bluuebunny/crossref_metadata_2025 huggingface dataset:
Finger exercise could reduce painfulness and radial artery complications related to coronary artery angiography
Authors: Zhang Kai , Hu Peng , Zhao Lin , Cai Liqin , Zhang Yi
Published: June 2023

Objective

To estimate if applying a finger exercise during trans-radial coronary artery angiography (CAG) could help to reduce a patient’s painfulness and evaluate its protective effects against radial artery complications.

Methods

This is a prospective, controlled, single-center trial. Overall, 390 patients who underwent coronary angiography through radial path in our hospital during 2022 were randomized 1 : 1 to the following two groups: test group: finger exercise in addition to routine perioperative care; control group: routine care. The success rate of radial puncture, the incidence of procedural radial artery dissection (RAD) and radial artery spasm (RAS), change of wrist circumference, pain degree related to the operation, occurrence of access site hemorrhagic complications, hemostasis time and postprocedure occurrence of radial artery occlusion (RAO) before discharge were recorded and compared between two groups.

Results

Compared to the control group, the test group had a higher success rate of radial puncture, lower incidence of RAS, RAD and RAO, slighter swelling of wrist and patients who felt less pain in the test group. There was no difference in prolonged hemostasis time or hemorrhagic complications between the two groups.

Conclusion

Finger exercise could help to make a patient more comfortable and reduce radial artery complications related to CAG.
MR-based techniques for intracortical vessel visualization and characterization: understanding the impact of microvascular disease on skeletal health
Authors: Löffler Maximilian T. , Wu Po-Hung , Kazakia Galateia J.
Published: June 2023

Purpose of review

The relationships between bone vasculature and bone microstructure and strength remain incompletely understood. Addressing this gap will require in vivo imaging capabilities. We describe the relevant vascular anatomy of compact bone, review current magnetic resonance imaging (MRI)-based techniques that allow in vivo assessment of intracortical vasculature, and finally present preliminary studies that apply these techniques to investigate changes in intracortical vessels in aging and disease.

Recent findings

Ultra-short echo time MRI (UTE MRI), dynamic contrast-enhanced MRI (DCE-MRI), and susceptibility-weighted MRI techniques are able to probe intracortical vasculature. Applied to patients with type 2 diabetes, DCE-MRI was able to find significantly larger intracortical vessels compared to nondiabetic controls. Using the same technique, a significantly larger number of smaller vessels was observed in patients with microvascular disease compared to those without. Preliminary data on perfusion MRI showed decreased cortical perfusion with age.

Development of in vivo techniques for intracortical vessel visualization and characterization will enable the exploration of interactions between the vascular and skeletal systems, and further our understanding of drivers of cortical pore expansion. As we investigate potential pathways of cortical pore expansion, appropriate treatment and prevention strategies will be clarified.
Characterization of left ventricular diastolic parameters of gated-single-photon emission computed tomography myocardial perfusion imaging in patients with diabetes and normal myocardial perfusion and systolic function
Authors: Ghaedian Tahereh , Abdinejad Maryam , Aieneh Pegah , Ebrahimi Sadegh , Rezaei Mehdi
Published: June 2023

Background

Diabetic cardiomyopathy is defined as an independent entity with a specified pathological progression from diastolic dysfunction with preserved ejection fraction to overt heart failure. Myocardial perfusion imaging (MPI) with gated-single-photon emission computed tomography (G-SPECT) has been introduced as a feasible tool to evaluate left ventricular (LV) diastolic function. The aim of this study was to investigate the characteristics of diastolic parameters derived from G-SPECT MPI in diabetic patients compared to patients at very low risk of coronary artery disease (CAD) and with no other CAD risk factors.

Methods

This cross-sectional study was performed on patients referred to the nuclear medicine department for G-SPECT MPI. Demographic and clinical data, as well as medical history, were extracted from a digital registry system including 4447 patients. Then, two matched groups of patients with only diabetes as cardiac risk factor (n = 126) and those without any identifiable CAD risk factors (n = 126) were selected. Diastolic parameters of MPI, including peak filling rate, time to peak filling rate, mean filling rate at the first third of diastole and second peak filling rate, were derived using quantitative software for eligible cases.

Results

The mean age of the diabetic and nondiabetic groups was 57.1 ± 14.9 and 56.7 ± 10.6 years, respectively (P = 0.823). Comparison of quantitative SPECT MPI parameters between the two groups showed a statistically significant difference only in total perfusion deficit scores, whereas none of the functional parameters, including diastolic and dyssynchrony indices and the shape index, were significantly different. There were also no significant differences in diastolic function parameters between diabetes and nondiabetes patients in the age and gender subgroups.

Conclusion

Based on the G-SPECT MPI findings, there is a comparable prevalence of diastolic dysfunction in patients with only diabetes as a cardiovascular risk factor and low-risk patients with no cardiovascular risk factors in the setting of normal myocardial perfusion and systolic function.
Avoiding deformity in proximal tibial nailing: risk factors, deformity rules, tips, and tricks
Authors: Krettek Christian , Edwards Elton
Published: June 2023

Malalignment is one of the most common problems linked to nailing of proximal tibial fractures. This review will cover technical aspects of intramedullary nailing and will help explain the various risk factors. Deformity rules aid in identifying the likely deformity and help to develop management strategies. Various tools and techniques are discussed which can help optimize the outcome.

Level of Evidence:

Therapeutic Level V
The role of computed tomography in the detection of traumatic arthrotomies of the elbow: a cadaveric study
Authors: Ladeira Craveiro Vinicius , Henderson Shasta , Boateng Henry , Garner Matthew R.
Published: June 2023

Purpose:

To evaluate the use of computed tomography (CT) imaging as a diagnostic tool for elbow arthrotomies using a standardized cadaveric arthrotomy model.

Method:

Nineteen intact fresh frozen cadaver elbows were CT scanned using 2 mm cuts with sagittal and coronal reformats in the plane of the joint and used as controls. An elbow arthrotomy at the posterocentral arthroscopic portal site was performed in all specimens using a 4.5 millimeter trocar. After arthrotomy, all elbows underwent a second CT scan followed by a standard saline load test (SLT). Images were randomized and reviewed by 2 blinded, independent reviewers. Bimodal scoring was performed for each specimen with regard to the presence of an arthrotomy indicated by presence of air in the joint. Regarding the SLT, saline exiting the arthrotomy wound was considered a positive test.

Results:

CT scans were found to have 100% sensitivity and 86% specificity for diagnosing elbow arthrotomies. Interrater reliability calculated with Cohen kappa statistic was near perfect at r = 0.89. The SLT had a sensitivity of 79% when 20 mL was injected. A total of 25 mL of saline was required to be injected for a sensitivity greater than 95%.

Conclusion:

This study demonstrates that CT scan is a reliable and less technically demanding method of diagnosis arthrotomies with high interrater reliability and high sensitivity and with results comparable with SLT. This technique may be useful in centers where trained providers are not readily available to perform SLT. Clinical study is required to validate our results.

Level of Evidence:

Level II.
Drowning in Children and Predictive Parameters
Authors: Peri Francesca , De Nardi Laura , Canuto Arianna , Gaiero Alberto , Noli Serena , Ferretti Marta , Vergine Gianluca , Falcioni Alice , Copponi Elisabetta , Tagliabue Bruna , Massart Francesco , Fabiani Elisabetta , Stringhi Carlo , Rubini Monica , Zamagni Giulia , Amaddeo Alessandro , Genovese Maria Rita , Norbedo Stefania
Published: June 2023

Background

Drowning is a serious and underestimated public health problem, with the highest morbidity and mortality reported among children. Data regarding pediatric outcomes of drowning are often inadequate, and data collection is poorly standardized among centers. This study aims to provide an overview of a drowning pediatric population in pediatric emergency department, focusing on its main characteristics and management and evaluating prognostic factors.

Methods

This is a retrospective multicenter study involving eight Italian Pediatric Emergency Departments. Data about patients between 0 to 16 years of age who drowned between 2006 and 2021 were collected and analyzed according to the Utstein-style guidelines for drowning.

Results

One hundred thirty-five patients (60.9% males, median age at the event 5; interquartile range, 3–10) were recruited and only those with known outcome were retained for the analysis (133). Nearly 10% had a preexisting medical conditions with epilepsy being the most common comorbidity. One third were hospitalized in the intensive care unit (ICU) and younger males had a higher rate of ICU admission than female peers. Thirty-five patients (26.3%) were hospitalized in a medical ward while 19 (14.3%) were discharged from the emergency department and 11 (8.3%) were discharged after a brief medical observation less than 24 hours. Six patients died (4.5%). Medium stay in the ED was approximately 40 hours. No difference in terms of ICU admission was found between cardiopulmonary resuscitation performed by bystanders or trained medical personnel (P = 0.388 vs 0.390).

Conclusions

This study offers several perspectives on ED victims who drowned. One of the major finding is that no difference in outcomes was seen in patients who received cardiopulmonary resuscitation performed by bystanders or medical services, highlighting the importance of a prompt intervention.
Modifiable Post-Mastectomy Radiation Therapy Factors and Impact on Implant-Based Breast Reconstruction Outcomes
Authors: Barnes Laura L. , Chew Jessica , Lem Melinda , Park Catherine , Yang Joanna C. , Prionas Nicolas , Piper Merisa
Published: June 2023

Introduction:

Intensity modulated radiation therapy (IMRT) and other modifiable radiation factors have been associated with decreased radiation toxicity. These factors could allow for improved reconstructive outcomes in patients requiring post-mastectomy radiation therapy (PMRT). However, they have not yet been well-studied in implant-based breast reconstruction (IBBR).

Methods:

We performed a retrospective chart review of patients who underwent mastectomy with immediate tissue expander placement followed by PMRT. Radiation characteristics were collected, including radiation technique, bolus regimen, X-ray energy, fractionation, maximum radiation hot spot (DMax), and tissue volume receiving >105% (V105%) or >107% (V107%) of the prescription dose. Reconstructive complications occurring after initiation of PMRT were analyzed with respect to these radiation characteristics.

Results:

68 patients (70 breasts) were included in this study. The overall complication rate was 28.6%, with infection being the most common complication (24.3%), requiring removal of the tissue expander or implant in greater than half of infections (15.7%). DMax was greater in patients who required explant after PMRT, and this approached statistical significance (114.5+/-7.2% v. 111.4+/-4.4%, p=0.059). V105% and V107% were also greater in patients who required explant after PMRT (42.1+/-17.1% v. 33.0+/-20.9% and 16.4+/-14.5% v. 11.3+/-14.6%, respectively), however this was not statistically significant (p=0.176 and p=0.313, respectively). There were no significant differences in complication rates between patients with respect to radiation technique or other radiation characteristics studied.

Conclusions:

Minimizing the radiation hot spots and volumes of tissue receiving greater than the prescription dose of radiation may improve reconstructive outcomes in patients undergoing IBBR followed by PMRT.
A Novel Method Using the Petal Pattern for Contouring a Domed Nipple in Tuberous Breasts
Authors: Go Ju Young , Lee Youngdae , Lee Won
Published: June 2023

The main cause of domed nipples is increased pressure, which causes the breast tissue to herniate toward the nipple-areola complex. It appears as a characteristic of a tuberous breast rather than occurring alone, and the boundary between the nipple and areolar region is unclear. The authors present a method using petal patterns for single-stage aesthetic correction of domed nipples. The method is designed by placing the left and right corners of each petal at the desired position as the edge boundary of the nipple. The number and width of petals are adjusted so that the obtuse angle between the nipple and areola is 90 to 100 degrees. The areolar and soft tissues in the designed patterns are excised together with the skin and collected using a barbed suture in a specially designed suture technique. Surgery is completed after the skin is sutured using nylon. Case examples are presented to illustrate the appropriate candidate selection and results. Overall, the aesthetic results are positive in terms of shape and patient satisfaction. This method is useful for contouring domed nipples. This new design is simple, leaves minimal scars, and provides the surgeon with an additional option for treating tuberous breasts. It can be used alone or along with breast augmentation.
Endoscopic Concurrent Gastrocnemius Muscle Resection and Soleus Muscle Neurectomy for Severe Muscular Calf Hypertrophy
Authors: Hsu Honda , Lee Jiunn-Tat
Published: June 2023

Background:

Selective neurectomy or muscle resection techniques for calf reduction conventionally focus on the gastrocnemius muscle. However, the underlying soleus muscle plays an important role in muscular calf hypertrophy. In the authors’ experience, the results of calf reduction have been suboptimal in patients with severe muscular calf hypertrophy who underwent gastrocnemius muscle resection only. This article describes a new calf reduction method that uses concurrent gastrocnemius muscle resection and soleus muscle neurectomy using an endoscope-assisted single-incision approach in patients with severe muscular calf hypertrophy.

Methods:

A total of 139 patients who underwent simultaneous gastrocnemius muscle resection and soleus muscle neurectomy for severe calf hypertrophy from March of 2017 to June of 2020 were retrospectively analyzed.

Results:

After combined gastrocnemius resection (mean weight per calf, 349 g) and soleus neurectomy, about 3.8 to 8.2 cm (mean, 6.4 cm) or 12.8% to 24.3% (mean, 16.6%) of the calf was reduced. Complications included cellulitis, hematoma, seroma, and mild depression (n = 1 each). Two patients had traction injury to the sural nerve. One patient developed Achilles tendon rupture at 2 months postoperatively. No patient complained of functional impairment with respect to easy fatigability, stability, gait, or sport activities at 6 months postoperatively.

Conclusion:

This study is the first to combine gastrocnemius muscle resection with selective soleus muscle neurectomy to achieve the most efficient calf reduction for severe muscular calf hypertrophy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Increased 68Ga-FAPI Uptake in Benign Metastasizing Leiomyoma
Authors: Wu Simin , Cai Jiayu , Chen Qi , Wu Jing , Chen Haojun
Published: June 2023

Benign metastasizing leiomyomas (BMLs) are benign disseminated extrauterine tumors in patients with prior history of uterine leiomyomas and may occur years after hysterectomy. In this case, we presented 18F-FDG and 68Ga-FAPI PET/CT findings in a 37-year-old woman with benign leiomyoma metastasizing to lung and pelvis. The metastatic lesions demonstrated faint 18F-FDG but elevated 68Ga-FAPI activity, indicating the low level of glucose metabolism but excessive accumulation of activated fibroblasts in the BMLs. This case demonstrated that 68Ga-FAPI PET/CT may be potentially useful in the evaluation of BMLs.
Unexpected Solitary Subcutaneous Metastasis From Esophageal Carcinoma Revealed by MDP Bone Scintigraphy
Authors: Liu Huipan , Xiang Feifan , Xie Yang , Liu Lin , Chen Yue
Published: June 2023

A 60-year-old man with back pain underwent 99mTc-MDP to evaluate bone metastases from newly esophageal carcinoma. No bone metastasis was found on the whole-body bone scan. Unexpectedly, subcutaneous metastasis revealed increased 99mTc-MDP activity.
The Impact of Postoperative Antibiotic and Duration After Implant-Based Breast Reconstruction on Resistance Among Cultured Species
Authors: Driscoll Cassandra R. , Grosser Joshua A. , Davidson Amelia L. , Lloyd Kelsey M. , Prabhu Shamit S. , Katz Adam J.
Published: June 2023

Background

There is a growing presence of literature within plastic surgery that establishes best practice for postoperative antibiotics after implant-based breast reconstruction (IBBR), although it has not been widely adopted or translated into clinical practice. This study aims to determine how antibiotic and duration affects patient outcomes. We hypothesize that IBBR patients who receive a longer duration of postoperative antibiotics will demonstrate higher rates of antibiotic resistance as compared with the institutional antibiogram.

Methods

A retrospective chart review included patients who underwent IBBR between 2015 and 2020 at a single institution. Variables of interest included patient demographics, comorbidities, surgical techniques, infectious complications, and antibiograms. Groups were classified by antibiotic (cephalexin, clindamycin, or trimethoprim/sulfamethoxazole) and duration (≤7 days, 8–14 days, and >14 days).

Results

There were a total of 70 patients who experienced infections included in this study. Onset of infection did not differ based on antibiotic during either device implantation (postexpander P = 0.391; postimplant P = 0.234). Antibiotic and duration did not have an established relationship with explantation rate either (P = 0.154). In patients who had Staphylococcus aureus isolated, there was significantly increased resistance to clindamycin when compared with the institutional antibiogram (sensitivities of 43% and 68%, respectively).

Conclusions

Neither antibiotic nor duration displayed a difference in overall patient outcomes, including explantation rates. In this cohort, S. aureus strains isolated in association with IBBR infections demonstrated a higher level of resistance to clindamycin compared with strains isolated and tested within the broader institution.
Reliable Location of Upper Extremity Lymphatic Channels for Use in Immediate Lymphatic Reconstruction
Authors: Wainwright D’Arcy , Weinstein Brielle , Le Nicole K. , Parikh Jeegan , Panetta Nicholas J.
Published: June 2023

Background

Breast cancer–related lymphedema (BCRL) is a limiting sequelae of breast cancer treatment that may negatively impact 30% to 50% of high-risk breast cancer survivors. Risk factors for development of BCRL include axillary lymph node dissection (ALND), and recently, axillary reverse lymphatic mapping and immediate lymphovenous reconstruction (ILR) at time of ALND have been implemented to prevent BCRL. Reliable anatomy of neighboring venules has been commented on in the literature; however, little information exists about anatomical location of local lymphatic channels amenable for bypass.

Methods

After institutional review board approval, patients who underwent ALND with axillary reverse lymphatic mapping and ILR at a tertiary cancer center from November 2021 to August 2022 were applicable for this study. The location and number of lymphatic channels used for ILR were identified and measured intraoperatively with the arm abducted to 90 degrees and soft tissue under no tension. Four measurements were taken to localize each lymphatic and were based on relationship with reliable anatomic landmarks including 4th rib, anterior axillary line, and lower border of the pectoralis major muscle. Demographics, oncologic treatments, intraoperative factors, and outcomes were prospectively maintained.

Results

Twenty-seven patients met inclusion for this study by August 2022 with a total of 86 lymphatic channels identified. Patients were on average 50 ± 12 years old with a body mass index of 30 ± 6 and had an average of 1 vein and 3 identifiable lymphatic channels amenable to bypass. Seventy percent of lymphatic channels were found in a cluster of 2 or more channels. The average horizontal location was 4.5 ± 1.4 cm lateral to the 4th rib. The average vertical location was 1.3 ± 0.9 cm from the superior border of the 4th rib.

Conclusions

These data comment upon intraoperatively identified and consistent location of upper extremity lymphatic channels used for ILR. These lymphatic channels are often found in clusters with 2 or more lymphatic channels at the same location. Such insight may aid in easier intraoperative identification of amenable vessels for the unexperienced surgeon, decrease in intraoperative time, and higher success of ILR.
Surgical Episodes of Care for Price Transparency using the Episode Grouper for Medicare
Authors: Perloff Jennifer , Hasley Rebecca , Kumar Senthil Subbiah , Chapman John , Coffron Matt , Opelka Frank
Published: June 2023

Objective:

This proof-of-concept explores the use of an episode grouper to more accurately identify the complete set of surgical services typically provided in a surgical episode of care and the corresponding range of prices, using colectomy for cancer as the example.

Summary /background data:

Price transparency is an important policy issue that will require surgeons to better understand the components and cost of care.

Methods:

This study uses the Episode Grouper for Medicare (EGM) business logic to construct colectomy surgical episodes of care for cancer using Medicare claims data for the Boston Hospital Referral Region (HRR) from 2012-2015. Descriptive statistics show the mean reimbursement based on patient severity and stage of surgery along with the number of unique clinicians billing for care and the mix of services provided.

Results:

The EGM episode grouper identified 3,182 colectomies in Boston between 2012 and 2015 with 1,607 done for cancer. The mean Medicare allowed amount per case is $29,954 and varies from $26,605 to $36,850 as you move from low to high severity cases. The intra-facility stage is the most expensive ($23,175 on average) compared to the pre ($780) and post ($6,479) facility stages. There is tremendous heterogeneity in service mix.

Conclusion:

Episode groupers are a potentially valuable tool for identifying variation in service mix and teaming patterns that correlate with total price. By looking at patient care holistically, stakeholders can identify opportunities for price transparency and care redesign that have heretofore been hidden.
Omics Signatures of Tissue Injury and Hemorrhagic Shock in Swine
Authors: LaCroix Ian S. , Cralley Alexis , Moore Ernest E. , Cendali Francesca I. , Dzieciatkowska Monika , Hom Patrick , Mitra Sanchayita , Cohen Mitchell , Silliman Christopher , Sauaia Angela , Hansen Kirk C. , D’Alessandro Angelo
Published: June 2023

Objective:

Advanced mass spectrometry methods were leveraged to analyze both proteomics and metabolomics signatures in plasma upon controlled tissue injury and hemorrhagic shock – isolated or combined - in a swine model, followed by correlation to viscoelastic measurements of coagulopathy via thrombelastography.

Summary Background Data:

TI and HS cause distinct molecular changes in plasma in both animal models and trauma patients. However, the contribution to coagulopathy of trauma, the leading cause of preventable mortality in this patient population remains unclear. The recent development of a swine model for isolated or combined TI + HS facilitated the current study.

Methods:

Male swine (n=17) were randomized to either isolated or combined tissue injury and hemorrhagic shock. Coagulation status was analyzed by thrombelastography during the monitored time course. The plasma fractions of the blood draws (at baseline, end of shock and at 30 min, 1, 2 and 4h after shock) were analyzed by mass spectrometry-based proteomics and metabolomics workflows.

Results:

HS– isolated or combined with TI - caused the most severe omic alterations during the monitored time course. While isolated TI delayed the activation of coagulation cascades. Correlation to TEG parameters of clot strength (MA) and breakdown (LY30) revealed signatures of coagulopathy which were supported by analysis of gene ontology enriched biological pathways.

Conclusion:

The current study provides a comprehensive characterization of proteomic and metabolomic alterations to combined or isolated TI and HS in a swine model, and identifies early and late omics correlates to viscoelastic measurements in this system.
Restoring Microcirculatory Perfusion in a Preclinical Model of Severe Hemorrhagic Shock: The Role of Microcirculatory Function
Authors: Kang Hae Sung , Khoraki Jad , Li Ru , Xu Haoxuan , Archambault Caitlin , Liebrecht Loren K. , Mangino Martin J.
Published: June 2023

Background

No reflow in capillaries (no reflow) is the lack of tissue perfusion that occurs once central hemodynamics are restored. This prevents oxygen transfer and debt repayment to vital tissues after shock resuscitation. Since metabolic swelling of cells and tissues can cause no reflow, it is a target for study in shock. We hypothesize no reflow secondary to metabolic cell swelling causes the problem not addressed by current strategies that increase central hemodynamics alone.

Methods

Anesthetized swine were bled until plasma lactate reached 7.5-9 mM. Intravenous low volume resuscitation (LVR) solutions were administered (6.8 ml/kg over 5 min) consisting of; 1.) LR, 2.) Autologous whole blood (WB), 3.) High dose Vitamin C (VC, 200 mg/kg), or 4.) 10% PEG-20 k, a polymer-based cell impermeant that corrects metabolic cell swelling. Outcomes were macro-hemodynamics (MAP), plasma lactate, capillary flow in the gut and tongue mucosa using orthogonal polarization spectral imaging (OPSI), and survival to 4 hours.

Results

All PEG-20 k resuscitated swine survived 240 min with MAP above 60 mmHg compared to 50% and 0% of the WB and LR groups, respectively. The VC group died at just over 2 hours with MAPs below 40 and high lactate. The LR swine only survived 30 min and died with low MAP and high lactate. Capillary flow positively correlated (P < 0.05) with survival and MAP. Sublingual OPSI correlated with intestinal OPSI and OPSI was validated with a histological technique.

Discussion

Targeting micro-hemodynamics in resuscitation may be more important than macro-hemodynamics. Fixing both is optimal. Sublingual OPSI is clinically achievable to assess micro-hemodynamic status. Targeting tissue cell swelling that occurs during ATP depletion in shock using optimized osmotically active cell impermeants in crystalloid LVR solutions improves perfusion in shocked tissues, which leverages a primary mechanism of injury.
High positive end-expiratory pressure ventilation mitigates the progression from unilateral pulmonary contusion to ARDS: An animal study
Authors: Landeck Tobias , Schwarz Henrike , Hammermüller Sören , Noreikat Katharina , Reske Stefan , Gottschaldt Udo , Nestler Christian , Wolf Samuel Johannes , Ramm Jan , Lange Mirko , Wrigge Hermann , Girrbach Felix , Brehm Walter , Reske Andreas Wolfgang
Published: June 2023

BACKGROUND

Pulmonary contusion (PC) is common in severely traumatized patients and can lead to respiratory failure requiring mechanical ventilation (MV). Ventilator-induced lung injury (VILI) might aggravate lung damage. Despite underrepresentation of trauma patients in trials on lung-protective MV, results are extrapolated to these patients, potentially disregarding important pathophysiological differences.

METHODS

Three MV protocols with different positive end-expiratory pressure (PEEP) levels: ARDSnetwork lower PEEP (ARDSnet-low), ARDSnetwork higher PEEP (ARDSnet-high), and open lung concept (OLC) were applied in swine for 24 hours following PC. Gas exchange, lung mechanics, quantitative computed tomography, and diffuse alveolar damage (DAD) score were analyzed. Results are given as median (interquartile range) at 24 hours. Statistical testing was performed using general linear models (group effect) over all measurement points and pairwise Mann-WhitneyUtests for DAD.

RESULTS

There were significant differences between groups: PEEP (p< 0.0001) ARDSnet-low (8 [8–10] cmH2O), ARDSnet-high (12 [12–12] cmH2O), OLC (21 [20–22] cmH2O). The fraction of arterial partial pressure of oxygen and inspired oxygen fraction (p= 0.0016) was lowest in ARDSnet-low (78 (73–111) mm Hg) compared with ARDSnet-high (375 (365–423) mm Hg) and OLC (499 (430–523) mm Hg). The end-expiratory lung volume (EELV) differed significantly (p< 0.0001), with highest values in OLC (64% [60–70%]) and lowest in ARDSnet-low (34% [24–37%]). Costa's surrogate for mechanical power differed significantly (p< 0.0001), with lowest values for ARDSnet-high (73 [58–76]) compared with OLC (105 [108–116]). Diffuse alveolar damage was lower in ARDSnet-high compared with ARDSnet-low (0.0007).

CONCLUSION

Progression to ARDS, 24 hours after PC, was mitigated by OLC and ARDSnet-high. Both concepts restored EELV. ARDSnet-high had the lowest mechanical power surrogate and DAD. Our data suggest, that ARDSnet-high restored oxygenation and functional lung volume and reduced physiological and histological surrogates for VILI. ARDSnet-low generated unfavorable outcomes, such as loss of EELV, increased mechanical power and DAD after PC in swine. The high respiratory rate in the OLC may blunt favorable effects of lung recruitment.
Inflammation Markers Among Schizophrenia Patients Who Use Cannabis
Authors: Fridman Jonathan , Bloemhof-Bris Esther , Weizman Shira , Kessler Tal , Porat Dorit , Ivry Amos , Wolf Aviva , Stryjer Rafael , Shelef Assaf
Published: June 2023

Objectives

The mechanism of inflammation of the immune system, for example, such circulatory markers as the neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV), has been shown in many studies to be associated with schizophrenia. In addition, it has been shown that the cannabidiol component reduces the activation of the acquired immune system. This study examined the differences in the levels of NLR and MPV among schizophrenia patients with cannabis use versus those without.

Methods

In 2019 to 2020, a retrospective cross-sectional study was conducted based on digital medical records. Demographic, clinical, and complete blood cell count data were collected from records of rehospitalization of active psychotic schizophrenia inpatients. Data on NLR, MPV values, and demographic and clinical characteristics were compared between the groups and according to the degree of prevalence of cannabis use.

Results

No differences were found in the NLR and MPV values between the groups.

Conclusion

The results were contrary to our expectations. These results may be explained by the presentation of a “pseudo-balanced” picture created when multiple processes affect inflammatory indices.
Medication Overuse Headache, Chronic Migraine and Monoclonal Antibodies Anti-CGRP: A Real-World Study
Authors: Krymchantowski Abouch , Jevoux Carla , Krymchantowski Ana Gabriela , Silva-Néto Raimundo Pereira
Published: June 2023

Objective

Medication overuse headache (MOH) in chronic migraineurs may be a cause or consequence of the overuse of symptomatic medications for headache attacks. It is highly prevalent in tertiary centers. We compared the efficacy of 3 anti-CGRP monoclonal antibodies with traditional pharmacological agents in patients with chronic migraine (CM) and MOH.

Methods

A randomized, cross-sectional, prospective, and open trial with real-world comparison groups was carried out. The sample consisted of 100 consecutive patients having CM and MOH.

Results

Eighty-eight patients (65 women and 23 men) were included in the study and divided into 4 groups: those having used erenumab (19.3%), galcanezumab (29.6%), fremanezumab (25%) and conventional medications, and the control group (26.1%). Ages ranged from 18 to 78 years (mean, 44.1 ± 13.6 years). In the 6 months of follow-up, there was a significant reduction in the number of headache days in the 3 groups when compared with the control (P < 0.0001).

Conclusions

The small number of patients included in each group and the open design do not allow definitive conclusions, but the use of anti-CGRP monoclonal antibodies in patients with CM and MOH may result in lessening the number of headache days when compared with conventional treatment with drugs.
Thermodynamics 2.0: Bridging the natural and social sciences
Authors: Poudel Ram , McGowan Jon , Georgiev Georgi Y. , Haven Emmanuel , Gunes Umit , Zhang Hongkun
Published: June 2023

Thermodynamics is a universal science. The language of thermodynamics is energy and its derivatives such as entropy and power. The physical theory of thermodynamics reigns across a full spectrum of non-living objects as well as living beings. In the traditions of the past, the dichotomy between matter and life resulted in the natural sciences studying matter while the social sciences focused on living beings. As the state of human knowledge continues to evolve, anticipating the sciences of matter (natural science) and of life (social science) becoming unified under a single overarching theory is not unnatural.

This article is part of the theme issue ‘Thermodynamics 2.0: Bridging the natural and social sciences (Part 1)’.
Trends in coagulase-negative staphylococci (CoNS), England, 2010–2021
Authors: Paranthaman Karthik , Wilson Allegra , Verlander Neville , Rooney Graeme , Macdonald Neil , Nsonwu Olisaeloka , Hope Russell , Fleming Paul , Hatcher James , Ogundipe Enitan , Ratnaraja Natasha , Wan Yu , Pichon Bruno , Westrop Samantha J. , Brown Colin S. , Demirjian Alicia
Published: June 2023

Objective. To review the epidemiology of coagulase-negative staphylococci (CoNS) in England over the recent 12 year period.

Methods. Laboratory-confirmed CoNS reported from sterile sites in patients in England to the UK Health Security Agency (UKHSA) between 2010 and 2021 were extracted from the national laboratory database and analysed.

Results. Overall, 668 857 episodes of CoNS were reported. Unspeciated CoNS accounted for 56 % (374 228) of episodes, followed by

Staphylococcus epidermidis

(26 %; 174 050),

S. hominis

(6.5 %; 43 501) and

S. capitis

(3.9 %; 25 773). Unspeciated CoNS increased by 8.2 % (95 % CI, 7.1–9.3) annually between 2010 and 2016, then decreased annually by 6.4 % (95 % CI: −4.8 to −7.9) until 2021. Speciated CoNS increased by 47.6 % (95 % CI, 44.5–50.9) annually between 2010 and 2016 and increased annually by 8.9 % (95 % CI: 5.1 to 12.8) until 2021. Antimicrobial susceptibility profiles differed by species.

Conclusions. Reports of CoNS from normally sterile body sites in patients in England increased between 2010 and 2016 and remained stable between 2017 and 2021. There has been a striking improvement in species-level identification of CoNS in recent years. Monitoring trends in CoNS epidemiology is crucial for development of observational and clinical intervention studies on individual species.
Identification and Attribution of Weekly Periodic Biases in Epidemiological Time Series Data
Authors: Gallagher Kit , Creswell Richard , Gavaghan David , Lambert Ben
Published: June 2023

COVID-19 data exhibit various biases, not least a significant weekly periodic oscillation observed globally in case and death data. There has been significant debate over whether this may be attributed to weekly socialising and working patterns, or is due to underlying biases in the reporting process. We characterise the weekly biases globally and demonstrate that equivalent biases also occur in the current cholera outbreak in Haiti. By comparing published COVID-19 time series to retrospective datasets from the United Kingdom (UK) that are not subject to the same reporting biases, we demonstrate that this dataset does not contain any weekly periodicity, and hence the weekly trends observed both in the UK and globally may be fully explained by biases in the testing and reporting processes. These conclusions play an important role in forecasting healthcare demand and determining suitable interventions for future infectious disease outbreaks.
Clinical prediction models for the management of blunt chest trauma in the Emergency Department: a systematic review
Authors: Battle Ceri , Cole Elaine , Carter Kym , Baker Edward
Published: June 2023

Introduction

The aim of this systematic review was to investigate how clinical prediction models compare in terms of their methodological development, validation, and predictive capabilities, for patients with blunt chest trauma presenting to the Emergency Department.

Methods

A systematic review was conducted across databases from Jan 2000 until March 2023. Studies were categorised into three types of multivariable prediction research and data extracted regarding methodological issues and the predictive capabilities of each model. Risk of bias and applicability were assessed.

Results

39 studies were included that discussed 22 different models. The most commonly observed study design was a single-centre, retrospective, chart review. The most widely externally validated clinical prediction models with moderate to good discrimination were the Thoracic Trauma Severity Score and the STUMBL Score.

Discussion

This review demonstrates that the predictive ability of some of the existing clinical prediction models is acceptable, but high risk of bias and lack of subsequent external validation limits the extensive application of the models. The Thoracic Trauma Severity Score and STUMBL Score demonstrate better predictive accuracy in both development and external validation studies than the other models, but require recalibration and / or update and evaluation of their clinical and cost effectiveness.
Acceleration of Large-Scale Single Cell Differential Gene Expression Analysis with FastDE
Authors: Connolly Erin , Aluru Maneesha , Chockalingam Sriram , Dhere Vishal , Gibson Greg , Pan Tony
Published: June 2023

The major bottleneck in single cell transcriptomic processing is identification of marker genes for individual cell clusters. We introduce FastDE, an implementation of the standard Wilcoxon Rank Sum test in C++ that results in 50X speed-up of the standard Seurat pipeline on a dataset of 1.2 million cells. Proof of methodology is demonstrated by replicating age and gender effects on immune cell differentiation in two large PBMC atlases.
SULFATED POLYSACCHARIDE FROM BROWN ALGAEDICTYOTA CARIBAEASTIMULATES MACROPHAGES TO AN ANTITUMORAL PHENOTYPE
Authors: Assef Alexia Nathália Brígido , Teles Felipe Barros , Cinelli Leonardo Paes , Wilke Diego Veras
Published: June 2023

Fucoidans are sulfated polysaccharides capable of exerting biological activities such as antitumor and immunomodulatory effects. Previous studies demonstrated the antitumor activity of non-cytotoxic fucoidan from the seaweedDictyota caribaea(Dc-SP)in vivo. Macrophages (Mφ) are innate immune cells capable of promoting or inhibiting tumor growth depending on the stimulus. This study aimed to evaluate the immunostimulant activity of Dc-SP on murine Mφ (RAW264.7)in vitro. Dc-SP was assessed for its ability to modify cell viability and stimulate the production of antitumor markers on RAW264.7 cells. Dc-SP induced an increase (p<0.05) in the production of NO and cytokines TNF-α, IL-1β, and IL-10. The exposure of Mφ to Dc-SP also increased (p<0.05) the expression of M1 macrophage markers such as iNOS, CD86, and MHC II. The antiproliferative activity of RAW264.7 cells stimulated with DC-SP on melanoma cells (B16-F10)in vitro. Dc-SP did not exhibit direct cytotoxicity on B16-F10, however, the conditioned medium (CM) of RAW264.7 previously stimulated with Dc-SP (CM-Dc-SP) showed antiproliferative activity on tumor cells. B16-F10 incubated with CM-Dc-SP showed a cytostatic profile, tumor cells did not alter membrane integrity, however, suffered morphological changes such as cell shrinkage and high granularity. In conclusion, Dc-SP stimulated Mφ to an antitumor phenotype.
A high-sensitivity ELISA for detection of human FGF18 in culture supernatants from tumor cell lines
Authors: Tsuchiya Yuichi , Komazawa-Sakon Sachiko , Tanaka Masato , Kanakogi Takumi , Moriwaki Kenta , Akiba Hisaya , Yagita Hideo , Okumura Ko , Entzminger Kevin C , Okumura CJ , Maruyama Toshiaki , Nakano Hiroyasu
Published: June 2023

Fibroblast growth factor 18 (FGF18) is elevated in several human cancers, such as gastrointestinal and ovarian cancers, and stimulates the proliferation of tumor cells. This suggests that FGF18 may be a promising candidate biomarker in cancer patients. However, the lack of a high-sensitivity enzyme-linked immunosorbent assay (ELISA) does not permit testing of this possibility. In this study, we generated monoclonal antibodies against human FGF18 and developed a high-sensitivity ELISA to measure human FGF18 at concentrations as low as 10 pg/mL. Of the eight tumor cell lines investigated, we detected human FGF18 in culture supernatants from four tumor cell lines, including HeLa, OVCAR-3, BxPC-3, and SW620 cells, albeit the production levels were relatively low in the latter two cell lines. Moreover, the in-house ELISA could detect murine FGF18 in sera from mice overexpressing murineFgf18in hepatocytes, although the sensitivity in detecting murine FGF18 was relatively low. This FGF18 ELISA could be a valuable tool to validate FGF18 as a potential biomarker for cancer patients and to test the contribution of FGF18 for various disease models in vivo and in vitro.
Salivary corticosterone reflects plasmatic levels in a wild seabird
Authors: Carbillet Jeffrey , Saks Lauri , Sepp Tuul
Published: June 2023

Wild animals have been increasingly exposed to a wide range of stressors, mainly due to the intensification of human activities and habitat modifications. Consequently, new tools in order to assess the physiological and health status of wild animals have been developed. In particular, glucocorticoids have received a special attention. Primarily metabolic hormones, they are also used to evaluate the stress level of organisms. While historically measured in blood samples, new less-invasive methods have been recently developed to measure glucocorticoids in matrices such as faeces, hairs/feathers, or saliva. To date, measurements in saliva are still in their infancy despite the numerous advantages of the matrix: non-invasive, reflects the biologically active portion of glucocorticoids, allows to measure both baseline and stress-induced levels. In addition, most studies using saliva have been performed on domestic and captive animals, and recent development in wild animals have focused on mammals. Here, we show, for the first time that saliva could also be reliably used in free-ranging birds, as glucocorticoid levels in saliva strongly correlated with plasma levels. This promising result opens new avenues for a non-invasive sampling method to assess health status of wild birds in conservation biology and ecology.
The T766M-EGFR lung cancer mutation promotes tumor growth by exploiting newfound mechanisms assembling ligand-free EGFR oligomer structures
Authors: Iyer R. Sumanth , Needham Sarah R. , Galdadas Ioannis , Davis Benjamin M. , Roberts Selene K. , Man Rico C.H. , Zanetti-Domingues Laura C. , Clarke David T. , Fruhwirth Gilbert O. , Parker Peter J. , Rolfe Daniel J. , Gervasio Francesco L. , Martin-Fernandez Marisa L.
Published: June 2023

Epidermal growth factor receptor (EGFR) is central to cell growth in physiology and pathophysiologies, including non-small cell lung cancer (NSCLC). EGFR has been successfully targeted with tyrosine kinase inhibitor generations, but the missense secondary T766M mutation is a common cause of resistance. Overcoming this therapeutic challenge has been hindered by poor understanding of how T766M dysregulates EGFR function leading to tumor progression. Here we show that T766M amplifies tumor growthin vivoby exploiting newly discovered oligomer assembly mechanisms employed by wild type (WT)-EGFR to maintain ligand-independent basal phosphorylation. These mechanisms, also shared by drug-resistant exon 20 EGFR insertions, reveal tumor growth promoting functions for hitherto orphan transmembrane and kinase interfaces and for the ectodomain tethered conformation of EGFR. Placing our findings into the context of a ligand-free oligomer structure model, we provide a framework for future drug discovery directed at tackling EGFR mutations in cancer by disabling oligomer-assembling interactions.
DNA binding analysis of rare variants in homeodomains reveals novel homeodomain specificity-determining residues
Authors: Kock Kian Hong , Kimes Patrick K. , Gisselbrecht Stephen S. , Inukai Sachi , Phanor Sabrina K. , Anderson James T. , Ramakrishnan Gayatri , Lipper Colin H. , Song Dongyuan , Kurland Jesse V. , Rogers Julia M. , Jeong Raehoon , Blacklow Stephen C. , Irizarry Rafael A. , Bulyk Martha L.
Published: June 2023

Homeodomains (HDs) are the second largest class of DNA binding domains (DBDs) among eukaryotic sequence-specific transcription factors (TFs) and play important roles in regulating development, body patterning, and cellular differentiation. Here, we analyzed 92 human HD mutants, including disease-associated variants and variants of unknown significance (VUSs), for their effects on DNA binding activity. Many of the variants altered DNA binding affinity and/or specificity. Biochemical analysis and structural modeling identified 14 novel specificity-determining positions, 5 of which do not contact DNA. The same missense substitution at analogous positions within different HDs often exhibited different effects on DNA binding. Variant effect prediction tools perform moderately well in distinguishing variants with altered binding affinity, but poorly in identifying those with altered specificity. Our results highlight the need for biochemical assays of TF coding variants and prioritize dozens of variants for further investigations into their pathogenicity and development of clinical diagnostics and precision therapies.