulated immune organs and cells, demonstrating superior biocompatibility.

Conclusion:

Rk1/CTX-Lip presents a promising new therapy for prostate cancer and holds potential for relieving concurrent fungal infections in cancer patients with low immunity.
Efficacy and Safety of AbobotulinumtoxinA for Treatment of Moderate-to-Severe Glabellar Lines: A Meta-Analysis
Authors: Han Xiaopan , Bai Jixian , Kuang Jing
Published: February 2024

Purpose:

This meta-analysis aimed to evaluate the safety and efficacy of abobotulinumtoxinA (ABO) and ABO solution for injection (ASI) for treating moderate-to-severe glabellar lines.

Methods:

The EMBASE, PubMed, and web of science databases were systematically searched. Methodological quality was checked using the Cochrane Risk of Bias tool. We also performed statistical analyses using Stata software to examine the efficacy and safety of ABO.

Results:

Nine randomized controlled trials were included in the meta-analysis. The results showed that at maximum frown, the proportion of responders as measured by the investigator’s live assessment and subject’s self-assessment of moderate-to-severe glabellar lines were significantly higher in the ABO and ASI treatment groups than in the placebo group. In addition, from baseline to maximum frown, the ≥1-grade improvement rate in moderate-to-severe glabellar lines severity was also significantly higher in the ABO and ASI treatment groups than in the placebo group. No significant differences in adverse events were found between ABO, ASI and placebo groups, indicating that ABO and ASI have good safety.

Conclusions:

ABO and ASI are effective and safe options for the treatment of moderate-to-severe glabellar lines. More high-quality studies are needed to verify these conclusions.
Trends and benefits of early hip arthroplasty for femoral neck fracture in China: a national cohort study
Authors: Wang Yuqing , Jiang Qiao , Long Huizhong , Chen Hu , Wei Jie , Li Xiaoxiao , Wang Haibo , Xie Dongxing , Zeng Chao , Lei Guanghua
Published: February 2024

Background:

Limited studies have examined the benefits of early arthroplasty within 48 h from admission to surgery for femoral neck fractures (FNFs). Using the national inpatient database, the authors aimed to investigate the trends in early arthroplasty within 48 h for FNFs in China and to assess its effect on in-hospital complications and 30-day readmission patterns.

Materials and methods:

This was a retrospective cohort study. Patients receiving primary total hip arthroplasty (THA) or hemiarthroplasty (HA) for FNFs in the Hospital Quality Monitoring System between 2013 and 2019 were included. After adjusting for potential confounders with propensity score matching, a logistic regression model was performed to compare the differences in in-hospital complications [i.e. in-hospital death, pulmonary embolism, deep vein thrombosis (DVT), wound infection, and blood transfusion], rates and causes of 30-day readmission between early and delayed arthroplasty.

Results:

During the study period, the rate of early THA increased from 18.0 to 19.9%, and the rate of early HA increased from 14.7 to 18.4% (P<0.001). After matching, 11 731 pairs receiving THA and 13 568 pairs receiving HA were included. Compared with delayed THA, early THA was associated with a lower risk of pulmonary embolism [odds ratio (OR) 0.51, 95% CI: 0.30–0.88], DVT (OR 0.59, 95% CI: 0.50–0.70), blood transfusion (OR 0.62, 95% CI: 0.55–0.70), 30-day readmission (OR 0.82, 95% CI: 0.70–0.95), and venous thromboembolism-related readmission (OR 0.50, 95% CI: 0.34–0.74). Similarly, early HA was associated with a lower risk of DVT (OR 0.70, 95% CI: 0.61–0.80) and blood transfusion (OR 0.74, 95% CI: 0.68–0.81) than delayed HA.

Conclusion:

Despite a slight increase, the rate of early arthroplasty remained at a low level in China. Given that early arthroplasty can significantly improve prognosis, more efforts are needed to optimize the procedure and shorten the time to surgery.
High incidence of gallstones after Roux-en-Y reconstruction gastrectomy in gastric cancer: a multicenter, long-term cohort study
Authors: Zhang Baoping , Nie Peng , Lin Yanyan , Ma Zelong , Ma Guogang , Wang Yongjin , Ma Yuhu , Zhao Jinyu , Zhang Jinduo , Yue Ping , Jiang Ningzu , Zhang Xianzhuo , Tian Liang , Lu Linzhi , Yuan Jinqiu , Meng Wenbo
Published: February 2024

Background:

Roux-en-Y reconstruction is a common anastomosis technique during gastrectomy in gastric cancer. There is a lack of studies on gallstones after Roux-en-Y reconstruction gastrectomy. This study investigated the incidence and potential risk factors associated with gallstones after Roux-en-Y reconstructive gastrectomy in gastric cancer.

Methods:

The study analyzed data from gastric cancer who underwent radical gastrectomy and Roux-en-Y reconstruction at two hospitals between January 2014 and December 2020. The patients fall into distal and total gastrectomy groups based on the extent of gastrectomy. The cumulative event probability curve was plotted using the Kaplan-Meier, and differences in gallstone between groups were evaluated using the Log-Rank. Propensity score matching (PSM) was applied to construct a balanced total versus distal gastrectomies cohort. A Cox regression was employed to analyze the risk factors for gallstones after Roux-en-Y reconstructive gastrectomy in gastric cancer. Further subgroup analysis was performed.

Results:

531 patients were included in this study, 201 in the distal gastrectomy group and 330 in the total gastrectomy. During the follow-up, there were 170 cases (32.02%) of developed gallstones, 145 cases of gallstones constituting 85.29% of all gallstones within two years after gastrectomy. Then, to reduce the impact of bias, a 1: 1 propensity score matching analysis was performed on the two groups of patients. A total of 344 patients were evaluated, with each subgroup comprising 172 patients. In the matched population, the Cox regression analysis revealed that females, BMI ≥ 23 kg/m2, total gastrectomy, No.12 lymph node dissection, and adjuvant chemotherapy were risk factors for gallstones after Roux-en-Y reconstructive gastrectomy. Subgroup analysis revealed a significantly higher incidence of gallstones after open total gastrectomy than after open distal gastrectomy.

Conclusion:

Significantly higher incidence of gallstones within two years after Roux-en-Y reconstructive gastrectomy for gastric cancer. Patients with these risk factors should be followed closely after gastrectomy to avoid symptomatic gallstones.
Colorectal Cancer Prevention
Authors: Pereyra Lisandro , Schlottmann Francisco , Steinberg Leandro , Lasa Juan
Published: February 2024

Objective:

To determine whether a publicly available advanced language model could help determine appropriate colorectal cancer (CRC) screening and surveillance recommendations.

Background:

Poor physician knowledge or inability to accurately recall recommendations might affect adherence to CRC screening guidelines. Adoption of newer technologies can help improve the delivery of such preventive care services.

Methods:

An assessment with 10 multiple choice questions, including 5 CRC screening and 5 CRC surveillance clinical vignettes, was inputted into chat generative pretrained transformer (ChatGPT) 3.5 in 4 separate sessions. Responses were recorded and screened for accuracy to determine the reliability of this tool. The mean number of correct answers was then compared against a control group of gastroenterologists and colorectal surgeons answering the same questions with and without the help of a previously validated CRC screening mobile app.

Results:

The average overall performance of ChatGPT was 45%. The mean number of correct answers was 2.75 (95% CI: 2.26-3.24), 1.75 (95% CI: 1.26-2.24), and 4.5 (95% CI: 3.93-5.07) for screening, surveillance, and total questions, respectively. ChatGPT showed inconsistency and gave a different answer in 4 questions among the different sessions. A total of 238 physicians also responded to the assessment; 123 (51.7%) without and 115 (48.3%) with the mobile app. The mean number of total correct answers of ChatGPT was significantly lower than those of physicians without [5.62 (95% CI: 5.32-5.92)] and with the mobile app [7.71 (95% CI: 7.39-8.03); P < 0.001].

Conclusions:

Large language models developed with artificial intelligence require further refinements to serve as reliable assistants in clinical practice.
Biliary stem cells in health and cholangiopathies and cholangiocarcinoma
Authors: Cardinale Vincenzo , Paradiso Savino , Alvaro Domenico
Published: February 2024

Purpose of review

This review discusses evidence regarding progenitor populations of the biliary tree in the tissue regeneration and homeostasis, and the pathobiology of cholangiopathies and malignancies.

Recent findings

In embryogenesis biliary multipotent progenitor subpopulation contributes cells not only to the pancreas and gall bladder but also to the liver. Cells equipped with a constellation of markers suggestive of the primitive endodermal phenotype exist in the peribiliary glands, the bile duct glands, of the intra- and extrahepatic bile ducts. These cells are able to be isolated and cultured easily, which demonstrates the persistence of a stable phenotype during in vitro expansion, the ability to self-renew in vitro, and the ability to differentiate between hepatocyte and biliary and pancreatic islet fates.

In normal human livers, stem/progenitors cells are mostly restricted in two distinct niches, which are the bile ductules/canals of Hering and the peribiliary glands (PBGs) present inside the wall of large intrahepatic bile ducts. The existence of a network of stem/progenitor cell niches within the liver and along the entire biliary tree inform a patho-biological-based translational approach to biliary diseases and cholangiocarcinoma since it poses the basis to understand biliary regeneration after extensive or chronic injuries and progression to fibrosis and cancer.
Community Health Workers: Improving Home Visiting Engagement of High-Risk Birthing People in Segregated Neighborhoods
Authors: Yu Xiao , Meghea Cristian I. , Raffo Jennifer E. , Meng Ran , Vander Meulen Peggy , Lloyd Celeste Sanchez , Roman Lee Anne
Published: February 2024

Context:

Racial and ethnic disparities in perinatal health remain a public health crisis. Despite improved outcomes from home visiting (HV) participation during pregnancy, most eligible individuals of color do not engage. Neighborhood segregation, a manifestation of structural racism, may impose constraints on engaging eligible individuals in HV.

Objective:

To examine whether race, ethnicity, and/or language-concordant community health workers (CHWs) increased HV engagement for birthing people in segregated neighborhoods.

Design:

Program evaluation using administrative linked data from birth records, Medicaid claims, and HV program participation. Strong Beginnings (SB), a program with HV provided by CHWs working with nurses and social workers, was compared with the Maternal Infant Health Program (MIHP), a state Medicaid-sponsored HV program without CHW involvement. Data were analyzed using χ2 tests and Poisson regressions.

Participants:

A total of 4560 individuals with a Medicaid-eligible birth between 2016 and 2019, including 1172 from SB and 3388 from the MIHP.

Main Outcome Measures:

Penetration (percentage of participants in HV among all Medicaid-eligible individuals across quintiles of neighborhood segregation) and dosage (the total number of home visits from both CHWs and nurses/social workers, and then restricted to those from nurses/social workers).

Results:

SB penetrated more segregated neighborhoods than the MIHP (58.4% vs 48.3%; P < .001). SB participants received a higher dosage of home visits (mean [SD]: 11.9 [6.1]) than MIHP participants (mean [SD]: 4.4 [2.8], P < .001). Importantly, CHWs did not replace but moderately increased home visits from nurses and social workers (51.1% vs 35.2% with ≥5 intervention visits, P < .001), especially in more segregated neighborhoods.

Policy Implication:

Community-informed HV models intentionally designed for people facing disparities may help facilitate program outreach to segregated neighborhoods with concentrated deprivation and reduce racial and ethnic disparities.

Conclusions:

An HV program provided by CHWs working with nurses and social workers was associated with an increase in penetration and dosage in segregated neighborhoods, compared with HV without CHW involvement. This underscores the value of CHWs partnering with licensed professional workers in improving HV engagement in disadvantaged communities.
Developing an Inclusive Training Environment: Accommodations in Physical Medicine and Rehabilitation Residency Training for Residents with a Disability
Authors: Hall Lauren , Hayano Todd , Morgan Woody , Steere Hannah , Babu Ashwin , Blauwet Cheri
Published: February 2024

This study examines the challenges and accommodations for medical residents with disabilities within physical medicine and rehabilitation (PM&R) training programs. Medical residency presents unique stressors and responsibilities, with the potential for added complexities for residents with disabilities. Few data exist regarding the prevalence and experiences of people with disabilities as medical trainees and the limited studies available highlight an underrepresentation of individuals with disability in medical training and practice. Through cross-sectional surveys administered to PM&R residents, this research assesses disability prevalence, characterizations, barriers to training, and accommodations provided. Out of 140 respondents, 9.3% identified as having disabilities, with varying prevalence among genders and disability types. Results revealed distinct challenges for residents with mobility and non-mobility disabilities, spanning learning environments, standardized testing, procedural skills, and accessibility. Self-provided accommodations exceeded program-provided ones, indicating room for improvement in program support. These findings underscore the need for proactive dialogue between residents and leadership to address barriers, enhance accommodations, and create an inclusive training environment. The study's insights emphasize the importance of advocating for equal opportunities and cultivating supportive conditions to enable individuals with disabilities to thrive in medical residency programs, ultimately contributing to more diverse and inclusive medical communities.
Impact of a Clinical Decision Support Alert on Informed Consent Documentation in the Neonatal Intensive Care Unit
Authors: Sangillo Emily , Jube-Desai Neena , El-Metwally Dina , Hughes Driscoll Colleen
Published: February 2024

Background:

Informed consent is necessary to preserve patient autonomy and shared decision-making, yet compliant consent documentation is suboptimal in the intensive care unit (ICU). We aimed to increase compliance with bundled consent documentation, which provides consent for a predefined set of common procedures in the neonatal ICU from 0% to 50% over 1 year.

Methods:

We used the Plan-Do-Study-Act model for quality improvement. Interventions included education and performance awareness, delineation of the preferred consenting process, consent form revision, overlay tool creation, and clinical decision support (CDS) alert use within the electronic health record. Monthly audits categorized consent forms as missing, present but noncompliant, or compliant. We analyzed consent compliance on a run chart using standard run chart interpretation rules and obtained feedback on the CDS as a countermeasure.

Results:

We conducted 564 audits over 37 months. Overall, median consent compliance increased from 0% to 86.6%. Upon initiating the CDS alert, we observed the highest monthly compliance of 93.3%, followed by a decrease to 33.3% with an inadvertent discontinuation of the CDS. Compliance subsequently increased to 73.3% after the restoration of the alert. We created a consultant opt-out selection to address negative feedback associated with CDS. There were no missing consent forms within the last 7 months of monitoring.

Conclusions:

A multi-faceted approach led to sustained improvement in bundled consent documentation compliance in our neonatal intensive care unit, with the direct contribution of the CDS observed. A CDS intervention directed at the informed consenting process may similarly benefit other ICUs.
Impact of a Bronchiolitis Clinical Pathway on Management Decisions by Preferred Language
Authors: Rosen Robert H. , Monuteaux Michael C. , Stack Anne M. , Michelson Kenneth A. , Fine Andrew M.
Published: February 2024

Background:

Clinical pathways standardize healthcare utilization, but their impact on healthcare equity is poorly understood. This study aims to measure the effect of a bronchiolitis pathway on management decisions by preferred language for care.

Methods:

We included all emergency department encounters for patients aged 1–12 months with bronchiolitis from 1/1/2010 to 10/31/2020. The prepathway period ended 10/31/2011, and the postpathway period was 1/1/2012–10/31/2020. We performed retrospective interrupted time series analyses to assess the impact of the clinical pathway by English versus non-English preferred language on the following outcomes: chest radiography (CXR), albuterol use, 7-day return visit, 72-hour return to admission, antibiotic use, and corticosteroid use. Analyses were adjusted for presence of a complex chronic condition.

Results:

There were 1485 encounters in the preperiod (77% English, 14% non-English, 8% missing) and 7840 encounters in the postperiod (79% English, 15% non-English, 6% missing). CXR, antibiotic, and albuterol utilization exhibited sustained decreases over the study period. Pathway impact did not differ by preferred language for any outcome except albuterol utilization. The prepost slope effect of albuterol utilization was 10% greater in the non-English versus the English group (p for the difference by language = 0.022).

Conclusions:

A clinical pathway was associated with improvements in care regardless of preferred language. More extensive studies involving multiple pathways and care settings are needed to assess the impact of clinical pathways on health equity.
Implementation of an Anterior Mediastinal Mass Pathway to Improve Time to Biopsy and Multidisciplinary Communication
Authors: Gahagen Rachel E. , Gaylord William C. , Drayton Jackson Meghan D. , McCallister Anne E. , Lutfi Riad , Belsky Jennifer A.
Published: February 2024

Background:

Mediastinal masses in children with cancer present unique challenges, including the risk of respiratory and hemodynamic compromise due to the complex anatomy of the mediastinum. Multidisciplinary communication is often a challenge in the management of these patients. After a series of patients with mediastinal masses were admitted to Riley Hospital for Children Pediatric Intensive Care Unit, the time from presentation to biopsy and pathology was greater than expected. We aimed to reduce the time to biopsy by 25% and demonstrate improved multidisciplinary communication within 6 months of protocol implementation for patients presenting to Riley Hospital for Children Emergency Department with an anterior mediastinal mass.

Methods:

Quality improvement methodology created a pathway that included early multidisciplinary communication. The pathway includes communication between the emergency department and multiple surgical and medical teams via a HIPPA-compliant texting platform. Based on patient stability, imaging findings, and sedation risks, the approach and timing of the biopsy were determined.

Results:

The pathway has been used 20 times to date. We successfully reduced the time to biopsy by 38%, from 25.1 hours to 15.4 hours. There was no statistically significant reduction in time to pathology. The multidisciplinary team reported improved communication from a baseline Likert score of 3.24 to 4.

Conclusions:

By initiating early multidisciplinary communication, we reduced the time to biopsy and pathology results, improving care for our patients presenting with anterior mediastinal masses.
The Value of Anterolateral Thigh Free Flap for the Reconstruction of Malignant Melanoma of the Sole of the Foot
Authors: Bae Yong Chan , Kim Joo Hyoung , Yi Changryul Claud
Published: February 2024

Background

Wide excision of malignant melanoma on the foot usually results in an extensive function-destroying defect, and the reconstruction of foot defects remains challenging for reconstructive surgeons. We propose using anterolateral thigh perforator (ALT) free flaps for the reconstruction of widespread defects caused by malignant melanoma in the sole.

Methods

This retrospective study included 34 patients who underwent reconstruction of sole defects caused by malignant melanoma resection with 35 ALT perforator free flaps between August 2005 and July 2021.

Results

In total, 18 male patients and 16 female patients were included (mean age at surgery, 65.4 years). The mean size of the flaps was 100.4 cm2. Thirty-three of the 35 flaps survived. Hematoma, seroma, and chronic ulceration were not identified in any cases. All patients achieved independent ambulation within the follow-up period, except 1 patient with gait discomfort. The 5-year overall and disease-free survival rates of patients were 64.4% and 56.6%, respectively.

Conclusions

The ALT flap is a versatile surgical option that should be considered for reconstruction of the sole after malignant melanoma resection, considering its various surgical advantages and the functional aspects of independent ambulation, the aesthetic aspects of wearing conventional footwear, and the anatomical aspects of the sole.