bluuebunny/crossref_metadata_2025 huggingface dataset:
HPB SO61 - Benefits of Dual-surgeon On-call team on Emergency Laparoscopic Cholecystectomy – a Single Centre Experience
Authors: Moscalu Andrei , Joshi Dipti , Jerin Sabu , Kathayat Lok , Nasef Hazem , Atkari Bence , Liao Christopher
Published: November 2024

Background

Since 2015, UK national guidance from National Institute for Health and Care Excellence (NICE) has been to offer laparoscopic cholecystectomy for patients presenting with acute cholecystitis within 7 days of admission. The aim of this study was to measure the benefits of a second team of surgeons doing emergency operations (first team dealt with emergency admissions and referrals) in terms of length of stay, conversion to open, morbidity, mortality, bile duct injury and rate of early cholecystectomy in a UK based district general hospital.

Method

Retrospective analysis of a prospectively maintained database was collected from electronic health records, admission and operative notes. Results were extracted in terms of index laparoscopic cholecystectomy, rate of conversion, intra-operative cholangiography, associated morbidity, mortality, bile duct injury, conversion to open, readmission rate and length of stay. The numbers and rates of cholecystectomy over the last six years duration was collected and compared year-on-year period, since early 2019 after the implementation of dual-surgeon on-call cover.

Results

Altogether, there was 944 cholecystectomy performed within 14 days, out of which 74% of cases was operated within the first week of presentation <8 days since admission. Majority of cholecystectomy was performed laparoscopically, there were twenty-three (2.43%) conversion to open, forty-six sub-total cholecystectomies (4.87%),intraoperative cholangiography was performed in 28.4% of cases and Indocyanine green (ICG) cholangiography was used in 50.5% of all cases. Average length-of-stay (LOS) was 2.2 days, there were eight cases (0.84%) of post-op bile leak, one bile-duct injury, one case of post-operative bleed, one case of small bowel injury and two deaths.

Conclusion

With the adoption of dual-surgeon on call, early laparoscopic cholecystectomy benefits both patient and hospital. It reduces time to surgery for patients, decreases overall length of stay, and reduces readmission rates and cost, with similar morbidity and mortality.
HPB SO62 - Association of positive bile cultures and the incidence of pancreatic fistulas post pancreaticoduodenectomy[PD]
Authors: Atluri Lakshmi Malvika , Chong Kenneth , Subar Daren
Published: November 2024

Background

Postoperative pancreatic fistula (POPF) remains a significant complication post pancreaticoduodenectomy (PD). Recent publications show no increased incidence of POPF due to positive bile cultures. A literature search on PubMed did not show any review on the relevance of specific cultures and their exact incidence of POPF.

POPF is defined as Drain Amylase greater than three times its serum level on or after postoperative day 3. A relatively benign clinical course is grade A, moderately unwell patients requiring medical/minimal intervention (grade B), and critically ill patients with sepsis, requiring invasive intervention (grade C). Grade B + C is defined as CR-POPF.

Method

A retrospective single-centre analysis of all patients with pancreaticoduodenectomy between 2017 and 2021 was reviewed. The clinical data that were reviewed were age, gender, length of stay[LOS], tumour staging, mortality rates, Pancreatic duct[PD], Pre-op stenting, the documented incidence of POPF/CR-POPF, Intra-Operative Bile Cultures[IOBC] and antibiotic sensitivity.

The primary outcome was POPF. Secondary outcomes were 90-day mortality, LOS, return to theatre, Postoperative haemorrhage (POPH), and organ-specific relevance of POPF. All data was analysed using SPSS IBM version 29. P< 0.05 was taken as clinically significant.

Results

100 patients were included in the study. The mean age was 68.8 (SD-9.5). The M: F ratio was 54:46. The mean postoperative length of hospital stay was 19.38 days. 48 patients (48%) were diagnosed with a POPF, among which, 22 patients (47.8%) developed a CR-POPF. 57 patients had a positive IOBC. The incidence of POPF in patients with Positive IOBC was 43/57(75.43%) and that was 5/43(11.62%) of the patients with Negative IOBC (P < .0001).10% of patients had postoperative haemorrhage (POPH). 9% had 90-day mortality. All 9% of patients who had a return to theatre had POPF.

Conclusion

Univariate analysis and logistic regression demonstrated that a positive IOBC had a higher associated incidence of POPF who underwent PD, with Klebsiella being the most common and statistically significant[P<.005]. The most common antibiotic found to be sensitive was Gentamicin, which is 25 per cent and, in combination with Co-amoxiclav, was found to be sensitive in 21.8% of cases. However, this is a single-centre retrospective study with variable operative techniques for different patient groups. Further studies would be warranted before correlating any results to all populations of patients developing POPF post pancreaticoduodenectomy.
HPB SO65 - An audit of the day-case rate of laparoscopic cholecystectomies at a busy district general hospital and factors affecting this
Authors: Stobiecka Roksana , Dunstan Matthew , Thomas Rhys
Published: November 2024

Background

The target day case rate of laparoscopic cholecystectomies at a busy district general hospital is 75%, as per Model Hospital Guidelines. The current rate at which day cases are achieved is 55%. This audit aims to identify factors relating to the DGH not reaching their day case target and explore potential solutions for these, with the intention to reduce patient’s hospital stay and, therefore, overall costs.

Method

119 patients had undergone a laparoscopic cholecystectomy in the first five months of 2024. Exclusion criteria included hot cholecystectomies, common bile duct explorations and planned admissions. The remaining 85 patients were included in this audit. The data proforma included age, ASA, BMI, co-morbidities, Nassar grade, scheduled and actual time of operation and any reasons for delay.

Results

Of the 85 patients included in this audit, 34% (29) were not daycases. 11 remained an inpatient due to post-operative nausea or pain, 3 due to requiring an MRCP, 9 were kept in for monitoring, 2 had intraoperative bleeding, 3 had social issues and 1 required IV antibiotics. 58% of the 29 had afternoon operations. 48% of the 29 had a Nassar grade of greater than 1. 38% of the 29 had a BMI greater than 30.

Conclusion

Various reasons for a case to not achieve daycase status were found, with the most common being post-operative pain or nausea. It would prove beneficial to educate patients on common post-operative symptoms and focus on managing these symptoms effectively. Pre-operative appointments should aim to explore a patients home setting at the time of the operation and ensure to book inpatient stays for those who require it, in advance. Theatre lists should be optimised by giving high-risk patients morning slots.
HPB SO68 - Evaluating the Outcome of Laparoscopic Cholecystectomy Against Key Performance Indicator (KPI) of the British Benign Upper GI Surgical Society (BBUGSS)
Authors: Zubair Farhan , Di Rollo Domenic , Khan Khurram Shahzad
Published: November 2024

Background

Laparoscopic cholecystectomy (LC) presents inherent challenges and potential for significant complications, influenced by both patient factors and surgical expertise. Recognizing this variability, the British Benign Upper GI Surgical Society (BBUGSS) has established Key Performance Indicators (KPIs) aimed at enhancing LC outcomes. This study conducts an audit of LC outcomes in a single centre district general hospital (DGH) in accordance with BBUGSS KPIs and thus aims to determine if quality LC by modern standards is achievable in a DGH.

Method

The present retrospective observational study examined all adult LC conducted between August 2022 and June 2024 by two specialized biliary surgeons at a single surgical unit within a DGH, which also serves as a referral center of biliary cases from affiliated hospitals. The analysis encompassed preoperative assessments, intraoperative observations, and postoperative outcomes, with a focus on aligning these findings against the benchmarks established by the BBUGSS KPIs.

Results

141 patients were included; median age was 54 years (IQR 41-64) and 59.6% were female. 37.6% were emergency cases, 44.2% were for acute cholecystitis, 22.7% for gallstone pancreatitis and 63.1% underwent intra-operative cholangiogram. KPIsBBUGSS StandardOur resultDay case for elective cases50%42%Readmission (within 30 days)<10%4.3%Laparoscopic cholecystectomy for acute cholecystitis (within 7 days)>35%97%Laparoscopic cholecystectomy for gallstone pancreatitis (within 2 weeks)>95%100%Conversion to open<5%0.7%Morbidity<10%1.4%Bile leak after elective surgery<1.5%0%Retained bile duct stones<2.5%0%Bile duct injury<0.3%0%Mortality<0.1%0%

Conclusion

This study shows that with the exception of day-case rate in elective LC, all KPIs were satisfactorily achieved, indicating that high quality LC is achievable within a DGH. The majority of readmissions within 30 days were related to inadequate postoperative analgesia. We have since enhanced pain management pathways. It is hoped that this will also improve same day discharge for elective cases to achieve BBGUGS standard. We are committed to conducting annual audits to monitor and optimize surgical outcomes and would encourage other centers to consider adopting the same approach.
HPB SO70 - Evaluating the Outcome of Laparoscopic Common Bile Duct Exploration Against Key Performance Indicator (KPI) of the British Benign Upper GI Surgical Society (BBUGSS)
Authors: Zubair Farhan , Di Rollo Domenic , Khan Khurram Shahzad
Published: November 2024

Background

Treatment of common bile duct (CBD) stone(s) can be challenging with a risk of significant complications. Laparoscopic common bile duct exploration (LCBDE) displays superior outcomes when compared to endoscopic retrograde cholangiopancreatography (ERCP). Acknowledging the impact of patient variables and surgical proficiency, the British Benign Upper GI Surgical Society (BBUGSS) developed Key Performance Indicators (KPIs) to optimize LCBDE outcomes. The present study comprises an audit of LCBDE outcomes with respect to the BBUGSS KPIs and aims to determine the feasibility and quality of LCBDE that can be achieved in a district general hospital (DGH) with a recently developed LCBDE service.

Method

This retrospective observational study examined all adult patients who underwent LCBDE between August 2022 and June 2024 by two specialized biliary surgeons at a single surgical unit within a DGH. This DGH also serves as a referral center for biliary cases from affiliated hospitals. The preference in our surgical unit is single stage management (laparoscopic cholecystectomy and simultaneous LCBDE) of CBD stones in surgically fit patients. The analysis included preoperative assessments, intraoperative observations, and postoperative outcomes, with respect to the published BBUGSS KPIs for LCBDE.

Results

60 patients were eligible for inclusion; median age was 56 years (IQR 40-67) and 40 (66.7%) were female. 33 (55%) were emergency cases. 52 (86.7%) were transcystic exploration; of these 8 (15.4%) utilised basket-in-catheter and 44 (84.6%) utilised choledochoscopes. Median post-operative stay for transcystic exploration was 1 day (IQR 0-2) and for cholechodotomy 8 days (IQR 5-9). Key Performance IndicatorBBUGSS StandardOur outcomeConversion rates<10%0%Bile duct clearance rates>85%91.7%Bile Leak Rates<5%0%Returns to theatre<5%0%Readmission rates (within 30 days)<15%6.7%Overall Morbidity<15%3.3%Overall Mortality<1%0%

Conclusion

This study indicates that the BBUGSS KPIs for LCBDE are satisfactorily achieved in our centre. Adequate ductal clearance with minimal morbidity was achieved. Our outcomes are likely attributed to the recent commencement of a specialist biliary service and utilisation of predominantly transcystic approach, with the aid of electrohydraulic lithotripsy where needed, as opposed to choledochotomy. Furthermore, the present study suggests a high quality LCBDE service is feasible in a DGH setting if there is sufficient clinical and managerial motivation. We suggest that single stage management of bile duct stones model should be considered in other similar centres.
HPB SO79 - Dropped Gallstones After Laparoscopic Cholecystectomy: An Umbrella Review
Authors: Abu Abduelraheim , Almoshantaf Mohammad
Published: November 2024

Background

The enduring presence of gallstones after laparoscopic cholecystectomy (LC) presents a substantial clinical obstacle, potentially resulting in morbidity and diagnostic intricacies, frequently leading to delayed identification.

This umbrella systematic review aims to investigate the available body of literature regarding the symptoms, signs, etiology, management strategies, and associated complications of retained gallstones.

Method

We performed an extensive search of the academic literature spanning several databases, namely PubMed, Embase, Scopus, Web of Science, and Google Scholar. Inclusion criteria for this research encompassed systematic reviews, with or without meta-analysis, focusing on the examination of spilled gallstones in terms of signs, symptoms, diagnosis, imaging, and management. The assessment of potential bias in the final study selection was undertaken utilizing the R-AMSTAR and Risk of Bias in Systematic Reviews (ROBIS) assessment tools.

Results

The most sites for lost gallstones were the subhepatic, perihepatic, retroperitoneal, right flank and pelvic regions. A higher proportion of patients underwent emergency laparoscopic cholecystectomy compared to those who underwent elective procedures. complications included intra-abdominal abscesses, foreign body granulomas, parietal wall abscesses or pelvic abscesses. Multiple stones more common than single stones. Various clinical presentations have been documented, including the presence of abdominal masses simulating malignancy, intestinal obstruction, pelvic pain or fistula formation. Surgical intervention emerged as the primary treatment approach. Computed tomography was the most frequently employed diagnostic modality for stone identification (70.2%), ultrasonography (US) (63.2%) and X-ray (42.9%).

Conclusion

Our study highlights the overlooked issue of spilled gallstones post-laparoscopic cholecystectomy, posing diagnostic challenges and potential complications. Surgeons and patient education regarding this is lacking, stressing the need for increased awareness. Comprehensive studies with larger cohorts are essential for understanding risk factors and developing effective interventions.
Pangenome Reveals Gene Content Variations and Structural Variants Contributing to Pig Characteristics
Authors: Du Heng , Zhuo Yue , Lu Shiyu , Li Wanying , Zhou Lei , Sun Feizhou , Liu Gang , Liu Jian-Feng
Published: November 2024

Pigs are among the most essential sources of high-quality protein in human diets. Structural variants (SVs) are a major source of genetic variants associated with diverse traits and evolutionary events. However, the current linear reference genome of pigs limits the presentation of position information for SVs. In this study, we generated a pangenome of pigs and a genome variation map of 599 deep-sequenced genomes across Eurasia. Moreover, a section-wide gene repertoire was constructed, which indicated that core genes were more evolutionarily conserved than variable genes. Subsequently, we identified 546,137 SVs, their enrichment regions, and relationships with genomic features and found significant divergence across Eurasian pigs. More importantly, the pangenome-detected SVs could complement heritability estimates and genome-wide association studies based only on single nucleotide polymorphisms. Among the SVs shaped by selection, we identified an insertion in the promoter region of the TBX19 gene, which may be related to the development, growth, and timidity traits of Asian pigs and may affect the gene expression. Our constructed pig pangenome and the identified SVs provide rich resources for future functional genomic research on pigs.
Confronting Rifles with Words: The High Islamic Council of Mali and Non-State Armed Groups
Authors: Parisi Piergiuseppe
Published: November 2024

Since the 2012 Tuareg rebellion and the takeover of large areas in the north of Mali by Islamic fundamentalist groups, Muslim religious leaders in the country have spearheaded important negotiation initiatives under the auspices of the High Islamic Council of Mali (HCIM). On more than one occasion, these initiatives have led to the liberation of detainees or the possibility of humanitarian convoys reaching communities caught in the midst of the armed conflict. Why were these initiatives successful (or unsuccessful)? How did religious leaders convince non-state armed groups to adopt conduct that complies with basic humanitarian norms? Drawing on desk-based and fieldwork research conducted as part of the Generating Respect Project, this article seeks to answer these questions and to identify the endogenous and contextual factors that contributed to the successes of the HCIM and its negotiators.
Association between physical activity patterns of working-age adults and social jetlag, depressive symptoms, and presenteeism
Authors: Seol Jaehoon , So Rina , Murai Fumiko , Matsuo Tomoaki
Published: November 2024

Objectives: This study aimed to evaluate the association of physical activity with social jetlag, depressive symptoms, and presenteeism.

Methods: This cross-sectional study included 8247 working-age adults (females, 44.6%; age, 20-64 years). Social jetlag was defined as the absolute difference between the midpoint of bedtime and wake time on workdays and free days. Depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale, and presenteeism was evaluated using the Work Functioning Impairment Scale. Exercise habits were classified into 4 groups based on the World Health Organization guidelines: nonactive (NA; n = 4223), insufficiently active (IA; n = 3009: exercise below guideline levels), weekend warriors (WW; n = 220: exercise 1-2 times per week meeting guideline levels), and regularly active (RA; n = 793: exercise at least 3 d/wk meeting guideline levels). Using multiple and Poisson regression analyses, we examined the association between exercise habits and each outcome.

Results: Social jetlag, depression, and presenteeism were more favorable with shorter sedentary times and longer durations of moderate- and vigorous-intensity exercise. Compared with the RA group, the NA group had a significantly higher prevalence of social jetlag (prevalence ratio [PR] = 1.30), depression (PR = 1.31), and presenteeism (PR = 1.35). The IA group had a significantly higher prevalence of depression (PR = 1.33) and presenteeism (PR = 1.38).

Conclusions: Exercising with a certain frequency and intensity may help prevent symptoms of depression and social jetlag, and consequently prevent presenteeism.
Goals of care conversations and advance care planning for paediatric patients living with serious illness
Authors: Rapoport Adam
Published: November 2024

Goals of care discussions and advance care planning aim to align the values and wishes of patients and their families with the care received. All paediatric health care practitioners who care for fetuses, infants, children or adolescents with serious illnesses have an ethical responsibility to educate themselves about these aspects of care. This statement assists care providers with important conversations. Effective communication is essential to clarify the goals of care and establish agreement on appropriate treatments for achieving those goals, including resuscitative and palliative measures.
Evaluation of a complex intervention: the Latch On randomized controlled trial of multicomponent breastfeeding support for women with a raised body mass index
Authors: McNestry Catherine , Hobbins Anna , Donnellan Niamh , Gillespie Paddy , McAuliffe Fionnuala M , O’Reilly Sharleen L ,   Latch On Consortium, McGuinness Denise , Killeen Sarah Louise , Mehegan John , Coughlan Barbara , O’Brien Eileen C , Conway Marie , O'Brien Denise , Szafranska Marcelina , Brosnan Mary , Sheehy Lucille , Murtagh Rosie , O'Hagan Lorraine , Corbett Marie , Walsh Michelle , Keogh Regina , Power Paula , Woodcock Marie , Phelan Mary , Carroll Amy , Murray Stephanie , Scallan Charmaine , Dunn Elizabeth
Published: November 2024

Background

Latch On’s objective was to achieve improved breastfeeding rates in women with raised body mass indices using a multicomponent breastfeeding support intervention.

Methods

A hybrid type 1 implementation-effectiveness trial with mixed-methods process and health economics analyses were conducted. Data collection included stakeholder questionnaires, interviews, focus groups, fidelity data, participant and health system costs.

Results

The intervention was delivered with fidelity but the high breastfeeding rates at 3 months were not different between intervention and usual care. Participants receiving the minimum intervention dose were more likely to initiate breastfeeding (P = 0.045) and be breastfeeding at hospital discharge (P = 0.01) compared with participants below the threshold. Participant exit interview themes highlighted the importance of improving breastfeeding support to women, the effect of COVID-19 on the breastfeeding experience, and found that the intervention improved the experience of establishing breastfeeding. The intervention cost €157 per participant, with no other cost difference between groups. Process analysis found that follow-up breastfeeding services continued in half of sites after study completion.

Conclusions

This low-cost intervention resulted in a more enjoyable breastfeeding experience for participants and changed practice in some study sites. The intervention dose received may impact effectiveness, but further research is needed to provide definitive evidence of clinical and cost effectiveness.
Mitochondrial Dysfunction and Cognitive Impairment in Schizophrenia: The Role of Inflammation
Authors: Wang Guanyu , Liu Senqi , Fan Xiaoyun , Li Jinming , Xue Qianzi , Liu Kang , Li Xue , Yang Yongfeng , Wang Xiujuan , Song Meng , Shao Minglong , Li Wenqiang , Han Yong , Lv Luxian , Su Xi
Published: November 2024

Background and Hypothesis

The complex immune-brain interactions and the regulatory role of mitochondria in the immune response suggest that mitochondrial damage reported in schizophrenia (SZ) may be related to abnormalities observed in immune and brain functions.

Study Design

Mitochondrial DNA copy number (mtDNA CN), a biomarker of mitochondrial function, was assessed in peripheral blood leukocytes (PBLs) of 121 healthy individuals and 118 SZ patients before and after 8 weeks of antipsychotic treatment, and a meta-analysis related to blood mtDNA CN was conducted. Plasma C-reactive protein (CRP) levels in SZ patients were obtained from the medical record system. Spearman correlation analysis and hierarchical linear regression were used to analyze the relationships among mtDNA CN, CRP levels, and cognitive function. A mediation model was constructed using the PROCESS program.

Study Results

Our results revealed the decreased mtDNA CN in PBLs from SZ patients (P = .05). The meta-analysis supported the decreased blood mtDNA CN in SZ patients (P < .01). The mtDNA CN in PBL was positively correlated with working memory (P = .02) and negatively correlated with plasma CRP levels (P = .039). Furthermore, a lower mtDNA CN in PBL in SZ patients was a significant predictor of worse working memory (P = .006). CRP acted as a mediator with an 8.0% effect.

Conclusions

This study revealed an association between peripheral mitochondrial dysfunction and cognitive impairment in SZ, with inflammation acting as a mediating effect. Therefore, mitochondrial dysfunction might provide novel targets for new treatments for cognitive impairment in SZ.
What is ‘high-risk research’? Comparing the social sciences and humanities and the natural sciences
Authors: Hamann Julian , Stein Daniel
Published: November 2024

Although high-risk research is a key concern for research policy and science studies, there is little knowledge about what funding agencies or researchers mean by risks. This paper draws on 80 grant proposals from the social sciences and humanities (SSH) and the natural sciences (NSC) that have been submitted to the Reinhart Koselleck funding program of the German Research Foundation. The qualitative analysis shows both similarities and differences in how applicants in the two fields claim risks: in both fields, the most prominent notions refer to results and methodologies. While results at risk are interpreted similarly, methodological risks differ between the two fields. The analysis also reveals a greater variety of different risks in the SSH compared to the NSC. The paper suggests that research policy and science studies should avoid treating “riskiness” as a given and consider different notions of risk across a disciplinary spectrum that includes the SSH.
Proteomics reveals that nanoplastics with different sizes induce hepatocyte apoptosis in mice through distinct mechanisms involving mitophagy dysregulation and cell cycle arrest
Authors: Lu Yan-Yang , Hua Weizhen , Sun Yiqiong , Lu Lu , Ren Hongyun , Huang Qingyu
Published: November 2024

Nanoplastics (NPs) can penetrate the intestinal barrier of organisms and accumulate in the liver, thereby inducing hepatocyte apoptosis. However, the underlying mechanisms remain incompletely elucidated. This study examined the effects of PS-NPs exposure on hepatocyte apoptosis and revealed the role of cell cycle arrest and mitophagy. The C57BL/6 mice were administered a diet containing 100 nm and 500 nm PS-NPs at a concentration of 0.1 g/kg for 180 days, respectively. TUNEL staining confirmed that 100 nm PS-NPs induced more pronounced apoptosis compared to 500 nm PS-NPs in mouse liver. Mechanistically, proteomic analysis revealed that Pdcd2l, associated with the S phase of cell cycle and apoptosis, exhibited the highest fold changes among all detected proteins in 100 nm and 500 nm PS-NPs exposure groups. Notably, the expression of Tbc1d17, Bcl2l13, and Pgam5 involved in mitophagosome formation in mouse liver was upregulated by 100 nm PS-NPs but not by 500 nm PS-NPs; moreover, mitophagosomes were observed in HepG2 cells exposed to 100 nm PS-NPs. Additionally, 100 nm PS-NPs internalized by HepG2 cells could penetrate lysosomes. The protein levels of Igf2r and Rab7a were altered, and p62 mRNA expression was increased in mouse liver, suggesting 100 nm PS-NPs, but not 500 nm PS-NPs, impaired lysosomal function and subsequently inhibited mitophagy degradation. Collectively, 500 nm PS-NPs induced Pdcd2l-mediated cell cycle arrest, thereby exacerbating hepatocyte apoptosis; while 100 nm PS-NPs not only triggered similar levels of cell cycle arrest as 500 nm PS-NPs, but also disrupted mitophagy, which was also associated with hepatocyte apoptosis.
Plant Viral Synergism: Co-expression of P1 and NIaPro Cistrons of Wheat Streak Mosaic Virus and Triticum Mosaic Virus Is Required for Synergistic Interaction in Wheat
Authors: Wong Chi Hzeng , Alexander Jeffrey , Tatineni Satyanarayana
Published: November 2024

Synergistic interactions among unrelated viruses in mixed infections can cause significant yield losses, and viral determinants of these interactions are poorly understood. Wheat ( Triticum aestivum L.) co-infection with wheat curl mite-transmitted wheat streak mosaic virus (WSMV) and Triticum mosaic virus (TriMV) results in disease synergism with a drastically increased symptom phenotype of stunted growth, leaf bleaching, and enhanced titers of both viruses compared with individual virus infections. In this study, we examined the viral determinants responsible for WSMV-TriMV disease synergism through transient expression of select cistrons of WSMV in wheat through TriMV and vice-versa. We found that expression of WSMV P1, NIa, or NIaPro in wheat through TriMV or vice-versa elicited moderate to severe symptoms with a moderate or no increase in virus titer. However, co-expression of P1 and NIaPro of WSMV in wheat through TriMV or vice-versa exhibited a WSMV-TriMV disease synergism-like phenotype with enhanced accumulation of genomic RNA copies and coat protein. Additionally, we found that the P3 of both viruses is dispensable for synergism. HCPro and NIaVPg of WSMV and TriMV are not the primary determinants but might have a minor role in efficient synergism. In co-infected wheat, the accumulation of virus-specific small interfering RNAs (vsiRNAs) was increased, similar to viral genomic RNA copies, despite the presence of two viral RNA-silencing suppressors (VRSS), which function through sequestration of vsiRNAs. Our findings revealed that WSMV-TriMV disease synergism is not caused by the suppression of host posttranscriptional gene silencing by two VRSS proteins in co-infected wheat, and the P1 and NIaPro of both viruses collectively drive synergistic interactions between WSMV and TriMV in wheat.

[Formula: see text] The author(s) have dedicated the work to the public domain under the Creative Commons CC0 “No Rights Reserved” license by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law, 2025.
Ciprofloxacin Dosage Optimization in Cystic Fibrosis Through Therapeutic Drug Monitoring
Authors: Sayadi Hamza , Fromage Yeleen , Monchaud Caroline , Languepin Jeanne , Masson-Rouchaud Alexandra , Labriffe Marc , Woillard Jean-Baptiste
Published: November 2024

Background:

Ciprofloxacin (CIP) is effective against many Gram-negative pathogens and penetrates well into respiratory secretions and pulmonary tissues, thus making it useful for treating respiratory infections in patients with cystic fibrosis (CF).

Methods:

A 13-year-old patient with severe CF and an acute respiratory exacerbation from multidrug-resistant Pseudomonas aeruginosa was treated with 700 mg of CIP every 8 hours. Bronchial secretions confirmed that P. aeruginosa was sensitive to high doses of CIP. Pharmacokinetic monitoring using 2 blood samples estimated the AUC24 at 50 hours*mg/L. This led to an increase in CIP dosage to 850 mg three time a day (TID), then to 1000 mg TID, and finally to 1200 mg every 6 hours.

Results:

CIP pharmacokinetics can vary significantly, particularly in patients with CF due to increased clearance, ultimately resulting in shorter half-lives and higher risks of therapeutic failure and resistance. Therapeutic drug monitoring helps when adjusting dosages to maintain effective blood concentrations.

Conclusions:

This case underscores the role of therapeutic drug monitoring in optimizing CIP dosing for patients with CF and highlights the necessity for close collaboration between clinicians and pharmacologists to ensure effective antibiotic exposure.
Postburn Abdominal Pain of Gastrointestinal Origin: A Scoping Review
Authors: Soltany Amjad , Hraib Munawar , Apelian Shant , Mallouhy Alin , Kounsselie Edwar , Diab Souliman
Published: November 2024

After burn injury, patients may have abdominal pain due to several causes and etiologies, some of which could be life-threatening, including pancreatitis, stress ulcers, Clostridium difficile infection, and so forth. This pain sometimes poses a major diagnostic challenge. This scoping review is the first reported review to address and discuss this entity of patients after burn injury in abdominal pain of gastrointestinal origin. A scoping review of PubMed, Google Scholar, and other electronic research sites was performed. All relevant articles of any study design were included in this review. Variables included in this study were sex distribution, age, related total burn surface area, incidence rate, characteristics of pain, diagnosis, management, outcomes, and mortality rate. The medical literature identified 114 articles. According to our inclusion criteria, 91 articles were reviewed in this article. Through these articles, we reviewed in detail the characteristics of postburn abdominal pain, the relevant diseases responsible for this complaint, the epidemiologic features of these diseases, and potential management approaches aiming to help burn specialists in making earlier diagnosis and, thus, timely treatment. Early recognition of postburn abdominal pain, as well as timely diagnosis and treatment, play a significant role in prognosis and mortality. Thus, it is extremely important for burn specialists and plastic surgeons to thoroughly investigate postburn abdominal pain. Also, one of the aims of this review was to shed light on the important role of the multidisciplinary team in burn patient management to improve the prognosis.
Vitreous Hydro-dissection with a Flute Needle for Inducing Posterior Vitreous Detachment in Pediatric Retinopathies
Authors: Guo Jingli , Zhou Yuhan , Zhao Chun , Gu Victoria Y. , Jiao Dian , Zhao Peiquan , Zhao Dongsheng
Published: November 2024

Purpose:

To present a novel intraoperative technique using a flute needle to induce posterior vitreous detachment (PVD) in pediatric retinal cases.

Methods:

Following 23-gauge pars plana vitrectomy in pediatric eyes with complex vitreoretinal disease, triamcinolone is applied for staining, and vitreous hydro-dissection is performed. A flute needle containing basic salt solution (BSS) is introduced to separate the thin residual posterior vitreous cortex from the retina near the vascular arcades. Gentle taps allow balanced salt solution (BSS) to enter the vitreous crevice, with controlled oscillation facilitating separation. PVD is then induced, and the vitrector is used to lift and complete the detachment.

Results:

Vitreous hydro-dissection with a flute needle was effective in inducing PVD in pediatric eyes with complex vitreoretinal disease. We report no intraoperative or postoperative complications.

Conclusion:

This adjuvant vitreous hydro-dissection technique facilitates PVD induction and may reduce the associated risk of iatrogenic retinal damage.
Epidemiology of International Patients with Lower-Limb Deficiencies Treated at a United States–Based Pediatric Prosthesis Clinic
Authors: Abouzaglo Shanee S. , Worrall Hannah M. , Shivers Claire , Jo Chan-Hee , Gill Corey S.
Published: November 2024

Introduction

Limited epidemiological or clinical research exists describing pediatric lower-limb deficiency (LLD) patients born outside the United States (US).

Objectives

The purpose of this study was to characterize a cohort of international patients treated at a single tertiary care orthopedic hospital. We set out to quantify the prevalence of international patients within a broader cohort of pediatric limb deficiency patients. In addition, we evaluated similarities and differences between adopted and nonadopted internationally born patients as well as their US-born counterparts.

Study Design

Retrospective chart review was performed on patients born outside the US between 1995 and 2020.

Methods

Patients were divided into groups based on place of birth, country of residence, and adoption status. Statistical analysis was performed using χ2 and t-test.

Results

A total of 111/579 (19.2%) patients seen in our limb difference clinic were born outside the US, with 39.6% adopted. Geographically, patients represented 32 countries, and 96.4% were born in low- or middle-income countries (LMICs). The most common causes of LLD were congenital malformations (72.1%), trauma (17.1%), and tumor (5.4%). Syme was the most common amputation level (26.6%), followed by knee disarticulation (23.7%) and transtibial (18.7%). Congenital diagnoses were more frequent in adoptees (93.1% vs. 58.2%), whereas nonadoptees often had trauma (25.4%) or tumor (8.9%) diagnoses leading to amputation (P = 0.0003). A total of 23/60 (38.3%) international patients with preexisting lower-limb amputations had never worn a prosthesis at the time of initial presentation.

Conclusions

Many pediatric patients with prosthetic needs presenting for care in the US were born in LMIC. Adopted and nonadopted internationally born patients had significant differences in clinical etiologies of their LLD.

Clinical Relevance Statement

Internationally born patients may constitute a substantial percentage of US-based specialty clinics treating children with lower-limb differences, particularly from low- or middle-income countries where access to orthopedic and prosthetic care may be limited. This study highlights the importance of multidisciplinary health care providers addressing these children’s distinct clinical needs for improved patient-centered care.
Rehabilitation of a quadruple amputee with leukemia: A challenging endeavor
Authors: Athani Badarinath , Pillai Ijaz N. , Prasad J Deepak , Shaji Aneeta
Published: November 2024

Making a person with quadruple amputation walk again is a challenging task for the rehabilitation team. Quadruple amputation secondary to symmetrical peripheral gangrene is a rare clinical scenario posing challenges in rehabilitation. Literature regarding rehabilitation of persons with multiple amputations is limited. This case describes the rehabilitation of a 57-year-old lady suffering from acute myeloid leukaemia who underwent quadruple amputation. She had undergone bilateral transtibial and bilateral transradial amputation after vasopressor-induced symmetrical peripheral gangrene. In view of expected guarded level of functional independence, ambulatory independence was the primary goal at admission to Department of PMR. The various steps taken in rehabilitation and modifications made to assistive devices are described in this article. Challenges faced during various phases of training, and subsequent ambulation are detailed in this article. Overcoming limitations, the client was made to be an indoor ambulator with appropriate prostheses and mobility aids. She was partially independent for activities of daily life after in-patient rehabilitation. The background of leukaemia and subsequent chemotherapy also affected the rehabilitation of this patient. Although various studies have described cases of quadruple amputation rehabilitation achieving functional independence and ambulation, the absence of specific guidelines and protocols make rehabilitation of persons with multiple amputations inefficient. This case study also shows the need for personalized goal setting for persons with multiple amputations. Realistic goal setting, psychological counselling, and an interdisciplinary approach are imperative in rehabilitation of persons with quadruple amputation. Flexible functional scales specific to persons with multiple amputations are necessary to evaluate such persons objectively. Studies with larger sample size, longer follow-ups, and comprehensive review of existing literature are needed to standardize rehabilitation of quadruple amputation and evaluate the various factors that may affect rehabilitation outcome.
Sepsis management of the acute care surgery patient: What you need to know
Authors: Maurer Lydia R. , Martin Niels D.
Published: November 2024

Increasingly, acute care surgeons have taken over the management of general surgery consult patients in the hospital, many of whom present with sepsis and/or in septic shock. In this article, we will discuss the intricacies of sepsis management for acute care surgery. The underlying tenants of sepsis management will be outlined with specific attention to the nuances associated with surgical patients. Ultimately, when a surgical problem is identified, this management will culminate with the need for specific source control — the unique aspect when a surgical as opposed to a medical disease process is the cause of sepsis. However, surgeons must also be competent in the other components of sepsis management including antimicrobial therapy and hemodynamic support. This article is designed for the surgeon or for any provider caring for patients with a potential acute care surgical problem, recognizing that different practice settings will vary with regard to resource availability for laboratory tests, invasive monitoring, diagnostics, and surgeon availability.
Signal growth in a pure time-modulated transmission line and the loss effect
Authors: Hagag Mohamed F. , Jones Thomas R. , Seddik Karim , Peroulis Dimitrios
Published: November 2024

We present the first comprehensive study for signal growth in transmission lines (TL) with purely time-modulated characteristic impedance

Z
o

(infinite superluminality). This study pioneers the investigation into the effects of varying the cell’s electrical length and the impact of loss on momentum bandgaps and amplification levels. It also thoroughly examines how time-modulated transmission line truncation by a static load influences the sensitivity of amplification gain to the relative phase between the incoming signal and modulation, comparing these findings with the case of parametric amplification. Varying

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is accomplished by loading TLs with a sinusoidally time-modulated capacitor (TMC). The study starts with a simple lumped model cell to facilitate understanding of the phenomena. Following this, transmission lines are introduced, and the effects of incorporating loss are examined. To accomplish this, three models are investigated: a lossless L-C TL lumped model loaded with a shunt lossless TMC and a TL loaded with a shunt lossless and lossy TMC. Dispersion diagrams are plotted and momentum bandgaps are identified at a modulation frequency double the signal frequency. Within the momentum bandgap, only imaginary frequencies are found and correlated to momentum bandgap width and signal growth level. Signal growth is confirmed using harmonic balance and transient simulations, and the results are consistent with the dispersion diagram outcomes.
Enhancement of reactive oxygen species production by ultra-short electron pulses
Authors: Tye J. , Solgaard O. , England R. J. , Trapp J. V. , Fielding A. , Brown C. P.
Published: November 2024

The development of laser-driven accelerators-on-chip has provided an opportunity to miniaturize devices for electron radiotherapy delivery. Laser-driven accelerators produce highly time-compressed electron pulses, on the 100 fs to 1 ps scale. This delivers electrons at high peak power yet low average beam current compared with conventional delivery devices, which generate pulses of approximately 3 µs. The biophysical effects of this time structure, however, are unclear. Here, we use a Monte Carlo simulation approach to explore the effects of the electron beam time structure on the production of reactive oxygen species (ROS) in water. Our results show a power law increase in the generation of hydroxyl ions per deposited electron with decreasing pulse length over the pulse length range of 10 µs to 100 fs. Similar trends were observed for hydrogen peroxide, superoxide, hydroperoxyl, hydronium and solvated electrons. In practical terms, this indicates a fourfold increase in the efficiency of free radical production for sub-picosecond pulses, relative to that of conventional microsecond pulses, for the same number of deposited electrons.
Parasite scars: the impact of salmon lice injury on sea trout populations
Authors: Vollset Knut Wiik , Lennox Robert J. , Lehmann Gunnar Bekke , Skår Bjørnar , Ulgenes Ivar , Skoglund Helge
Published: November 2024

Spillback effects of the parasitic salmon louse from fish farms to wild fish are a critical environmental concern for countries with wild salmon. The ectoparasitic louse causes significant physical and physiological damage to wild salmonids that probably have long-term impacts on individuals and population dynamics. However, empirical links between injuries and abundance of lice have not been established in the wild. This study establishes a strong association between dorsal fin injuries in wild sea trout (
Salmo trutta
) and infestation with salmon lice at a marine site in Norway. We further assessed the prevalence of such injuries on sea trout returning to spawning grounds from snorkelling observations in 16 rivers in Hardangerfjord, western Norway, from 2007 to 2021. The prevalence of injuries decreased with distance from the fjord outlet, from approximately 70% in middle and outer parts to approximately 10% in the inner parts. Additionally, a negative correlation was found between sea trout population size and the proportion of the population with dorsal fin damage. The results demonstrate that salmon lice inflict high levels of injury on significant portions of sea trout populations in areas with intensive fish farming, leading to poorer population status in affected populations.
Cell division cycle fluctuation of Pal concentration in Escherichia coli
Authors: Mertens Laureen M.Y. , Liu Xinwei , Verheul Jolanda , Egan Alexander J.F. , Vollmer Waldemar , den Blaauwen Tanneke
Published: November 2024

The Tol-Pal proteins stabilize the outer membrane during cell division in many Gram-negative bacteria, including Escherichia coli. Pal is an outer membrane lipoprotein that can bind peptidoglycan. It accumulates at the septum during division by a mobilization-and-capture mechanism. This work further substantiates and extends knowledge of Pal’s localization in E. coli using immunolabelling; this method enables the detection of endogenous proteins. The midcell localization of Pal and TolB, as seen with fluorescent protein fusions, during cell division, was confirmed. The retention of Pal in newly formed cell poles seemed to persist longer than observed with fluorescent Pal fusions. The concentration of endogenous Pal during the cell division cycle fluctuated: it decreased initially (to half the fluorescence concentration (32.1 au µm−3) of the maximum (64.1 au µm−3) reached during the cell cycle) and then increased during the second half of the cell division cycle. We probed for possible regulators and proposed two new putative regulators of Pal. By deleting the periplasmic protease, Prc decreased the total Pal abundance (to ~65% of the fluorescence concentration in WT cells) and affected its concentration fluctuation during the cell cycle. This suggests that Prc controls a cell division stage-specific regulator of Pal. Immunolabelling also supported the prediction that the small RNA MicA suppresses Pal expression (the fluorescence concentration of Pal in cells without MicA is double that of Pal in WT cells). However, the regulation by MicA occurred in a cell cycle-independent manner. All these findings urge further research on the tight regulation of the dividing cell envelope stability.
Campylobacter sputorum subsp. bovis subsp. nov., isolated from cattle, and an emended description of Campylobacter sputorum
Authors: Miller William G. , Williams Tina G. , Wood Delilah F. , Chapman Mary H.
Published: November 2024

Six urease-negative Campylobacter strains were isolated from cattle faeces over a 19-month period from 2009 to 2010. These strains were initially identified as Campylobacter sputorum by 16S rRNA gene and atpA typing. Initial studies characterizing these strains by multilocus sequence typing and genome sequencing further supported their classification as C. sputorum but indicated that these strains form a divergent clade within the species. A polyphasic study was undertaken here to clarify their taxonomic position. Phylogenetic analyses were performed based on 16S rRNA gene sequences and the concatenated sequences of 330 core genes, with the latter analysis also placing the six strains into a clade distinct from the three C. sputorum biovars. Pairwise digital DNA–DNA hybridization values identified these strains as C. sputorum, and the pairwise average nucleotide identity values were consistent with those observed between current Campylobacter subspecies pairs. Standard phenotypic testing was also performed. All strains are microaerobic, anaerobic, motile, Gram-negative and oxidase- and catalase-positive; cells are curved rods or spirals. Strains can be distinguished from the C. sputorum biovars by the presence of alkaline phosphatase activity and triphenyltetrazolium chloride reduction and absence of nitrate reduction. The data presented here show that these strains represent a novel subspecies within C. sputorum, for which the name C. sputorum subsp. bovis subsp. nov. (type strain RM8705T=LMG 32300T=CCUG 75470T) is proposed.