bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial intelligence-based non-invasive tumor segmentation, grade stratification and prognosis prediction for clear-cell renal-cell carcinoma
Authors: Chen Siteng , Song Dandan , Chen Lei , Guo Tuanjie , Jiang Beibei , Liu Aie , Pan Xianpan , Wang Tao , Tang Heting , Chen Guihua , Xue Zhong , Wang Xiang , Zhang Ning , Zheng Junhua
Published: August 2023

Due to the complicated histopathological characteristics of clear-cell renal-cell carcinoma (ccRCC), non-invasive prognosis before operative treatment is crucial in selecting the appropriate treatment. A total of 126 345 computerized tomography (CT) images from four independent patient cohorts were included for analysis in this study. We propose a V Bottleneck multi-resolution and focus-organ network (VB-MrFo-Net) using a cascade framework for deep learning analysis. The VB-MrFo-Net achieved better performance than VB-Net in tumor segmentation, with a Dice score of 0.87. The nuclear-grade prediction model performed best in the logistic regression classifier, with area under curve values from 0.782 to 0.746. Survival analysis revealed that our prediction model could significantly distinguish patients with high survival risk, with a hazard ratio (HR) of 2.49 [95% confidence interval (CI): 1.13–5.45, P = 0.023] in the General cohort. Excellent performance had also been verified in the Cancer Genome Atlas cohort, the Clinical Proteomic Tumor Analysis Consortium cohort, and the Kidney Tumor Segmentation Challenge cohort, with HRs of 2.77 (95%CI: 1.58–4.84, P = 0.0019), 3.83 (95%CI: 1.22–11.96, P = 0.029), and 2.80 (95%CI: 1.05–7.47, P = 0.025), respectively. In conclusion, we propose a novel VB-MrFo-Net for the renal tumor segmentation and automatic diagnosis of ccRCC. The risk stratification model could accurately distinguish patients with high tumor grade and high survival risk based on non-invasive CT images before surgical treatments, which could provide practical advice for deciding treatment options.
GRAS family member LATERAL SUPPRESSOR regulates the initiation and morphogenesis of watermelon lateral organs
Authors: Jiang Yanxin , Zhang Anran , He Wenjing , Li Qingqing , Zhao Bosi , Zhao Hongjiao , Ke Xubo , Guo Yalu , Sun Piaoyun , Yang Tongwen , Wang Zheng , Jiang Biao , Shen Junjun , Li Zheng
Published: August 2023

The lateral organs of watermelon (Citrullus lanatus), including lobed leaves, branches, flowers, and tendrils, together determine plant architecture and yield. However, the genetic controls underlying lateral organ initiation and morphogenesis remain unclear. Here, we found that knocking out the homologous gene of shoot branching regulator LATERAL SUPPRESSOR in watermelon (ClLs) repressed the initiation of branches, flowers, and tendrils and led to developing round leaves, indicating that ClLs undergoes functional expansion compared with its homologs in Arabidopsis (Arabidopsis thaliana), rice (Oryza sativa), and tomato (Solanum lycopersicum). Using ClLs as the bait to screen against the cDNA library of watermelon, we identified several ClLs-interacting candidate proteins, including TENDRIL (ClTEN), PINOID (ClPID), and APETALA1 (ClAP1). Protein–protein interaction assays further demonstrated that ClLs could directly interact with ClTEN, ClPID, and ClAP1. The mRNA in situ hybridization assay revealed that the transcriptional patterns of ClLs overlapped with those of ClTEN, ClPID, and ClAP1 in the axillary meristems and leaf primordia. Mutants of ClTEN, ClPID, and ClAP1 generated by the CRISPR/Cas9 gene editing system lacked tendrils, developed round leaves, and displayed floral diapause, respectively, and all these phenotypes could be observed in ClLs knockout lines. Our findings indicate that ClLs acts as lateral organ identity protein by forming complexes with ClTEN, ClPID, and ClAP1, providing several gene targets for transforming the architecture of watermelon.
Superiority-Seeking and the Preference for Exclusion
Authors: Imas Alex , Madarász Kristof
Published: August 2023

We propose that a person’s desire to consume an object or possess an attribute increases in how much others want but cannot have it. We term this motive imitative superiority-seeking and show that it generates preferences for exclusion that help explain a host of market anomalies and make novel predictions in a variety of domains. In bilateral exchange, trade becomes more zero-sum, leading to an endowment effect. People’s value of consuming a good increases in its scarcity, which generates a motive for firms and organizations to engage in exclusionary policies. A monopolist producing at constant marginal cost can increase profits by randomly excluding buyers relative to the standard optimal mechanism of posting a common price. In the context of auctions, a seller can extract greater revenues by randomly barring a subset of consumers from bidding. Moreover, such non-price-based exclusion leads to higher revenues than the classic optimal sales mechanism. A series of experiments provides direct support for these predictions. In basic exchange, a person’s willingness to pay for a good increases as more people are explicitly barred from the opportunity to acquire it. In auctions, randomly excluding people from the opportunity to bid substantially increases bids amongst those who retain this option. Consistent with our predictions, exclusion leads to bigger gains in expected revenue than increasing competition through inclusion. Our model of superiority-seeking generates “Veblen effects,” rationalizes attitudes against redistribution and provides a novel motive for social exclusion and discrimination.
Sources and Transmission of Country Risk
Authors: Hassan Tarek A , Schreger Jesse , Schwedeler Markus , Tahoun Ahmed
Published: August 2023

We use textual analysis of earnings conference calls held by listed firms around the world to measure the amount of risk managers and investors at each firm associated with each country at each point in time. Flexibly aggregating this firm-country-quarter-level data allows us to systematically identify spikes in perceived country risk (“crises”) and document their source and pattern of transmission to foreign firms. While this pattern usually follows a gravity structure, it often changes dramatically during crises. For example, while crises originating in developed countries propagate disproportionately to foreign financial firms, emerging market crises transmit less financially and more to traditionally exposed countries. We apply our measures to show that elevated perceptions of a country’s riskiness, particularly those of foreign and financial firms, are associated with significant falls in local asset prices, capital outflows, and an increased likelihood of a sudden stop.
Radioactivity level evaluation in granite building raw material production area in Cenxi, China
Authors: Liu Zebin , Lu Hao , Wang Tianfu , Wang Shangwei , Liu Guanhua , Lai Wanchang
Published: August 2023

This study was conducted to evaluate the radioactivity level in the granite building raw material production area in Cenxi, China. Natural radionuclide concentrations, γ absorbed dose rates (ADRs) and radon exhalation rates were measured in the area. The spatial distribution of natural radionuclides, γ ADR and radon exhalation rate were mapped with GPS information. The radioactivity levels in the study area were analysed based on the descriptive statistics and frequency distribution of measurement data. According to the Chinese standard, the granite raw materials used for building and decoration in this region were classified based on their radiological hazards. In addition, radiation protection measures were proposed for the mining of local granite building materials products as well as environmental protection around the work area and resident safety.
Evaluation of neurotoxicity and the role of oxidative stress of cobalt nanoparticles, titanium dioxide nanoparticles, and multiwall carbon nanotubes in Caenorhabditis elegans
Authors: Chen Cheng , Chen Jingrong , Lin Xinpei , Yang Jiafu , Qu Huimin , Li Lisong , Zhang Duanyan , Wang Wei , Chang Xiangyu , Guo Zhenkun , Cai Ping , Yu Guangxia , Shao Wenya , Hu Hong , Wu Siying , Li Huangyuan , Bornhorst Julia , Aschner Michael , Zheng Fuli
Published: August 2023

The widespread use of nanomaterials in daily life has led to increased concern about their potential neurotoxicity. Therefore, it is particularly important to establish a simple and reproducible assessment system. Representative nanomaterials, including cobalt nanoparticles (CoNPs), titanium dioxide nanoparticles (TiO2-NPs), and multiwall carbon nanotubes (MWCNTs), were compared in terms of their neurotoxicity and underlying mechanisms. In 0, 25, 50, and 75 μg/ml of these nanomaterials, the survival, locomotion behaviors, acetylcholinesterase (AchE) activity, reactive oxygen species production, and glutathione-S transferase 4 (Gst-4) activation in wildtype and transgenic Caenorhabditis elegans (C. elegans) were evaluated. All nanomaterials induced an imbalance in oxidative stress, decreased the ratio of survival, impaired locomotion behaviors, as well as reduced the activity of AchE in C. elegans. Interestingly, CoNPs and MWCNTs activated Gst-4, but not TiO2-NPs. The reactive oxygen species scavenger, N-acetyl-l-cysteine, alleviated oxidative stress and Gst-4 upregulation upon exposure to CoNPs and MWCNTs, and rescued the locomotion behaviors. MWCNTs caused the most severe damage, followed by CoNPs and TiO2-NPs. Furthermore, oxidative stress and subsequent activation of Gst-4 were involved in nanomaterials-induced neurotoxicity. Our study provides a comprehensive comparison of the neurotoxicity and mechanisms of typical nanomaterials, which could serve as a model for hazard assessment of environmental pollutants using C. elegans as an experimental model system.
Mismatch between primary and secondary growth and its consequences on wood formation in Qinghai spruce
Authors: Yu Biyun , Rossi Sergio , Su Hongxin , Zhao Ping , Zhang Shaokang , Hu Baoqing , Li Xuebin , Chen Lin , Liang Hanxue , Huang Jian-Guo
Published: August 2023

The connections between the primary and secondary growth of trees allows better understanding of the dynamics of carbon sequestration in forest ecosystems. The relationship between primary and secondary growth of trees could change due to the diverging responses of meristems to climate warming. In this study, the bud phenology and radial growth dynamics of Qinghai spruce (Picea crassifolia) in arid and semi-arid areas of China in 2019 and 2020 were weekly monitored to analyze their response to different weather conditions and their links with carbon sink. Xylem anatomical traits (i.e. lumen radial diameter and cell wall thickness) were quantified along cell radial files after the end of xylem lignification to calculate the early-to-latewood transition date. Winter and early spring (January–March) were warmer in 2020 with a colder April compared with 2019. Precipitation in April–June was lower in 2020 than in 2019. In 2019, bud phenology occurred earlier, while the onset of xylem formation and the early-to-latewood transition date were delayed. The duration from the beginning of split bud and exposed shoot to the early-to-latewood transition date was positively correlated with the radial width of earlywood (accounting for ~80% of xylem width) and total xylem width. The longer duration of xylem cell division did not increase xylem cell production and radial width. Moreover, the duration from bud burst to the early-to-latewood transition date in 2020 was negatively linked with early phloem cell production as compared with 2019. Our findings suggest that warm conditions in winter and early spring promote the xylogenesis of Qinghai spruce, but might delay bud burst. However, the xylem width increments largely depend on the duration from bud burst to the start of latewood cell division rather than on the earlier xylogenesis and longer duration of xylem cell differentiation induced by warm conditions.
Evolutionary history, biogeography, and a new species of Sphoeroides (Tetraodontiformes: Tetraodontidae): how the major biogeographic barriers of the Atlantic Ocean shaped the evolution of a pufferfish genus
Authors: Araujo Gabriel S , Kurtz Yan R , Sazima Ivan , Carvalho Pedro Hollanda , Floeter Sergio R , Vilasboa Anderson , Rotundo Matheus M , Ferreira Carlos E L , Barreiros João Pedro , Pitassy Diane E , Carvalho-Filho Alfredo
Published: August 2023

Tetraodontidae is the most speciose family of Tetraodontiformes and is represented by fish popularly known as pufferfishes. They are characterized by modified jaws with four dental plates and the ability ﻿to inflate their bodies. Tetraodontids are distributed throughout the world and have a wide range of habitat use. One of its genera, Sphoeroides, shows a biogeographical pattern, with 19 of its 21 species restricted to coastal regions of the Americas. Although represented in large-scale phylogenies, the evolutionary history and biogeography of the genus have not been explored in detail. The present study aims to understand the historical and biogeographic processes that shaped the evolutionary history of Sphoeroides. Including samples from all biogeographic regions of its occurrence, we reconstruct a phylogenetic/biogeographic history hypothesis for the genus. Our results show that Sphoeroides is a paraphyletic group comprising Colomesus; indicate a central role of the biogeographic barriers of the Atlantic Ocean in the diversification of the genus; and identified a cryptic species in Brazilian waters, formally known as S. spengleri, described here through integrative taxonomy. We also propose nomenclatural changes given the position of Colomesus deeply nested within Sphoeroides.
Hiding in the mists: molecular phylogenetic position and description of a new genus and species of snake (Dipsadidae: Xenodontinae) from the remote cloud forest of the Lost World
Authors: Kok Philippe J R , Means D Bruce
Published: August 2023

Pantepui s.l. is a remote, biodiverse region of ~400 000 km2 containing at least five endemic reptile genera and a number of ancient vertebrate lineages. Here, we describe an additional endemic snake genus and species, Paikwaophis krukigen. nov., sp. nov. (Dipsadidae: Xenodontinae), recently collected in the Pantepui cloud forest that sits at the base of the steep cliffs of Roraima-tepui and Wei-Assipu-tepui (table mountains of the Eastern Tepui Chain) in Guyana, South America. Multilocus molecular data strongly support Paikwaophisgen. nov. to be most closely related to Xenopholis Peters, 1869, although both genera are strikingly different morphologically. Osteological and other phenotypic data suggest that Paikwaophis is semi-fossorial; its diet includes minute lizards. Paikwaophis is currently the only known Pantepui endemic snake genus. The immature female holotype is the only known specimen.
Foreign Bodies: Retained Items Ranging From Insignificant to Life-Threatening
Authors: Theodorou Daphne J. , Theodorou Stavroula J. , Kakitsubata Yousuke
Published: August 2023

Foreign bodies (FBs) may pose diagnostic difficulty to radiologists for a number of reasons, as the unaccustomed items, though not uncommon, can often comprise incidental or unexpected findings on the radiologic evaluation, inappropriate position of variable objects can be deliberate, accidental or due to assault, and urgent discovery of the potentially harmful material can be challenging. Because FBs can practically be found in all major organ systems of the human body and may occasionally intimidate normal activity and function, early and specific diagnosis can have a significant impact on treatment—that is where radiologists play a vital role helping the clinicians avoid unproductive diagnostic odysseys.
Morphologic Changes of the Intervertebral Disk During Growth
Authors: Moens Aaron J.B.W.D. , Magré Joëll , Kruyt Moyo C. , Castelein René M. , de Reuver Steven
Published: August 2023

Study Design.

Cross-sectional.

Objective.

The aim of this study was to describe morphologic changes of the annulus fibrosus (AF) and nucleus pulposus (NP) in children during growth using magnetic resonance imaging.

Summary of Background Data.

Little is known of intervertebral disk (IVD) maturation as opposed to degeneration, such as changes in relative AF/NP proportions and orientation during growth. Studies suggest that IVD plays a role in the etiology of pediatric spinal deformities. Therefore, understanding the morphologic development of the AF and NP during growth is key.

Materials and Methods.

An existing database of children aged 0 to 18 that had magnetic resonance imaging for indications unrelated to the spine were analyzed. The AF/NP were segmented semiautomatically from T1 to L5. The parameters: mean IVD height, cross-sectional area, slenderness (height/width ratio), volume (ratio), and relative position of the centroid of the NP within the IVD in three directions (x, y, z) were extracted, and compared between age, sex, and spinal level.

Results.

IVD height increased modestly and predominantly in the low-thoracic and lumbar spine during the first 5 to 10 years of life. Cross-sectional area and thus volume increased steadily at all levels throughout growth. IVD slenderness decreased sharply in the first years of life and remains relatively stable throughout the remainder of growth. IVDs were smaller and more slender in females, especially in the mid-thoracic spine at early adolescence. In the upper-thoracic and mid-thoracic spine the NP comprises 10% to 12% of total IVD volume during growth, this percentage increases in the low-thoracic and lumbar spine towards 20% to 25%. In the anterior-posterior direction, the position of the nucleus increasingly shifts with age, possibly in line with the developing sagittal profile of the spine.

Conclusion.

This study describes the development of thoracic and lumbar IVDs during growth and may be used as a reference for future studies on the role of IVD in the etiology of disk-related disorders.
Early sodium bicarbonate infusion was associated with improved outcome in critically ill patients with acute moderate metabolic acidosis: a retrospective observational study
Authors: Huang Sai , Yang Bo , Peng Yaojun , Wang Libo , Wang Lili , Wang Jing , Zhou Xuan , Zhu Hanyu , Chen Li , Feng Cong
Published: August 2023

Background

Sodium bicarbonate (SB) infusion is widely administered for severe metabolic acidosis (MA). However, evidence supporting its effect on mortality in patients with acute moderate MA (MMA) has not yet been established. This study investigated the effect of early SB administration on mortality in critically ill patients with acute MMA and in other subgroups.

Methods

We retrospectively analyzed a large intensive care unit (ICU) database, Medical Information Mart for Intensive Care (MIMIC)-IV. Patients with acute MMA were identified using MIMIC-IV. Propensity score analysis (PSA) was performed to explain baseline differences in the probability of receiving SB. The marginal structural Cox model (MSCM) was developed to adjust for both baseline and time-varying confounding variables. The primary outcome was ICU mortality, and the secondary outcome was hospital mortality.

Results

In total, 1738 patients with acute MMA were identified; 484 were enrolled in the SB group and 1254 in the non-SB group. In the PSA, early SB infusion was not associated with reduced ICU mortality (hazard ratio [HR]: 0.88; 95% confidence interval [CI]: 0.67–1.14; P = 0.33) in the overall cohort. However, it was associated with improved ICU survival in patients with sepsis (HR: 0.69; 95% CI: 0.48–0.99; P < 0.05), sepsis shock (HR: 0.61; 95% CI: 0.40–0.93; P < 0.05), and sepsis and lactic acidosis (lactate >2.2 mmol/L; HR: 0.69; 95% CI: 0.48–0.99; P < 0.05). The results from MSCM were similar to those obtained for PSA.

Conclusion

Early SB infusion was associated with improved ICU survival outcomes in critically ill adult patients with sepsis, septic shock, and sepsis and lactic acidosis and acute MMA. Further large randomized controlled trials are required to confirm these results.
Combining Multiple Oncoplastic Techniques to Facilitate Extreme Oncoplastic Breast Conservation
Authors: Schwartz Jean-Claude D.
Published: August 2023

Centers of excellence strive for high rates of breast conservation surgery. Given the increased patient satisfaction, evidence for improved survival, decreased rates of complications, reduced costs, and fewer surgical procedures compared to mastectomy and reconstruction, this makes sense. As such, surgeons have devised approaches to offer breast conservation to patients with more extensive disease that would have been classically recommended to undergo mastectomy. These ambitious attempts at breast conservation are supported by recent studies that have established their oncological safety. “Extreme oncoplasty” refers to Wise-pattern volume displacement surgery where the breast is immediately reconstructed after a multifocal or multicentric breast cancer is excised. The authors that described this concept also described a Wise-pattern “split reduction” to allow for excision of the skin directly over the cancer, insuring a clear anterior margin. Although extreme oncoplasty has been broadly discussed and published on by many groups, there are few reports that provide insight into the surgical details necessary to successfully perform this surgery. Here, we combine three different oncoplastic techniques: the Wise-pattern split reduction, immediate nipple reconstruction, and autologous volume replacement to demonstrate our approach to extreme oncoplastic breast conservation in a challenging patient.
Hybrid Regenerative Therapy for Successful Reconstruction of an Infected Traumatized Diabetic Foot Wound
Authors: Saha Srinjoy
Published: August 2023

Diabetic foot ulcers are a significant complication of diabetes, affecting millions globally, and require appropriate antibiotics, surgical debridement, wound care, and metabolic optimization for management. This article presents an innovative hybrid regenerative therapy for reconstructing an infected, traumatized foot wound of a 62-year-old man with diabetes mellitus who presented with a week-old injury after a car accident. At presentation, he had a 14 × 10 cm dorsal foot wound with skin necrosis, pus discharge, and bony instability owing to partial fractures and joint dislocations. Antibiotics were administered to treat multidrug-resistant bacteria and followed by surgical debridement and the application of a portable Velnext negative pressure wound therapy device. Once the wound condition stabilized, hybrid regenerative therapy was performed weekly. Six milliliters platelet-rich plasma and 6 mL platelet-poor plasma were prepared from 27 mL of venous blood mixed with 3 mL sodium citrate and injected into the tendons, soft-tissues, and muscles. Next, the exposed bones and tendons were covered with platelet-rich fibrin and semi-occlusive membranes, and a Velnext negative pressure wound therapy device was applied over them. The wound improved progressively during the subsequent 6 weeks and was finally covered with a split-skin graft. The patient had a successful 18-month postoperative period until now with stable grafts, anatomical restoration, and excellent foot functionality. Thus, hybrid regenerative therapy, encompassing several prevalent methods for healing wounds, has excellent benefits for treating complex diabetic foot ulcers.
Virtual Reality During Chemotherapy Infusion
Authors: Burrai Francesco , De Marinis Maria Grazia , Piredda Michela
Published: August 2023

Patients with cancer receiving infusional chemotherapy show negative symptoms such as worry about their survival, anxiety, anguish, depression, fear, magnified perception of the passage of time, and difficulty managing boredom. Patients also suffer various side effects produced by chemotherapy such as nausea, vomiting, pain, and fatigue, which, together with psychological distress, drastically reduce their quality of life and adherence to therapy with a corresponding reduction in the probability of the individual's survival. Virtual Reality is one of the most innovative and promising digital health interventions, capable of quickly and effectively producing a positive influence on the psychosomatic axis, improving patients' quality of life during chemotherapy. Virtual Reality, through its 3-dimensional multisensory technology, isolates sensory channels from the negative external environment and enables an experience of being physically and psychologically present within virtual scenarios, in which patients can perceive sensations, emotions, cognitions, and interactions as if they really were in different surroundings. This article systematically expounds the scientific conditions necessary for effective, appropriate, and safe implementation of Virtual Reality interventions in holistic nursing practice, describing the underpinning conceptual framework, the types, technological characteristics, methods of use, duration, type of virtual content, and implementation procedure of Virtual Reality.
Evaluation of ciliary body morphology and position of the implantable collamer lens in low-vault eyes using ultrasound biomicroscopy
Authors: Yiming Ye , Xi Chen , Huan Yao , Liming Chen , Na Yu , Pei Chen , Ying Yang , Yan Li , Keming Yu
Published: August 2023

Purpose:

To investigate the ciliary body anatomy and position of the implantable collamer lens (ICL) in low-vault eyes and analyze factors related to insufficient vault.

Setting:

Zhongshan Ophthalmic Center, Guangzhou, China.

Design:

Retrospective case–control observational study.

Methods:

In this study, 73 eyes of 73 patients with an insufficient vault (<250 μm) were matched with 73 eyes with an ideal vault (250 to 750 μm). Ultrasound biomicroscopy was used to determine the ciliary body morphology and ICL position. The biometric parameters acquired by Scheimpflug tomography were compared. The correlation between the vault and these factors was analyzed, and the least absolute shrinkage and selection operator method was used to screen the risk factors for low vault.

Results:

The low-vault group had a steeper corneal curvature, thicker lens thickness (LT), higher crystalline lens rise, and shorter axial length (AL) (all P < .005). The ciliary process length (CPL) and maximum ciliary body thickness (CBTmax) were significantly smaller, and the trabecular–ciliary angle (TCA), iris–ciliary angle (ICA), and ciliary sulcus width (CSW) were significantly greater in the low-vault eyes (all P < .005). The low-vault group had more ICL haptics below the ciliary process, and TCA, ICA, CPL, CBTmax, CSW, and haptic position were related to the postoperative vault (all P < .05). CPL, AL, and LT were identified as predictors of a low vault.

Conclusions:

Malposition of ICL haptics behind the ciliary process is a risk factor for low vault. A shorter CPL, thicker LT, and shorter AL are significant risk factors for the postoperative low vault.
Angle, anterior chamber parameters, and intraocular pressure changes after early phacoemulsification in acute angle-closure glaucoma
Authors: Anbar Mohamed A. , Mahmoud Hany A. , Abdellah Marwa M.
Published: August 2023

Purpose:

To evaluate the safety and efficacy of phacoemulsification as a first line treatment of acute angle closure glaucoma (AACG) and to evaluate the preoperative and postoperative anterior chamber angle width and anterior chamber parameters using anterior segment OCT(AS-OCT) and Pentacam.

Sittings:

Sohag University Hospital, Sohag city, Egypt.

Design:

Prospective comparative interventional case series study.

Methods:

Patients presented with AACG. After control of high intraocular pressure (IOP), all participants were scheduled for phacoemulsification within a week after the attack. Preoperative and postoperative angle width, anterior chamber volume and anterior chamber depth was measured by AS-OCT and Pentacam to evaluate angle changes.

Results:

Fifty eyes with AACG were enrolled in the study. The mean IOP was lowered significantly from 40.23 ± 10.4 mmHg preoperatively to 11.4 ± 3.3 mmHg 3 months after surgery. The mean preoperative temporal angle widened from 18.13 ± 3.65 degree to 36.16 ± 4.46 3 months after phacoemulsification. Also, the mean preoperative nasal angle widened from 17.80 ± 3.45 preoperatively to 36.18 ± 4.47 3-month postoperative. The mean preoperative AC volume was 49.4 ± 5.73 μL. After surgery the AC volume increased significantly to 138.2 ± 29.78 μL. The mean preoperative ACD was 1.58 ± 0.12 mm that deepened significantly after surgery to 3.19 ± 0.43 mm.

Conclusion:

Early phacoemulsification is very effective in treatment of AACG cases immediately after medical control of high IOP and resolution of corneal oedema. This was proved by imaging and measuring the angle width, anterior chamber volume and anterior chamber depth using AS- OCT and Pentacam.
Central Application Service for Physician Assistants Fifteen-Year Data Report 2002–2016
Authors: Hussaini Sobia Shariff , Coplan Bettie , Gillette Chris , Russell Gregory B. , McDaniel M. Jane
Published: August 2023

Purpose

This study highlights trends in available physician assistant (PA) applicant and matriculant data over the first 15 years of the Central Application Service for Physician Assistants (CASPA) service (2002–2016). This study expands knowledge identified in the CASPA 10-year data report.

Methods

This was a retrospective analysis of CASPA data from all CASPA-participating PA programs between 2002 and 2016. Central Application Service for Physician Assistants staff verified all applicant academic information. In addition, beginning in 2007, the online CASPA admissions portal linked matriculant data with applicant data.

Results

During the first 15 years of the CASPA service, there was a 194% increase in the number of CASPA-participating programs (from 68 to 200) and a 409% increase in the number of total applicants. Several trends identified in the CASPA 10-year report persisted, including increasing grade point averages among applicants and matriculants and lower matriculation rates among underrepresented minority applicants and applicants who reported economic disadvantage.

Conclusion

This 15-year comprehensive analysis of the CASPA data will benefit the profession by providing historical information that faculty and policymakers can use as a basis for developing and evaluating future admissions policies and practices.
Personal health behaviors and physical activity and nutrition counseling by nurse practitioners: An online survey
Authors: McCormick Sherry J. , Smith-Holmquist Natasha , Benton Melissa J.
Published: August 2023

Background:

Healthy lifestyle counseling improves nutritional intake and participation in exercise, yet the rate of patient counseling varies and clinicians' personal behaviors can influence counseling practices.

Purpose:

This cross-sectional study evaluated lifestyle counseling by nurse practitioners (NPs) and the relationship between their personal behaviors and patient counseling.

Methodology:

Practicing NPs (N = 1,220) completed an online survey regarding personal behaviors and counseling for healthy body weight, moderate-vigorous physical activity, muscle strengthening, fruit and vegetable consumption, and dietary protein.

Results:

The majority reported counseling “usually” or “often” for healthy weight (54%), moderate-vigorous physical activity (53%), and fruits/vegetables (57%), whereas only 44% and 17% reported “usually” or “often” counseling for dietary protein and muscle strengthening. When NPs did not personally engage in the behavior, the odds for counseling were significantly reduced: NPs were 21% less likely to counsel for moderate-vigorous physical activity (odds ratio [OR] = 0.79 [0.65–0.97], p = .026), 27% less likely to counsel for muscle strengthening (OR = 0.73 [0.60–0.90], p = .004), 57% less likely to counsel for fruit/vegetable consumption (OR = 0.43 [0.35–0.54], p < .001), and 72% less likely to counsel for dietary protein (OR = 0.28 [0.18–0.45], p < .001). Personal body mass index did not predict counseling for a healthy weight.

Conclusion:

Although NPs report regular patient counseling regarding healthy lifestyle behaviors, the odds for counseling are increased approximately 20–75% when they engage in the behaviors themselves.

Implications:

Promotion of healthy behaviors during professional education may have long-term implications for preventive health counseling.
Speak-Up Behavior of Oncology Nurses
Authors: Gencer Ozge , Duygulu Sergul
Published: August 2023

OBJECTIVE

The aim of this study is to examine the mediating roles of organizational trust and structural empowerment on the speak-up behavior of oncology nurses.

BACKGROUND

Organizational trust can create opportunities for a good working environment. Structural empowerment is an important factor affecting the speak-up behavior of nurses. The intermediary roles of organizational trust and structural empowerment on speak-up behavior are not specific.

METHODS

A correlational descriptive research design was used, and 232 nurses from 2 different hospital levels (the Ministry of Health hospital and university hospital) responded to 4 questionnaires.

RESULT

The results reflect that organizational trust and structural empowerment are a factor on nurses' speak-up behavior.

CONCLUSION

The findings demonstrate that a work environment where organizational trust is developed and a structural empowerment framework is in place contributes to nurses' speak-up behavior among oncology nurses.
Systemic Immune-Inflammation Index is a Prognostic Predictor for Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis
Authors: Wei Chan-Juan , Xue Juan-Juan , Zhou Xiao , Xia Xiao-Shuang , Li Xin
Published: August 2023

Objective:

To investigate whether baseline systemic immune-inflammation index (SII) is associated with 3-month poor prognosis and early neurological outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis.

Patients and Methods:

A total of 221 consecutive patients were enrolled in the retrospective study. The primary endpoints were poor functional outcomes or death at 3 months. Secondary endpoints were early neurological deterioration (END) or symptomatic intracerebral hemorrhage within 24 hours. Receiver operating characteristic curve analyses was performed to assess the overall discriminative ability of SII in predicting the 4 endpoints. We also performed the Spearman correlation test to evaluate the relationship between SII and stroke severity. Univariable and multivariable logistic regression analyses were performed to evaluate the associations between SII and endpoints.

Results:

The cutoff values of SII were 504.99×109/L for predicting a 3-month poor prognosis (sensitivity, 70.9% and specificity, 69.6%), 524.47×109/L for predicting 3-month death (sensitivity, 78.9% and specificity, 59.9%) and 504.99×109/L for predicting END (sensitivity, 70.7% and specificity, 62.6%), respectively. A positive association between SII and the National Institutes of Health Stroke Scale was observed (r
s = 0.306, P < 0.001). Multivariable analyses indicated that SII was independently associated with 3-month poor prognosis [odds ratio (OR) = 5.384; 95% CI: 2.844-10.193; P < 0.001], 3-month death (OR = 2.592, 95% CI: 1.046-6.421, P = 0.040) and END (OR = 3.202, 95% CI: 1.796-5.707, P < 0.001).

Conclusion:

Increased baseline SII was associated with END and 3-month poor outcomes, and may act as a potential prognostic predictor for acute ischemic stroke patients treated with intravenous thrombolysis.
Venous Thromboembolism Prophylaxis After Spontaneous Intracerebral Hemorrhage
Authors: Dong Chang , Li Ying , Ma, MD Zhuang
Published: August 2023

Background:

Patients with spontaneous intracerebral hemorrhage (sICH) are at high risk for venous thromboembolism (VTE). The administration of mechanical and pharmacological VTE prophylaxis after sICH is important but challenging. The safety and efficacy of the optimal anticoagulant dose, timing, and type of VTE chemoprophylaxis in cases of sICH are still unclear, and clinicians are concerned that it may lead to cerebral hematoma expansion, which is associated with poor prognosis. Through this literature review, we aim to summarize the latest guidelines, recommendations, and clinical research progress to support evidence-based treatment strategies.

Review Summary:

It has been proven that intermittent pneumatic compression can effectively reduce the risk of VTE and should be used at the time of hospital admission, whereas gradient compression stockings or lack of prophylaxis in sICH cases are not recommended by current guidelines. Studies regarding pharmacological VTE prophylaxis in patients with ICH were reviewed and summarized. Prophylactic anticoagulation for VTE in patients with ICH seems to be safe and was not associated with cerebral hematoma expansion. Meanwhile, the prophylactic efficacy of anticoagulation for pulmonary embolism seems to be more obvious than that of deep vein thrombosis in patients with ICH.

Conclusions:

Clinicians should pay attention to the prevention and management of VTE after sICH. Intermittent pneumatic compression should be applied to patients with sICH on the day of hospital admission. After documentation of bleeding cessation, early initiation of pharmacological VTE prophylaxis (24 h to 48 h from sICH onset) seems to be safe and effective in pulmonary embolism prophylaxis.
Late-Onset COL4A1 Mutation with Recurrent Ischemic and Hemorrhagic Strokes
Authors: Lee Jenny J. , Patel Smit , Hinman Jason D.
Published: August 2023

Introduction:

Mutations in type IV collagen gene COL4A1 are identified as a cause of autosomal dominant cerebrovascular disease. We report an unusual late-onset presentation.

Case Report:

A 64-year-old male was found to have an ischemic stroke and diffuse white matter changes. Genetic testing revealed COL4A1 gene mutation of heterozygous Alu insertion at intron 16. Alu elements are known as “jumping genes,” and Alu insertion is not previously reported in COL4A1 genetic syndromes. Our case has attributes consistent with a heritable leukoencephalopathy: (1) late-onset presentation, (2) intracerebral hemorrhages and microbleeds, (3) bilateral symmetrical leukoencephalopathy, (4) recurrence over a short period of time, (5) bilateral retinopathy, and (6) family history notable for brain aneurysm, kidney diseases, and early-onset stroke.

Conclusions:

Although the majority of COL4A1 genetic syndromes featuring cerebral small vessel disease are in children, this case highlights a late-onset patient with key features of COL4A1 syndromes associated with a heterozygous Alu intronic insertion.
Recurrent Cerebral Infarction Due to Moyamoya Disease Complicated With Systemic Lupus Erythematosus
Authors: Wang Qisong , Yao Qiang , Yuan Si , Shen Yan , Feng Yang , Liu Luji , Zhu Yipu , Zhao Yanying , Cui Junzhao , Qin Jin , Tian Jing , Zhao Ruijie , Liu Lijuan , Zhou Yicong , Liu Xiaoyun
Published: August 2023

Introduction:

We report a rare case of moyamoya disease caused by an RNF213 mutation, complicated with systemic lupus erythematosus.

Case Report:

A 32-year-old woman experienced 4 cerebral ischemia stroke events within 6 months. The main symptom was left limb weakness with blurred vision in the right eye. Results of digital subtraction angiography conducted at another hospital were consistent with moyamoya disease. On genetic testing, we found that the patient carried 2 mutations in the moyamoya disease-related gene RNF213 (p.R4810K, p.T1727M). On the basis of the laboratory immunologic indicators, such as positive antibodies and abnormal immunoglobulin levels and imaging examinations, the patient was finally diagnosed as moyamoya disease complicated with systemic lupus erythematosus. She was treated with aspirin, butylphthalide, urinary kallidinogenase, and sodium methylprednisolone.

Conclusions:

This was a 32-year-old young patient diagnosed with moyamoya disease carrying RNF213 gene mutation and accompanied by lupus with cerebral ischemic event as the first occurrence. The patient’s condition was complex; therefore, comprehensive analysis and in-depth consideration were needed to avoid a missed diagnosis and misdiagnosis. When the primary disease cannot be identified, genetic testing can help to clarify the diagnosis of moyamoya disease.
Sporadic Creutzfeldt-Jakob Disease Initially Presenting With Posterior Reversible Encephalopathy Syndrome
Authors: Mikhaiel John P. , Parasram Melvin , Manning Thomas , Al-Dulaimi Mohammed W. , Barnes Erin C. , Falcone Guido J. , Hwang David Y. , Prust Morgan L.
Published: August 2023

Introduction:

Sporadic Creutzfeldt-Jakob disease (sCJD) is a fatal neurodegenerative condition caused by prion proteins. Cortical and subcortical diffusion-weighted imaging restriction on magnetic resonance imaging (MRI) is associated with sCJD. Posterior reversible encephalopathy syndrome (PRES) results from impaired vessel autoregulation due to an identifiable trigger, which is associated with subcortical fluid-attenuated inversion recovery changes on MRI. We report a case of sCJD initially presenting with PRES.

Case Report:

A 70-year-old woman presented to an outside hospital with progressive confusion and difficulty in managing activities of daily living. Initial examination revealed stuporous mental state and stimulus-induced myoclonus. MRI revealed bilateral subcortical occipital lobe T2-fluid-attenuated inversion recovery hyperintensities without contrast enhancement suggestive of PRES. Electroencephalogram (EEG) revealed frequent generalized periodic discharges meeting criteria for nonconvulsive status epilepticus. Clinical examination and EEG did not improve despite escalating antiseizure medications. Initial lumbar puncture was unremarkable. She was transferred to our hospital with a presumptive diagnosis of PRES, although there was no clear trigger. Continuous EEG revealed ongoing generalized periodic discharges with myoclonic activity meeting criteria for myoclonic seizures that were refractory to multiple antiseizure medications. Repeat MRI showed resolution of PRES but revealed subtle diffuse cortical diffusion-weighted imaging restriction. Repeat lumbar puncture was performed and 14-3-3 and real-time quaking-induced conversion returned positive, confirming sCJD.

Conclusions:

This case reports highlights that sCJD can present with neuroimaging consistent with PRES. The diagnosis of sCJD should be considered in patients with PRES who continue to show neurological decline despite optimal management and radiographic improvement of PRES on MRI. Further research is needed to identify a pathophysiological relationship between these clinical phenotypes.
Clinical Profile and Outcome of Young Infants With Hypernatremic Dehydration Presenting to the Emergency Department
Authors: Tanwar Priya , Kapoor Kanika , Kumar Ajay , Gangopadhyay Sukanya , Gera Rani
Published: August 2023

Objectives

The aim of this study was to evaluate the clinical profile and outcome of young infants presenting to the pediatric emergency department with hypernatremic dehydration.

Methods

A prospective observational study was conducted at a tertiary care teaching hospital over a period of 18 months. All outborn sick young infants aged 2 months or younger who presented to the emergency department with symptoms and signs of possible sepsis and/or dehydration were screened, and those with hypernatremia were enrolled in the study. Those infants born at less than 37 weeks of gestation and gross congenital anomaly were excluded. Hypernatremic dehydration was defined as serum sodium levels (Se Na+)higher than 145 mEq/L. Variables used in the study were defined as per standard definitions. Acute kidney injury was defined and staged using serum creatinine as per modified neonatal Kidney Disease Improving Global Outcome guidelines. Clinical presentation, laboratory parameters, and comorbidities were compared among outcome groups (survived and died).

Results

Of 1124 outborn young infants who met the eligibility criteria for screening, 63 were diagnosed to have hypernatremic dehydration and 55 were enrolled. The hospital-based period prevalence of hypernatremic dehydration in young infants was 4.89%. The median age of presentation was 17 days (10–30). Male-to-female ratio was 1.1:1. Seventy-three percent were first in birth order. Feeding pattern showed 61.8%, 30.9%, and 7.3% of infants were exclusively breastfed, top fed, and mixed fed, respectively. The median serum sodium at the time of admission was 160 (153.5–167) mg/dL. Three (5.5%) infants had mild, 39 (70.9%) had moderate, and 13 (23.6%) had severe hypernatremic dehydration. There was statistically significant correlation between median platelet count with severity of hypernatremic dehydration. The mean time taken to correct serum sodium level was 3.30 ± 1.60 days. The case fatality rate was 41.8%. Those who died had statistically more severe hypernatremic dehydration, acute kidney injury, sepsis, and need for ventilation.

Conclusions

Acute kidney injury stage 3, shock, and need for ventilation are associated with poor outcome in infants with hypernatremic dehydration
Reconstructing Pinch Strength after Ulnar Nerve Injury by Transferring the Opponens Pollicis Motor Branch
Authors: Bertelli Jayme Augusto
Published: August 2023

Background:

With ulnar nerve injuries, paralysis of the first dorsal interosseous and adductor pollicis muscle weakens the patient’s pinch. In the palm, we transferred the opponens pollicis motor branch to the deep terminal division of the ulnar nerve for pinch reconstruction.

Methods:

Sixteen patients with ulnar nerve injuries around the elbow underwent reconstruction and were followed up postoperatively for a minimum of 14 months. Their mean age was 41 ± 16 years, and the mean interval between injury and surgery was 134 ± 126 days (range, 2 to 390 days). Preoperatively and postoperatively, grasp, key, and subterminal key pinch strength were measured using dynamometers.

Results:

Reinnervation of the first dorsal interosseous muscle was observed in 15 of the 16 patients. Mean grasp strength improved from 15.5 ± 8.5 kg preoperatively to 24 ± 10 kg postoperatively, achieving 57% ± 16% of contralateral hand strength. Preoperatively, terminal key pinch averaged 3 ± 1 kg, which improved postoperatively to 5.5 ± 2 kg, achieving 71 ± 24% of the strength measured contralaterally. Preoperatively to postoperatively, subterminal key pinch force increased from 0 to 2.4 ± 1.3 kg, achieving 61% ± 27% that of the unaffected side. Patients who underwent surgery within 6 months of their injury showed a mean subterminal key pinch strength recovery of 63% ± 27% of the normal side, whereas those who underwent surgery between 7 and 13 months after injury showed a mean subterminal key pinch strength recovery of 51% ± 29%.

Conclusion:

Transferring the opponens pollicis motor branch to the deep terminal division of the ulnar nerve improved pinch and grasp strength without jeopardizing thumb function.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.