bluuebunny/crossref_metadata_2025 huggingface dataset:
Cushing syndrome caused by an ectopic ACTH-producing pituitary adenoma of the clivus region: A rare case report and literature review
Authors: He Yutao , Tang Ziyi , Tang Na , Lu Yu , Niu Fangfang , Ye Jiao , Zhang Zheng , Fang Chenghong , Yao Lei
Published: June 2023

Rationale:

Ectopic ACTH-producing pituitary adenoma (EAPA) of the clivus region is extraordinarily infrequent condition and merely a few reports have been reported to date.

Patient concerns:

The patient was a 53-year-old woman who presented with Cushing-like appearances and a soft tissue mass in the clivus region.

Diagnoses:

The final diagnosis of clivus region EAPA was established by clinical, radiological and histopathological findings.

Interventions:

The patient underwent gross total clivus tumor resection via transsphenoidal endoscopy.

Outcomes:

Half a year after surgery, the patient Cushing-like clinical manifestations improved significantly, and urinary free cortisol and serum adrenocorticotropin (ACTH) returned to normal.

Lessons:

Given the extreme scarcity of these tumors and their unique clinical presentations, it may be possible to misdiagnose and delayed treatment. Accordingly, it is especially crucial to summarize such lesions through our present case and review the literature for their precise diagnosis and the selection of optimal treatment strategies.
Early diagnostic value of intima-media thickness and D-dimer levels for vascular dementia
Authors: Xia Haiping , Jin Biao , Su Cen , Zhao Kangren , Ma Rui
Published: June 2023

To evaluate the diagnostic value of combination of D-dimer and Doppler Intima-Media Thickness (IMT) based on clinical data for vascular dementia (VaD). In this study, 100 cases of initial VaD were diagnosed by Zhenjiang Fourth People Hospital as VaD group, and 100 healthy were engaged as control group, medical history and test results were collected for evaluation. IMT and D-dimer were highly correlated with the onset of VaD. The sensitivity of combination diagnosis for early VaD: 90.2%, the specificity: 87.9%, the area under the curve (AUC) is 0.872, which were superior to IMT or D-dimer alone. D-dimer and IMT are significantly increased in the initial onset of cerebrovascular diseases, and combined detection of them is conducive to early diagnosis and evaluation of the disease. Given the limitations of D-dimer and IMT, combined detection is more conducive to early diagnosis and prognosis, and can be used as screening and routine examination items, even evaluate the severity of cognitive decline.
Early Life Oral Antibiotics Are Associated With Pediatric-Onset Inflammatory Bowel Disease—A Nationwide Study
Authors: Jawad Ali Bashir , Jansson Sabine , Wewer Vibeke , Malham Mikkel
Published: June 2023

Objectives:

Early-life environmental triggers are thought to play a larger role in pediatric-onset inflammatory bowel disease (pIBD) compared to adult-onset IBD. We aimed to assess the risk of developing pIBD after exposure to oral antibiotics during the first 5 years of life.

Methods:

In a nation-wide cohort study, we identified all patients diagnosed with pIBD (<18 years at diagnosis) in Denmark between 1995 and 2018 from the National Patient Registry and matched them with up to 10 reference individuals. Antibiotic exposure was defined as being prescribed antibiotics during first 5 years of life. Data were retrieved from the National Prescription Register. Outcome was developing pIBD. Risk estimates are presented by hazard ratios (HR) with 95% confidence intervals (CI).

Results:

We identified 1927 pIBD patients and 18,318 reference individuals. Oral antibiotic exposure during the first 5 years of life was associated with a higher risk of developing pIBD (HR = 1.33 [95% CI: 1.2–1.5], P <0.0001). The risk was also increased if patients had ≥4 antibiotic prescriptions compared to no antibiotics (HR = 1.33 [95% CI: 1.2–1.5], P <0.0001). Broad-spectrum antibiotics increased the risk of pIBD compared to narrow-spectrum antibiotics (HR = 1.29 [95% CI: 1.2–1.4], P < 0.0001). When stratified by IBD subtypes, only Crohn disease was significantly associated with exposure to antibiotics (HR = 1.37 [95% CI: 1.1–1.7], P = 0.002).

Conclusions:

In this nationwide registry-based study, we found that oral antibiotic exposure during first 5 years of life was associated with an increased risk of pIBD. Repeated antibiotic exposures increased risk estimates.
Validation and Reference Scores of the Transition Readiness Assessment Questionnaire in Adolescent and Young Adult IBD Patients
Authors: van Gaalen Martha A.C. , van Gijn Emma , van Pieterson Merel , de Ridder Lissy , Rizopoulos Dimitris , Escher Johanna C.
Published: June 2023

Objectives:

Transition readiness can predict a successful transition from pediatric to adult care. This study aimed to validate and develop age-dependent reference scores for the (Dutch version of) Transition Readiness Assessment Questionnaire (TRAQ), in adolescents and young adults (AYAs) with inflammatory bowel disease (IBD).

Methods:

TRAQ has 20 items (score 1–5) distributed over 5 domains (total sum score 100) and is completed by AYAs. Following the COnsensus-based Standards for the selection of health Measurement INstruments methodology, we conducted the translation, back-to back translation, pretesting, and validation of the final Dutch version of TRAQ (TRAQ-NL) questionnaire. We used a Rasch model for structural validation, hypothesis testing for construct validity, and Cronbach alpha to demonstrate reliability. Reference scores were calculated using percentiles.

Results:

Two hundred fifty TRAQ questionnaires were evaluated in 136 AYAs with IBD [56% Crohn disease, 58% male, median age 17.5 years (range 15.7–20.4)]. The overall mean item score was 3.87 (range 1.45–5). With good reliability (Cronbach alpha 0.87), TRAQ-NL discriminated well between knowledge levels, especially in the lower levels. Transition readiness was defined as low, moderate, adequate, or excellent in patients with TRAQ percentile scores (PC) <25th (<3.375 mean item score), 25th–50th (3.375–3.9), 50th–90th (3.91–4.7), or >90th (>4.7). Younger patients, concomitant illness, fewer visits to the transition clinic, and parental dependence were associated with significantly lower TRAQ scores.

Conclusion:

TRAQ(-NL) is reliable and valid, with age-dependent PC to identify (in)adequate transfer readiness. TRAQ can now be more easily used as a patient-reported outcome measure to monitor transition readiness longitudinally in routine care for AYAs IBD patients.
Unusual Aspects of Small Cell Carcinoma of the Ovary of Hypercalcaemic Type
Authors: Mazibrada Jasenka , Jayatunge Nishani , Domecq Celine , Witkowski Leora , Croce Sabrina , Foulkes William D. , McCluggage W. Glenn
Published: June 2023

Small cell carcinoma of the ovary of hypercalcaemic type (SCCOHT) is a rare and aggressive ovarian neoplasm that is most common in the second and third decades. Molecular studies have established inactivating SMARCA4 alterations as the driver of SCCOHT, these being present in over 95% of these neoplasms. SMARCA4 alterations almost always result in loss of immunoreactivity with SMARCA4 (BRG1) antibody, and this is an extremely useful adjunct in the diagnosis of SCCOHT. Herein, we report 7 cases of SCCOHT (2 from the same patient) with retention of nuclear immunoreactivity with SMARCA4, but with SMARCA4 alterations identified on molecular testing. All cases exhibited loss of SMARCA2 (BRM) immunoreactivity. In addition, following the identification of diffuse TLE1 immunoreactivity in one of these cases (which did not exhibit an SS18 gene rearrangement characteristic of synovial sarcoma), we stained a total of 63 cases of SCCOHT (14 on whole tissue sections: 49 on tissue microarray) with this marker and 7 of 14 (50%) and 22 of 49 (45%) were positive on whole sections and tissue microarray, respectively. Most cases were focally positive but occasional cases exhibited diffuse immunoreactivity. Our observations highlight the importance of SMARCA2 immunohistochemical staining and molecular testing in suspected cases of SCCOHT that exhibit retained SMARCA4 immunoreactivity. Th common expression of TLE1 in these neoplasms represents a potential diagnostic pitfall since synovial sarcoma may be considered in the differential, especially in cases with retained SMARCA4 immunohistochemistry.
Use of Evidence-Based Interventions to Promote Healthy Weight, Nutrition, and Physical Activity in Community Health Improvement Plans from Large Local Health Departments
Authors: Dupuis Roxanne , Reiner Jennifer F. , Silver Santana , Barrett Jessica L. , Daly James G. , Lee Rebekka M. , Gortmaker Steven L. , Cradock Angie L.
Published: June 2023

We sought to identify evidence-based healthy weight, nutrition, and physical activity strategies related to obesity prevention in large local health department (LHD) Community Health Improvement Plans (CHIPs). We analyzed the content of the most recent, publicly available plans from 72 accredited LHDs serving a population of at least 500 000 people. We matched CHIP strategies to the County Health Rankings and Roadmaps' What Works for Health (WWFH) database of interventions. We identified 739 strategies across 55 plans, 62.5% of which matched a “WWFH intervention” rated for effectiveness on diet and exercise outcomes. Among the 20 most commonly identified WWFH interventions in CHIPs, 10 had the highest evidence for effectiveness while 4 were rated as likely to decrease health disparities according to WWFH. Future prioritization of strategies by health agencies could focus on strategies with the strongest evidence for promoting healthy weight, nutrition, and physical activity outcomes and reducing health disparities.
Paradigm Shifts in Alloplastic Breast Reconstruction: A Nationwide Analysis of Direct-To-Implant Trends
Authors: Yesantharao Pooja S. , Arquette Connor , Cheesborough Jennifer E. , Lee Gordon K. , Nazerali Rahim S.
Published: June 2023

BACKGROUND:

Direct-to-implant breast reconstruction is an attractive choice for appropriately-selected patients, as a single-stage procedure can enhance global metrics of care. In an era of high-value healthcare, therefore, it is important to investigate utilization of such procedures. This study investigated direct-to-implant trends over the past decade on a nationwide basis.

METHODS:

This was a retrospective investigation of direct-to-implant reconstruction between 2010-2018 in the United States, using the National Inpatient Sample (NIS) database. All study analyses were undertaken using Stata v15.0.

RESULTS:

The weighted sample included 287,093 women who underwent implant-based reconstruction between 2010-2018, of whom 43,064 (15%) underwent direct-to-implant reconstruction. Across the study period, the proportion of direct-to-implant procedures significantly increased (p=0.03), relative to staged and delayed implant-based procedures. While direct-to-implant patients were younger, more likely to be white and privately-insured, the proportion of non-white, publicly-insured patients undergoing direct-to-implant reconstruction significantly increased by 2018 (p<0.05). Furthermore, direct-to-implant utilization amongst Medicaid patients increased at 2.2 times the rate in Medicaid expansion states compared to non-expansion states. Direct-to-implant patients had significantly higher APR-DRG risk scores in 2018 than in 2010 (p=0.02), indicating expanding clinical indications for this procedure. Direct-to-implant reconstruction had significantly lower inpatient charges than staged procedures (p=0.03), when considering expander placement and expander-implant exchange.

CONCLUSION:

Overall, utilization of direct-to-implant breast reconstruction has significantly increased over the past decade, facilitated by expanding clinical indications and improved insurance coverage. However, certain disparities continue to exist. Further work should investigate drivers of disparities to allow continued expansion of direct-to-implant reconstruction as clinically appropriate.
Reduction of Tendon Fibrosis Using Galectin-3 Inhibitors
Authors: Spielman Amanda F. , Griffin Michelle F. , Titan Ashley L. , Guardino Nicholas , Cotterell Asha C. , Akras Deena , Wan Derrick C. , Longaker Michael T.
Published: June 2023

Background:

Fibrosis is a complication of both tendon injuries and repairs. The authors aimed to develop a mouse model to assess tendon fibrosis and to identify an antifibrotic agent capable of overcoming it.

Methods:

The Achilles tendon of adult C57Bl/6 mice was exposed via skin incision, followed by 50% tendon injury and abrasion with sandpaper. Sham operations were conducted on contralateral hindlimbs. Histologic analyses and immunofluorescent staining for fibrotic markers (collagen type 1 [Col1], α-smooth muscle actin [α-SMA]) were used to confirm that the model induced tendon fibrosis. A second experiment further examined the role of α-SMA in adhesion formation using α-SMA.mTmG mice (6 to 8 weeks old; n = 3) with the same injury model. Lastly, α-SMA.mTmG mice were randomized to either condition 1 (tendon injury [control group]) or condition 2 (tendon injury with galectin-3 inhibitor [Gal3i] treatment at time of injury [treatment group]).

Results:

Histologic analyses confirmed tendon thickening and collagen deposition after tendon injury and abrasion compared with control. Immunofluorescence showed higher levels of Col1 and α-SMA protein expression after injury compared with sham (P < 0.05). Real-time quantitative polymerase chain reaction also demonstrated increased gene expression of Col1 and α-SMA after injury compared with sham (P < 0.05). Gal3 protein expression also increased after injury and colocalized with α-SMA
+ fibroblasts surrounding the fibrotic tendon. Gal3i treatment decreased collagen deposition and scarring observed in the treatment group (P < 0.05).

Conclusions:

The authors’ study provides a reproducible and reliable model to investigate tendon fibrosis. Findings suggest the potential of Gal3i to overcome fibrosis resulting from tendon injuries.

Clinical Relevance Statement:

Tendon injuries are common presentations to hand surgeons. Complications include adhesion formation, which results in reduced strength and frequent reinjury. Advancements in management require a better understanding of the mechanisms behind tendon fibrosis in order to identify ways to overcome it.
Midface Prelamination by Using a Three-Dimensional Cervicothoracic Prefabricated Flap
Authors: Li Haizhou , Gao Yashan , Gu Bin , Ren Jieyi , Xie Feng , Zhou Shuangbai , Xie Yun , Zan Tao , Li QingFeng
Published: June 2023

The midface is an important area in aesthetics and function and a complex area to manage after burn injuries, trauma, and tumor resection. Traditional treatment to reconstruct midface defects involving the nose, lips, and cheeks requires multiple sequential flap operations but results in a patch-like appearance, which remains a major challenge for head and neck reconstructive surgeons. This article describes how the authors perform prelamination using the prefabricated cervicothoracic flap on the anterior chest for midface reconstruction. The key point of the authors’ procedure is to three-dimensionalize the cervicothoracic prefabricated flap with flap folding; flap rotation; and cartilage grafts for coverage, lining, and support of the nose and lips. This technique may be indicated for extensive midface defects involving total nose and lip loss. It provides a uniform matched facial appearance and significant functional improvement. Donor-site morbidity and the need for multiple flap procedures could be reduced.
Immunophenotypic analysis in participants with Kaposi sarcoma following pomalidomide administration
Authors: Lurain Kathryn , Polizzotto Mark N. , Krug Laurie T. , Shoemaker Griffin , Singh Amrit , Jensen Stig M.R. , Wyvill Kathleen M. , Ramaswami Ramya , Uldrick Thomas S. , Yarchoan Robert , Sereti Irini
Published: June 2023

Objective:

Evaluate baseline differences by HIV status and the impact of pomalidomide on lymphocyte counts and T cell subsets in patients with Kaposi sarcoma (KS).

Design:

We prospectively evaluated CD4+ and CD8+ T cell phenotypes in 19 participants with KS enrolled on a phase 1/2 study of pomalidomide (NCT01495598), 7 without HIV and 12 with HIV on antiretroviral therapy.

Methods:

Trial participants received pomalidomide 5 mg orally for 21 days of 28-day cycles for up to 1 year. Flow cytometry was performed on peripheral blood mononuclear cells at baseline, after 3 cycles, and at end-of-treatment. Lymphocyte count and T cell subset comparisons were evaluated by Wilcoxon signed-rank and Mann-Whitney tests.

Results:

At baseline, HIV+ participants had lower CD4+ counts (median 416 vs 742 CD4+ T cells/μL, p = 0.006), and a decreased proportion of CD57+ (senescent) CD8+ T cells (p = 0.007) compared with HIV- participants. After 3 cycles, pomalidomide led to an increased proportion of CD45RO+CD27+ (central memory) CD4+ (p = 0.002) and CD8+ (p = 0.002) T cells, a decrease in CD45RO-CD27- (effector) CD4+ cells (p = 0.0002), and expansion of CD38+/HLADR+ (activated) CD4+ (p = 0.002) and CD8+ (p= < 0.0001) T cells. Increased numbers of activated CD8+ T cells persisted at end-of-treatment (p = 0.002). After 3 cycles and at end-of-treatment, there was reduction in the proportion of CD57+ (senescent) CD4+ (p = 0.001, 0.0006) and CD8+ (p =  < 0.0001, 0.0004) T cells.

Conclusions:

Administration of pomalidomide decreased T cell senescence and increased T cell activation in patients with KS, suggesting pomalidomide activity in KS stems in part from its immunomodulatory effects.
Undertreatment of opioid use disorder in patients hospitalized with injection drug use associated infections
Authors: Rosenthal Elana S. , Brokus Christopher , Sun Junfeng , Carpenter Joseph E. , Catalanotti Jillian , Eaton Ellen F. , Steck Alaina R. , Kuo Irene , Burkholder Greer A. , Akselrod Hana , Mcgonigle Keanan , Moran Timothy , Mai William , Notis Melissa , Del Rio Carlos , Greenberg Alan , Saag Michael S. , Kottilil Shyamasundaran , Masur Henry , Kattakuzhy Sarah
Published: June 2023

Objective:

To evaluate the association between medication for opioid use disorder (MOUD) initiation and addiction consultation and outcomes for patients hospitalized with infectious complications of injecting opioids.

Design:

Retrospective cohort study

Setting:

Four academic medical centers in the United States

Participants:

322 patients hospitalized with infectious complications of injecting opioids in 2018.

Exposures:

Inpatient receipt of MOUD, initiation of MOUD, and addiction consultation

Measurements:

The main outcomes of interest were: 1) premature discharge; 2) MOUD on discharge; 3) linkage to outpatient MOUD; 4) one-year readmission; 5) death.

Results:

322 patients were predominately male (59%), white (66%), and median age 38, with 36% unstably housed, and 30% uninsured. 145 (45%) patients received MOUD during hospitalization, including only 65 (28%) patients not on baseline MOUD. Discharge was premature for 64 (20%) patients. In the year following discharge, 27 (9%) patients were linked to MOUD, and 159 (50%) patients had at least one readmission. Being on MOUD during hospitalization was significantly associated with higher odds of planned discharge (OR 3.87, P < 0.0001), MOUD on discharge (OR 129.7, P < 0.0001), and linkage to outpatient MOUD (OR 1.25, p < 0.0001), however was not associated with readmission.

Limitations:

Retrospective study. Post-discharge data are likely underestimated.

Conclusions:

There was dramatic undertreatment with MOUD from inpatient admission to outpatient linkage, and high rates of premature discharge and readmission. Engagement in addiction care during hospitalization is a critical first step in improving the care continuum for individuals with opioid use disorder, however additional interventions may be needed to impact long-term outcomes like readmission.
The application of new metrics for understanding trends in undiagnosed HIV among key populations
Authors: Gray Richard T. , Camara Hawa , Khawar Laila , Grulich Andrew , GUY Rebecca , Mcgregor Skye , Medland Nicholas
Published: June 2023

Objective:

Investigate the utility of novel metrics for understanding trends in undiagnosed HIV.

Methods:

We produced estimates for the number of people living with undiagnosed HIV and the number of new HIV infections using Australian surveillance data and the ECDC HIV modelling tool. Using these estimates, we calculated: 1) the Total Diagnosed Fraction, the proportion of all people with HIV diagnosed; 2) the Yearly Diagnosed Fraction, the proportion of people who have not yet received a diagnosis who received a diagnosis during each year; and 3) the Case Detection Rate, which is the annual ratio of new HIV diagnoses to new HIV infections each year; from 2008 to 2019. We report trends in these metrics for Australian-born and overseas-born men who reported male-to-male sex and heterosexual women and men.

Results:

Each metric for the Australian-born male-to-male sexual contact group improved consistently. In contrast, the metrics for the overseas-born group worsened (Total Diagnosed Fraction: 85.0% to 81.9%, Yearly Diagnosed Fraction: 23.1% to 17.8%, and Case Detection Rate: 0.74 to 0.63). In heterosexuals, women and men had consistent increasing trends for the Total Diagnosed Fraction and Yearly Diagnosed Fraction but with women having consistently higher estimates. Heterosexual men had a declining Case Detection Rate, falling below one in 2011, compared to an increase for women.

Conclusions:

The additional metrics provided important information on Australia's progress toward HIV elimination. The more dynamic changes in the undiagnosed population seen highlight diverging trends for key populations not seen in the Total Diagnosed Fraction.
FDG PET/CT in Dressler Syndrome
Authors: Taywade Sameer , Gupta Tanisha , Kumar Rajesh , Choudhary Rahul , Kumar Deepak
Published: June 2023

Nuclear imaging has paramount role in the evaluation of 4I (infective, inflammatory, innervation, infiltrative) cardiac diseases. We present a case of persistent pyrexia post-percutaneous transluminal coronary angioplasty with a history of inferior wall myocardial infarction 2 months back. Repeat coronary angiogram revealed that Right Coronary Artery (RCA) thrombus and IV antibiotics were started in suspicion of coronary stent infection. 18F-FDG PET/CT revealed no hypermetabolism along RCA stent, with uptake along pericardium and inferior wall. 99mTc-MIBI myocardial perfusion study showed perfusion defect in RCA territory corresponding to hibernating viable myocardium. Eventually patient was diagnosed with Dressler syndrome. Thus, molecular imaging helped in narrowing differentials in post cardiac intervention pyrexia and precise diagnosis.
Examination of the Novel National Institutes of Health-Supported Relative Citation Ratio, a Measure of Research Productivity, Among Academic Plastic Surgeons
Authors: Patel Parth A. , Keane Charles A. , Akhter Maheen F. , Fang Amanda Hua , Soto Edgar , Boyd Carter J.
Published: June 2023

Background

Considerable interest has been devoted to quantifying research productivity for the purposes of academic appointment and promotion in plastic surgery. A novel bibliometric, the relative citation ratio (RCR), integrates features unavailable in prior metrics, such as the h-index, including the ability to compare researchers in distinct fields. This investigation examines the RCR in relation to established measures of academic productivity and provides the benchmark data in plastic surgery.

Methods

Online sources were queried to identify the characteristics of 955 academic plastic surgeons from 94 programs, ie, academic rank, gender, degrees, and fellowships. Bibliometric data were acquired using the iCite and Scopus databases. Comparative and correlational analyses of variables were performed.

Results

Academic plastic surgeons were exceptionally productive, with a mean RCR of 1.20 (interquartile range, 0.79–1.67) and a weighted RCR of 17.68 (interquartile range, 5.14–52.48). Increased mean RCR was significantly associated with advanced academic rank and fellowship training. Increased weighted RCR was significantly associated with advanced academic rank, male gender, PhD acquisition, publication experience, and fellowship training. The h-index was weakly correlated with mean RCR but strongly correlated with weighted RCR and publication experience.

Conclusions

The RCR was associated with established markers of academic productivity, indicating its validity as a reliable field-normalized measure for the evaluation of plastic surgery faculty. Because scholarly output is a potential factor with respect to decisions of hiring, promotion, and allocation of funding, this modality of standardized comparison is paramount for plastic surgeons who exist within a larger general surgery department.
Predictors of Recovery Expectancy in Preparation for Pelvic Reconstructive Surgery in Women With Pelvic Organ Prolapse: A Prospective Cohort Study
Authors: Doering Andrew , Hale Douglass , Hamner Jennifer , Heit Michael
Published: June 2023

Importance

Recovery expectancy is a modifiable predictor of actual recovery after surgery. Identifying predictors of recovery expectancy will allow clinicians to preoperatively modify recovery expectancy and optimize actual recovery.

Objectives

The primary objective was to identify patient characteristics that predict a patient's recovery expectancy. The secondary objective was to validate previous research demonstrating that recovery expectancy predicted actual recovery.

Study Design

This is a prospective cohort study of women undergoing pelvic reconstructive surgery. Patients completed a preoperative survey to collect data on potential sociodemographic, clinical, and psychosocial, including investment in life roles, predictors of recovery expectancies. Actual recovery was measured at postoperative weeks 2 and 6. Predictors of recovery expectancy were identified.

Results

Two hundred one women were recruited with 174 included in the final analysis. Variables significantly associated with recovery expectancy during bivariate analysis (P < 0.05) were education level, total prior surgical procedures, pelvic pain, back pain, bodily pain, sick role investment, optimism, satisfaction with participation in social roles, overall social support, job satisfaction, and professionalism. Sick role investment was the only independent predictor of recovery expectancy (F = 3.46, df = 13, P < 0.001). Greater sick role investment was associated with increased probability of prolonged recovery. Patients with low recovery expectancies had less actual recovery compared with patients with high recovery expectancies (P = 0.014).

Conclusions

This study confirmed prior work that recovery expectancy predicts actual recovery after reconstructive pelvic surgery and may establish recovery expectancy as a mediator between sick role investment and actual postdischarge surgical recovery.
Early Postoperative Fever and Atelectasis in Patients Undergoing Upper Abdominal Surgery
Authors: Lim Leerang , Lee Jihyuk , Hwang So Yeong , Lee Hannah , Oh Seung-Young , Kang Christine , Ryu Ho Geol
Published: June 2023

Background:

Atelectasis is a common complication after upper abdominal surgery and considered as a cause of early postoperative fever (EPF) within 48 hours after surgery. However, the pathophysiologic mechanism how atelectasis causes fever remains unclear.

Study design:

Adult patients who underwent elective major upper abdominal surgery under general anesthesia at Seoul National University Hospital between January and December of 2021 were retrospectively analyzed. The primary outcome was the association between fever and atelectasis within 2 days after surgery.

Results:

Of the 1624 patients, 810 patients (49.9%) developed EPF. The incidence of atelectasis was similar between the fever group and the no fever group (51.6% vs. 53.9%, p = 0.348). Multivariate analysis showed no significant association between atelectasis and EPF. Culture tests (21.7% vs. 8.8%, p < 0.001) and prolonged use of antibiotics (25.9% vs. 13.9%, p < 0.001) were more frequent in the fever group compared to the no fever group. However, the frequency of bacterial growth on culture tests and postoperative pulmonary complications within 7 days were similar between the two groups.

Conclusion:

EPF after major upper abdominal surgery was not associated with radiologically detected atelectasis. EPF was also not associated with the increased risk of postoperative pulmonary complications, bacterial growth on culture studies, or prolonged hospital length of stay.
Role of renal venous oxygen pressure for renal function monitoring after related living-donor kidney transplantation: cohort study
Authors: Escarramán-Martínez Diego , Fernández-Bravo Montserrat , Kammar-García Ashuin , Guerrero-Gutiérrez Manuel Alberto , Meza-Comparán Héctor David , Mancilla-Galindo Javier , Sánchez-Díaz Jesús Salvador , Cendejas-Ríos Emilio , Escorza-Molina Carla Adelina , Noriega-Salas Lorena , Bernaldez-Gómez Germán
Published: June 2023

Introduction

Monitoring of renal function after kidney transplantation (KT) is performed by measuring serum creatinine (SCr), urine volumes (UV), and glomerular filtration rate (GFR). Other methods based on oxygen metabolism such as the renal venous oxygen pressure (PrvO2) may be useful. We aimed to explore the correlation between PrvO2and SCr, UV, and GFR five days after KT (SCr5, UV5, and GFR5, respectively).

Methods

We conducted a prospective cohort study in adult patients scheduled for living-donor KT. A venous blood sample was taken from the renal vein after declamping the renal artery and blood gas determinations were made. Correlation analyses between PrvO2and SCr5, UV5, and GFR5, were done by calculating the Spearman correlation coefficient together with generalized linear models (GLM). A Spearman correlation analysis was performed between the percentage decrease in SCr (%ΔSCr) and PrvO2. A GLM was also performed to determine the association of PrvO2with slow graft function (SGF).

Results

42 patients were included; 66.7% were men, and the median age was 31 years (IQR: 27-43.5). PrvO2was negatively correlated with SCr5 (ρ=-0.53, p=0.003), and positively correlated with GFR5 (ρ=0.49, p=0.001) and %ΔSCr (ρ=0.47, p=0.002). A higher PrvO2was associated with an increase in GFR in univariable (β=1.24, 95%CI: 0.56-1.93, p=0.001) and multivariable (β=1.24, 95%CI: 0.53-1.94, p=0.001) analyses. No association was found between PrvO2and SGF.

Conclusion

PrvO2could be used to monitor renal function in the first 5 days following related living-donor KT given its good correlation with SCr and GFR.
Automating intended target identification for paraphasias in discourse using a large language model
Authors: Salem Alexandra C. , Gale Robert C. , Fleegle Mikala , Fergadiotis Gerasimos , Bedrick Steven
Published: June 2023

Purpose

To date there are no automated tools for the identification and fine-grained classification of paraphasias within discourse, the production of which is the hallmark characteristic of most people with aphasia (PWA). In this work we fine-tune a large language model (LLM) to automatically predict paraphasia targets in Cinderella story retellings.

Method

Data consisted of 353 Cinderella story retellings containing 2,489 paraphasias from PWA, for which research assistants identified their intended targets. We supplemented this training data with 256 sessions from control participants, to which we added 2,427 synthetic paraphasias. We conducted four experiments using different training data configurations to fine-tune the LLM to automatically “fill in the blank” of the paraphasia with a predicted target, given the context of the rest of the story retelling. We tested the experiments’ predictions against our human-identified targets and stratified our results by ambiguity of the targets and clinical factors.

Results

The model trained on controls and PWA achieved 46.8% accuracy at exactly matching the human-identified target. Fine-tuning on PWA data, with or without controls, led to comparable performance. The model performed better on targets with less human ambiguity, and on paraphasias from participants with less severe or fluent aphasia.

Conclusion

We were able to automatically identify the intended target of paraphasias in discourse using just the surrounding language about half of the time. These findings take us a step closer to automatic aphasic discourse analysis. In future work, we will incorporate phonological information from the paraphasia to further improve predictive utility.
Concussion acutely disrupts auditory processing in Division I football student-athletes
Authors: Krizman Jennifer , Colegrove Danielle , Cunningham Jenna , Bonacina Silvia , Nicol Trent , Nerrie Matt , Kraus Nina
Published: June 2023

Diagnosis, assessment, and management of sports-related concussion requires a multi-modal approach. Yet, currently, an objective assessment of auditory processing is not included. The auditory system is uniquely complex, relying on exquisite temporal precision to integrate signals across many synapses, connected by long axons. Given this complexity and precision, together with the fact that axons are highly susceptible to damage from mechanical force, we hypothesize that auditory processing is susceptible to concussive injury. We measured the frequencyfollowing response (FFR), a scalp-recorded evoked potential that assesses processing of complex sound features, including pitch and phonetic identity. FFRs were obtained on male Division I Collegiate football players prior to contact practice to determine a pre-season baseline of auditory processing abilities, and again after sustaining a sports-related concussion. We predicted that concussion would decrease pitch and phonetic processing relative to the student-athlete’s preseason baseline. We found that pitch and phonetic encoding was smaller post-concussion. Studentathletes who sustained a second concussion showed similar declines after each injury. Auditory processing should be included in the multimodal assessment of sports-related concussion. Future studies that extend this work to other sports, other injuries (e.g., blast exposure), and to female athletes are needed.
Developing pediatric eye care program in Nepal: Insurmountable Mountains can be reduced to mole hills. The Orbis experience in Nepal
Authors: Bora Rishi Raj , Gogate Parikshit , Saravanan Saibaba , Misra Sailesh Kumar , Gurung Reeta , Sapkota Yuddha Dhoj , Adhikari Srijana , Joshi Purushottam , Pant Suresh Raj , Bachracharya Kabindra , Adhikari Hari Bikram , Gurung Govind , Singh Sanjay Kumar
Published: June 2023

Background

Nepal straddles the Himalayas and its geography has posed challenge to delivering eye care in children. This manuscript describes the pediatric eye care facilities developed, and children examined and treated under the Orbis International’s childhood blindness initiative.

Methods

Between 2010-2017 Orbis International had supported the Nepal Netra Jyoti Sangh (NNJS) and Tilganga Institute of Ophthalmology (TIO) to develop pediatric eye care centers in major hospitals, along with their outreach. This manuscript looks at the impact of that intervention. Reports of Nepal Netra Jyoti Sangh, Tilganga Institute of Ophthalmology and Orbis International were studied, along with publications on ophthalmology from Nepal. Eight child friendly pediatric eye care centers were set-up, pediatric eye care teams were trained, an outreach program especially for children’s eye problems was designed and outcome monitoring and research promoted.

Results

Between 2010–17 1,281,153 children had been examined by 8 pediatric eye centres (average 20,018 per hospital per year, range 10,729 –39,485) and the average outpatient per month per hospital was 1668 (range 894 - 3,290). Between 2010 – 2017, 42,430 children had been operated upon by 8 hospitals (average 663 per hospital per year, ranged from 96 – 1,465) and the average pediatric eye surgery per month per hospital was 55 (ranged from 8 to 122).

In the years 2018 & 2019 (21 months) post-project, all the 8 hospitals had operated on 14,252 children (average of 1,782 per hospital, range 185 - 4438) and the average pediatric eye surgery per month per hospital was 85 (range 9 to 211). 19 publications on pediatric eye care were published in indexed journals.

Conclusion

Orbis childhood blindness amelioration initiative in Nepal resulted in more than a million children examined, and >50,000 children underwent eye surgeries in the 8 pediatric eye care centres and the good service continued after the project was over.
Critical thermal maxima and oxygen uptake inElysia viridis(Montagu, 1804), a sea slug capable of photosynthesis
Authors: Laetz Elise M. J. , Kahyaoglu Can , Borgstein Natascha M. , Merkx Michiel , van der Meij Sancia E. T. , Verberk Wilco C. E. P.
Published: June 2023

Photosynthetic animals produce oxygen internally, providing an ideal lens for studying how oxygen dynamics influence thermal sensitivity. The sea slug,Elysia viridis, can retain functional chloroplasts from its food algaBryopsis plumosafor months, but retention is limited when fedChaetomorphasp., limiting potential oxygenic benefits. We fed slugs each alga and exposed them to 17°C (their current yearly maximum temperature) and 22°C (the increase predicted for 2100), to examine plasticity in thermal tolerance and changes in oxygen uptake when fed and starving. We also examined slugs under increased illumination to examine a potential tradeoff between increased oxygen production, and a faster rate of chloroplast degradation. Following exposure to these conditions, we performed ramping trials, subjecting them to acute thermal stress to determine their thermal tolerance. We also measured oxygen uptake before and after ramping. We observed increases in thermal tolerance for specimens exposed to 22°C, indicating they acclimated to temperatures higher than they naturally experience. Fed slugs exhibited higher rates of oxygen consumption before exposure to acute thermal stress, and suppressed their oxygen uptake more after it, than starved slugs. Under higher light, slugs exhibited improved thermal tolerance, possibly because increased oxygen production alleviated host oxygen limitation. Accordingly, this advantage disappeared later in the starvation period when photosynthesis ceased due to chloroplast digestion. In conclusion,E. viridiscan suppress metabolism to cope with heat waves, however, starvation influences a slug’s thermal tolerance and oxygen uptake, so continuous access to algal food for chloroplast retention is critical when facing thermal stress.

Summary Statement

Oxygen has been implicated in determining an ectotherm’s thermal sensitivity. Examining photosynthetic (and therefore oxygen-producing) sea slugs under various conditions helps elucidate how oxygen and other factors impact thermal tolerance.
Multi-omics data and analysis reveal the formation of key pathways of different colors inTorenia fournieriflowers
Authors: Song Jiaxing , Kong Haiming , Yang Jing , Jing Jiaxian , Li Siyu , Ma Nan , Yang Rongchen , Cao Yuman , Wang Yafang , Hu Tianming , Yang Peizhi
Published: June 2023

Abstract

Torenia fournieriLind. is an ornamental plant, popular for its numerous flowers and variety of colors. However, its genomic evolution, as well as the genetic and metabolic basis of flower color formation, remain poorly understood. Here we report a chromosome-level reference genome ofT. fourniericomprising 164.4 Mb. Phylogenetic analysis revealed the phylogenetic placement of the species, and comparative genomics analysis indicated thatT. fournierishared a whole genome duplication (WGD) event withAntirrhinum majus. Through joint transcriptomics and metabolomics analyses, we characterized the differential genes and metabolites in the anthocyanin synthesis pathway in fiveT. fournierivarieties. We identified many metabolites related to pelargonidin, peonidin, and naringenin in Rose (R) color samples. On the other hand, the blue (B) and blue-violet (D) color samples contained many metabolites related to petunidin, cyanidin, quercetin, and malvidin. The formation of different flower colors inT. fournieriinvolves multiple genes and metabolites. We analyzed the results and obtained significantly different genes and metabolites related to the biosynthesis of flavonoids and anthocyanins, which are key metabolites in the formation of different flower colors. OurT. fournierigenome data provide a basis for studying the differentiation of this species and provide a valuable model genome enabling genetic studies and genomics-assisted breeding ofT. fournieri.

Highlight

The genome ofTorenia fournieriwas reported for the first time, and the formation mechanism of different colors inTorenia fournieriflowers was analyzed by genomics, transcriptomics and metabolomics.
Patient-Specific Haemodynamic Analysis of Virtual Grafting Strategies in Type-B Aortic Dissection: Impact of Compliance Mismatch
Authors: Girardin Louis , Stokes Catriona , Thet Myat Soe , Oo Aung Ye , Balabani Stavroula , Díaz-Zuccarini Vanessa
Published: June 2023

Introduction

Compliance mismatch between the aortic wall and Dacron Grafts is a clinical problem concerning aortic haemodynamics and morphological degeneration. The aortic stiffness introduced by grafts can lead to an increased left ventricular (LV) afterload. This study quantifies the impact of compliance mismatch by virtually testing different Type-B aortic dissection (TBAD) surgical grafting strategies in patient-specific, compliant computational fluid dynamics (CFD) simulations.

Materials and Methods

A post-operative case of TBAD was segmented from computed tomography angiography data. Three virtual surgeries were generated using different grafts; two additional cases with compliant grafts were assessed. Compliant CFD simulations were performed using a patient-specific inlet flow rate and three-element Windkessel outlet boundary conditions informed by 2D-Flow Magnetic Resonance Imaging (2DMRI) data. The wall compliance was calibrated using Cine-MRI images. Pressure, wall shear stress (WSS) indices and energy loss (EL) were computed.

Results

Increased aortic stiffness and longer grafts increased aortic pressure and EL. Implementing a compliant graft matching the aortic compliance of the patient reduced the pulse pressure by 11% and EL by 4%. The endothelial cell activation potential (ECAP) differed the most within the aneurysm, where the maximum percentage difference between the reference case and the mid (MDA) and complete (CDA) descending aorta replacements increased by 16% and 20%, respectively.

Conclusion

This study highlights the negative impact of increased graft length on LV condition after surgical aortic replacement in TBAD. To mitigate the associated risks to the patient, graft manufacturers should allocate more resources toward developing compliant biomimetic grafts.
Fungal infections in Sudan: an underestimated health problem
Authors: Ahmed Sarah A. , Ismail Mawahib , Albirair Mohamed , Nail Abdelsalam Mohamed Ahmed , Denning David W.
Published: June 2023

Fungal diseases are associated with high morbidity and mortality, yet their epidemiology and burden are not well addressed. While deaths probably exceed 1.5 million per year, many cases remain undiagnosed and underreported. Estimating the burden of these diseases is needed for prioritization and implementation of effective control programs. Here we used a model based on population at risk to estimate the burden of serious fungal infections in Sudan. The prevalence of the susceptible population including HIV, TB, cancer, asthma, and COPD was obtained from the literature. Incidence and prevalence of fungal infections were calculated using local data when applicable and if not available then regional or international figures were used. In total, the estimated number of Sudanese suffering from fungal disease is 5 M (10% of the total population). Tinea capitis, recurrent vulvovaginitis and keratitis are estimated to affect 4,127,760, 631,261, and 6,552 patients, respectively. HIV-related mycosis is estimated to affect 5,945 oral candidiasis, 1,921 esophageal candidiasis, 571Pneumocystispneumonia, and 462 cryptococcal meningitis cases.Aspergillusinfections are estimated as follow: 3,438 invasive aspergillosis, 14,950 chronic pulmonary aspergillosis, 67,860 allergic bronchopulmonary aspergillosis cases, while the prevalence of severe asthma with fungal sensitization and fungal rhinosinusitis was 86,860 and 93,600 cases, respectively. The neglected tropical disease eumycetoma was estimated to affect 16,837 cases with a rate of 36/100,000. Serious fungal infections are quite common in Sudan and require urgent attention to improve diagnosis, promote treatment, and develop surveillance programs.

Author Summary

Fungal infections are present globally, but the burden is higher in sub-Saharan Africa. Many of these infections occur because of underline clinical conditions such as HIV, TB, cancer, asthma, and chronic obstructive pulmonary disease (COPD), while some may occur without underline conditions. We used the prevalence of susceptible populations to estimate the burden of fungal diseases in Sudan. Based on that, we found a total of 5 million Sudanese suffering from fungal infection. The most common disease was scalp infection (tinea capitis), followed by recurrent vulvovaginitis. Fungal eye infection was estimated to affect 6,552 patients, and the subcutaneous neglected tropical disease eumycetoma affects 16,837 individuals. We also reported a high burden for HIV- and TB-related mycoses. The study highlighted the need to develop surveillance programs for fungal infections in Sudan.
Childhood growth trajectory patterns are associated with the pubertal gut microbiota
Authors: López-Domínguez Lorena , Bourdon Celine , Hamilton Jill , Taibi Amel , Bassani Diego G , dos Santos Vaz Juliana , Buffarini Romina , Tovo Rodrigues Luciana , Santos Iná S , Matijasevich Alicia , Borges M Carolina , Hanley Anthony J , Barros Aluísio JD , Bandsma Robert HJ , Comelli Elena M
Published: June 2023

The relationship between growth and gut microbiota establishment is critical but under-investigated during late childhood. This is an important knowledge gap since the adult microbiota connects with other organs to influence health. We studied gut microbial communities composition and dietary patterns in 13 years old males and females from the 2004 Pelotas birth cohort (Brazil). We had previously shown that three BMIZ and HAZ patterns of growth since birth are present in this cohort, reflecting the nutritional status of these children. Here, we show that there is an association between growth patterns and gut microbiota, which encompasses the five pubertal stages, and which is affected by sex. Using Partial Least Square Path Modelling, we also show that there is a strong relationship between dietary patterns and gut microbiota, in males but not females. These data provide the microbiota and dietary profiles of highly phenotyped children and highlight the importance of childhood growth and sex for the maturation of the gut microbiota and long-term healthy growth. The role of pubertal diet in the relationships identified, further underlies the importance of dietary patterns establishment during adolescence while providing an opportunity for late modification of growth-microbiota relationships.